Insight gained from responses to surveys on reference dosimetry practices.

PURPOSE: To present the results and discuss potential insights gained through surveys on reference dosimetry practices. METHODS: Two surveys were sent to medical physicists to learn about the current state of reference dosimetry practices at radiation oncology clinics worldwide. A short survey designed to maximize response rate was made publicly available and distributed via the AAPM website and a medical physics list server. Another, much more involved survey, was sent to a smaller group of physicists to gain insight on detailed dosimetry practices. The questions were diverse, covering reference dosimetry practices on topics like measurements required for beam quality specification, the actual measurement of absorbed dose and ancillary equipment required like electrometers and environment monitoring measurements. RESULTS: There were 190 respondents to the short survey and seven respondents to the detailed survey. The diversity of responses indicates nonuniformity in reference dosimetry practices and differences in interpretation of reference dosimetry protocols. CONCLUSIONS: The results of these surveys offer insight on clinical reference dosimetry practices and will be useful in identifying current and future needs for reference dosimetry.

Accurate machine-specific reference and small-field dosimetry for a self-shielded neuro-radiosurgical system.

BACKGROUND: The newly available ZAP-X stereotactic radiosurgical system is designed for the treatment of intracranial lesions, with several unique features that include a self-shielding, gyroscopic gantry, wheel collimation, non-orthogonal kV imaging, short source-axis distance, and low-energy megavoltage beam. Systematic characterization of its radiation as well as other properties is imperative to ensure its safe and effective clinical application. PURPOSE: To accurately determine the radiation output of the ZAP-X with a special focus on the smaller diameter cones and an aim to provide useful recommendations on quantification of small field dosimetry. METHODS: Six different types of detectors were used to measure relative output factors at field sizes ranging from 4 to 25 mm, including the PTW microSilicon and microdiamond diodes, Exradin W2 plastic scintillator, Exradin A16 and A1SL ionization chambers, and the alanine dosimeter. The 25 mm cone served as the reference field size. Absolute dose was determined with both TG-51-based dosimetry using a calibrated PTW Semiflex ion chamber and measurements using alanine dosimeters. RESULTS: The average radiation output factors (maximum deviation from the average) measured with the microDiamond, microSilicon, and W2 detectors were: for the 4 mm cone, 0.741 (1.0%); for the 5 mm cone: 0.817 (1.0%); for the 7.5 mm cone: 0.908 (1.0%); for the 10 mm cone: 0.946 (0.4%); for the 12.5 mm cone: 0.964 (0.2%); for the 15 mm cone: 0.976 (0.1%); for the 20 mm cone: 0.990 (0.1%). For field sizes larger than 10 mm, the A1SL and A16 micro-chambers also yielded consistent output factors within 1.5% of those obtained using the microSilicon, microdiamond, and W2 detectors. The absolute dose measurement obtained with alanine was within 1.2%, consistent with combined uncertainties, compared to the PTW Semiflex chamber for the 25 mm reference cone. CONCLUSION: For field sizes less than 10 mm, the microSilicon diode, microDiamond detector, and W2 scintillator are suitable devices for accurate small field dosimetry of the ZAP-X system. For larger fields, the A1SL and A16 micro-chambers can also be used. Furthermore, alanine dosimetry can be an accurate verification of reference and absolute dose typically measured with ion chambers. Use of multiple suitable detectors and uncertainty analyses were recommended for reliable determination of small field radiation outputs.

The effect of electron backscatter and charge build up in media on beam current transformer signal for ultra-high dose rate (FLASH) electron beam monitoring.

Objective.Beam current transformers (BCT) are promising detectors for real-time beam monitoring in ultra-high dose rate (UHDR) electron radiotherapy. However, previous studies have reported a significant sensitivity of the BCT signal to changes in source-to-surface distance (SSD), field size, and phantom material which have until now been attributed to the fluctuating levels of electrons backscattered within the BCT. The purpose of this study is to evaluate this hypothesis, with the goal of understanding and mitigating the variations in BCT signal due to changes in irradiation conditions.Approach.Monte Carlo simulations and experimental measurements were conducted with a UHDR-capable intra-operative electron linear accelerator to analyze the impact of backscattered electrons on BCT signal. The potential influence of charge accumulation in media as a mechanism affecting BCT signal perturbation was further investigated by examining the effects of phantom conductivity and electrical grounding. Finally, the effectiveness of Faraday shielding to mitigate BCT signal variations is evaluated.Main Results.Monte Carlo simulations indicated that the fraction of electrons backscattered in water and on the collimator plastic at 6 and 9 MeV is lower than 1%, suggesting that backscattered electrons alone cannot account for the observed BCT signal variations. However, our experimental measurements confirmed previous findings of BCT response variation up to 15% for different field diameters. A significant impact of phantom type on BCT response was also observed, with variations in BCT signal as high as 14.1% when comparing measurements in water and solid water. The introduction of a Faraday shield to our applicators effectively mitigated the dependencies of BCT signal on SSD, field size, and phantom material.Significance.Our results indicate that variations in BCT signal as a function of SSD, field size, and phantom material are likely driven by an electric field originating in dielectric materials exposed to the UHDR electron beam. Strategies such as Faraday shielding were shown to effectively prevent these electric fields from affecting BCT signal, enabling reliable BCT-based electron UHDR beam monitoring.

AAPM WGTG51 Report 385: Addendum to the AAPM's TG-51 protocol for clinical reference dosimetry of high-energy electron beams.

An Addendum to the AAPM's TG-51 protocol for the determination of absorbed dose to water is presented for electron beams with energies between 4 MeV and 22 MeV ( 1.70 cm ≤ R 50 ≤ 8.70 cm $1.70\nobreakspace {\rm cm} \le R_{\text{50}} \le 8.70\nobreakspace {\rm cm}$ ). This updated formalism allows simplified calibration procedures, including the use of calibrated cylindrical ionization chambers in all electron beams without the use of a gradient correction. New k Q $k_{Q}$ data are provided for electron beams based on Monte Carlo simulations. Implementation guidance is provided. Components of the uncertainty budget in determining absorbed dose to water at the reference depth are discussed. Specifications for a reference-class chamber in electron beams include chamber stability, settling, ion recombination behavior, and polarity dependence. Progress in electron beam reference dosimetry is reviewed. Although this report introduces some major changes (e.g., gradient corrections are implicitly included in the electron beam quality conversion factors), they serve to simplify the calibration procedure. Results for absorbed dose per linac monitor unit are expected to be up to approximately 2 % higher using this Addendum compared to using the original TG-51 protocol.

Assessing the accuracy of electronic portal imaging device (EPID)-based dosimetry: II. Evaluation of a dosimetric uncertainty budget and development of a new film-in-EPID absorbed dose calibration methodology.

PURPOSE: The aim of this study is to reduce the uncertainty associated with determining dose-to-water using an amorphous silicon electronic portal imaging detector (EPID) under reference conditions by developing a direct calibration formalism based on radiochromic film measurements made within the EPID panel and detailed Monte Carlo simulations. To our knowledge, this is the first EPID-based dosimetry study reporting an uncertain budget METHODS: Pixel sensitivity and relative off-axis response were mapped by simultaneously irradiating film contained within the imager panel and acquiring an EPID image set. The detector panel was disassembled for the purpose of modeling the EPID in detail using the EGSnrc DOSXYZnrc usercode, which was in turn used to calculate dose-to-film in the EPID and dose-to-water in water conversion factors RESULTS: A direct comparison of the two correction methodologies investigated in this work, the previously established empirical method and the proposed simultaneous measurement approach involving in-EPID film dosimetry, produced an agreement with an RMS deviation of 1.4% overall. A combined standard relative uncertainty of 3.3% (k = 1) was estimated for the determination of absorbed dose to water at the position of the EPID using the proposed calibration methodology CONCLUSIONS: This work describes a direct method of calibrating EPID response in terms of absorbed dose to water requiring fewer measurements than other empirical approaches, and without 2D spatial interpolation of correction factors.

Assessing the accuracy of electronic portal imaging device (EPID)-based dosimetry: I. Quantities influencing long-term stability.

PURPOSE: The aim of this study is to reduce the uncertainty associated with determining dose-to-water using an amorphous silicon electronic portal imaging detector (EPID) under reference conditions by identifying and accounting for operational and environmental factors influencing the long-term stability of EPID response. METHODS: Measurements of the EPID relative response, corrected for variations in linear accelerator (linac) output, were performed regularly over a period of 12 months. For every acquired image set, measurements of detector supply voltages, internal operating temperature, and ambient environmental conditions were obtained. Pearson r correlation coefficients were then calculated for each pair of variables, a subset of which were fitted using multiple linear regression to develop a predictive model of EPID response. Principal component analysis was performed on the dataset to reveal the internal structure of the data in a way that best accounts for the observed variations. RESULTS: The +5.5 V power supply voltage, internal operating temperature, and the accumulated dose absorbed in EPID were identified as having the greatest influence on the long-term stability of EPID response. By correcting for the combined effect of these variables, the mean difference in linac output as measured by the EPID relative to a reference class chamber improved from -0.46% to 0.23% over the period of the study. CONCLUSIONS: This work suggests that the stability of an EPID over a period of a year can be improved by a factor of two by monitoring and accounting for the effects of variations in power supply voltage, internal temperature of the detector, and accumulated absorbed dose.

Monte Carlo optimization and experimental validation of a prototype ionization chamber for accurate magnetic resonance image guided radiation therapy (MRgRT) daily output constancy measurements in solid phantoms.

PURPOSE: To optimize the design, develop and test a prototype ionization chamber for accurate daily output constancy measurements in solid phantoms in clinical magnetic resonance-guided radiation therapy (MRgRT) radiotherapy beams. Up to 4% variations in response using commercial ionization chambers have been previously reported; the prototype ionization chamber developed here aims to minimize these variations. METHODS: Monte Carlo simulations with the EGSnrc code system are used to optimize an ionization chamber design by increasing the thickness of a brass (high-density, nonferromagnetic, easy-to-machine) wall until results consistent with no air gap are produced for simulations with a 1.5 T and 0.35 T magnetic field, with a 0.2 mm air gap and varying the placement of the chamber model within the air gap. Based on the results of these simulations, prototype ionization chambers are manufactured and tested in conventional linac beams and in a 7 MV Elekta Unity MR-linac. The chambers are rotated about their axes, both parallel and perpendicular to the 1.5 T magnetic field, through 360º in a plastic phantom with measurements made at each cardinal angle. This reveals any variation in chamber response by varying the thickness of the air gap between the chamber and the phantom. RESULTS: Monte Carlo simulations demonstrate that the optimal thickness of the chamber wall to mitigate the effect of an asymmetric air gap between the chamber and the plastic phantom is 1.1 mm of brass. With this thickness, the differences between simulations with and without an air gap and with asymmetric placement of the chamber within the air gap are less than 0.2%. A prototype chamber constructed with a 1.1 mm brass wall thickness exhibits less than 0.3% variation in response when rotated about its axis in the plastic phantom in a beam from an MR-linac, independent of whether its axis is parallel or perpendicular to the magnetic field. CONCLUSION: The optimized ionization chamber design and validated prototype for accurate MR-linac daily output constancy measurements allows utilization of conventional phantoms and procedures in MRgRT systems. This can minimize disruption to clinical workflow for MR-linac quality assurance measurements.

Calorimeter measurements of absolute dose in aluminum, a surrogate of bone, to validate dose-to-medium in Acuros XB.

Objective. While the accuracy of dose calculations in water with Acuros XB is well established, experimental validation of dose in bone is limited. Acuros XB reports both dose-to-medium and dose-to-water, and these values differ in bone, but there are no reports of measurements of validation in bone. This work compares Acuros XB calculations to measurements of absolute dose in aluminum (medium similar to bone). The validity of using selected relative dosimeters in aluminum is also investigated.Approach. A calorimeter with an aluminum core embedded in an aluminum phantom was selected as bone surrogate for the measurement of absolute dose. Matching the medium of the core to the medium of the phantom allowed eliminating the calculation of the conversion between media. The dose was measured at the fixed depth of 3.3 cm in aluminum (∼9 g·cm-2) with 6X, 10X, 6FFF and 10FFF photon beams from a TrueBeam Varian linac. In addition, experimental cross-calibration between water and aluminum was performed for an IBA CC13 ionization chamber, a PTW microDiamond and EBT3 Gafchromic film.Main results. Calculations with Acuros XB dose-to-medium in aluminum differed from the calorimetry data by -2.8% to -3.5%, depending on the beam. Use of dose-to-water would have resulted in about 39% discrepancy. The cross calibration coefficient between water and aluminum yielded values of about 0.87 for the CC13 chamber, 0.91 for the microDiamond, and 0.88 for the film, and independent of the beam within about ±1%.Significance. It was demonstrated the value of the dose-to-medium in aluminum (surrogate of bone) computed with Acuros XB is close to the value of the absolute dose measured with a calorimeter, and there is a significant discrepancy when dose-to-water is used instead. The use of an ionization chamber, a microDiamond and Gafchromic film in aluminum required a considerable correction from calibration in water.

AAPM WGTG51 Report 374: Guidance for TG-51 reference dosimetry.

Practical guidelines that are not explicit in the TG-51 protocol and its Addendum for photon beam dosimetry are presented for the implementation of the TG-51 protocol for reference dosimetry of external high-energy photon and electron beams. These guidelines pertain to: (i) measurement of depth-ionization curves required to obtain beam quality specifiers for the selection of beam quality conversion factors, (ii) considerations for the dosimetry system and specifications of a reference-class ionization chamber, (iii) commissioning a dosimetry system and frequency of measurements, (iv) positioning/aligning the water tank and ionization chamber for depth ionization and reference dose measurements, (v) requirements for ancillary equipment needed to measure charge (triaxial cables and electrometers) and to correct for environmental conditions, and (vi) translation from dose at the reference depth to that at the depth required by the treatment planning system. Procedures are identified to achieve the most accurate results (errors up to 8% have been observed) and, where applicable, a commonly used simplified procedure is described and the impact on reference dosimetry measurements is discussed so that the medical physicist can be informed on where to allocate resources.

High spatial resolution dosimetry with uncertainty analysis using Raman micro-spectroscopy readout of radiochromic films.

PURPOSE: The purpose of this work is to develop a new approach for high spatial resolution dosimetry based on Raman micro-spectroscopy scanning of radiochromic film (RCF). The goal is to generate dose calibration curves over an extended dose range from 0 to 50 Gy and with improved sensitivity to low (<2 Gy) doses, in addition to evaluating the uncertainties in dose estimation associated with the calibration curves. METHODS: Samples of RCF (EBT3) were irradiated at a broad dose range of 0.03-50 Gy using an Elekta Synergy clinical linear accelerator. Raman spectra were acquired with a custom-built Raman micro-spectroscopy setup involving a 500 mW, multimode 785 nm laser focused to a lateral spot diameter of 30 µm on the RCF. The depth of focus of 34 µm enabled the concurrent collection of Raman spectra from the RCF active layer and the polyester laminate. The preprocessed Raman spectra were normalized to the intensity of the 1614 cm-1 Raman peak from the polyester laminate that was unaltered by radiation. The mean intensities and the corresponding standard deviation of the active layer Raman peaks at 696, 1445, and 2060 cm-1 were determined for the 150 × 100 µm2 scan area per dose value. This was used to generate three calibration curves that enabled the conversion of the measured Raman intensity to dose values. The experimental, fitting, and total dose uncertainty was determined across the entire dose range for the dosimetry system of Raman micro-spectroscopy and RCF. RESULTS: In contrast to previous work that investigated the Raman response of RCFs using different methods, high resolution in the dose response of the RCF, even down to 0.03 Gy, was obtained in this study. The dynamic range of the calibration curves based on all three Raman peaks in the RCF extended up to 50 Gy with no saturation. At a spatial resolution of 30 × 30 µm2 , the total uncertainty in estimating dose in the 0.5-50 Gy dose range was [6-9]% for all three Raman calibration curves. This consisted of the experimental uncertainty of [5-8]%, and the fitting uncertainty of [2.5-4.5]%. The main contribution to the experimental uncertainty was determined to be from the scan area inhomogeneity which can be readily reduced in future experiments. The fitting uncertainty could be reduced by performing Raman measurements on RCF samples at further intermediate dose values in the high and low dose range. CONCLUSIONS: The high spatial resolution experimental dosimetry technique based on Raman micro-spectroscopy and RCF presented here, could become potentially useful for applications in microdosimetry to produce meaningful dose estimates in cellular targets, as well as for applications based on small field dosimetry that involve high dose gradients.

A modified formalism for electron beam reference dosimetry to improve the accuracy of linac output calibration.

PURPOSE: To present and demonstrate the accuracy of a modified formalism for electron beam reference dosimetry using updated Monte Carlo calculated beam quality conversion factors. METHODS: The proposed, simplified formalism allows the use of cylindrical ionization chambers in all electron beams (even those with low beam energies) and does not require a measured gradient correction factor. Data from a previous publication are used for beam quality conversion factors. The formalism is tested and compared to the present formalism in the AAPM TG-51 protocol with measurements made in Elekta Precise electron beams with energies between 4 MeV and 22 MeV and with fields shaped with a 10 × 10 cm2 clinical applicator as well as a 20 × 20 cm2 clinical applicator for the 18 MeV and 22 MeV beams. A set of six ionization chambers are used for measurements (two cylindical reference-class chambers, two scanning-type chambers and two parallel-plate chambers). Dose per monitor unit is derived using the data and formalism provided in the TG-51 protocol and with the proposed formalism and data and compared to that obtained using ionization chambers calibrated directly against primary standards for absorbed dose in electron beams. RESULTS: The standard deviation of results using different chambers when TG-51 is followed strictly is on the order of 0.4% when parallel-plate chambers are cross-calibrated against cylindrical chambers. However, if parallel-plate chambers are directly calibrated in a cobalt-60 beam, the difference between results for these chambers is up to 2.2%. Using the proposed formalism and either directly calibrated or cross-calibrated parallel-plate chambers gives a standard deviation using different chambers of 0.4%. The difference between results that use TG-51 and the primary standard measurements are on the order of 0.6% with a maximum difference in the 4 MeV beam of 2.8%. Comparing the results obtained with the proposed formalism and the primary standard measurements are on the order of 0.4% with a maximum difference of 1.0% in the 4 MeV beam. CONCLUSIONS: The proposed formalism and the use of updated data for beam quality conversion factors improves the consistency of results obtained with different chamber types and improves the accuracy of reference dosimetry measurements. Moreover, it is simpler than the present formalism and will be straightforward to implement clinically.

Step-size effect on calculated photon and electron beam Cherenkov-to-dose conversion factors.

PURPOSE: Previous work presented and validated in-water Cherenkov emission (CE)-based radiotherapy dosimetry. Condensed history Monte Carlo (MC)-calculated electron beam CE-to-dose conversion with <4π CE detection, however, could exhibit step-size dependence. This work presents a physics update and numerical study of this step-size dependence in photon and electron beams, elucidates the CE generation physics, and guides further research. METHODS: The CE-to-dose conversion, kCθ±Î´Î¸, is calculated for photons (6X, 15X) and electrons (6E, 20E) on-axis in-water with: θ±Î´Î¸∈{90°±90°(4π),90°±5°,45°±45°,90°±45°}, 10 cm equivalent square, 100 cm SSD, 1cm voxel radius and beam-dependent length. Relative deviation from single-scattering (SS) simulation is evaluated on maximum fractional electron step energy loss ESTEPE∈0.01-0.25. Standard uncertainties (k=1, 108histories) are reported. A simplified method considering only the straight step direction is also implemented. RESULTS: No significant step-size effect (>0.1%) was observed for dose and all kCθ±Î´Î¸, except for surface dosimetry at 90°±5° (-1.6%±0.5%, 20E), which is not recommended. Electron SS deviation uncertainties (k=1), otherwise, varied from <0.2% overall to <0.1% with large apertures. Photon uncertainties varied from <1.1% overall to <0.2% non-superficially with large apertures. The simplified straight-step method exhibited overall greater deviation from SS, most notably -2.8%±0.1% (6E) and -2.5%±0.4% (20E) superficially with 90°±45°, and -1.4%±0.3% (6X) and -0.6%±0.2% (15X) non-superficially with 90°±5° for ESTEPE∈[0.10,0.25]. CONCLUSIONS: We demonstrate step-size independence of newly-implemented correction in EGSnrc directional Cherenkov calculations. This advances clinical CE-based dosimetry and is useful for the general Monte Carlo community.

Cherenkov emission-based external radiotherapy dosimetry: II. Electron beam quality specification and uncertainties.

PURPOSE: Cherenkov emission (CE) is ubiquitous in external radiotherapy. It is also unique in that it carries the promise of 3D, micrometer-resolution, perturbation-free, in-water dosimetry with a beam quality-independent detector response calibration. Our aim is to bring CE-based dosimetry into the clinic and we motivate this here with electron beams. We Monte Carlo (MC) calculate and characterize broad-beam CE-to-dose conversion factors in water for a clinically representative library of electron beam qualities, address beam quality specification and reference depth selection, and develop a preliminary uncertainty budget based on our MC results and relative experimental work of a companion study (Paper I). METHODS: Broad electron beam CE-to-dose conversion factors k C θ ± δ θ include CE generated at polar angles θ ± Î´Î¸ on beam axis in water. With modifications to the EGSnrc code SPRRZnrc, k C θ ± δ θ factors are calculated for a total of 20 electron beam qualities from four BEAMnrc models (Varian Clinac 2100C/D, Clinac 21EX, TrueBeam, and Elekta Precise). We examine beam quality, depth, and detection angle dependence for θ ± δ θ = 90 ∘ ± 90 ∘ (4π detection), 90 ∘ ± 5 ∘ , 45 ∘ ± 45 ∘ , and 90 ∘ ± 45 ∘ . As discussed in Paper I, 4π detection offers the strongest CE-dose correlation and θ = 90 ∘ with small δθ is most practical. The two additional configurations are considered as a compromise between these two extremes. We address beam quality specification and reference depth selection in terms of the electron beam quality specifier R 50 , obtained from the depth of 50% CE C 50 , and derive a best-case uncertainty budget for the CE-based dosimetry formalism proposed in Paper I at each detection configuration. RESULTS: The k C θ ± δ θ factor was demonstrated to capture variations in the beam spectrum, angle, photon contamination, and electron fluence below the CE threshold (∼260 keV in the visible) in accordance with theory. The root-mean-square deviation and maximum deviation of a second-order polynomial fit of simulated R 50 values in terms of C 50 were 0.05 and 0.11 mm at 4π and 0.20 and 0.33 mm at 90 ∘ ± 5 ∘ detection, respectively. The fit performance on experimental data in Paper I was in agreement with these values within experimental uncertainties (±1.5 mm, 95% CI). A two-term power function fit of k C θ ± δ θ in terms of R 50 at a reference depth d ref = a R 50 + b resulted in total d ref -dependent dose uncertainty contribution estimate of 0.8% and 1.1% and preliminary best-case estimate of the combined standard dose uncertainty of 1.1% and 1.3% at 4π and 90 ∘ ± 5 ∘ detection, respectively. The results and corresponding uncertainties with the two intermediate apertures were generally of the same order as the 4π case. In addition, a theoretically consistent downstream shift of the percent-depth CE (PDC) by the difference between R 50 and C 50 improved the depth dependence of the 4π conversion by an order of magnitude (±2.8%). Therefore, a large aperture centered on a θ value between 45 ∘ and 90 ∘ combined with a downstream PDC shift may be recommended for beam-axis CE-based electron beam dosimetry in water. CONCLUSIONS: By delivering R 50 -based CE-to-dose conversion data and demonstrating the potential for dosimetric uncertainty on the order of 1%, we bring CE-based electron beam dosimetry closer to clinical realization.

Cherenkov emission-based external radiotherapy dosimetry: I. Formalism and feasibility.

PURPOSE: Cherenkov emission (CE)-based external beam dosimetry is envisioned to involve the detection of CE directly in water with placement of a high-resolution detector out of the field, avoiding perturbations encountered with traditional dosimeters. In this work, we lay out the groundwork for its implementation in the clinic and motivate CE-based dosimeter design efforts. To that end, we examine a formalism for broad-beam in-water CE-based dosimetry of external radiotherapy beams, design and test a Monte Carlo (MC) simulation framework for the calculation of CE-to-dose conversion factors used by the formalism, and demonstrate the experimental feasibility of this method. METHODS: The formalism is conceptually analogous to ionization-based dosimetry and employs CE-to-dose conversion factors, k C θ ± δ θ , including only and all CE generated within polar angles θ ± Î´Î¸ on beam axis. The EGSnrc user code SPRRZnrc is modified to calculate k C θ ± δ θ , as well as CE spectral and angular distributions. The modified code is tested with monoenergetic parallel electrons on a thin water slab. Detector configurations are examined for broad 6-22 MeV electron beams from a BEAMnrc TrueBeam model, with a focus on θ ± δ θ = 90 ∘ ± 90 ∘ (4π detection), 90 ∘ ± 5 ∘ , and 42 ∘ ± 5 ∘ ( θ = 42 ∘ is the CE angle of relativistic electrons in water). We perform a relative experimental validation at 90 ∘ with electron beams, using a simple detector design with spherical optics and geometrical optics approximation of the sensitive volume, which spans the water tank. Due to transient charged particle equilibrium, broad photon beams are generally less sensitive to beam quality, depth, and angle. RESULTS: For 0.1-50 MeV electrons on a thin water slab, the code outputs CE photon spectral density per unit mass (calculated from dose and k C θ ± δ θ ) and angle in agreement with theory within ±0.03% and ± 0 . 01 ∘ , respectively, corresponding to the output precision. The 42 ∘ configuration was found impractical due to detection considerations. Detection at 90 ∘ ± δ θ for small δθ exhibited beam quality dependence of the same order as well as strong superficial depth dependence. A 4π configuration ameliorates these effects. A more practical approach may employ a large numerical aperture. In comparing with literature, we find that these effects are less pronounced for broad photon beams in water, as expected. Measured relative k C 90 ∘ ± δ θ at small δθ were within 1% of simulated factors (relative to their local average) for percent-depth CE (PDC) >50%. At other depths, deviations were in accordance with signal-to-noise, known detector limitations, and approximations. It was found that the CE spectrum is beam quality and depth invariant, while for electron beams the CE angular distribution is strongly dependent on beam quality and depth. However, the uncertainty of CE and PDC measurement at 90 ∘ ± δ θ detection for small δθ due to ± 0 . 1 ∘ deviations around δθ was shown to be ≤1% and <0.1% (k = 1), respectively. The robustness to expected detector setup variations was found to result in ≤1% (k = 1) local uncertainty contribution for PDC >50%. CONCLUSIONS: Based on our MC and experimental studies, we conclude that the CE-based method is promising for high-resolution, perturbation-free, three-dimensional dosimetry in water, with specific applications contingent on comprehensive detector development and characterization.

On the impact of ICRU report 90 recommendations on kQ factors for high-energy photon beams.

PURPOSE: To assess the impact of the ICRU report 90 recommendations on the beam-quality conversion factor, kQ , used for clinical reference dosimetry of megavoltage linac photon beams. METHODS: The absorbed dose to water and the absorbed dose to the air in ionization chambers representative of those typically used for linac photon reference dosimetry are calculated at the reference depth in a water phantom using Monte Carlo simulations. Depth-dose calculations in water are also performed to investigate changes in beam quality specifiers. The calculations are performed in a cobalt-60 beam and MV photon beams with nominal energy between 6 MV and 25 MV using the EGSnrc simulation toolkit. Inputs to the calculations use stopping-power data for graphite and water from the original ICRU-37 report and the new proposed values from the recently published ICRU-90 report. Calculated kQ factors are compared using the two different recommendations for key dosimetry data and measured kQ factors. RESULTS: Less than about 0.1% effects from ICRU-90 recommendations on the beam quality specifiers, the photon component of the percentage depth-dose at 10 cm, %dd(10)x , and the tissue-phantom ratio at 20 cm and 10 cm, TPR1020, are observed. Although using different recommendations for key dosimetric data impact water-to-air stopping-power ratios and ion chamber perturbation corrections by up to 0.54% and 0.40%, respectively, we observe little difference (≤0.14%) in calculated kQ factors. This is contradictory to the predictions in ICRU-90 that suggest differences up to 0.5% in high-energy photon beams. A slightly better agreement with experimental values is obtained when using ICRU-90 recommendations. CONCLUSION: Users of the addendum to the TG-51 protocol for reference dosimetry of high-energy photon beams, which recommends Monte Carlo calculated kQ factors, can rest assured that the recommendations of ICRU report 90 on basic data have little impact on this central dosimetric parameter.

Technical Note: On the use of cylindrical ionization chambers for electron beam reference dosimetry.

PURPOSE: To investigate the use of cylindrical chambers for electron beam dosimetry independent of energy by studying the variability of relative ion chamber perturbation corrections, one of the main concerns for electron beam dosimetry with cylindrical chambers. METHODS: Measurements are made with sets of cylindrical and plane-parallel reference-class chambers as a function of depth in water in 8 MeV and 18 MeV electron beams. The ratio of chamber readings for similar chambers is normalized in a high-energy electron beam and can be thought of as relative perturbation corrections. Data are plotted as a function of mean electron energy at depth for a range of depths close to the phantom surface to R80 , the depth at which the ionization falls to 80% of its maximum value. Additional, similar measurements are made in a Virtual Water® phantom with cylindrical chambers at the reference depth in a 4 MeV electron beam. RESULTS: The variability of relative ion chamber perturbation corrections for nominally identical cylindrical Farmer-type chambers is found to be less than 0.4%, no worse than plane-parallel chambers with similar specifications. CONCLUSIONS: This work discusses several issues related to the use of plane-parallel ion chambers and suggests that reference-class cylindrical chambers may be appropriate for reference dosimetry of all electron beams. This would simplify the reference dosimetry procedure and improve accuracy of beam calibration.

Electron beam water calorimetry measurements to obtain beam quality conversion factors.

PURPOSE: To provide results of water calorimetry and ion chamber measurements in high-energy electron beams carried out at the National Research Council Canada (NRC). There are three main aspects to this work: (a) investigation of the behavior of ionization chambers in electron beams of different energies with focus on long-term stability, (b) water calorimetry measurements to determine absorbed dose to water in high-energy beams for direct calibration of ion chambers, and (c) using measurements of chamber response relative to reference ion chambers, determination of beam quality conversion factors, kQ , for several ion chamber types. METHODS: Measurements are made in electron beams with energies between 8 MeV and 22 MeV from the NRC Elekta Precise clinical linear accelerator. Ion chamber measurements are made as a function of depth for cylindrical and plane-parallel ion chambers over a period of five years to investigate the stability of ion chamber response and for indirect calibration. Water calorimetry measurements are made in 18 MeV and 22 MeV beams. An insulated enclosure with fine temperature control is used to maintain a constant temperature (drifts less than 0.1 mK/min) of the calorimeter phantom at 4°C to minimize effects from convection. Two vessels of different designs are used with calibrated thermistor probes to measure radiation induced temperature rise. The vessels are filled with high-purity water and saturated with H2 or N2 gas to minimize the effect of radiochemical reactions on the measured temperature rise. A set of secondary standard ion chambers are calibrated directly against the calorimeter. Finally, several other ion chambers are calibrated in the NRC 60 Co reference field and then cross-calibrated against the secondary standard chambers in electron beams to realize kQ factors. RESULTS: The long-term stability of the cylindrical ion chambers in electron beams is better (always <0.15%) than plane-parallel chambers (0.2% to 0.4%). Calorimetry measurements made at 22 MeV with two different vessel geometries are consistent within 0.2% after correction for the vessel perturbation. Measurements of absorbed dose calibration coefficients for the same secondary standard chamber separated in time by 10 yr are within 0.2%. Drifts in linac output that would affect the transfer of the standard are mitigated to the 0.1% level by performing daily ion chamber normalization measurements. Calibration coefficients for secondary standard ion chambers can be achieved with uncertainties less than 0.4% (k = 1) in high-energy electron beams. The additional uncertainty in deriving calibration coefficients for well-behaved chambers indirectly against the secondary standard reference chambers is negligible. The kQ factors measured here differ by up to 1.3% compared to those in TG-51, an important change for reference dosimetry measurements. CONCLUSIONS: The measurements made here of kQ factors for eight plane-parallel and six cylindrical ion chambers will impact future updates of reference dosimetry protocols by providing some of the highest quality measurements of this crucial dosimetric parameter.