Characterization of a novel scale maille contralateral breast shield: SMART Armor.

During breast radiotherapy treatment, the contralateral breast receives radiation doses to the skin and subcutaneous tissue caused mainly from incident electron contamination and low energy photon scatter radiation. Measurements have shown that for a typical hybrid tangential treatment, these dose levels can be up to 17% of maximum applied prescription dose if no shielding is used during the treatment process. This work examined the use of different shielding metals, aluminum, copper, and lead to reduce peripheral radiation dose to evaluate the optimal metal to form the basis of a contralateral breast radiation shield. This work also shows a simple but novel method to substantially reduce this unwanted radiation dose with the use of a copper scale maille sheet which can be easily and accurately draped over a patient's contralateral breast during treatment. The copper scale maille is flexible and can thus conform around typical breast shapes. It can also form irregular shaped edges to match those outlined by typical tangential treatment fields. As the shield is made from copper, it is nontoxic and can potentially be used directly on patients for treatment. The designed copper scale maille has shown to reduce contralateral breast skin and subcutaneous dose by up to 80% for typical radiation fields used in breast radiotherapy.

Comparison of Epson scanner quality for radiochromic film evaluation.

Epson Desktop scanners have been quoted as devices which match the characteristics required for the evaluation of radiation dose exposure by radiochromic films. Specifically, models such as the 10000XL have been used successfully for image analysis and are recommended by ISP for dosimetry purposes. This note investigates and compares the scanner characteristics of three Epson desktop scanner models including the Epson 10000XL, V700, and V330. Both of the latter are substantially cheaper models capable of A4 scanning. As the price variation between the V330 and the 10000XL is 20-fold (based on Australian recommended retail price), cost savings by using the cheaper scanners may be warranted based on results. By a direct comparison of scanner uniformity and reproducibility we can evaluate the accuracy of these scanners for radiochromic film dosimetry. Results have shown that all three scanners can produce adequate scanner uniformity and reproducibility, with the inexpensive V330 producing a standard deviation variation across its landscape direction of 0.7% and 1.2% in the portrait direction (reflection mode). This is compared to the V700 in reflection mode of 0.25% and 0.5% for landscape and portrait directions, respectively, and 0.5% and 0.8% for the 10000XL. In transmission mode, the V700 is comparable in reproducibility to the 10000XL for portrait and landscape mode, whilst the V330 is only capable of scanning in the landscape direction and produces a standard deviation in this direction of 1.0% compared to 0.6% (V700) and 0.25% (10000XL). Results have shown that the V700 and 10000XL are comparable scanners in quality and accuracy with the 10000XL obviously capable of imaging over an A3 area as opposed to an A4 area for the V700. The V330 scanner produced slightly lower accuracy and quality with uncertainties approximately twice as much as the other scanners. However, the results show that the V330 is still an adequate scanner and could be used for radiation dosimetry purposes. As such, if budgetary requirements are limited, the V700 scanner would be the recommended option at a price eight times cheaper than the 10000XL; however, the V330 produces adequate results at a price which is 2.5 times cheaper again. This may be a consideration for smaller institutions or individuals working with radiochromic film dosimetry.

Measurement and effects of MOSKIN detectors on skin dose during high energy radiotherapy treatment.

During in vivo dosimetry for megavoltage X-ray beams, detectors such as diodes, Thermo luminescent dosimeters (TLD's) and MOSFET devices are placed on the patient's skin. This of course will affect the skin dose delivered during that fraction of the treatment. Whilst the overall impact on increasing skin dose would be minimal, little has been quantified concerning the level of increase in absorbed dose, in vivo dosimeters produce when placed in the beams path. To this extent, measurements have been made and analysis performed on dose changes caused by MOSKIN, MOSFET, skin dose detectors. Maximum increases in skin dose were measured as 15 % for 6 MV X-rays and 10 % for 10 MV X-rays at the active crystal of the MOSKIN device which is the thickest part of the detector. This is compared to 32 and 26 % for a standard 1 mm thick LiF TLD at 10 × 10 cm(2) field size for 6 and 10 MV X-rays respectively. Radiochromic film, EBT2 has been shown to provide a high resolution 2 dimensional map of skin dose from these detectors and measures the effects of in vivo dosimeters used for radiotherapy dose assessment.

Variations in daily quality assurance dosimetry from device levelling, feet position and backscatter material.

Daily quality assurance procedures are an essential part of radiotherapy medical physics. Devices such as the Sun Nuclear, DQA3 are effective tools for analysis of daily dosimetry including flatness, symmetry, energy, field size and central axis radiation dose measurement. The DQA3 can be used on the treatment couch of the linear accelerator or on a dedicated table/bed for superficial and orthovoltage x-ray machines. This device is levelled using its dedicated feet. This work has shown that depending on the quantity of backscatter material behind the DQA3 device, the position of the levelling feet can affect the measured central axis dose by up to 1.8 % (250 kVp and 6 MV) and that the introduction of more backscatter material behind the DQA3 can lead to up to 7.2 % (6 MV) variations in measured central axis dose. In conditions where no backscatter material is present, dose measurements can vary up to 1 %. As such this work has highlighted the need to keep the material behind the DQA3 device constant as well as maintaining the accuracy of the feet position on the device to effectively measure the most accurate daily constancy achievable. Results have also shown that variations in symmetry and energy calculations of up to 1 % can occur if the device is not levelled appropriately. As such, we recommend the position of the levelling feet on the device be as close as possible to the device so that a constant distance is kept between the DQA3 and the treatment couch and thus minimal levelling variations also occur. We would also recommend having no extra backscattering material behind the DQA3 device during use to minimise any variations which might occur from these backscattering effects.

Effect of scanner lens on lateral response artefact in radiochromic film dosimetry.

Radiochromic film is a good dosimeter choice for patient QA for complex treatment techniques because of its near tissue equivalency, high spatial resolution and established method of use. Commercial scanners are typically used for film dosimetry, with Epson scanners being the most common. Radiochromic film dosimetry is not straightforward having some well-defined problems which must be considered, one of the main ones being the Lateral Response Artefact (LRA) effect. Previous studies showed that the contributing factors to LRA are from the structure of the active ingredients of the film and the components and construction of the flatbed scanner. This study investigated the effect of the scanner lens on the LRA effect, as part of a wider investigation of scanner design effects and uncertainties. Gafchromic EBT3 films were irradiated with 40 × 40 cm2 field size 6 MV beams. Films were analysed using images captured by a Canon 7D camera utilising 18 mm, 50 mm and 100 mm focal length lenses compared to images scanned with a conventional Epson V700 scanner. The magnitude of the LRA was observed to be dependent on the focal length of the lens used to image the film. A substantial reduction in LRA was seen with the use of the 50 mm and 100 mm lenses, by factors of 3-5 for the 50 mm lens and 4-30 for the 100 mm lens compared to conventional desktop scanner techniques. This is expected to be from the longer focal length camera lens system being able to collect more light from distant areas compared to the scanner-based system. This provides an opportunity to design film dosimetry systems that minimise this artefact.

Scanner uniformity improvements for radiochromic film analysis with matt reflectance backing.

A simple and reproducible method for increasing desktop scanner uniformity for the analysis of radiochromic films is presented. Scanner uniformity, especially in the non-scan direction, for transmission scanning is well known to be problematic for radiochromic film analysis and normally corrections need to be applied. These corrections are dependant on scanner coordinates and dose level applied which complicates dosimetry procedures. This study has highlighted that using reflectance scanning in combination with a matt, white backing material instead of the conventional gloss scanner finish, substantial increases in the scanner uniformity can be achieved within 90% of the scanning area. Uniformity within ±1% over the scanning area for our epsonV700 scanner tested was found. This is compared to within ±3% for reflection scanning with the gloss backing material and within ±4% for transmission scanning. The matt backing material used was simply 5 layers of standard quality white printing paper (80 g/m(2)). It was found that 5 layers was the optimal result for backing material however most of the improvements were seen with a minimum of 3 layers. Above 5 layers, no extra benefit was seen. This may eliminate the need to perform scanner corrections for position on the desktop scanners for radiochromic film dosimetry.

A comparison between EPSON V700 and EPSON V800 scanners for film dosimetry.

Radiochromic film is a good dosimeter choice for patient QA for complex treatment techniques (IMRT, VMAT, SABR, SBRT) because of its near tissue equivalency, very high spatial resolution and established method of use. Commercial scanners are usually used for film dosimetry, among which EPSON scanners are the most common. NCCI have used an EPSON V700 scanner, but recently acquired a new model EPSON V800 scanner. The purpose of this work was to evaluate any differences between these two scanners to consider whether they can be used interchangeably or not. Different aspects of film dosimetry, e.g. lateral response artefact (LRA) effect, orientation effect, scanner response etc., were compared. EBT3 films were irradiated with 40 × 40 cm2 field size 6 MV beams and scanned in both the scanners. The scanned images were read in ImageJ V1.49 software. The data obtained was then copied in MS Excel to compare the scanners. The V800 scanner causes more polarisation, which results in more LRA effect than for the V700 scanner. The responses of the scanners in all three colour channels are not the same for the same film and irradiation. The V800 scanner shows an increase of response of up to 1.6% compared to 3.7% increase in the V700 scanner after scanning a piece of irradiated film 20 times. The scanners cannot be used interchangeably. The correction factors for LRA effect and the calibration curves are different. Further characterisation, evaluation and commissioning is required before clinical use.

Monte Carlo calculated output correction factors for Gafchromic EBT3 film for relative dosimetry in small stereotactic radiosurgery fields.

To calculate small field output correction factors, [Formula: see text], for Gafchromic EBT3 film using Monte Carlo simulations. These factors were determined for a Novalis Trilogy linear accelerator equipped with Brainlab circular cones with diameters of 4.0 to 30.0 mm. The BEAMnrc Monte Carlo code was used to simulate the Novalis Trilogy linear accelerator and the Brainlab cones with diameters 4.0 to 30 mm. The DOSXYZnrc code was used to simulate Gafchromic EBT3 film with the atomic composition specified by the manufacturer. Small field correction factors were calculated according to new IAEA TRS-483 Code of Practice for small field dosimetry. The depth of calculation was 10 cm and a source to surface distance of 100 cm. The X-ray beam used in the simulations was a 6 MV SRS. The correction factors were then used to determine field output factors with Gafchromic EBT3 film. These field output factors were validated using three solid state detectors and applying correction factors from the TRS-483 Code of Practice. The solid state detectors were IBA SFD diode, PTW 60018 SRS diode and PTW 60019 microDiamond. The Monte Carlo calculated output correction factors, [Formula: see text], for Gafchromic EBT3 film ranged between 0.998 to 1.004 for Brainlab circular cones with diameters between 4.0 and 30.0 mm. The uncertainty for these factors was 2.0%. The field output factors obtained with Gafchromic EBT3 film were within 2% of the mean results obtained with the three solid state detectors. For field sizes 4 mm diameter and above, Gafchromic EBT3 film has field output correction factors within 1% of unity. Therefore, Gafchromic EBT3 film can be considered to be correction less and supports the assumption made about this film in the TRS-483 Code of Practice.

A novel extrapolation method using OSL detectors for very small field output factor measurement for stereotactic radiosurgery.

Appropriate methods for the determination of very small X-ray beam output factors are essential to ensure correct clinical outcomes for stereotactic radiosurgery. To date, substantial work has been performed in identifying and quantifying suitable dosimeters for relative output factor (ROF) measurements including recent IAEA published recommendations. In this work, we provide a novel method using optically stimulated luminescent dosimeters (OSLDs) with different effective sizes of the readout area to determine ROFs. This involves applying an extrapolation technique to assess ROFs for 6MV SRS X-ray beams with field diameters ranging from 4 to 30 mm as defined by the Brainlab SRS cones. By combining the use of multiple sized OSLDs and water droplets to remove air gaps located around the OSLD detectors, both volume averaging and density variation effects were minimised to estimate ROFs for an extrapolated zero volume detector. The measured results showed that for a 4 mm diameter cone, the ROF was 0.660 ± 0.032 (2SD) as compared to 0.661 ± 0.01 and 0.651 ± 0.018 for the PTW 600019 microDiamond detector and Gafchromic EBT3 film respectively. Whilst the uncertainties were larger than conventional detectors, the technique shows promise and improvements in accuracy may be obtained by higher quality manufacturing techniques. Based on these results, using OSLDs with different effective sizes of readout area and an extrapolation technique shows promise for use as an independent verification tool for very small X-ray field ROFs in the clinical department.

Skin and build up dose determination for a 2.5 MV medical linear accelerator imaging beam.

The 2.5 MV Imaging beam produced by a Varian TrueBeam linear accelerator produces a dose build up effect at the beam entrance similar to other high energy photon beams. The surface dose values were found to range from 39% of maximum dose at a 5 cm × 5 cm field size up to 69% of maximum at a 40 cm × 40 cm field. The depth of maximum dose deposition was found to range from 5 mm at smaller field sizes to 4 mm at larger field sizes. Whilst large absorbed doses will not be delivered utilizing these beams, the data provided will allow the medical physics community to assess and estimate doses to patient's skin and subcutaneous tissue from low energy MV imaging beams.

Measurement of dose reductions for superficial x-rays backscattered from bone interfaces.

Accurate measurement and knowledge of dose delivered during superficial x-ray radiotherapy is required for patient dose assessment. Some tumours treated near the surface (within the first few centimetres) can have large posterior bone structures. This can cause perturbations to dose delivered due to changed backscatter contributions from the bony structure as compared to full water or tissue scattering conditions. Measured results have shown that up to 7.5% of Dmax reductions in dose can occur near the water/bone interface for 100 kVp, using 10 cm diameter field sizes when a 1 cm thick slab of bone is located at 2 cm depth. At smaller field sizes such as 2 cm diameter these values reduce to 2% for the same energy. Larger variations (up to 12.5% of maximum) have been seen at the phantom surface when the bone layer is directly behind the point of interest (within 0.5 mm) and smaller effects (up to 5% of maximum) at depths down to 5 cm. Interesting to note is the fact that for larger field sizes, an increase in percentage dose is found at the water/bone interface due to the production of low energy backscattered electrons similar to the effect found in lead. However, they are much smaller in magnitude and thus would not cause any significant dosimetric effects. In the case where large bony structures lie relatively close to the surface and the tissue above this region is being treated, a dosimeter such as radiochromic film can be used to estimate the dose reduction that may occur due to the changed backscatter conditions.

Measurement of radiotherapy superficial X-ray dose under eye shields with radiochromic film.

Accurate measurement and knowledge of dose delivered under eye shield during superficial X-ray radiotherapy is required for patient peripheral dose assessment. Critical structures can include the cornea, lens and retina. Measurement of dose under eye shields has been historically performed with Thermoluminescent Dosimeters (TLD's) due to their small size and design. Restrictions include the energy dependence and the fact that they only provide a point dose assessment. This note investigates the use of a low energy dependence radiochromic thin film for measurement of dose under eye shields in a phantom and compares results to theoretical calculation of dose. Results have shown a good match between predicted and experimentally measured results at the centre of an eye shield irradiated with 50kVp and 150kVp beams. The added advantage of radiochromic film compared to TLD measurements is the two dimensional dose map which is recorded for the assessment of dose providing not only an assessment at the site of the cornea, lens and retina in a phantom but in other areas as well. Radiochromic film has been found to accurately measure dose under eye shield in phantom treatments.

Megavoltage x-ray skin dose variation with an angle using grid carbon fibre couch tops.

It is well known that a skin dose from high-energy x-ray radiation varies with the angle of beam incidence or the presence of a radiotherapy linear accelerator couch top material. This note investigates changes produced to the skin dose from a Varian carbon fibre grid couch top at differing angles of incidence for 6 MV x-rays as is often the case clinically. Results have shown that the skin dose can easily be measured using an EBT Gafchromic film whereby the delivered skin dose can be quantified to a high level of spatial resolution, not easily achieved with other skin dose detectors. Results have shown a significant increase in the skin dose specifically at the point of a cross-sectional carbon fibre grid. Values in % of the skin dose increased from approximately 27% (an open area within a 10 cm x 10 cm field) up to 55% (same field size) at the centre of the carbon fibre mesh strip (0 degrees incidence). This is compared to 19% of the skin dose for an open field of a 10 cm x 10 cm beam without the couch material present. At larger angles similar effects occur with values changing from 52% to 75% (60 degrees , 10 cm x 10 cm) in the open area and under the grid, respectively. This produces a wave effect for the skin dose. The average skin dose magnitude increases with the angle of incidence of the beam, ranging from 37.5% to 66% from 0 degrees to 60 degrees (10 x 10 cm), respectively. The symmetric wave nature of the skin dose profile skews to deliver an increased dose on the posterior side of the carbon fibre grid as the angle of incidence increases. Simulated fractional dose delivery on a phantom has shown that over 30 fractions the wave nature of the delivered skin dose is minimized due to the random nature of most patient positioning on the treatment couch. However, some variations are still present as the ratio of the open to grid area is approximately 4:1 and the dose spread is not necessarily completely averaged during a typical fractionated radiotherapy treatment. As such, if the treatment type results in a more rigorously positioned patient on the treatment couch, the wave nature of skin dose delivery may need to be taken into account.

X-Ray energy dependence of the dose response of SIRAD radiation dosimeters.

SIRADs (self-indicating instant radiation alert dosimeters) are designed to measure accident radiation doses. As the energy of radiation is usually unknown in such situations, a detector with a weak energy dependence of its response to dose would be ideal. We have studied the energy dependence of the dose response of SIRADs in the range from 50kVp to 10MV, which corresponds to photon equivalent energies from 25.5keV to 2.2MeV. The response to the same dose at 25.5keV is (29+/-4)%(+/-1s) lower than the response at 1.4MeV. The response to a dose slowly increases with radiation energy. This energy dependence is relatively weak in comparison with the dependence for radiographic films and similar in magnitude to the dependence for lithium fluoride thermoluminescence dosimeters. This energy dependence of the response diminishes the accuracy of dose assessments in radiation fields of unknown energy, but does not significantly compromise the core ability of the devices to provide visual estimates of radiation doses.

Practical time considerations for optically stimulated luminescent dosimetry (OSLD) in total body irradiation.

Total body irradiation (TBI) treatments are used to treat the whole body in preparation for hematopoietic stem cell (or bone marrow) transplantation. Our standard clinical regimen is a 12 Gy in 6 fraction, bi-daily technique using 6 MV X-rays at an extended Source-to-Surface distance (SSD) of 300 cm. Utilizing these characteristics, the beam dose rate is reduced below 7 cGy/min as is standard for TBI treatment. Dose received by the patient is monitored using optically stimulated luminescent dosimetry (OSLD). This work presents some practical calibration corrections based on time-dependant factors for OSLD calibration related to TBI procedure. Results have shown that a negligible difference is seen in OSL sensitivity for 6 MV X-rays irradiated in standard SSD (100 cm) and high dose rate (600 cGy/min) conditions compared to extended SSD (300 cm) and low TBI dose rate (6 cGy/min) conditions. Results have also shown that whilst short term signal fading occurs in the OSL after irradiation at a high dose rate (37% reduction in signal in the first 15 min), thereafter, negligible differences are seen in the OSL signal between 600 and 7 cGy/min irradiations. Thus a direct comparison can be made between calibration OSLs and clinical TBI OSLs between 15 min and 2 h. Finally a table is presented to provide corrections between calibration OSL readout and clinical TBI dose readout for a period up to 7 days. Combining these three results allows users to pre-irradiate their calibration OSLs at standard dose rate and SSD, up to 1 week prior to clinical treatment, and still provide accurate in-vivo dosimetry. This can help with time saving and work efficiency in the clinic.

Measurement of high energy x-ray beam penumbra with Gafchromic EBT radiochromic film.

High energy x-ray beam penumbra are measured using Gafchromic EBT film. Gafchromic EBT, due to its limited energy dependence and high spatial resolution provide a high level of accuracy for dose assessment in penumbral regions. The spatial resolution of film detector systems is normally limited by the scanning resolution of the densitometer. Penumbral widths (80%/20%) measured at Dmax were found to be 2.8, 3.0, 3.2, and 3.4 mm (+/- 0.2 mm) using 5, 10, 20, and 30 cm square field sizes, respectively, for a 6 MV linear accelerator produced x-ray beam. This is compared to 3.2 mm +/- 0.2 mm (Kodak EDR2) and 3.6 mm +/- 0.2 mm (Kodak X-Omat V) at 10 cm x 10 cm measured using radiographic film. Using a zero volume extrapolation technique for ionization chamber measurements, the 10 cm X 10 cm field penumbra at Dmax was measured to be 3.1 mm, a close match to Gafchromic EBT results. Penumbral measurements can also be made at other depths, including the surface, as the film does not suffer significantly from dosimetric variations caused by changing x-ray energy spectra. Gafchromic EBT film provides an adequate measure of penumbral dose for high energy x-ray beams.

Measurement of energy dependence for XRCT radiochromic film.

Gafchromic XRCT, radiochromic film is assessed over a broad energy range, from kilovoltage to megavoltage x rays for variations in reflected optical density to dose response. A large energy dependence was found with reflected optical density output for the same delivered dose varying from 7.8 +/- 0.35 at 25.5 keV (50 kVp) peaking at 12.1 +/- 0.5 at 54 keV (125 kVp) to 0.975 +/- 0.03 at 2300 keV (10 MV) when normalized to 1 at 1400 keV (6 MV) energy. The response is constant (within 3%) in the 36-69 keV equivalent photon energy range, which corresponds to x-ray tube generating potentials of approximately 100-150 kVp. This matches well with beam qualities for diagnostic computed topography applications.

Visible absorption spectra of radiation exposed SIRAD dosimeters.

SIRAD badge dosimeters are a new type of personal dosimeter designed to measure radiation exposure up to 200 R and give a visual qualitative measurement of exposure. This is performed using the active dosimeter window, which contains a radiochromic material amalgamated in the badge assembly. When irradiated, the badges active window turns blue, which can be matched against the given colour chart for a qualitative assessment of the exposure received. Measurements have been performed to analyse the absorption spectra of the active window, and results show that the window automatically turns a blue colour upon irradiation and produces two peaks in the absorption spectra located at 617 nm and 567 nm. When analysed with a common computer desktop scanner, the optical density response of the film to radiation exposure is non-linear but reproducible. The net OD of the film was 0.21 at 50 R exposure and 0.31 at 200 R exposure when irradiated with a 6 MV x-ray energy beam. When compared to the calibration colour strips at 6 MV x-ray energy the film's OD response matches relatively well within 3.5%. An approximate 8% reduction in measured OD to exposure was seen for 250 kVp x-rays compared to 6 MV x-rays. The film provides an adequate measurement and visually qualitative assessment of radiation exposure for levels in the range of 0 to 200 R.

Absorption spectra of irradiated XRCT radiochromic film.

Gafchromic XRCT radiochromic film is a self-developing high sensitivity radiochromic film product which can be used for assessment of delivered radiation doses which could match applications such as computed tomography (CT) dosimetry. The film automatically changes colour upon irradiation changing from a yellow to green/brown colour. The absorption spectra of Gafchromic XRCT radiochromic film as measured with reflectance spectrophotometry have been investigated to analyse the dosimetry characteristics of the film. Results show two main absorption peaks produced from irradiation located at 636 nm and 585 nm. This is similar to EBT Gafchromic film. A high level of sensitivity is found for this film with a 1 cGy applied dose producing an approximate net optical density change of 0.3 at 636 nm. This high sensitivity combined with its relatively energy independent nature around the 100 kVp to 150 kVp x-ray energy range provides a unique enhancement in dosimetric measurement capabilities over currently available dosimetry films for CT applications.

Weak energy dependence of EBT gafchromic film dose response in the 50 kVp-10 MVp X-ray range.

The energy dependence of the dose response of EBT Gafchromic film is assessed over a broad energy range, from superficial to megavoltage X-rays. The film is auto-developing and sensitive, it provides accurate dose assessment of low doses (about 1-2 Gy) used in radiotherapy. The energy dependence of the response of EBT film was found to be very weak: the variations do not exceed 10% over the range from 50 kVp to 10 MVp X-rays. By contrast, variations of the response of Gafchromic HS film are as big as 30% over the same range, and variations of the response of Radiographic film exceed one order of magnitude. This weak dependence provides significantly higher accuracy of dose measurements under conditions of varying spectral quality of X-ray beams, which are common in radiation therapy.