Evaluation of scanning resolution, detector choice and detector orientation to be used for accurate and time-efficient commissioning of a 6MV clinical linear accelerator.

The present study is aimed at exploring different scanning parameters, detectors and their orientations for time-efficient and accurate commissioning of a 6 MV clinical linear accelerator (LINAC). Beam profiles and percentage depth dose (PDD) curves were measured with a PTW dosimetry diode, a PTW Semiflex and a PinPoint ion chamber in different orientations. To acquire beam data, equidistant (step size of 0.5 mm, 1 mm, 2 mm and 3 mm) and fanline (step size of 2-0.5 mm, 2-1 mm, 3-0.5 mm and 3-1 mm) scanning modes were employed and data measurement time was recorded. Scan time per measurement point was also varied (0.2 s, 0.5 s and 1.0 s) to investigate its effect on the accuracy and acquisition time of beam data. Accuracy of the measured data was analyzed on the basis of the variation between measured data and data modeled by a treatment planning system. Beam profiles (particularly in penumbra region) were found to be sensitive to variation in scanning resolution and showed an improved accuracy with decrease in step size, while PDD curves were affected negligibly. The accuracy of beam data obtained with the PTW dosimetry diode and the PinPoint ion chamber was higher than those obtained with the PTW Semiflex ion chamber for small fields (2 × 2 cm2 and 3 × 3 cm2). However, the response of the PTW diode and the PinPoint ion chamber was significantly indifferent in these fields. Furthermore, axial orientation of the PTW Semiflex ion chamber improved accuracy of profiles and PDDs as compared to radial orientation, while such a difference was not significant for the PinPoint ion chamber. It is concluded that a scan time of 0.2 s/point with a fanline scanning resolution of 2-1 mm for beam profiles and 3 mm for PDDs are most favorable in terms of accuracy and time efficiency. For small fields (2 × 2 cm2 and 3 × 3 cm2), a PinPoint ion chamber in radial orientation or a dosimetry diode in axial orientation are recommended for both beam profiles and PDDs. If a PinPoint ion chamber and a PTW dosimetry diode are not available, a Semiflex ion chamber in axial orientation may be used for small fields.

Assessment of skin doses in small field radiotherapy for 6 MV photons and beam spectral analysis at skin surface: an EGSnrc based Monte Carlo study.

This study aims at the estimation of skin doses during small field radiotherapy with 6 MV photons and analysis of beam spectra at skin surface. The EGSnrc Monte Carlo code was used for spectral analysis and dose scoring in a water phantom. Percent skin dose (PSD) was calculated at a depth of 70 µm (relative to 10 cm depth), and the effects of field size, collimation, source-to-surface distance, and tissue inhomogeneity (bone/air) below the skin were evaluated. Low-energy photons and contaminant electrons from the machine head or back-scattered from underlying tissue were found to be the major contributors to skin dose. As the field size was reduced, the beam hardened, while the photon and electron fluences at the skin decreased compared to those at the reference depth of 10 cm. This resulted in a PSD reduction for fields smaller than the reference field size. Multi leaf collimators increased the PSD (up to 4%) while variation in source-to-skin dose showed a negligible effect. A substantial increase in PSD has been observed (up to 6%) when high Z material like bone was placed below the skin. In contrast, air as underlying material decreased the skin dose. The skin dose varied considerably with various clinical and geometric parameters. It is concluded that, although the skin doses were low for small fields compared to those for the reference field, skin doses may become substantial when escalated target doses are delivered with multi leaf collimators. Moreover, the presence of high Z materials such as bones or metallic implants below the skin can result in significant enhancement of the skin dose.

Feasibility study of using Stereotactic Field Diode for field output factors measurement and evaluating three new detectors for small field relative dosimetry of 6 and 10 MV photon beams.

This study assesses the feasibility of using stereotactic field diode (SFD) as an alternate to gaf chromic films for field output factor (FF) measurement and further evaluating three new detectors for small field dosimetry. Varian 21EX linear accelerator was used to generate 6 and 10 MV beams of nominal square fields ranging from 0.5 × 0.5 cm2 to 10 × 10 cm2 . One passive (EBT3 films) and five active detectors including IBA RAZOR diode(RD), SFD, RAZOR nanochamber (RNC), pinpoint chamber (PTW31023), and semiflex chamber (PTW31010) were employed. FFs were measured using films and SFD while beam profiles and percentage depth dose (PDD) distribution were acquired with active detectors. Polarity (kpol ) and recombination (ks ) effects of ion chambers were determined and corrected for output ratio measurement. Correction factors (CF) of RD, RNC, and PTW31023 in axial and radial orientation were also measured. Stereotactic field diode measured FFs have shown good agreement with films (with difference of <1%). RD and RNC measured beam profiles were within 3% deviation from the SFD values. Variation in kpol with field size for RNC and PTW31023 was up to 4% and 0.4% (for fields ≥ 1 × 1 cm2 ), respectively, while variation in ks of PTW31023 was <0.2 %. The maximum values of CF have been calculated to be 5.2%, 2.0%, 13.6%, and 25.5% for RD, RNC, PTW31023-axial, and PTW31023-radial respectively. This study concludes that SFD with appropriate CFs as given in TRS 483 may be used for measuring FFs as an alternate to EBT3 films. Whereas RD and RNC may be used for beam profile and PDD measurement in small fields. Considering the limit of usability of 2%, RNC may be used without CF for FF measurement in the smallfields investigated in this study.

Monte Carlo commissioning of radiotherapy LINAC-Introducing an improved methodology.

PURPOSE: Monte Carlo (MC) commissioning of medical linear accelerator (LINAC) is a time-consuming process involving a comparison between measured and simulated cross beam/lateral profiles and percentage depth doses (PDDs) for various field sizes. An agreement between these two data sets is sought by trial and error method while varying the incident electron beam parameters, such as electron beam energy or width, etc. This study aims to improve the efficiency of MC commissioning of a LINAC by assessing the feasibility of using a limited number of simulated PDDs. MATERIALS AND METHODS: Using EGSnrc codes, a Varian Clinac 2100 unit has been commissioned for 6 MV photon beam, and a methodology has been proposed to identify the incident electron beam parameters in a speedier fashion. Impact of voxel size in 3-dimensions and cost functions used for comparison of the measured and simulated data have been investigated along with the role of interpolation. RESULTS: A voxel size of 1 × 1×0.5 cm3 has been identified as suitable for accurate and fast commissioning of the LIANC. The optimum number of simulated PDDs (required for further interpolation) has been found to be five. CONCLUSION: The present study suggests that PDDs alone at times can be insufficient for an unambiguous commissioning process and should be supported by including the lateral beam profiles in the process.

Measurement of 6 MV small field beam profiles - comparison of micro ionization chamber and linear diode array with monte carlo code.

The objective of this study is to analyze small field photon beams acquired with commonly available detectors. Beam profiles of 6 MV photons from the Siemens Primus Linear Accelerator were measured with a micro ion chamber (IC CC01, IBA) and linear diode array (LDA-99SC, IBA). Data was acquired using a water phantom for small fields (0.5×0.5 cm2 to 4×4 cm2) at depth of maximum dose, 5 cm and 10 cm. Profiles were also generated with EGSnrc Monte Carlo code. Measured and simulated profiles were compared in terms of percentage difference of the area under the simulated and measured profiles (PD), ratio of the measured to simulated dose at the point of maximum deviation within the central region of profile (R), full width half maximum (FWHM) and penumbra. For field sizes ≥1×1 cm2, the maximum PD is 3.17 % and 2.87 % for IC and LDA respectively, whereas R is in the range of 0.95-1.05 for IC and 0.99-1.05 for LDA. LDA measured FWHM and penumbra are also in better agreement with the simulated results. This study demonstrated that LDA can be used for acquisition of beam profiles for field size as low as 1×1 cm2.

Testicular choriocarcinoma: diagnosed on cervical lymph node biopsy.

Choriocarcinoma is a very rare germinal testicular tumour and in literature its incidence has been reported to be 0.3% of all germinal testicular tumours. An important tumour marker is serum beta-hCG which not only helps in establishing diagnosis but also in assessing response to chemotherapy. In this study we present a case of testicular choriocarcinoma, who presented with abdominal pain, cough, generalized weakness and left sided cervical mass. Incisional biopsy of cervical mass was performed. Histopathology revealed metastatic choriocarcinoma. Serum beta-hCG levels were 1227 ng/mL. Patient received intravenous cycles of PEB (cisPlatin, Etoposide, Bleomycin) chemotherapy but he had progressive disease both radiologically and on tumour marker monitoring. He was planned for salvage chemotherapy but was lost to follow up there after. It is concluded that in males, choriocarcinoma carries a very dismal prognosis and a very poor response to chemotherapy and radiotherapy; surgery has no role in the management.

Assessment of dose error due to nylon mesh of treatment couch.

PURPOSE: This study aims at the assessment of dose error in patients undergoing radiotherapy due to treatment couch of Co-60 teletherapy unit. MATERIALS AND METHODS: In this study beam attenuation due to treatment couch of Co-60 unit was measured in air for different gantry angles and field sizes. Polymethylmethacrylate (PMMA) phantom was used to estimate the effect of depth on attenuation. Impact of couch on surface dose was also evaluated. RESULTS: Beam attenuation due to couch was in the range of 0.5-28% for different gantry angles with standard field size of 10 × 10 cm(2) with optimum position of metallic cranks. Maximum attenuation (29%) was observed with smallest field size i.e. 5 × 5 cm(2). Beam attenuation has been found higher in phantom as compared to that in air However, no particular trend of attenuation has been noted with varying depth of phantom. A 6% increase in surface dose has also been observed due to couch insertion for normal beam incidence. Maximum error of 80% is also note-worthy for most unfavorable situation of irradiation at 180 degree through the metallic cranks. CONCLUSION: It has been determined that ignoring the treatment couch and its accessories can result in dose error of 0.5-80%, depending on gantry angle, field size and position of couch accessories. Therefore, consideration of dose error due to couch during treatment planning is recommended.

Estimation of absorbed dose to thyroid in patients treated with radiotherapy for various cancers.

This study is aimed at the evaluation of the absorbed dose to the thyroid gland from scattered/primary radiations in patients who have undergone radiotherapy. In this study, the skin entrance dose (SED) on the anterior neck at the level of the thyroid gland was measured using thermoluminescent dosimeters for 57 patients during radiotherapy with (60)Co teletherapy unit. Phantom dosimetry was also performed to find the correlation between the SED and the dose at the depth of the thyroid. SED of patients treated for breast cancer was 6.77±3.49 Gy and that of those with Hodgkin's disease and Ca. lung irradiation were 21.29±13.52 Gy and 28.80±14.94 Gy, respectively. SED at the level of the thyroid gland was found to be highest for patients whose thyroid gland was within the radiation field, while lowest for patients with skull irradiation. Thyroid gland is recommended to be shielded or excluded from the field whenever possible.