Performance of a commercial optical CT scanner and polymer gel dosimeters for 3-D dose verification

Performance analysis of a commercial three-dimensional (3-D) dose mapping system based on optical CT scanning of polymer gels is presented. The system consists of BANG 3 polymer gels (MGS Research, Inc., Madison, CT), OCTOPUS laser CT scanner (MGS Research, Inc., Madison, CT), and an in-house developed software for optical CT image reconstruction and 3-D dose distribution comparison between the gel, film measurements and the radiation therapy treatment plans. Various sources of image noise (digitization, electronic, optical, and mechanical) generated by the scanner as well as optical uniformity of the polymer gel are analyzed. The performance of the scanner is further evaluated in terms of the reproducibility of the data acquisition process, the uncertainties at different levels of reconstructed optical density per unit length and the effects of scanning parameters. It is demonstrated that for BANG 3 gel phantoms held in cylindrical plastic containers, the relative dose distribution can be reproduced by the scanner with an overall uncertainty of about 3% within approximately 75% of the radius of the container. In regions located closer to the container wall, however, the scanner generates erroneous optical density values that arise from the reflection and refraction of the laser rays at the interface between the gel and the container. The analysis of the accuracy of the polymer gel dosimeter is exemplified by the comparison of the gel/OCT-derived dose distributions with those from film measurements and a commercial treatment planning system (Cadplan, Varian Corporation, Palo Alto, CA) for a 6 cm x 6 cm single field of 6 MV x rays and a 3-D conformal radiotherapy (3DCRT) plan. The gel measurements agree with the treatment plans and the film measurements within the "3%-or-2 mm" criterion throughout the usable, artifact-free central region of the gel volume. Discrepancies among the three data sets are analyzed.     

Investigation of Kodak extended dose range (EDR) film for megavoltage photon beam dosimetry

We have investigated the dependence of the measured optical density on the incident beam energy, field size and depth for a new type of film, Kodak extended dose range (Kodak EDR). Film measurements have been conducted over a range of field sizes (3 x 3 cm2 to 25 x 25 cm2) and depths (d(max) to 15 cm), for 6 MV and 15 MV photons within a solid water phantom, and the variation in sensitometric response (net optical density versus dose) has been reported. Kodak EDR film is found to have a linear response with dose, from 0 to 350 cGy, which is much higher than that typically seen for Kodak XV film (0-50 cGy). The variation in sensitometric response for Kodak EDR film as a function of field size and depth is observed to be similar to that of Kodak XV film; the optical density varied in the order of 2-3% for field sizes of 3 x 3 cm2 and 10 x 10 cm2 at depths of d(max), 5 cm and 15 cm in the phantom. Measurements for a 25 x 25 cm2 field size showed consistently higher optical densities at depths of d(max), 5 cm and 15 cm, relative to a 10 x 10 cm2 field size at 5 cm depth, with 4-5% differences noted at a depth of 15 cm. Fractional depth dose and profiles conducted with Kodak EDR film showed good agreement (2%/2 mm) with ion chamber measurements for all field sizes except for the 25 x 25 cm2 at depths greater than 15 cm, where differences in the order of 3-5% were observed. In addition, Kodak EDR film measurements were found to be consistent with those of Kodak XV film for all fractional depth doses and profiles. The results of this study indicate that Kodak EDR film may be a useful tool for relative dosimetry at higher dose ranges.     

Film dosimetry in the peripheral region using multiple sensitometric curves

We present a method for applying film dosimetry to the peripheral region utilizing multiple sensitometric curves. There are many instances when the dose to the peripheral region outside the field edges is of clinical and/or research interest. Published peripheral dose data may be insufficient if detailed dose modeling is required, and in those cases measurements must be performed. Film dosimetry is an attractive approach for dose measurement in the peripheral region because it integrates dose, overcoming the low-dose-rate problem, and is time efficient, as it acquires an entire plan of data in a single exposure. However, film response increases at energies below approximately 300 keV. As the scattered photon spectrum changes with distance from the field edge, this increased film sensitivity causes changes in the film response along profiles perpendicular to the field edge. A single sensitometric curve is therefore no longer sufficient for accurate conversion of the optical density to dose. Our new method uses multiple sensitometric curves defined at increasing distances from the field edge. To convert an optical density profile, the dose at each point in the profile is defined as a linear combination of the doses calculated using the two sensitometric curves that bracket the point of interest. A single set of sensitometric curves derived at one field size and source-to-surface distance (SSD) can be applied to density profiles for other field sizes and SSDs. We verified our new method by comparison to ion chamber measurements using three different types of film. Agreement with chamber measurements was within 7%, or less than 2 mm in regions of high gradient, over a wide range of field sizes and SSDs.     

Comparison of ionization chambers of various volumes for IMRT absolute dose verification

IMRT plans are usually verified by phantom measurements: dose distributions are measured using film and the absolute dose using an ionization chamber. The measured and calculated doses are compared and planned MUs are modified if necessary. To achieve a conformal dose distribution, IMRT fields are composed of small subfields, or "beamlets." The size of beamlets is on the order of 1 x 1 cm2. Therefore, small chambers with sensitive volumes < or = 0.1 cm3 are generally used for absolute dose verification. A dosimetry system consisting of an electrometer, an ion chamber, and connecting cables may exhibit charge leakage. Since chamber sensitivity is proportional to volume, the effect of leakage on the measured charge is relatively greater for small chambers. Furthermore, the charge contribution from beamlets located at significant distances from the point of measurement may be below the small chambers threshold and hence not detected. On the other hand, large (0.6 cm3) chambers used for the dosimetry of conventional external fields are quite sensitive. Since these chambers are long, the electron fluence through them may not be uniform ("temporal" uniformity may not exist in the chamber volume). However, the cumulative, or "spatial" fluence distribution (as indicated by calculated IMRT dose distribution) may become uniform at the chamber location when the delivery of all IMRT fields is completed. Under the condition of "spatial" fluence uniformity, the charge collected by the large chamber may accurately represent the absolute dose delivered by IMRT to the point of measurement. In this work, 0.6, 0.125, and 0.009 cm3 chambers were used for the absolute dose verification for tomographic and step-and-shoot IMRT plans. With the largest, 0.6 cm3 chamber, the measured dose was equal to calculated within 0.5%, when no leakage corrections were made. Without leakage corrections, the error of measurement with a 0.125 cm3 chamber was 2.6% (tomographic IMRT) and 1.5% (step-and-shoot IMRT). When doses measured by a 0.125 cm3 chamber were corrected for leakage, the difference between the calculated and measured doses reduced to 0.5%. Leakage corrected doses obtained with the 0.009 cm3 chamber were within 1.5%-1.7% of calculated doses. Without leakage corrections, the measurement error was 16% (tomographic IMRT) and 7% (step-and-shoot IMRT).     

Predicting energy response of radiographic film in a 6 MV x-ray beam using Monte Carlo calculated fluence spectra and absorbed dose

The advantage of radiographic film is that it allows two-dimensional, high-resolution dose measurement. While there is concern over its photon energy dependence, these problems are considered acceptable within small fields, where the scatter component is small. The application of film dosimetry to intensity modulated radiotherapy (IMRT) raises additional concern since the primary fluence may vary significantly within the field. The varying primary fluence in combination with a large scatter fraction, present for large fields and large depths, causes the spectrum at various points within the IMRT field to differ from the spectrum in the uniform fields typically used for calibrating the film. As a result, significant artifacts are introduced in the measured dose distribution. The purpose of this work is to quantify and develop a method to correct for these artifacts. Two approaches based on Monte Carlo (MC) simulations are examined. In the first method, the film artifact, as quantified by film and ion chamber output measurements in uniform square fields, is derived from the MC calculated ratio of absorbed doses to film and to water. In the second method, the measured film artifact is correlated with MC calculated photon spectra, revealing a strong correlation between the measured artifact and the "scatter"-to-"primary" ratio, defined by the ratio of the number of photons below to the number of photons above 0.1 MeV, independent of field size and depth. These methods are evaluated in high- and low-dose regions of a large intensity-modulated field created with a central block. The spectral approach is also tested with a clinical IMRT field. The absorbed dose method accurately corrects the measured film dose in the open part of the field and in points under the block and outside the field. The dose error is reduced from as much as 16% of the open field dose to less than 1%, as verified with an ion chamber. The spectral method accurately corrects the measured film dose in the open region of the centrally blocked field, but does not fully correct for the film artifact for points under the block and outside the field, where the spectrum is substantially different. Applied to the clinical field, the corrected film measurement shows good agreement with data obtained with a two-dimensional diode array.     

Effect of processing time delay on the dose response of Kodak EDR2 film

Kodak EDR2 film is a widely used two-dimensional dosimeter for intensity modulated radiotherapy (IMRT) measurements. Our clinical use of EDR2 film for IMRT verifications revealed variations and uncertainties in dose response that were larger than expected, given that we perform film calibrations for every experimental measurement. We found that the length of time between film exposure and processing can affect the absolute dose response of EDR2 film by as much as 4%-6%. EDR2 films were exposed to 300 cGy using 6 and 18 MV 10 x 10 cm2 fields and then processed after time delays ranging from 2 min to 24 h. An ion chamber measured the relative dose for these film exposures. The ratio of optical density (OD) to dose stabilized after 3 h. Compared to its stable value, the film response was 4%-6% lower at 2 min and 1% lower at 1 h. The results of the 4 min and 1 h processing time delays were verified with a total of four different EDR2 film batches. The OD/dose response for XV2 films was consistent for time periods of 4 min and 1 h between exposure and processing. To investigate possible interactions of the processing time delay effect with dose, single EDR2 films were irradiated to eight different dose levels between 45 and 330 cGy using smaller 3 x 3 cm2 areas. These films were processed after time delays of 1, 3, and 6 h, using 6 and 18 MV photon qualities. The results at all dose levels were consistent, indicating that there is no change in the processing time delay effect for different doses. The difference in the time delay effect between the 6 and 18 MV measurements was negligible for all experiments. To rule out bias in selecting film regions for OD measurement, we compared the use of a specialized algorithm that systematically determines regions of interest inside the 10 x 10 cm2 exposure areas to manually selected regions of interest. There was a maximum difference of only 0.07% between the manually and automatically selected regions, indicating that the use of a systematic algorithm to determine regions of interest in large and fairly uniform areas is not necessary. Based on these results, we recommend a minimum time of 1 h between exposure and processing for all EDR2 film measurements.     

Effective point of measurement of cylindrical ionization chambers for heavy charged particles

Cylindrical ionization chambers are used for the determination of absorbed dose in beams of heavy charged particles, where the effective point of measurement, Peff (the point in depth to which the measured dose refers), is a priori not known. A measurement of Peff for a Farmer-type chamber in a carbon ion beam is presented. It is based on a comparison of relative depth dose curves measured with a cylindrical chamber and a plane-parallel Markus chamber. Both measurements were compared against another high-precision relative depth dose measurement using large-area plane-parallel chambers. For Peff, a value of 72 +/- 7% of the inner radius of the chamber is obtained. The relative depth dose curve for the cylindrical chamber is calculated using an averaging of the depth dose values over the curved inner surface of the active volume while taking account of the different depths of points on the inner surface. Within the measurement uncertainty of 0.2 mm the measurements agree well with the calculated Bragg curve for the Farmer chamber. The result for Peff is in correspondence with the value suggested in a new code of practice by the IAEA for protons and ions, and somewhat less than that suggested by Palmans for protons. The measurements show that cylindrical chambers are in general well suited for depth dose measurements in fields of heavy charged particles if the correct Peff is used.     

Three-dimensional dose verification for intensity modulated radiation therapy using optical CT based polymer gel dosimetry

Dose distributions generated from intensity-modulated-radiation-therapy (IMRT) treatment planning present high dose gradient regions in the boundaries between the target and the surrounding critical organs. Dose accuracy in these areas can be critical, and may affect the treatment. With the increasing use of IMRT in radiotherapy, there is an increased need for a dosimeter that allows for accurate determination of three-dimensional (3D) dose distributions with high spatial resolution. In this study, polymer gel dosimetry and an optical CT scanner have been employed to implement 3D dose verification for IMRT. A plastic cylinder of 17 cm diameter and 12 cm height, filled with BANG3 polymer gels (MGS Research, Inc., Madison, CT) and modified to optimal dose-response characteristics, was used for IMRT dose verification. The cylindrical gel phantom was immersed in a 24 x 24 x 20 cm water tank for an IMRT irradiation. The irradiated gel sample was then scanned with an optical CT scanner (MGS Research Inc., Madison, CT) utilizing a single He-Ne laser beam and a single photodiode detector. Similar to the x-ray CT process, filtered back-projection was used to reconstruct the 3D dose distribution. The dose distributions measured from the gel were compared with those from the IMRT treatment planning system. For comparative dosimetry, a solid water phantom of 24 x 24 x 20 cm, having the same geometry as the water tank for the gel phantom, was used for EDR2 film and ion chamber measurements. Root mean square (rms) deviations for both dose difference and distance-to-agreement (DTA) were used in three-dimensional analysis of the dose distribution comparison between treatment planning calculations and the gel measurement. Comparison of planar dose distributions among gel dosimeter, film, and the treatment planning system showed that the isodose lines were in good agreement on selected planes in axial, coronal, and sagittal orientations. Absolute point-dose verification was performed with ion chamber measurements at four different points, varying from 48% to 110% of the prescribed dose. The measured and calculated doses were found to agree to within 4.2% at all measurement points. For the comparison between the gel measurement and treatment planning calculations, rms deviations were 2%-6% for dose difference and 1-3 mm for DTA, at 60%-110% doses levels. The results from this study show that optical CT based polymer gel dosimetry has the potential to provide a high resolution, accurate, three-dimensional tool for IMRT dose distribution verification.     

A Monte Carlo based three-dimensional dose reconstruction method derived from portal dose images

The verification of intensity-modulated radiation therapy (IMRT) is necessary for adequate quality control of the treatment. Pretreatment verification may trace the possible differences between the planned dose and the actual dose delivered to the patient. To estimate the impact of differences between planned and delivered photon beams, a three-dimensional (3-D) dose verification method has been developed that reconstructs the dose inside a phantom. The pretreatment procedure is based on portal dose images measured with an electronic portal imaging device (EPID) of the separate beams, without the phantom in the beam and a 3-D dose calculation engine based on the Monte Carlo calculation. Measured gray scale portal images are converted into portal dose images. From these images the lateral scattered dose in the EPID is subtracted and the image is converted into energy fluence. Subsequently, a phase-space distribution is sampled from the energy fluence and a 3-D dose calculation in a phantom is started based on a Monte Carlo dose engine. The reconstruction model is compared to film and ionization chamber measurements for various field sizes. The reconstruction algorithm is also tested for an IMRT plan using 10 MV photons delivered to a phantom and measured using films at several depths in the phantom. Depth dose curves for both 6 and 10 MV photons are reconstructed with a maximum error generally smaller than 1% at depths larger than the buildup region, and smaller than 2% for the off-axis profiles, excluding the penumbra region. The absolute dose values are reconstructed to within 1.5% for square field sizes ranging from 5 to 20 cm width. For the IMRT plan, the dose was reconstructed and compared to the dose distribution with film using the gamma evaluation, with a 3% and 3 mm criterion. 99% of the pixels inside the irradiated field had a gamma value smaller than one. The absolute dose at the isocenter agreed to within 1% with the dose measured with an ionization chamber. It can be concluded that our new dose reconstruction algorithm is able to reconstruct the 3-D dose distribution in phantoms with a high accuracy. This result is obtained by combining portal dose images measured prior to treatment with an accurate dose calculation engine.     

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.     

Evaluation of polymer gels and MRI as a 3-D dosimeter for intensity-modulated radiation therapy.

BANG gel (MGS Research, Inc., Guilford, CT) has been evaluated for measuring intensity-modulated radiation therapy (IMRT) dose distributions. Treatment plans with target doses of 1500 cGy were generated by the Peacock IMRT system (NOMOS Corp., Sewickley, PA) using test target volumes. The gels were enclosed in 13 cm outer diameter cylindrical glass vessels. Dose calibration was conducted using seven smaller (4 cm diameter) cylindrical glass vessels irradiated to 0-1800 cGy in 300 cGy increments. Three-dimensional maps of the proton relaxation rate R2 were obtained using a 1.5 T magnetic resonance imaging (MRI) system (Siemens Medical Systems, Erlangen, Germany) and correlated with dose. A Hahn spin echo sequence was used with TR = 3 s, TE = 20 and 100 ms, NEX = 1, using 1 x 1 x 3 mm3 voxels. The MRI measurements were repeated weekly to identify the gel-aging characteristics. Ionization chamber, thermoluminescent dosimetry (TLD), and film dosimetry measurements of the IMRT dose distributions were obtained to compare against the gel results. The other dosimeters were used in a phantom with the same external cross-section as the gel phantom. The irradiated R2 values of the large vessels did not precisely track the smaller vessels, so the ionization chamber measurements were used to normalize the gel dose distributions. The point-to-point standard deviation of the gel dose measurements was 7.0 cGy. When compared with the ionization chamber measurements averaged over the chamber volume, 1% agreement was obtained. Comparisons against radiographic film dose distribution measurements and the treatment planning dose distribution calculation were used to determine the spatial localization accuracy of the gel and MRI. Spatial localization was better than 2 mm, and the dose was accurately determined by the gel both within and outside the target. The TLD chips were placed throughout the phantom to determine gel measurement precision in high- and low-dose regions. A multidimensional dose comparison tool that simultaneously examines the dose-difference and distance-to-agreement was used to evaluate the gel in both low-and high-dose gradient regions. When 3% and 3 mm criteria were used for the comparisons, more than 90% of the TLD measurements agreed with the gel, with the worst of 309 TLD chip measurements disagreeing by 40% of the criteria. All four MRI measurement session gel-measured dose distributions were compared to evaluate the time behavior of the gel. The low-dose regions were evaluated by comparison with TLD measurements at selected points, while high-dose regions were evaluated by directly comparing measured dose distributions. Tests using the multidimensional comparison tool showed detectable degradation beyond one week postirradiation, but all low-dose measurements passed relative to the test criteria and the dose distributions showed few regions that failed.     

Evaluation of Kodak EDR2 film for dose verification of intensity modulated radiation therapy delivered by a static multileaf collimator

A new type of radiographic film, Kodak EDR2 film, was evaluated for dose verification of intensity modulated radiation therapy (IMRT) delivered by a static multileaf collimator (SMLC). A sensitometric curve of EDR2 film irradiated by a 6 MV x-ray beam was compared with that of Kodak X-OMAT V (XV) film. The effects of field size, depth and dose rate on the sensitometric curve were also studied. It is found that EDR2 film is much less sensitive than XV film. In high-energy x-ray beams, the double hit process is the dominant mechanism that renders the grains on EDR2 films developable. As a result, in the dose range that is commonly used for film dosimetry for IMRT and conventional external beam therapy, the sensitometric curves of EDR2 films cannot be approximated as a linear function, OD = c * D. Within experimental uncertainty, the film sensitivity does not depend on the dose rate (50 vs 300 MU/min) or dose per pulse (from 1.0 x 10(-4) to 4.21 x 10(-4) Gy/pulse). Field sizes and depths (up to field size of 10 x 10 cm2 and depth = 10 cm) have little effect on the sensitometric curves. Percent depth doses (PDDs) for both 6 and 23 MV x rays were measured with both EDR2 and XV films and compared with ion chamber data. Film data are within 2.5% of the ion chamber results. Dose profiles measured with EDR2 film are consistent with those measured with an ion chamber. Examples of measured IMRT isodose distributions versus calculated isodoses are presented. We have used EDR2 films for verification of all IMRT patients treated by SMLC in our clinic. In most cases, with EDR2 film, actual clinical daily fraction doses can be used for verification of composite isodose distributions of SMLC-based IMRT.     

A new approach in dose measurement and error analysis for narrow photon beams (beamlets) shaped by different multileaf collimators using a small detector

Dose measurement for narrow stereotactic beams and intensity modulation radiotherapy beamlets is difficult and error-prone due to the lack of lateral electron equilibrium. A small detector position error and finite sensitive volume as well as the nonfocus collimation could result in considerable (> 10%) measurement errors. A new method is introduced here to measure the dose and error components so that the accuracy and precision of the dose measurement can be improved. Based on superposition principle, we can create exactly the small field of interest by subtraction of a reference open field (O-field) and two strip fields (S-fields) from the sum of four quadrant fields (Q-fields). The position effect on the dose measurement is determined by the standard deviation of the four Q-field readings. The collimator leaf-edge effect (LEE) is quantified by the difference between the readings of the two S-fields using a detector that has very small sensitive volume. The detector-volume effect can be analytically estimated from the integrals of the dose distributions of the two S-fields over the detector volume. Using a pinpoint ion chamber (PTW N31006) and a stereotactic silicon diode detector (Scanditronix, DEB050), we have measured scatter factors (SF) and tissue-maximum ratios for 6-MV x-ray fields with sizes of 3 x 3 and 6 x 6 mm2 shaped by a BrainLAB micromultileaf collimator (microMLC) (M3), 4.4 x 4.4 and 8.8 x 8.8 mm2 shaped by a 3DLine double-focus MLC, and 5 x 5 and 10 x 10 mm2 by a Varian Millennium MLC. Our experimental results demonstrate that the large errors are often caused by a small setup error or measuring point displacement from the central ray of the beam. The LEE is almost independent of the depth but closely related to the field size and the type of MLC. The volume effect becomes significant when the detector diameter is comparable to the half size of the small fields. Application of the new method using different detectors had achieved less than 8.3% total experiment error for all of the small fields of interest except for the SF of the 3 x 3 mm2 field from the pinpoint ion chamber that has 15% volume effect. Importantly, the new method using a solid water phantom is clinically convenient and highly reproducible.     

Three-dimensional dose reconstruction of breast cancer treatment using portal imaging

In this study, we present an algorithm for three-dimensional (3-D) dose reconstruction using portal images obtained with an electronic portal imaging device (EPID). For this purpose an algorithm for 2-D dose reconstruction, which was previously developed in our institution, was adapted. The external contour of the patient was used to correct for absorption of primary photons, but the presence of inhomogeneities was not taken into account. The accuracy of the algorithm was determined by irradiating two anthropomorphic breast phantoms with 6 MV photons. The dose values derived from portal images were compared with results from 3-D dose calculations, which, in turn, were verified with data obtained with an ionization chamber and film dosimetry. It was found that the application of contour information significantly improves the accuracy of 2-D dose reconstruction. If the total dose at the isocenter plane resulting from all treatment beams is reconstructed, the average deviation from the planned dose is 0.1%+/-1.7% (1 SD). If contour information is not available, the differences increase up to +/-20% for the individual beams. In that case, the dose can only be reconstructed with reasonable accuracy when (nearly) opposing beams are used. The average deviation of the 3-D reconstructed dose from the planned dose in the irradiated volume is 1.4%+/-5.4% (1 SD). If the irradiated volume is enclosed by planes less than 5 cm distant from the isocenter plane, then the average deviation is only 0.5%+/-3.4% (1 SD). It can be concluded that the proposed algorithm for a 3-D dose reconstruction allows a determination of the dose at the isocenter plane and the dose-volume histogram with an accuracy acceptable for an independent verification of the treatment.     

An assessment of GafChromic film for measuring 50 kV and 100 kV percentage depth dose curves

Percentage depth dose (PDD) curves were obtained for 50 kV and 100 kV x-rays on a Gulmay Medical D3000 DXR unit. Different dosimetry systems were compared including a Scanditronix Wellhofer small volume cylindrical ion chamber, a Wellhofer photon PFD diode, a PTW soft x-ray parallel plate chamber (N23342) and two types of radiochromic film: GafChromic EBT and GafChromic MD55. The PDD curves were also compared to BEAMnrc Monte Carlo predictions. GafChromic film was found to be a valid choice of dosimeter for measuring percentage depth dose curves at 100 kV and 50 kV. All the dosimeters showed agreement with predictions at depths greater than 10 mm, while near the surface GafChromic film and PFD diodes give the best agreement to Monte Carlo values.     

Portal dosimetry using x-ray film: an experimental and computational study

To evaluate the accuracy and precision of relative portal dosimetry using x-ray film, we compared the radiation doses measured by x-ray film and by an ion chamber at various portal planes that were 0 to 50 cm behind an 18 cm thick phantom. In addition, we calculated photon spectra at the measurement planes by using the Monte Carlo particle transport technique. The experiments showed that the film usually measured relative doses to within 5% of the measurements by the ion chamber and that the errors were associated with the changes in the spectra of photon energy fluence at portal planes. The relative magnitude of low-energy fluence in the photon fluence spectrum and its variance across the portal plane caused the film response to differ from the ion-chamber response especially with lead screen on top of film in the film cassette. Relative film dosimetry may be improved to accuracy of better than 2% by using solid water or other tissue equivalent cassettes.     

Buildup/surface dose and exit dose measurements for a 6-MV linear accelerator

The central axis dose distribution in the buildup region for the Varian Clinac 6/100 6-MV x-ray beam was measured in a polystyrene phantom using a fixed volume (0.5 cm3) parallel-plate ionization chamber (2.4-mm plate separation). Results for the surface dose measurements ranged from approximately 8% of the maximum dose for a 5 X 5 cm field, up to 36% for a 40 X 40 cm field, 100-cm source-skin distance. The effect of a 0.6-cm-thick polycarbonate blocking tray and metal filters on the surface and buildup dose is also reported. In addition, ionization measurements were made to document the dose perturbations caused by the absence of backscattering material at the exit surface of a polystyrene phantom. Exit dose measurements showed a 15% reduction in dose with essentially no scattering material beyond the measurement point. Near full scatter condition could be restored by placing 5-10 mm (depending on field size) of unit density material directly behind the ion chamber's distal surface.     

Midplane dose determination using in vivo dose measurements in combination with portal imaging

The possibility of using portal films in combination with semiconductor in vivo measurements for midplane dose distribution is investigated. A general algorithm, using measured entrance and exit doses and available beam data of the Linac, is proposed to derive the midplane dose for symmetrical inhomogeneities. Experimental verification of the algorithm with phantom measurements is performed for different kinds of inhomogeneities (Al, air and cork) and phantom thicknesses from 13 cm to 30 cm. When using only the entrance dose and the exit dose, provided by the diodes on the beam axis, the algorithm predicts for the different inhomogeneities midplane doses in all cases within 1% of the midplane doses measured with an ionization chamber. When using the portal film in combination with entrance and exit dose measurements to estimate the midplane dose in an off-axis position, the calculated midplane doses are within 3% of the midplane doses measured with an ionization chamber. The midplane doses calculated with the algorithm are compared to the midplane doses obtained with simplified calculation methods, i.e. the arithmetical mean and the geometrical mean of the measured entrance and exit doses. The geometrical mean especially seems to give acceptable results (within 5%) and can as such be used as an easy rule of thumb to estimate roughly the midplane dose. Finally, critical considerations on the validity and the precision of the proposed algorithm are given. The present results confirm the possibility of using the portal film for midplane dose distribution determination at the patient level.     

Laser 3-D measuring system and real-time visual feedback for teaching and correcting breathing

We present a novel method for real-time 3-D body-shape measurement during breathing based on the laser multiple-line triangulation principle. The laser projector illuminates the measured surface with a pattern of 33 equally inclined light planes. Simultaneously, the camera records the distorted light pattern from a different viewpoint. The acquired images are transferred to a personal computer, where the 3-D surface reconstruction, shape analysis, and display are performed in real time. The measured surface displacements are displayed with a color palette, which enables visual feedback to the patient while breathing is being taught. The measuring range is approximately 400×600×500 mm in width, height, and depth, respectively, and the accuracy of the calibrated apparatus is ±0.7 mm. The system was evaluated by means of its capability to distinguish between different breathing patterns. The accuracy of the measured volumes of chest-wall deformation during breathing was verified using standard methods of volume measurements. The results show that the presented 3-D measuring system with visual feedback has great potential as a diagnostic and training assistance tool when monitoring and evaluating the breathing pattern, because it offers a simple and effective method of graphical communication with the patient.     

Treatment verification in the presence of inhomogeneities using EPID-based three-dimensional dose reconstruction

Treatment verification is a prerequisite for the verification of complex treatments, checking both the treatment planning process and the actual beam delivery. Pretreatment verification can detect errors introduced by the treatment planning system (TPS) or differences between planned and delivered dose distributions. In a previous paper we described the reconstruction of three-dimensional (3-D) dose distributions in homogeneous phantoms using an in-house developed model based on the beams delivered by the linear accelerator measured with an amorphous silicon electronic portal imaging device (EPID), and a dose calculation engine using the Monte Carlo code XVMC. The aim of the present study is to extend the method to situations in which tissue inhomogeneities are present and to make a comparison with the dose distributions calculated by the TPS. Dose distributions in inhomogeneous phantoms, calculated using the fast-Fourier transform convolution (FFTC) and multigrid superposition (MGS) algorithms present in the TPS, were verified using the EPID-based dose reconstruction method and compared to film and ionization chamber measurements. Differences between dose distributions were evaluated using the gamma-evaluation method (3%/3 mm) and expressed as a mean gamma and the percentage of points with gamma> 1 (P(gamma>1)). For rectangular inhomogeneous phantoms containing a low-density region, the differences between film and reconstructed dose distributions were smaller than 3%. In low-density regions there was an overestimation of the planned dose using the FFTC and MGS algorithms of the TPS up to 20% and 8%, respectively, for a 10 MV photon beam and a 3 x 3 cm2 field. For lower energies and larger fields (6 MV, 5 x 5 cm2), these differences reduced to 6% and 3%, respectively. Dose reconstruction performed in an anthropomorphic thoracic phantom for a 3-D conformal and an IMRT plan, showed good agreement between film data and reconstructed dose values (P(gamma>1) <6%). The algorithms of the TPS underestimated the dose in the low-dose regions outside the treatment field, due to an implementation error of the jaws and multileaf collimator of the linac in the TPS. The FFTC algorithm of the TPS showed differences up to 6% or 6 mm at the interface between lung and breast. Two intensity-modulated radiation therapy head and neck plans, reconstructed in a commercial phantom having a bone-equivalent insert and an air cavity, showed good agreement between film measurement, reconstructed and planned dose distributions using the FFTC and MGS algorithm, except in the bone-equivalent regions where both TPS algorithms underestimated the dose with 4%. Absolute dose verification was performed at the isocenter where both planned and reconstructed dose were within 2% of the measured dose. Reproducibility for the EPID measurements was assessed and found to be of negligible influence on the reconstructed dose distribution. Our 3-D dose verification approach is based on the actual dose measured with an EPID in combination with a Monte Carlo dose engine, and therefore independent of a TPS. Because dose values are reconstructed in 3-D, isodose surfaces and dose-volume histograms can be used to detect dose differences in target volume and normal tissues. Using our method, the combined planning and treatment delivery process is verified, offering an easy to use tool for the verification of complex treatments.