Characterization of Recombination Effects in a Liquid Ionization Chamber Used for the Dosimetry of a Radiosurgical Accelerator

Most modern radiation therapy devices allow the use of very small fields, either through beamlets in Intensity-Modulated Radiation Therapy (IMRT) or via ...

Centre Oscar Lambret

The dose distribution around an intravascular brachytherapy 90Y line source with centering balloon catheters was measured with a plastic scintillator, TLD and radiochromic film. The absolute dose rates measured with the three detectors in a solid water phantom at 1, 2 and 3 mm distance from the centering balloon surfaces are in agreement within 3.5%, when the detectors are calibrated with the same 90Sr/90Y source. The dose rates measured with the plastic scintillator in the solid water phantom are in agreement with those directly measured in water. The measured relative dose distributions can be reproduced by Monte Carlo calculations. Also, the influence of the balloon diameter on the dose rate can be reproduced by the calculations. The dose rate calibration routinely performed with the plastic scintillator was checked for fifty-one sources with a well chamber and with another dedicated dose rate checking device. These measurements show that the consistency of the calibration of these sources was better than 10%. In a previous paper absolute dose rates for five other 90Y sources measured with TLD and radiochromic film in a solid water phantom were compared with those obtained with the plastic scintillator in water [Piessens and Reynaert, "Verification of absolute dose rates for intravascular beta sources," Phys. Med. Biol. 45, 2219-2231 (2000)]. Differences of 25 to 41%, depending on the balloon diameter, were reported. In this paper we show the evidence for three main reasons for these previously observed discrepancies: an inconsistency between a detector calibration performed with a 6 MeV electron beam and with a calibrated 90Sr/90Y source from NIST (16%), inaccuracies of the measuring distances in the solid water phantom (maximum 7.5%) and a time instability of the plastic scintillator, probably due to radiation damage (6%).

Dose distributions for 90Y intravascular brachytherapy sources used with balloon catheters.

To determine accurately the radiation burden of both patients and staff from intracoronary radiotherapy (IRT) with (192)Ir and to investigate the importance of IRT in the patient dose compared with interventional X-rays.

Patient doses in gamma-intracoronary radiotherapy: the Radiation Burden Assessment Study.

An automated electrodeposition system for the preparation of radioactive stents and an automated dosimetry system based on the Optidos beta-scintillation detector for the quality control of the radioactive stents have been developed. Custom-made application software programmed in Visual Basic was used to control liquid flow and electroplating currents in the electrodeposition system, and to run the dual motion actuator and radiation detector for the automated measurement of the radioactivity distribution. The automation of the electroplating process increased the precision, ease, repeatability, and radiation safety of the process. The radioactive beta-emitting 188Re stents might be useful for the treatment of patients with inoperable lung cancer.

Development of an automated electroplater and dosimetry system for the electrodeposition and quality control of radioactive stents.

The accuracy of dose computation within the lungs depends strongly on the performance of the calculation algorithm in regions of electronic disequilibrium that arise near tissue inhomogeneities with large density variations. There is a lack of data evaluating the performance of highly developed analytical dose calculation algorithms compared to Monte Carlo computations in a clinical setting. We compared full Monte Carlo calculations (performed by our Monte Carlo dose engine MCDE) with two different commercial convolution/superposition (CS) implementations (Pinnacle-CS and Helax-TMS's collapsed cone model Helax-CC) and one pencil beam algorithm (Helax-TMS's pencil beam model Helax-PB) for 10 intensity modulated radiation therapy (IMRT) lung cancer patients. Treatment plans were created for two photon beam qualities (6 and 18 MV). For each dose calculation algorithm, patient, and beam quality, the following set of clinically relevant dose-volume values was reported: (i) minimal, median, and maximal dose (Dmin, D50, and Dmax) for the gross tumor and planning target volumes (GTV and PTV); (ii) the volume of the lungs (excluding the GTV) receiving at least 20 and 30 Gy (V20 and V30) and the mean lung dose; (iii) the 33rd percentile dose (D33) and Dmax delivered to the heart and the expanded esophagus; and (iv) Dmax for the expanded spinal cord. Statistical analysis was performed by means of one-way analysis of variance for repeated measurements and Tukey pairwise comparison of means. Pinnacle-CS showed an excellent agreement with MCDE within the target structures, whereas the best correspondence for the organs at risk (OARs) was found between Helax-CC and MCDE. Results from Helax-PB were unsatisfying for both targets and OARs. Additionally, individual patient results were analyzed. Within the target structures, deviations above 5% were found in one patient for the comparison of MCDE and Helax-CC, while all differences between MCDE and Pinnacle-CS were below 5%. For both Pinnacle-CS and Helax-CC, deviations from MCDE above 5% were found within the OARs: within the lungs for two (6 MV) and six (18 MV) patients for Pinnacle-CS, and within other OARs for two patients for Helax-CC (for Dmax of the heart and D33 of the expanded esophagus) but only for 6 MV. For one patient, all four algorithms were used to recompute the dose after replacing all computed tomography voxels within the patient's skin contour by water. This made all differences above 5% between MCDE and the other dose calculation algorithms disappear. Thus, the observed deviations mainly arose from differences in particle transport modeling within the lungs, and the commissioning of the algorithms was adequately performed (or the commissioning was less important for this type of treatment). In conclusion, not one pair of the dose calculation algorithms we investigated could provide results that were consistent within 5% for all 10 patients for the set of clinically relevant dose-volume indices studied. As the results from both CS algorithms differed significantly, care should be taken when evaluating treatment plans as the choice of dose calculation algorithm may influence clinical results. Full Monte Carlo provides a great benchmarking tool for evaluating the performance of other algorithms for patient dose computations.

Accuracy of patient dose calculation for lung IMRT: A comparison of Monte Carlo, convolution/superposition, and pencil beam computations.

To recompute clinical intensity-modulated treatment plans for ethmoid sinus cancer and to compare quantitatively the dose-volume histograms (DVHs) of the planning target volume (PTV) and the optic organs at risk.

Comparison of dose-volume histograms of IMRT treatment plans for ethmoid sinus cancer computed by advanced treatment planning systems including Monte Carlo.

The conversion of computed tomography (CT) numbers into material composition and mass density data influences the accuracy of patient dose calculations in Monte Carlo treatment planning (MCTP). The aim of our work was to develop a CT conversion scheme by performing a stoichiometric CT calibration. Fourteen dosimetrically equivalent tissue subsets (bins), of which ten bone bins, were created. After validating the proposed CT conversion scheme on phantoms, it was compared to a conventional five bin scheme with only one bone bin. This resulted in dose distributions D(14) and D(5) for nine clinical patient cases in a European multi-centre study. The observed local relative differences in dose to medium were mostly smaller than 5%. The dose-volume histograms of both targets and organs at risk were comparable, although within bony structures D(14) was found to be slightly but systematically higher than D(5). Converting dose to medium to dose to water (D(14) to D(14wat) and D(5) to D(5wat)) resulted in larger local differences as D(5wat) became up to 10% higher than D(14wat). In conclusion, multiple bone bins need to be introduced when Monte Carlo (MC) calculations of patient dose distributions are converted to dose to water.

Conversion of CT numbers into tissue parameters for Monte Carlo dose calculations: a multi-centre study.

To formulate uncertainty-based stopping criteria for Monte Carlo (MC) calculations of intensity-modulated radiotherapy and intensity-modulated arc therapy patient dose distributions and evaluate their influence on MC simulation times and dose characteristics.

Evaluation of uncertainty-based stopping criteria for monte carlo calculations of intensity-modulated radiotherapy and arc therapy patient dose distributions.

A self-consistent approach for the Monte Carlo calculation of free-air chamber (FAC) correction factors needed to convert the chamber reading into the quantity air-kerma at the point of measurement is introduced, and its implementation in the new EGSnrc user code egs_fac is discussed. To validate the method, comparisons between computed and measured FAC correction factors for attenuation Ax, scatter (Ascat), and electron loss (Aeloss) are performed in the medium energy range where the experimental determination is believed to be accurate. The Monte Carlo calculations utilize a full simulation of the x-ray tube with BEAMnrc and a detailed model of the parallel-plate FAC. Excellent agreement between the computed Ascat and Aeloss and the measured values for these correction factors currently used in the National Research Council (NRC) of Canada primary FAC standard is observed. Our simulations also agree with previous Monte Carlo results for Ascat and Aeloss for the 135 and 250 kVp Consultative Committee for Ionizing Radiation reference beam qualities. The computed attenuation correction agrees with the measured Aatt within the stated uncertainties, although the authors' simulations demonstrate that the evacuated-tube technique employed at NRC to measure the attenuation correction slightly overestimates Aatt in the medium energy range. The newly introduced corrections for backscatter, beam geometry, and lack of charged particle equilibrium along the beam axis are found to be negligible. On the other hand, the correction for photons leaking through the FAC aperture, currently ignored in the NRC standard, is shown to be significant.

Novel approach for the Monte Carlo calculation of free-air chamber correction factors.

We investigated the influence of beam modulation on treatment planning by comparing four available stereotactic radiosurgery (SRS) modalities: Gamma-Knife-Perfexion, Novalis-Tx Dynamic-Conformal-Arc (DCA) and Dynamic-Multileaf-Collimation-Intensity-Modulated-radiotherapy (DMLC-IMRT), and Cyberknife.

Dosimetric comparison of different treatment modalities for stereotactic radiosurgery of arteriovenous malformations and acoustic neuromas.

The purpose of this investigation was the creation of a new protocol allowing more precise dose calculations on megavoltage CT (MVCT) images for tomotherapy, both for adaptive and StatRT planning. Daily MVCT images offer, next to positioning purposes, the possibility for daily dose check and adaptive planning. Dose calculations use the image value to density table (IVDT) to calculate physical densities from Hounsfield Units (HUs). These measured HUs change over time, leading to a dose calculation error. We noticed dose calculation variations due to IVDT changes of: 0.2% dose during a day, up to 1.6% dose from long-term variations, and up to 1.5% dose due to technical interventions. An analysis was performed applying the general methodology of a calibration problem. A model HU = bρc - 1020 was obtained using a weighted least squares inverse prediction method (HU as function of density) taking into account the heteroscedasticity. The b parameter is the major variable and depends also on the dose rate (DR). We demonstrate the correction for DR variations and the constance of the c parameter. Instead of scanning the whole tissue characterization phantom daily, we propose a simplified daily protocol: (a) morning airscan-like procedure with only two inserts on the table (defining b and thus the IVDT curve), (b) DR variations throughout the day can be corrected for using the DR model. A patient-specific protocol for which two inserts next to the patient are scanned could also be used, but results in equal uncertainties and is less practical. Therefore we recommend the morning procedure with dose rate variation correction. Applying the proposed transformations and the model, the correct IVDT of the moment can be reconstructed, with a simple measurement in the morning, and corrected with DR changes during the day. This corresponds with a linear mapping in time of the proposed IVDT function. The dosimetric variation is hereby reduced from up to 3% to 0.4 % for the tested pelvic and head-and-neck cases. In practice, several IVDT curves corresponding to "b" values can be entered. The correct IVDT curve of that moment can then be chosen from the list. Instead of the two high-density inserts on table, any calibrated single density phantom could be used in order to create the IVDT curve of the day, but it should have a larger size than the current inserts.

Nick Reynaert

Department of Medical Physics

Centre Oscar Lambret

Characterization of Recombination Effects in a Liquid Ionization Chamber Used for the Dosimetry of a Radiosurgical Accelerator

Nick Reynaert

.css-o250i3{font-size:18px;font-family:Open Sans,sans-serif;line-height:21.6px;}Department of Medical Physics

Centre Oscar Lambret

Characterization of Recombination Effects in a Liquid Ionization Chamber Used for the Dosimetry of a Radiosurgical Accelerator

Department of Medical Physics