Correction factors for low perturbation in vivo diodes used in the determination of entrance doses in high energy photon beams

PURPOSE: Low perturbation diodes, with thin buildup caps, can be used to reduce perturbations to the delivered dose. The literature states that additional correction factors are required for low perturbation diodes, however, there are few reported studies into their use. This report measured the dose perturbations and correction factors for diodes with varying buildup cap thicknesses. METHODS AND MATERIALS: Scanditronix EDP15, EDD5, and EDD2 diodes were investigated. Dose perturbations and correction factors for field size, source-surface distance (SSD), obliquity, and wedge were measured in megavoltage photon beams. RESULTS: EDP15 produces a 6% dose perturbation. EDD5 produces a perturbation between 1% and 2%. EDD2 perturbation is negligible. The variation of correction factors for the full buildup EDP15 diode is small and consistent with the literature. The low perturbation diode EDD2 has large correction factors. The field size correction factor varies from 1.38 to 0.87 for 10 MV. The SSD correction factor varies from 0.92 to 1.09 for 10 MV. At the maximum angle measured, the obliquity correction factor is 0.73 for 10 MV. Intermediate results were observed for the EDD5 diode. CONCLUSIONS: It is expected that it will be very difficult to achieve accurate in vivo dosimetry using the EDD2 diode. The EDD5 diode may represent a reasonable compromise between EDD2 and the full buildup EDP15. The EDD5 dose perturbation is small and the correction factors are not as large as for EDD2, so accurate in vivo dosimetry may be possible as long as the obliquity is below 45 degrees.     

Ionization chamber-based reference dosimetry of intensity modulated radiation beams

The present paper addresses reference dose measurements using thimble ionization chambers for quality assurance in IMRT fields. In these radiation fields, detector fluence perturbation effects invalidate the application of open-field dosimetry protocol data for the derivation of absorbed dose to water from ionization chamber measurements. We define a correction factor C(Q)IMRT to correct the absorbed dose to water calibration coefficient N(D, w)Q for fluence perturbation effects in individual segments of an IMRT delivery and developed a calculation method to evaluate the factor. The method consists of precalculating, using accurate Monte Carlo techniques, ionization chamber, type-dependent cavity air dose, and in-phantom dose to water at the reference point for zero-width pencil beams as a function of position of the pencil beams impinging on the phantom surface. These precalculated kernels are convolved with the IMRT fluence distribution to arrive at the dose-to-water-dose-to-cavity air ratio [D(a)w (IMRT)] for IMRT fields and with a 10x10 cm2 open-field fluence to arrive at the same ratio D(a)w (Q) for the 10x10 cm2 reference field. The correction factor C(Q)IMRT is then calculated as the ratio of D(a)w (IMRT) and D(a)w (Q). The calculation method was experimentally validated and the magnitude of chamber correction factors in reference dose measurements in single static and dynamic IMRT fields was studied. The results show that, for thimble-type ionization chambers the correction factor in a single, realistic dynamic IMRT field can be of the order of 10% or more. We therefore propose that for accurate reference dosimetry of complete n-beam IMRT deliveries, ionization chamber fluence perturbation correction factors must explicitly be taken into account.     

Comparison of entrance and exit dose measurements using ionization chambers and silicon diodes

A high precision patient dosimetry method has been developed, based on the use of p-type diodes. First, entrance as well as exit dose calibration factors have to be determined under reference irradiation conditions. Secondly, a set of correction factors must be added for situations deviating from the reference conditions, i.e. for different source-skin distances, phantom (patient) thicknesses, field sizes or for insertion of a wedge into the photon beam. Finally some other detector characteristics such as the temperature dependence of the response have to be taken into account. For most irradiation conditions this procedure is sufficiently accurate to allow entrance as well as exist dose determinations with a diode to be in good agreement with dose values measured by an ionization chamber. The main factors effecting the value of the correction factors, the dependence of the diode sensitivity on the energy and the dose per pulse, have been investigated to explain some of the observed phenomena. Despite a strong energy dependence of the sensitivity, the correction factors are, for a particular type of diode, the same for 4 and 8 MV x-ray beams. The variation in the values for the correction factors with integrated dose received by the diode is small. These findings indicate that the correction factors, once available, can be applied under a number of circumstances. Due to the difference in behaviour of various diodes, even from the same batch, it is, however, necessary to determine the characteristics for each diode individually.     

In vivo dosimetry: intercomparison between p-type based and n-type based diodes for the 16-25 MV energy range

This paper compares two different types of diodes designed to cover the energy range from 16 to 25 MV, one n-type (diode-A) and the other p-type (diode-B). A 18 MV x-ray beam has been used for all tests. Signal stability postirradiation, intrinsic precision and linearity of response with dose, front-back symmetry, and dose decrease under the diode were studied. Also, the water equivalent thickness of the build up caps was determined. Both types of diodes were calibrated to give entrance dose. Entrance correction factors for field size, tray, source skin distance, angle, and wedge were determined. Finally, the effect of dose rate, temperature and accumulated dose on the diode's response were studied. Only diode-A had full build-up for 18 MV x rays and standard irradiation conditions. Field size correction factor was about 2%-4% for field sizes bigger than 20 x 20 cm2 for both diodes. Tray correction factor was negligible for diode-A while diode-B would overestimate the dose by a 2% for a 40 x 40 cm2 field size if the correction factor was not applied. Wedge correction factors are only relevant for the 60 degrees wedge, being the correction factor for diode-A significantly higher than for diode-B. Diode-A showed less temperature dependence than diode-B. Sensitivity dependence on dose per pulse was a 1.5% higher for diode-A than for diode-B and therefore a higher SSD dependence was found for diode-A. The loss of sensitivity with accumulated radiation dose was only about 0.3% for diode-A, after 300 Gy, while it amounted to 8% for diode-B. Weighing the different correction factors for both types of diodes no conclusions about which type is better can be driven. From these results it can be also seen that the dependence of the diode response on dose rate in a pulsed beam does not seem to be associated with the fact of being n-type or p-type but could be related to the doping level of the diodes.     

Accurate skin dose measurements using radiochromic film in clinical applications

Megavoltage x-ray beams exhibit the well-known phenomena of dose buildup within the first few millimeters of the incident phantom surface, or the skin. Results of the surface dose measurements, however, depend vastly on the measurement technique employed. Our goal in this study was to determine a correction procedure in order to obtain an accurate skin dose estimate at the clinically relevant depth based on radiochromic film measurements. To illustrate this correction, we have used as a reference point a depth of 70 micron. We used the new GAFCHROMIC dosimetry films (HS, XR-T, and EBT) that have effective points of measurement at depths slightly larger than 70 micron. In addition to films, we also used an Attix parallel-plate chamber and a home-built extrapolation chamber to cover tissue-equivalent depths in the range from 4 micron to 1 mm of water-equivalent depth. Our measurements suggest that within the first millimeter of the skin region, the PDD for a 6 MV photon beam and field size of 10 x 10 cm2 increases from 14% to 43%. For the three GAFCHROMIC dosimetry film models, the 6 MV beam entrance skin dose measurement corrections due to their effective point of measurement are as follows: 15% for the EBT, 15% for the HS, and 16% for the XR-T model GAFCHROMIC films. The correction factors for the exit skin dose due to the build-down region are negligible. There is a small field size dependence for the entrance skin dose correction factor when using the EBT GAFCHROMIC film model. Finally, a procedure that uses EBT model GAFCHROMIC film for an accurate measurement of the skin dose in a parallel-opposed pair 6 MV photon beam arrangement is described.     

A global calibration model for a-Si EPIDs used for transit dosimetry

Electronic portal imaging devices (EPIDs) are not only applied for patient setup verification and detection of organ motion but are also increasingly used for dosimetric verification. The aim of our work is to obtain accurate dose distributions from a commercially available amorphous silicon (a-Si) EPID for transit dosimetry applications. For that purpose, a global calibration model was developed, which includes a correction procedure for ghosting effects, field size dependence and energy dependence of the a-Si EPID response. In addition, the long-term stability and additional buildup material for this type of EPID were determined. Differences in EPID response due to photon energy spectrum changes have been measured for different absorber thicknesses and field sizes, yielding off-axis spectrum correction factors based on transmission measurements. Dose measurements performed with an ionization chamber in a water tank were used as reference data, and the accuracy of the dosimetric calibration model was determined for a large range of treatment conditions. Gamma values using 3% as dose-difference criterion and 3 mm as distance-to-agreement criterion were used for evaluation. The field size dependence of the response could be corrected by a single kernel, fulfilling the gamma evaluation criteria in case of virtual wedges and intensity modulated radiation therapy fields. Differences in energy spectrum response amounted up to 30%-40%, but could be reduced to less than 3% using our correction model. For different treatment fields and (in)homogeneous phantoms, transit dose distributions satisfied in almost all situations the gamma criteria. We have shown that a-Si EPIDs can be accurately calibrated for transit dosimetry purposes.     

Monte Carlo study of si diode response in electron beams

Silicon semiconductor diodes measure almost the same depth-dose distributions in both photon and electron beams as those measured by ion chambers. A recent study in ion chamber dosimetry has suggested that the wall correction factor for a parallel-plate ion chamber in electron beams changes with depth by as much as 6%. To investigate diode detector response with respect to depth, a silicon diode model is constructed and the water/silicon dose ratio at various depths in electron beams is calculated using EGSnrc. The results indicate that, for this particular diode model, the diode response per unit water dose (or water/diode dose ratio) in both 6 and 18 MeV electron beams is flat within 2% versus depth, from near the phantom surface to the depth of R50 (with calculation uncertainty <0.3%). This suggests that there must be some other correction factors for ion chambers that counter-balance the large wall correction factor at depth in electron beams. In addition, the beam quality and field-size dependence of the diode model are also calculated. The results show that the water/diode dose ratio remains constant within 2% over the electron energy range from 6 to 18 MeV. The water/diode dose ratio does not depend on field size as long as the incident electron beam is broad and the electron energy is high. However, for a very small beam size (1 X 1 cm(2)) and low electron energy (6 MeV), the water/diode dose ratio may decrease by more than 2% compared to that of a broad beam.     

The effect of collimator backscatter radiation on photon output of linear accelerators

The field-size dependence of the photon output of linear accelerators in air has been attributed in part to changes in the amount of radiation backscattered from the collimator jaws into the dose monitor chamber. This possible effect was investigated for a variety of accelerators with energies from 4 to 15 MV by measuring the monitor unit rate (MU/min) for different collimator openings. This measurement was made without dose rate feedback control, i.e., with constant electron beam current in the accelerator. The monitor unit rate was independent of collimator setting for all machines tested. Hence, it is concluded that backscattered radiation from the collimator jaws into the dose monitor chamber does not contribute to the variation of output with field size.     

Initial evaluation of a commercial EPID modified to a novel direct-detection configuration for radiotherapy dosimetry

Electronic portal imaging devices (EPIDs) integrated with medical linear accelerators utilize an indirect-detection EPID configuration (ID-EPID). Amorphous silicon ID-EPIDs provide high quality low dose images for verification of radiotherapy treatments but they have limitations as dosimeters. The standard ID-EPID configuration includes a high atomic number phosphor scintillator screen, a 1 mm copper layer, and other nonwater equivalent materials covering the detector. This configuration leads to marked differences in the response of an ID-EPID compared to standard radiotherapy dosimeters such as ion chambers in water. In this study the phosphor and copper were removed from a standard commercial EPID to modify the configuration to a direct-detection EPID (DD-EPID). Using solid water as the buildup and backscatter for the detector, dosimetric measurements were performed on the DD-EPID and compared to standard dose-in-water data for 6 and 18 MV photons. The sensitivity of the DD-EPID was approximately eight times less than the ID-EPID but the signal was sufficient to produce accurate and reproducible beam profile measurements for open beams and an intensity-modulated beam. Due to the lower signal levels it was found necessary to ensure that the dark field correction (no radiation) DD-EPID signal was stable or updated frequently. The linearity of dose response was comparable to the ID-EPID but with a greater under-response at low doses. DD-EPID measurements of field size output factors and beam profiles at the depth of maximum dose (dmax), and tissue-maximum ratios between the depths of 0.5 and 10 cm, were in close agreement with dose in water measurements. At depths beyond dmax the DD-EPID showed a greater change in response to field size than ionisation chamber measurements and the beam penumbrae were broader compared to diode scans. The modified DD-EPID configuration studied here has the potential to improve the performance of EPIDs for dose verification of radiotherapy treatments.     

Telescopic measurements of backscattered radiation from secondary collimator jaws to a beam monitor chamber using a pair of slits

A contribution to field-size dependent output by backscattered radiation (BSR) from secondary collimator jaws to a beam monitor chamber of a linear accelerator was measured with a Farmer ionization chamber, positioned 200 cm from the source behind a low-melting-point alloy slab with a 10-cm wide slit. Another slit was positioned against the collimator jaws. Both slits were in the form of a 6.3-mm-diam hole in the middle and were aligned to the source. The use of a pair of slits was intended to eliminate any influence on the ion chamber readings due to field-size dependent charge contribution from the flattening filter and collimator jaw forward scattering. In addition, the setup permits to observe the degree of field-size dependence on BSR. Charge measurements from the Therac-20 18-MV x rays showed a 7.5% field-size dependence on BSR whereas 6- and 18-MV x rays from Varian Clinac-1800 showed less than 2% dependence on BSR. The telescopic method was found to be easy to use and permitted direct determination of BSR contributions.     

Influence of electrodes on the photon energy deposition in CVD-diamond dosimeters studied with the Monte Carlo code PENELOPE

A new dosimeter, based on chemical vapour deposited (CVD) diamond as the active detector material, is being developed for dosimetry in radiotherapeutic beams. CVD-diamond is a very interesting material, since its atomic composition is close to that of human tissue and in principle it can be designed to introduce negligible perturbations to the radiation field and the dose distribution in the phantom due to its small size. However, non-tissue-equivalent structural components, such as electrodes, wires and encapsulation, need to be carefully selected as they may induce severe fluence perturbation and angular dependence, resulting in erroneous dose readings. By introducing metallic electrodes on the diamond crystals, interface phenomena between high- and low-atomic-number materials are created. Depending on the direction of the radiation field, an increased or decreased detector signal may be obtained. The small dimensions of the CVD-diamond layer and electrodes (around 100 microm and smaller) imply a higher sensitivity to the lack of charged-particle equilibrium and may cause severe interface phenomena. In the present study, we investigate the variation of energy deposition in the diamond detector for different photon-beam qualities, electrode materials and geometric configurations using the Monte Carlo code PENELOPE. The prototype detector was produced from a 50 microm thick CVD-diamond layer with 0.2 microm thick silver electrodes on both sides. The mean absorbed dose to the detector's active volume was modified in the presence of the electrodes by 1.7%, 2.1%, 1.5%, 0.6% and 0.9% for 1.25 MeV monoenergetic photons, a complete (i.e. shielded) (60)Co photon source spectrum and 6, 18 and 50 MV bremsstrahlung spectra, respectively. The shift in mean absorbed dose increases with increasing atomic number and thickness of the electrodes, and diminishes with increasing thickness of the diamond layer. From a dosimetric point of view, graphite would be an almost perfect electrode material. This study shows that, for the considered therapeutic beam qualities, the perturbation of the detector signal due to charge-collecting graphite electrodes of thicknesses between 0.1 and 700 microm is negligible within the calculation uncertainty of 0.2%.     

Comparative dosimetry of diode and diamond detectors in electron beams for intraoperative radiation therapy

The aim of the present study is to examine the validity of using silicon semiconductor detectors in degraded electron beams with a broad energy spectrum and a wide angular distribution. A comparison is made with diamond detector measurements, which is the dosimeter considered to give the best results provided that dose rate effects are corrected for. Two-dimensional relative absorbed dose distributions in electron beams (6-20 MeV) for intraoperative radiation therapy (IORT) are measured in a water phantom. To quantify deviations between the detectors, a dose comparison tool that simultaneously examines the dose difference and distance to agreement (DTA) is used to evaluate the results in low- and high-dose gradient regions, respectively. Uncertainties of the experimental measurement setup (+/- 1% and +/- 0.5 mm) are taken into account by calculating a composite distribution that fails this dose-difference and DTA acceptance limit. Thus, the resulting area of disagreement should be related to differences in detector performance. The dose distributions obtained with the diode are generally in very good agreement with diamond detector measurements. The buildup region and the dose falloff region show good agreement with increasing electron energy, while the region outside the radiation field close to the water surface shows an increased difference with energy. The small discrepancies in the composite distributions are due to several factors: (a) variation of the silicon-to-water collision stopping-power ratio with electron energy, (b) a more pronounced directional dependence for diodes than for diamonds, and (c) variation of the electron fluence perturbation correction factor with depth. For all investigated treatment cones and energies, the deviation is within dose-difference and DTA acceptance criteria of +/- 3% and +/- 1 mm, respectively. Therefore, p-type silicon diodes are well suited, in the sense that they give results in close agreement with diamond detectors, for practical measurements of relative absorbed dose distributions in degraded electron beams used for IORT.     

Measurements of dose distributions in small beams of 6 MV x-rays

Dose distributions produced by small circular beams of 6 MV x-rays have been measured using ionisation chambers of small active volume. Specific quantities measured include tissue maximum ratios (TMR), total scatter correction factors (St), collimator scatter correction factors (Sc) and off-axis ratios (OAR). Field sizes ranged from 12.5 to 30 mm diameter, and were defined by machined auxiliary collimators with the movable jaws set for a 4 cm x 4 cm field size. Due to the lack of complete lateral electronic equilibrium for these small fields, the accuracy of the measurements was also investigated. This was accomplished by studying dose response as a function of detector size. Uncertainties of 2.5% were observed for the central axis dose in the 12.5 mm field when measuring with an ionisation chamber with a diameter of 3.5 mm. The total scatter correction factor exhibits a strong field size dependence for fields below 20 mm diameter, while the collimator scatter correction factor is constant and is defined by the setting of the movable jaws. Off-axis ratio measurements show larger dose gradients at the beam edges than those achieved with conventional collimator systems. Corrected profiles measured with an ionisation chamber are compared with measurements made with photographic film and LiF thermoluminescent dosemeters.     

Dose buildup for obliquely incident photon beams

For obliquely incident photon beams, the buildup of dose with depth is markedly different from normally incident beams. However, relatively little data on this topic exists for high-energy photon beams of energy greater than 6 MV. Measurements of dose in the buildup region were made using a plane-parallel ionization chamber in a polystyrene phantom with obliquely incident 6-, 10-, 18-, and 24-MV x-ray beams angled 0 degrees to 84 degrees. Buildup curves at these angles were plotted and from these an obliquity factor, defined as the ratio of ionization charge collected at a point for a particular angle of incidence to that collected at the same point at normal incidence, was determined. For each energy, the obliquity factor as a function of depth, field size, and source-chamber distance was studied. Results indicate that the obliquity factor is highly dependent on the beam energy, angle of incidence, the collimator opening, and the source-skin distance. A mathematical expression has been developed to predict the dose in the buildup region of high-energy photon beams for various angles of beam incidence, field size, and chamber distance.     

The impact of MLC transmitted radiation on EPID dosimetry for dynamic MLC beams

The purpose of this study was to experimentally quantify the change in response of an amorphous silicon (a-Si) electronic portal imaging device (EPID) to dynamic multileaf collimator (dMLC) beams with varying MLC-transmitted dose components and incorporate the response into a commercial treatment planning system (TPS) EPID prediction model. A combination of uniform intensity dMLC beams and static beams were designed to quantify the effect of MLC transmission on EPID response at the central axis of 10 x 10 cm2 beams, at off-axis positions using wide dMLC beam profiles, and at different field sizes. The EPID response to MLC transmitted radiation was 0.79 +/- 0.02 of the response to open beam radiation at the central axis of a 10 x 10 cm2 field. The EPID response to MLC transmitted radiation was further reduced relative to the open beam response with off-axis distance. The EPID response was more sensitive to field size changes for MLC transmitted radiation compared to open beam radiation by a factor of up to 1.17 at large field sizes. The results were used to create EPID response correction factors as a function of the fraction of MLC transmitted radiation, off-axis distance, and field size. Software was developed to apply the correction factors to each pixel in the TPS predicted EPID image. The corrected images agreed more closely with the measured EPID images in areas of intensity modulated fields with a large fraction of MLC transmission and, as a result the accuracy of portal dosimetry with a-Si EPIDs can be improved. Further investigation into the detector response function and the radiation source model are required to achieve improvements in accuracy for the general case.     

A preliminary dosimetric characterization of chemical vapor deposition diamond detector prototypes in photon and electron radiotherapy beams

Three radiation detectors based on polycrystalline diamond films with different thickness and resistivity, obtained by microwave chemical vapor deposition, were tested to assess their suitability for relative dosimetry of photon and electron beams supplied by clinical linear accelerators. All samples showed a linear response as a function of the absorbed dose. The sensitivity per unit of detector sensitive volume spanned between 7 and 43 nC Gy(-1) mm(-3) with an applied electric field of 40 kV/cm. The dose rate dependence was evaluated following the Fowler theory and delta coefficient values between 0.95 and 1.00 were found for the three samples when polarized at 40 kV/cm. Percentage depth dose curves, output factors, and normalized dose profiles were determined for 6 and 10 MV photon beams and for 6 and 15 MeV electron beams. The results obtained with the diamond detectors were in good agreement with those obtained by reference detector measurements [all the data were within the experimental uncertainty of 1% (1sigma)].     

Surface dose for megavoltage photon beams outside the treatment field

Measurements made on photon beams from four different radiotherapy machines have demonstrated that skin dose several centimeters outside the boundary of a treatment field may be as much as 20% of the central axis maximum dose. This surface dose has been measured for an AECL Theratron 80, Siemens Mevatron VI, Varian Clinac 20, and CGR Sagittaire for distances up to 12 cm outside the field boundary and for depths up to the depth of maximum central axis dose. This dose has also been measured as a function of field size and of source-to-skin distance. For the lower energy photon beams, this radiation is significantly attenuated in the first 2-3 mm of tissue, while for higher energy beams, a buildup phenomenon with a dmax of 2-3 mm is observed. The magnitude of this radiation is approximately linearly dependent upon field dimension for all energies.     

Real-time optical-fibre luminescence dosimetry for radiotherapy: physical characteristics and applications in photon beams

A new optical-fibre radiation dosimeter system, based on radioluminescence and optically stimulated luminescence from carbon-doped aluminium oxide, was developed and tested in clinical photon beams. This prototype offers several features, such as a small detector (1 x 1 x 2 mm3), high sensitivity, real-time read-out and the ability to measure both dose rate and absorbed dose. The measurements describing reproducibility and output dependence on dose rate, field size and energy all had standard deviations smaller than 1%. The signal variation with the angle of incidence was smaller than 2% (1 SD). Measurements performed in clinical situations suggest the potential of using this real-time system for in vivo dosimetry in radiotherapy.     

Wedge factor dependence on depth and field size for various beam energies using symmetric and half-collimated asymmetric jaw settings.

The depth- and field-size dependence of the in-phantom wedge factor have been determined for a Cobalt-60 (Co-60) teletherapy unit and four medical linear accelerators with 4-, 6-, 10-, and 18-MV x-ray beams containing 15 degrees-60 degrees (nominal) lead, brass, and steel wedge filters. Measurements were made with ionization chambers in solid water or water with a source-skin distance of 80 or 100 cm. Field sizes varied from 4 x 4 cm up to a maximum allowable size for each wedge filter. Measurements were performed for symmetric and half-collimated asymmetric fields at depth of maximum dose, 5- and 10-cm depths. For half-collimated fields, wedge factor reference points were located at a fixed off-axis distance from the collimator's rotational axis. These systematic measurements on wedges indicate that the wedge factor dependence on depth and field size is a function of beam energy as well as the design of the treatment head and wedge filters. Significance of the results reported herein are discussed for the most commonly used treatment depths and field sizes with various beam energies and wedge filters.     

In vivo dosimeters for HDR brachytherapy: a comparison of a diamond detector, MOSFET, TLD, and scintillation detector

The large dose gradients in brachytherapy necessitate a detector with a small active volume for accurate dosimetry. The dosimetric performance of a novel scintillation detector (BrachyFOD) is evaluated and compared to three commercially available detectors, a diamond detector, a MOSFET, and LiF TLDs. An 192Ir HDR brachytherapy source is used to measure the depth dependence, angular dependence, and temperature dependence of the detectors. Of the commercially available detectors, the diamond detector was found to be the most accurate, but has a large physical size. The TLDs cannot provide real time readings and have depth dependent sensitivity. The MOSFET used in this study was accurate to within 5% for distances of 20 to 50 mm from the 192Ir source in water but gave errors of 30%-40% for distances greater than 50 mm from the source. The BrachyFOD was found to be accurate to within 3% for distances of 10 to 100 mm from an HDR 192Ir brachytherapy source in water. It has an angular dependence of less than 2% and the background signal created by Cerenkov radiation and fluorescence of the plastic optical fiber is insignificant compared to the signal generated in the scintillator. Of the four detectors compared in this study the BrachyFOD has the most favorable combination of characteristics for dosimetry in HDR brachytherapy.