Patient skin dose measurements using a cable free system MOSFETs based in fluoroscopically guided percutaneous vertebroplasty, percutaneous disc decompression, radiofrequency medial branch neurolysis, and endovascular critical limb ischemia.

The purpose of this work has been to dosimetrically investigate four fluoroscopically guided interventions: the percutaneous vertebroplasty (PVP), the percutaneous disc decompression (PDD), the radiofrequency medial branch neurolysis (RF) (hereafter named spine procedures), and the endovascular treatment for the critical limb ischemia (CLI). The X-ray equipment used was a Philips Integris Allura Xper FD20 imaging system provided with a dose-area product (DAP) meter. The parameters investigated were: maximum skin dose (MSD), air kerma (Ka,r), DAP, and fluoroscopy time (FT). In order to measure the maximum skin dose, we employed a system based on MOSFET detectors. Before using the system on patients, a calibration factor Fc and correction factors for energy (CkV) and field size (CFD) dependence were determined. Ka,r, DAP, and FT were extrapolated from the X-ray equipment. The analysis was carried out on 40 patients, 10 for each procedure. The average fluoroscopy time and DAP values were compared with the reference levels (RLs) proposed in literature. Finally, the correlations between MSD, FT, Ka,r, and DAP values, as well as between DAP and FT values, were studied in terms of Pearson's product-moment coefficients for spine procedures only. An Fc value of 0.20 and a very low dependence of CFD on field size were found. A third-order polynomial function was chosen for CkV. The mean values of MSD ranged from 2.3 to 10.8cGy for CLI and PVP, respectively. For these procedures, the DAP and FT values were within the proposed RL values. The statistical analysis showed little correlation between the investigated parameters. The interventional procedures investigated were found to be both safe with regard to deterministic effects and optimized for stochastic ones. In the spine procedures, the observed correlations indicated that the estimation of MSD from Ka,r or DAP was not accurate and a direct measure of MSD is therefore recommended.

Comparison between small radiation therapy electron beams collimated by Cerrobend and tubular applicators.

The purpose of this study was to compare the dosimetric properties of small field electron beams shaped by circular Cerrobend blocks and stainless steel tubular applicators. Percentage depth dose curves, beam profiles, and output factors of small-size circular fields from 2 to 5 cm diameter, obtained either by tubular applicators and Cerrobend blocks, were measured for 6, 10, and 15 MeV electron beam energies. All measurements were performed using a PTW microDiamond 60019 premarket prototype. An overall similar behavior between the two collimating systems can be observed in terms of PDD and beam profiles. However, Cerrobend collimators produce a higher bremsstrahlung background under irradiation with high-energy electrons. In such irradiation condition, larger output factors are observed for tubular applicators. Similar dosimetric properties are observed using circular Cerrobend blocks and stainless steel tubular applicators at lower beam energies. However, Cerrobend collimators allow the delivery of specific beam shapes, conformed to the target area. On the other hand, in high-energy irradiation conditions, tubular applicators produce a lower bremsstrahlung contribution, leading to lower doses outside the target volume. In addition, the higher output factors observed at high energies for tubular applicators lead to reduced treatment times.

A synthetic diamond diode in volumetric modulated arc therapy dosimetry.

PURPOSE: The aim of this work is to investigate the behavior of a single crystal diamond diode (SCDD) for volumetric modulated arc therapy (VMAT) dose verifications. This delivery technique is one of the most severe test of a dosimeter performance due to the modulation of the dose rate achieved by simultaneously changing the velocity of the gantry and the position of the collimator leaves. The performed measurements with VMAT photon beams can therefore contribute to an overall global validation of the device to be used in dose distribution verifications. METHODS: The SCDD response to 6 MVRX has been tested and compared with reference ionization chambers and treatment planning system (TPS) calculations in different experiments: (a) measurements of output factors for small field sizes (square fields of side ranging between 8 mm and 104 mm) by SCDD and A1SL ionization chamber; (b) angular dependence evaluation of the entire experimental set-up by SCDD, A1SL, and Farmer ionization chambers; and (c) acquisition of dose profiles for a VMAT treatment of a pulmonary disease in latero-lateral and gantry-target directions by SCDD and A1SL ionization chamber. RESULTS: The output factors measured by SCDD favorably compare with the ones obtained by A1SL, whose response is affected by the lack of charged particle equilibrium and by averaging effect when small fields are involved. From the experiment on angular dependence, a good agreement is observed among the diamond diode, the ion chambers, and the TPS. In VMAT profiles, the absorbed doses measured by SCDD and A1SL compare well with the TPS calculated ones. An overall better agreement is observed in the case of the diamond dosimeter, which is also showing a better accuracy in terms of distance to agreement in the high gradient regions. CONCLUSIONS: Synthetic diamond diodes, whose performance were previously studied for conformal and IMRT radiotherapy techniques, were found to be suitable detectors also for dosimetric measurements in volumetric arc therapy treatments.