Technical note: Consistency of IAEA's TRS-483 and AAPM's extended TG-51 protocols for clinical reference dosimetry of the CyberKnife M6 machine.

BACKGROUND: While IAEA's TRS-483 code of practice is adapted for the calibration of CyberKnife machines, AAPM's TG-51 is still the protocol recommended by the manufacturer for their calibration. The differences between both protocols could lead to differences in absorbed dose to water during the calibration process. PURPOSE: The aims of this work are to evaluate the difference resulting from the application of TG-51 (including the manufacturer's adaptations) and TRS-483 in terms of absorbed dose to water for a CyberKnife M6, and to evaluate the consistency of TRS-483. METHODS: Measurements are performed on a CyberKnife M6 unit under machine-specific reference conditions using a calibrated Exradin A12 ionization chamber. Monte Carlo (MC) simulations are performed to estimate k Q msr , Q 0 f msr , f ref $k_{Q_{\mathrm{msr}},Q_0}^{f_{\mathrm{msr}},f_{\mathrm{ref}}}$ and k vol $k_{\text{vol}}$ using a fully modeled detector and an optimized CyberKnife M6 beam model. The latter is also estimated experimentally. Differences between the adapted TG-51 and TRS-483 protocols are identified and their impact is quantified. RESULTS: When using an in-house experimentally-evaluated volume averaging correction factor, a difference of 0.11% in terms of absorbed dose to water per monitor unit is observed when applying both protocols. This disparity is solely associated to the difference in beam quality correction factor. If a generic volume averaging correction factor is used during the application of TRS-483, the difference in calibration increases to 0.14%. In both cases, the disparity is not statistically significant according to TRS-483's reported uncertainties on their beam quality correction factor (i.e., 1%). MC results lead to k Q msr , Q 0 f msr , f ref = 1.0004 ± 0.0002 $k_{Q_{\mathrm{msr}},Q_0}^{f_{\mathrm{msr}},f_{\mathrm{ref}}}=1.0004\pm 0.0002$ and k vol = 1.0072 ± 0.0009 $k_{\text{vol}}=1.0072\pm 0.0009$ . Results illustrate that the generic beam quality correction factor provided in the TRS-483 might be overestimated by 0.36% compared to our specific model and that this overestimation could be due to the volume averaging component. CONCLUSIONS: For clinical reference dosimetry of the CyberKnife M6, the application of TRS-483 is found to be consistent with TG-51.

Dual- and multi-energy CT for particle stopping-power estimation: current state, challenges and potential.

Range uncertainty has been a key factor preventing particle radiotherapy from reaching its full physical potential. One of the main contributing sources is the uncertainty in estimating particle stopping power (ρs) within patients. Currently, theρsdistribution in a patient is derived from a single-energy CT (SECT) scan acquired for treatment planning by converting CT number expressed in Hounsfield units (HU) of each voxel toρsusing a Hounsfield look-up table (HLUT), also known as the CT calibration curve. HU andρsshare a linear relationship with electron density but differ in their additional dependence on elemental composition through different physical properties, i.e. effective atomic number and mean excitation energy, respectively. Because of that, the HLUT approach is particularly sensitive to differences in elemental composition between real human tissues and tissue surrogates as well as tissue variations within and among individual patients. The use of dual-energy CT (DECT) forρsprediction has been shown to be effective in reducing the uncertainty inρsestimation compared to SECT. The acquisition of CT data over different x-ray spectra yields additional information on the material elemental composition. Recently, multi-energy CT (MECT) has been explored to deduct material-specific information with higher dimensionality, which has the potential to further improve the accuracy ofρsestimation. Even though various DECT and MECT methods have been proposed and evaluated over the years, these approaches are still only scarcely implemented in routine clinical practice. In this topical review, we aim at accelerating this translation process by providing: (1) a comprehensive review of the existing DECT/MECT methods forρsestimation with their respective strengths and weaknesses; (2) a general review of uncertainties associated with DECT/MECT methods; (3) a general review of different aspects related to clinical implementation of DECT/MECT methods; (4) other potential advanced DECT/MECT applications beyondρsestimation.

Quality correction factors of composite IMRT beam deliveries: theoretical considerations.

PURPOSE: In the scope of intensity modulated radiation therapy (IMRT) dosimetry using ionization chambers, quality correction factors of plan-class-specific reference (PCSR) fields are theoretically investigated. The symmetry of the problem is studied to provide recommendable criteria for composite beam deliveries where correction factors are minimal and also to establish a theoretical limit for PCSR delivery k(Q) factors. METHODS: The concept of virtual symmetric collapsed (VSC) beam, being associated to a given modulated composite delivery, is defined in the scope of this investigation. Under symmetrical measurement conditions, any composite delivery has the property of having a k(Q) factor identical to its associated VSC beam. Using this concept of VSC, a fundamental property of IMRT k(Q) factors is demonstrated in the form of a theorem. The sensitivity to the conditions required by the theorem is thoroughly examined. RESULTS: The theorem states that if a composite modulated beam delivery produces a uniform dose distribution in a volume V(cyl) which is symmetric with the cylindrical delivery and all beams fulfills two conditions in V(cyl): (1) the dose modulation function is unchanged along the beam axis, and (2) the dose gradient in the beam direction is constant for a given lateral position; then its associated VSC beam produces no lateral dose gradient in V(cyl), no matter what beam modulation or gantry angles are being used. The examination of the conditions required by the theorem lead to the following results. The effect of the depth-dose gradient not being perfectly constant with depth on the VSC beam lateral dose gradient is found negligible. The effect of the dose modulation function being degraded with depth on the VSC beam lateral dose gradient is found to be only related to scatter and beam hardening, as the theorem holds also for diverging beams. CONCLUSIONS: The use of the symmetry of the problem in the present paper leads to a valuable theorem showing that k(Q) factors of composite IMRT beam deliveries are close to unity under specific conditions. The theoretical limit k(Q(pcsr),Q(msr) ) (f(pcsr),f(msr) )=1 is determined based on the property of PCSR deliveries to provide a uniform dose in the target volume. The present approach explains recent experimental observations and proposes ideal conditions for IMRT reference dosimetry. The result of this study could potentially serve as a theoretical basis for reference dosimetry of composite IMRT beam deliveries or for routine IMRT quality assurance.

On charged particle equilibrium violation in external photon fields.

PURPOSE: In a recent paper by Bouchard et al. [Med. Phys. 36(10), 4654-4663 (2009)], a theoretical model of quality correction factors for idealistic so-called plan-class specific reference (PCSR) fields was proposed. The reasoning was founded on the definition of PCSR fields made earlier by Alfonso et al. [Med. Phys. 35(11), 5179-5186 (2008)], requiring the beam to achieve charged particle equilibrium (CPE), in a time-averaged sense, in the reference medium. The relation obtained by Bouchard et al. was derived using Fano's theorem (1954) which states that if CPE is established in a given medium, the dose is independent of point-to-point density variations. A potential misconception on the achievability of the condition required by Fano (1954) might be responsible for false practical conclusions, both in the definition of PCSR fields as well as the theoretical model of quality correction factor. METHODS: In this paper, the practical achievability of CPE in external beams is treated in detail. The fact that this condition is not achievable in single or composite deliveries is illustrated by an intuitive method and is also formally demonstrated. CONCLUSIONS: Fano's theorem is not applicable in external beam radiation dosimetry without (virtually) removing attenuation effects, and therefore, the relation conditionally defined by Bouchard et al. (2009) cannot be valid in practice. A definition of PCSR fields in the recent formalism for nonstandard beams proposed by Alfonso et al. (2008) should be modified, revising the criterion of CPE condition. The authors propose reconsidering the terminology used to describe standard and nonstandard beams. The authors argue that quality correction factors of intensity modulated radiation therapy PCSR fields (i.e., k(Q(pcsr),Q) (f(pcsr),f(ref) )) could be unity under ideal conditions, but it is concluded that further investigation is necessary to confirm that hypothesis.

Reference dosimetry using radiochromic film.

The objectives of this study are to identify and quantify factors that influence radiochromic film dose response and to determine whether such films are suitable for reference dosimetry. The influence of several parameters that may introduce systematic dose errors when performing reference dose measurements were investigated. The effect of the film storage temperature was determined by comparing the performance of three lots of GAFCHROMIC EBT2 films stored at either 4ºC or room temperature. The effect of high (> 80%) or low (< 20%) relative humidity was also determined. Doses measured in optimal conditions with EBT and EBT2 films were then compared with an A12 ionization chamber measurement. Intensity-modulated radiation therapy quality controls using EBT2 films were also performed in reference dose. The results obtained using reference dose measurements were compared with those obtained using relative dose measurements. Storing the film at 4ºC improves the stability of the film over time, but does not eliminate the noncatalytic film development, seen as a rise in optical density over time in the absence of radiation. Relative humidity variations ranging from 80% to 20% have a strong impact on the optical density and could introduce dose errors of up to 15% if the humidity were not controlled during the film storage period. During the scanning procedure, the film temperature influences the optical density that is measured. When controlling for these three parameters, the dose differences between EBT or EBT2 and the A12 chamber are found to be within ± 4% (2σ level) over a dose range of 20-350 cGy. Our results also demonstrate the limitation of the Anisotropic Analytical Algorithm for dose calculation of highly modulated treatment plans.

Adaptive confidence regions for indirect tracking of moving tumors in radiotherapy.

BACKGROUND: Target motion in the course of radiotherapy is one of the largest factors affecting the treatment quality of highly dynamic sites such as lung. A critical component of real-time motion management is not only the prediction of tumor location at a future point in time but assessment of positional uncertainty for the purposes of margin adjustment and optimization of validation schemes. PURPOSE: In this study, we propose to investigate the ability of a confidence estimator to accurately reflect the reliability of individual target position predictions and prospectively detect large prediction errors by relying exclusively on a surrogate signal. METHODS: This work uses a Bayesian framework for indirect tracking. While constant covariance estimates are commonly used to express the uncertainty of the models involved, in this study new adaptive estimates are derived from the surrogate behavior to reflect increasing uncertainty when the breathing conditions differ from the reference conditions observed during the training step. The accuracy of the resulting 95% predicted confidence regions (CRs) is evaluated on nine breathing sequences involving changes of respiratory types (free, thoracic, abdominal, deep). The breathing motions are collected simultaneously from a lung target and two different surrogate signals (an external marker and an anatomical location within the liver). Receiver operating characteristic (ROC) analysis is performed to evaluate the ability of the predicted uncertainty to prospectively detect large prediction errors. RESULTS: Higher CR accuracy is obtained when using the proposed adaptive estimates over using constant estimations: on average over the cohort, the proportion of actual target positions lying within the 95% CR is increased by 40 and 35 p.p. with the internal and external surrogates. The time-dependent inflation of the CR width tends to match the magnitude variation of the prediction errors: the adaptive CR effectively enlarges when the target position cannot be predicted reliably, which corresponds to potentially high prediction errors. More precisely, the ROC analysis indicates that the proposed uncertainty estimate can detect if prediction errors are greater than 5 mm with on average high sensitivity (90%) and modest specificity (54% and 47% from internal and external surrogates, respectively). CONCLUSIONS: While relying exclusively on the surrogate motion characteristics being continuously monitored, the Bayesian framework coupled to adaptive uncertainty estimations can provide reliable CR able to detect large prediction errors. The findings of this study could be further used to automatically trigger risk management mechanisms prospectively.

One-step iterative reconstruction approach based on eigentissue decomposition for spectral photon-counting computed tomography.

Purpose: We propose a one-step tissue characterization method for spectral photon-counting computed tomography (SPCCT) using eigentissue decomposition (ETD), tailored for highly accurate human tissue characterization in radiotherapy. Methods: The approach combines a Poisson likelihood, a spatial prior, and a quantitative prior constraining eigentissue fractions based on expected values for tabulated tissues. There are two regularization parameters: α for the quantitative prior, and ß for the spatial prior. The approach is validated in a realistic simulation environment for SPCCT. The impact of α and ß is evaluated on a virtual phantom. The framework is tested on a virtual patient and compared with two sinogram-based two-step methods [using respectively filtered backprojection (FBP) and an iterative method for the second step] and a post-reconstruction approach with the same quantitative prior. All methods use ETD. Results: Optimal performance with respect to bias or RMSE is achieved with different combinations of α and ß on the cylindrical phantom. Evaluated in tissues of the virtual patient, the one-step framework outperforms two-step and post-reconstruction approaches to quantify proton-stopping power (SPR). The mean absolute bias on the SPR is 0.6% (two-step FBP), 0.6% (two-step iterative), 0.6% (post-reconstruction), and 0.2% (one-step optimized for low bias). Following the same order, the RMSE on the SPR is 13.3%, 2.5%, 3.2%, and 1.5%. Conclusions: Accurate and precise characterization with ETD can be achieved with noisy SPCCT data without the need to rely on post-reconstruction methods. The one-step framework is more accurate and precise than two-step methods for human tissue characterization.

Uncertainty-driven determination of target measurement times for indirect tracking validation in adaptive radiotherapy.

Objective. Hybrid indirect tumor tracking strategies combine continuous monitoring of surrogate signals with episodic radiographic imaging of the target to check and update their models during the treatment. This validation process is traditionally performed at predetermined and fixed-rate time intervals. This study investigates a new validation procedure based on the real-time uncertainty associated with the predicted target positions.Approach. An adaptive version of a Bayesian method for indirect tracking is developed to simulate different validation processes within a single framework: no validation, regular validation and uncertainty-based validation. While regular validation involves measuring targets at fixed intervals, uncertainty-based validation takes advantage of a key Bayesian feature, which is the real-time confidence information associated with predictions. The validation processes are applied to ground truth breathing signals consisting of a lung target and two different surrogates (one internal, one external). Their impact on prediction accuracy is evaluated with root-mean-square error (RMSE) and incidence of large errors. The number of validation measurements triggered is also examined.Main results. When using the internal surrogate and compared to regular validation, uncertainty-based validation results in significantly better prediction accuracy while using fewer validation measurements: RMSE and fraction of large errors are reduced on average by 12% and 26% respectively, with 36% fewer validation measurements. With the external surrogate, whose correlation with the target is less stable over time, more validation measurements are automatically triggered, which leads to a substantial reduction of prediction errors: RMSE and fraction of large errors are reduced on average by 17% and 28% respectively compared to regular validation. It is also observed that depending on the initial instant, regular validation can result in worse prediction accuracy compared to no validation.Significance. Uncertainty-based validation has the potential to be more efficient and effective than a validation process performed at prescheduled and fixed-rate time intervals.

Monte Carlo investigation of electron fluence perturbation in MRI-guided radiotherapy beams using six commercial radiation detectors.

With the integration of treatments with MRI-linacs to the clinical workflow, the understanding and characterization of detector response in reference dosimetry in magnetic fields are required. The external magnetic field perturbs the electron fluence. The degree of perturbation depends on the irradiation conditions and on the detector type. The purpose of this study is to evaluate the magnetic field impact on the electron fluence spectra in several detectors to provide a deeper understanding of detector response in these conditions. Monte Carlo calculations of the electron fluence are performed in six detectors (solid-state: PTW60012 and PTW60019, ionization chambers: PTW30013, PTW31010, PTW31021, and PTW31022) in water and irradiated by a 7 MV FFF photon beam with a small and a reference field, at 0 and 1.5 T. Three chamber axis orientations are investigated: parallel or perpendicular (either the Lorentz force pointing towards the stem or the tip) to the magnetic field and always perpendicular to the photon beam. One orientation for the solid-state detector is studied: parallel to the photon beam and perpendicular to the magnetic field. Additionally, electron fluence spectra are calculated in modified detector geometries to identify the underlying physical mechanisms behind the fluence perturbations. The total electron fluence in the Farmer chamber varies up to 1.24% and 5.12% at 1.5 T, in the parallel and perpendicular orientation, respectively. The interplay between the gyration radius and the Farmer chamber cavity length significantly affects the electron fluence in the perpendicular orientation. For the small-cavity chambers, the maximal variation in total electron fluence is 0.19% in the parallel orientation for the reference field. Significant small-field effects occur in these chambers; the magnetic field reduces the total electron fluence (with respect to the no field case) between 9.86% and 14.50%, depending on the orientation. The magnetic field strongly impacted the solid-state detectors in both field sizes, probably due to the high-Z components and cavity density. The maximal reductions of total electron fluence are 15.06 ± 0.09% (silicon) and 16.00 ± 0.07% (microDiamond). This work provides insights into detector response in magnetic fields by illustrating the interplay between several factors causing dosimetric perturbation effects: (1) chamber and magnetic field orientation, (2) cavity size and shape, (3) extracameral components, (4) air gaps and their asymmetry, (5) electron energy. Low-energy electron trajectories are more susceptible to change in magnetic fields, and are associated with detector response perturbation. Detectors with higher density and high-Z extracameral components exhibit more significant perturbations in the presence of a magnetic field, regardless of field size.

Efficient dose-rate correction of silicon diode relative dose measurements.

PURPOSE: Silicon diodes are often the detector of choice for relative dose measurements, particularly in the context of radiotherapy involving small photon beams. However, a major drawback lies in their dose-rate dependency. Although ionization chambers are often too large for small field output factor (OF) measurements, they are valuable instruments to provide reliable percent-depth dose (PDD) curves in reference beams. The aim of this work is to propose a practical and accurate method for the characterization of silicon diode dose-rate dependence correction factors using ionization chamber measurements as a reference. METHODS: The robustness of ionization chambers for PDD measurements is used to quantify the dose-rate dependency of a diode detector. A mathematical formalism, which exploits the error induced in percent-depth ionization (PDI) curves for diodes by their dose-rate dependency, is developed to derive a dose-rate correction factor applicable to diode relative measurements. The method is based on the definition of the recombination correction factor given in the addendum to TG 51 and is applied to experimental measurements performed on a CyberKnife M6 radiotherapy unit using a PTW 60012 diode detector. A measurement-based validation is provided by comparing corrected PDI curves to measurements performed with a PTW 60019 diamond detector, which does not exhibit dose-rate dependence. RESULTS: Results of dose-rate correction factors for PDI curves, off-axis ratios (OARs), tissue-phantom ratios, and small field OFs are coherent with the expected behavior of silicon diode detectors. For all considered setups and field sizes, the maximum correction and the maximum impact of the uncertainties induced by the correction are obtained for OARs for the 60 mm collimator, with a correction of 2.5% and an uncertainty of 0.34%. For OFs, corrections range from 0.33% to 0.82% for all field sizes considered, and increase with the reduction of the field size. Comparison of PDI curves corrected for dose-rate and for in-depth beam quality variations illustrates excellent agreement with measurements performed using the diamond detector. CONCLUSION: The proposed method allows the efficient and precise correction of the dose-rate dependence of silicon diode detectors in the context of clinical relative dosimetry.

A probabilistic approach for determining Monte Carlo beam source parameters: I. Modeling of a CyberKnife M6 unit.

Objective.During Monte Carlo modeling of external radiotherapy beams, models must be adjusted to reproduce the experimental measurements of the linear accelerator being considered. The aim of this work is to propose a new method for the determination of the energy and spot size of the electron beam incident on the target of a linear accelerator using a maximum likelihood estimation.Approach.For that purpose, the method introduced by Francesconet al(2008Med. Phys.35504-13) is expanded upon in this work. Simulated tissue-phantom ratios and uncorrected output factors using a set of different detector models are compared to experimental measurements. A probabilistic formalism is developed and a complete uncertainty budget, which includes a detailed simulation of positioning errors, is evaluated. The method is applied to a CyberKnife M6 unit using four detectors (PTW 60012, PTW 60019, Exradin A1SL and IBA CC04), with simulations being performed using the EGSnrc suite.Main results.The likelihood distributions of the electron beam energy and spot size are evaluated, leading toEˆ=7.42±0.17MeVandFˆ=2.15±0.06mm. Using these results and a 95% confidence region, simulations reproduce measurements in 13 out of the 14 considered setups.Significance.The proposed method allows an accurate beam parameter optimization and uncertainty evaluation during the Monte Carlo modeling of a radiotherapy unit.

A probabilistic approach for determining Monte Carlo beam source parameters: II. Impact of beam modeling uncertainties on dosimetric functions and treatment plans.

Objective.The Monte Carlo method is recognized as a valid approach for the evaluation of dosimetric functions for clinical use. This procedure requires the accurate modeling of the considered linear accelerator. In Part I, we propose a new method to extract the probability density function of the beam model physical parameters. The aim of this work is to evaluate the impact of beam modeling uncertainties on Monte Carlo evaluated dosimetric functions and treatment plans in the context of small fields.Approach.Simulations of output factors, output correction factors, dose profiles, percent-depth doses and treatment plans are performed using the CyberKnife M6 model developed in Part I. The optimized pair of electron beam energy and spot size, and eight additional pairs of beam parameters representing a 95% confidence region are used to propagate the uncertainties associated to the source parameters to the dosimetric functions.Main results.For output factors, the impact of beam modeling uncertainties increases with the reduction of the field size and confidence interval half widths reach 1.8% for the 5 mm collimator. The impact on output correction factors cancels in part, leading to a maximum confidence interval half width of 0.44%. The impact is less significant for percent-depth doses in comparison to dose profiles. For these types of measurement, in absolute terms and in comparison to the reference dose, confidence interval half widths less than or equal to 1.4% are observed. For simulated treatment plans, the impact is more significant for the treatment delivered with a smaller field size with confidence interval half widths reaching 2.5% and 1.4% for the 5 and 20 mm collimators, respectively.Significance.Results confirm that AAPM TG-157's tolerances cannot apply to the field sizes studied. This study provides an insight on the reachable dose calculation accuracy in a clinical setup.

GPUMCD: A new GPU-oriented Monte Carlo dose calculation platform.

PURPOSE: Monte Carlo methods are considered as the gold standard for dosimetric computations in radiotherapy. Their execution time is, however, still an obstacle to the routine use of Monte Carlo packages in a clinical setting. To address this problem, a completely new, and designed from the ground up for the GPU, Monte Carlo dose calculation package for voxelized geometries is proposed: GPUMCD. METHOD: GPUMCD implements a coupled photon-electron Monte Carlo simulation for energies in the range of 0.01-20 MeV. An analog simulation of photon interactions is used and a class II condensed history method has been implemented for the simulation of electrons. A new GPU random number generator, some divergence reduction methods, as well as other optimization strategies are also described. GPUMCD was run on a NVIDIA GTX480, while single threaded implementations of EGSnrc and DPM were run on an Intel Core i7 860. RESULTS: Dosimetric results obtained with GPUMCD were compared to EGSnrc. In all but one test case, 98% or more of all significant voxels passed the gamma criteria of 2%-2 mm. In terms of execution speed and efficiency, GPUMCD is more than 900 times faster than EGSnrc and more than 200 times faster than DPM, a Monte Carlo package aiming fast executions. Absolute execution times of less than 0.3 s are found for the simulation of 1M electrons and 4M photons in water for monoenergetic beams of 15 MeV, including GPU-CPU memory transfers. CONCLUSION: GPUMCD, a new GPU-oriented Monte Carlo dose calculation platform, has been compared to EGSnrc and DPM in terms of dosimetric results and execution speed. Its accuracy and speed make it an interesting solution for full Monte Carlo dose calculation in radiation oncology.

Validation of an electron Monte Carlo dose calculation algorithm in the presence of heterogeneities using EGSnrc and radiochromic film measurements.

The purpose of this study is to validate Eclipse's electron Monte Carlo algorithm (eMC) in heterogeneous phantoms using radiochromic films and EGSnrc as a reference Monte Carlo algorithm. Four heterogeneous phantoms are used in this study. Radiochromic films are inserted in these phantoms, including in heterogeneous media, and the measured relative dose distributions are compared to eMC calculations. Phantoms A, B, and C contain 1D heterogeneities, built with layers of lung- (phantom A) and bone- (phantoms B and C) equivalent materials sandwiched in Plastic Water. Phantom D is a thorax anthropomorphic phantom with 2D lung heterogeneities. Electron beams of 6, 9, 12 and 18 MeV from a Varian Clinac 2100 are delivered to these phantoms with a 10 × 10 cm2 applicator. Monte Carlo simulations with an independent algorithm (EGSnrc) are also used as a reference tool for two purposes: (1) as a second validation of the eMC dose calculations, and (2) to calculate the stopping power ratio between radiochromic films and bone medium, when dose is measured inside the heterogeneity. Percent depth dose (PDD) film measurements and eMC calculations agree within 2% or 3 mm for phantom A, and within 3% or 3 mm for phantoms B and C for almost all beam energies. One exception is observed with phantom B and the 6 MeV, where measured PDDs and those calculated with eMC differ by up to 4 mm. Gamma analysis of the measured and calculated 2D dose distributions in phantom D agree with criteria of 3%, 3mm for 9, 12, and 18 MeV beams, and criteria of 5%, 3 mm for the 6 MeV beam. Dose calculations in heterogeneous media with eMC agree within 3% or 3 mm with radiochromic film measurements. Six (6) MeV beams are not modeled as accurately as other beam energies. The eMC algorithm is suitable for clinical dose calculations involving lung and bone.

Reference dosimetry of modulated and dynamic photon beams.

In the late 1980s, a new technique was proposed that would revolutionize radiotherapy. Now referred to as intensity-modulated radiotherapy, it is at the core of state-of-the-art photon beam delivery techniques, such as helical tomotherapy and volumetric modulated arc therapy. Despite over two decades of clinical application, there are still no established guidelines on the calibration of dynamic modulated photon beams. In 2008, the IAEA-AAPM work group on nonstandard photon beam dosimetry published a formalism to support the development of a new generation of protocols applicable to nonstandard beam reference dosimetry (Alfonso et al 2008 Med. Phys. 35 5179-86). The recent IAEA Code of Practice TRS-483 was published as a result of this initiative and addresses exclusively small static beams. But the plan-class specific reference calibration route proposed by Alfonso et al (2008 Med. Phys. 35 5179-86) is a change of paradigm that is yet to be implemented in radiotherapy clinics. The main goals of this paper are to provide a literature review on the dosimetry of nonstandard photon beams, including dynamic deliveries, and to discuss anticipated benefits and challenges in a future implementation of the IAEA-AAPM formalism on dynamic photon beams.

Traceable reference dosimetry in MRI guided radiotherapy using alanine: calibration and magnetic field correction factors of ionisation chambers.

Magnetic resonance imaging (MRI)-guided radiotherapy (RT) (MRIgRT) falls outside the scope of existing high energy photon therapy dosimetry protocols, because those protocols do not consider the effects of the magnetic field on detector response and on absorbed dose to water. The aim of this study is to evaluate and demonstrate the traceable measurement of absorbed dose in MRIgRT systems using alanine, made possible by the characterisation of alanine sensitivity to magnetic fields reported previously by Billaset al(2020Phys. Med. Biol.65115001), in a way which is compatible with existing standards and calibrations available for conventional RT. In this study, alanine is used to transfer absorbed dose to water to MRIgRT systems from a conventional linac. This offers an alternative route for the traceable measurement of absorbed dose to water, one which is independent of the transfer using ionisation chambers. The alanine dosimetry is analysed in combination with measurements with several Farmer-type chambers, PTW 30013 and IBA FC65-G, at six different centres and two different MRIgRT systems (Elekta Unity™ and ViewRay MRIdian™). The results are analysed in terms of the magnetic field correction factors, and in terms of the absorbed dose calibration coefficients for the chambers, determined at each centre. This approach to reference dosimetry in MRIgRT produces good consistency in the results, across the centres visited, at the level of 0.4% (standard deviation). Farmer-type ionisation chamber magnetic field correction factors were determined directly, by comparing calibrations in some MRIgRT systems with and without the magnetic field ramped up, and indirectly, by comparing calibrations in all the MRIgRT systems with calibrations in a conventional linac. Calibration coefficients in the MRIgRT systems were obtained with a standard uncertainty of 1.1% (Elekta Unity™) and 0.9% (ViewRay MRIdian™), for three different chamber orientations with respect to the magnetic field. The values obtained for the magnetic field correction factor in this investigation are consistent with those presented in the summary by de Pooteret al(2021Phys. Med. Biol.6605TR02), and would tend to support the adoption of a magnetic field correction factor which depends on the chamber type, PTW 30013 or IBA FC65-G.

Eigencolor radiochromic film dosimetry.

PURPOSE: The goal of this work is to propose a new multichannel method correcting for systematic thickness disturbances and to evaluate its precision in relevant radiation dosimetry applications. METHODS: The eigencolor ratio technique is introduced and theoretically developed to provide a method correcting for thickness disturbances. The method is applied to EBT3 GafchromicTM film irradiated with cobalt-60 and 6 MV photon beams and digitized with an Epson 10000XL photo scanner. Dose profiles and output factors of different field sizes are measured and analyzed. Variance analysis of the previous method of Bouchard et al. ["On the characterization and uncertainty analysis of radiochromic film dosimetry" Med Phys. 2009;36:1931-1946] is adapted to the new approach. Uncertainties are predicted for relevant applications. RESULTS: Results show that systematic disturbances attributed to thickness variations are efficiently corrected. The method is shown efficient to identify and correct for dark spots which cause systematic errors in single-channel distributions. Applications of the method in the context of relative dosimetry yields standard uncertainties ranging between 0.8% and 1.9%, depending on the region of interest (ROI) size and the film irradiation. Variance analysis predicts that uncertainty levels between 0.3% and 0.6% are achievable with repeated measurements. Uncertainties are found to vary with absorbed dose and ROI size. CONCLUSIONS: The proposed multichannel method is efficient for accurate dosimetry, reaching uncertainty levels comparable to previous publications with EBT film. The method is also promising for applications beyond clinical QA, such as machine characterization and other advanced dosimetry applications.

Monte Carlo calculation of detector perturbation and quality correction factors in a 1.5 T magnetic resonance guided radiation therapy small photon beams.

Objective.With future advances in magnetic resonance imaging-guided radiation therapy, small photon beams are expected to be included regularly in clinical treatments. This study provides physical insights on detector dose-response to multiple megavoltage photon beam sizes coupled to magnetic fields and determines optimal orientations for measurements.Approach.Monte Carlo simulations determine small-cavity detector (solid-state: PTW60012 and PTW60019, ionization chambers: PTW31010, PTW31021, and PTW31022) dose-responses in water to an Elekta Unity 7 MV FFF photon beam. Investigations are performed for field widths between 0.25 and 10 cm in four detector axis orientations with respect to the 1.5 T magnetic field and the photon beam. The magnetic field effect on the overall perturbation factor (PMC) accounting for the extracameral components, atomic composition, and density is quantified in each orientation. The density (Pρ) and volume averaging (Pvol) perturbation factors and quality correction factors (kQB,QfB,f) accounting for the magnetic field are also calculated in each orientation.Main results.Results show thatPvolremains the most significant perturbation both with and without magnetic fields. In most cases, the magnetic field effect onPvolis 1% or less. The magnetic field effect onPρis more significant on ionization chambers than on solid-state detectors. This effect increases up to 1.564 ± 0.001 with decreasing field size for chambers. On the contrary, the magnetic field effect on the extracameral perturbation factor is higher on solid-state detectors than on ionization chambers. For chambers, the magnetic field effect onPMCis only significant for field widths <1 cm, while, for solid-state detectors, this effect exhibits different trends with orientation, indicating that the beam incident angle and geometry play a crucial role.Significance.Solid-state detectors' dose-response is strongly affected by the magnetic field in all orientations. The magnetic field impact on ionization chamber response increases with decreasing field size. In general, ionization chambers yieldkQB,QfB,fcloser to unity, especially in orientations where the chamber axis is parallel to the magnetic field.

Potential of a probabilistic framework for target prediction from surrogate respiratory motion during lung radiotherapy.

Purpose.Respiration-induced motion introduces significant positioning uncertainties in radiotherapy treatments for thoracic sites. Accounting for this motion is a non-trivial task commonly addressed with surrogate-based strategies and latency compensating techniques. This study investigates the potential of a new unified probabilistic framework to predict both future target motion in real-time from a surrogate signal and associated uncertainty.Method.A Bayesian approach is developed, based on a Kalman filter theory adapted specifically for surrogate measurements. Breathing motions are collected simultaneously from a lung target, two external surrogates (abdominal and thoracic markers) and an internal surrogate (liver structure) for 9 volunteers during 4 min, in which severe breathing changes occur to assess the robustness of the method. A comparison with an artificial non-linear neural network (NN) is performed, although no confidence interval prediction is provided. A static worst-case scenario and a simple static design are investigated.Results.Although the NN can reduce the prediction errors from thoracic surrogate in some cases, the Bayesian framework outperforms in most cases the NN when using the other surrogates: bias on predictions is reduced by 38% and 16% on average when using respectively the liver and the abdomen for the simple scenario, and by respectively 40% and 31% for the worst-case scenario. The standard deviation of residuals is reduced on average by up to 42%. The Bayesian method is also found to be more robust to increasing latencies. The thoracic marker appears to be less reliable to predict the target position, while the liver shows to be a better surrogate. A statistical test confirms the significance of both observations.Conclusion.The proposed framework predicts both the future target position and the associated uncertainty, which can be valuably used to further assist motion management decisions. Further investigation is required to improve the predictions by using an adaptive version of the proposed framework.

Investigation of three radiation detectors for accurate measurement of absorbed dose in nonstandard fields.

PURPOSE: To establish accurate experimental dosimetry techniques for reference dose measurements in nonstandard composite fields. METHODS: A cylindrical PMMA phantom filled with water was constructed, at the center of which reference absorbed dose to water for a head and neck IMRT delivery was measured. Based on the proposed new formalism for reference dosimetry of nonstandard fields [Alfonso et al., Med. Phys. 35, 5179-5186 (2008)], a candidate plan-class specific reference (pcsr) field for a typical head and neck IMRT delivery was created on the CT images of the phantom. The absorbed dose to water in the pcsr field normalized to that in a reference 10 x 10 cm2 field was measured using three radiation detectors: Gafchromic EBT films, a diamond detector, and a guarded liquid-filled ionization chamber developed in-house (GLIC-03). Pcsr correction factors [formula in text] were determined for five different types of air-filled ionization chambers (Exradin A12, NE-2571, Exradin A1SL, Exradin A14, and PinPoint 31006) in a fully rotated delivery and in a delivery with the same MLC settings and weights but from a single gantry angle (a collapsed delivery). RESULTS: The combined standard uncertainty in measuring the correction factor [formula in text] using the three dosimetry techniques was 0.3%. For all the air-filled ionization chambers and the pcsr field tested, the correction factor was not different from unity by more than +/- 0.8%. For the fully rotated delivery, the correction factors were in a narrow range of 0.9955-0.9986, while in the collapsed delivery, they were in a slightly broader range of 0.9922-1.0048. In the collapsed delivery, the Farmer-type chambers (Exradin A12 and NE2571) had very similar correction factors (0.9922 and 0.9931, respectively), whereas the correction factors for the smaller chambers showed more distinct chamber-type dependence. CONCLUSIONS: The authors have established three experimental dosimetry techniques that allow reference measurements of nonstandard field correction factors [formula in text] for air-filled ionization chambers at the 0.3% 1sigma uncertainty level. These techniques can be used to determine criteria for the selection of plan-class specific reference fields and ultimately improve clinical reference dosimetry of nonstandard fields.