Reproducibility of three-dimensional cephalometric landmarks in cone-beam and low-dose computed tomography.

OBJECTIVES: The purpose of this study is to compare the reproducibility of three-dimensional cephalometric landmarks on three-dimensional computed tomography (3D-CT) surface rendering using clinical protocols based on low-dose (35-mAs) spiral CT and cone-beam CT (I-CAT). The absorbed dose levels for radiosensitive organs in the maxillofacial region during exposure in both 3D-CT protocols were also assessed. MATERIALS AND METHODS: The study population consisted of ten human dry skulls examined with low-dose CT and cone-beam CT. Two independent observers identified 24 cephalometric anatomic landmarks at 13 sites on the 3D-CT surface renderings using both protocols, with each observer repeating the identification 1 month later. A total of 1,920 imaging measurements were performed. Thermoluminescent dosimeters were placed at six sites around the thyroid gland, the submandibular glands, and the eyes in an Alderson phantom to measure the absorbed dose levels. RESULTS: When comparing low-dose CT and cone-beam CT protocols, the cone-beam CT protocol proved to be significantly more reproducible for four of the 13 anatomical sites. There was no significant difference between the protocols for the other nine anatomical sites. Both low-dose and cone-beam CT protocols were equivalent in dose absorption to the eyes and submandibular glands. However, thyroid glands were more irradiated with low-dose CT. CONCLUSIONS: Cone-beam CT was more reproducible and procured less irradiation to the thyroid gland than low-dose CT. CLINICAL RELEVANCE: Cone-beam CT should be preferred over low-dose CT for developing three-dimensional bony cephalometric analyses.

Impact of the number of discrete angles used during dose computation for TomoTherapy treatments.

PURPOSE: To quantify systematically the effect on accuracy of discretizing gantry rotation during the dose calculation process of TomoTherapy treatments. METHODS: Up to version 4.0.x included, TomoTherapy treatment planning system (TPS) approximates gantry rotation by computing dose from 51 discrete angles corresponding to the center of the projections used to control the binary multileaf collimator. Potential effects on dose computation accuracy for off-axis targets and low modulation factors have been shown previously for a few treatment configurations. In versions 4.1.x and later, TomoTherapy oversamples the projections to better account for gantry rotation, but only during full scatter optimization and final calculation (i.e., not during optimization in "beamlet" mode). The effect on accuracy of changing the number of angles was quantified with the following framework: (1) predict the impact of the discretization of gantry rotation for various modulation factors, target sizes, and off-axis positions using a simplified analytical algorithm; (2) perform regular quality assurance using measurements with EDR2 radiographic films; (3) isolating the effect of changing the number of discretized angles only (51, 153, and 459) using a previously validated Monte Carlo model (TomoPen). The diameters of the targets were 2, 3, and 5 cm; off-axis central positions of target volumes were 5, 10 and 15, and 17 cm (when accepted by the treatment unit); planned modulation factors were 1.3 and 2.0. RESULTS: For extreme configurations (3 cm tumor, 1.3 modulation factor, 15 cm off-axis position), effects on dose distributions were significant with 89.3% and 95.4% of the points passing gamma tests with 2%∕2 mm and 3%∕3 mm criteria, respectively, for TPS software version 4.0.x (51 gantry angles). The passing rate was 100% for both gamma criteria for the 4.1.x version (153 gantry angles). Those differences could be attributed almost completely to gantry motion discretization using TomoPen. Using 51 gantry angles for dose computation, TomoPen reproduced within statistical uncertainties (<1% standard deviation) dose distributions computed with version 4.0.x. Using 153 and 459 gantry angles, TomoPen reproduced within statistical uncertainties measurements and dose distributions computed with version 4.1.x. CONCLUSIONS: When low modulation factors and significant off-axis positions are used, accounting for gantry rotation during dose computation using at least 153 gantry angles is required to ensure optimal accuracy.

Monte Carlo computed machine-specific correction factors for reference dosimetry of TomoTherapy static beam for several ion chambers.

PURPOSE: To determine k(Q(msr),Q(o) ) (f(msr),f(o) ) correction factors for machine-specific reference (msr) conditions by Monte Carlo (MC) simulations for reference dosimetry of TomoTherapy static beams for ion chambers Exradin A1SL, A12; PTW 30006, 31010 Semiflex, 31014 PinPoint, 31018 microLion; NE 2571. METHODS: For the calibration of TomoTherapy units, reference conditions specified in current codes of practice like IAEA∕TRS-398 and AAPM∕TG-51 cannot be realized. To cope with this issue, Alfonso et al. [Med. Phys. 35, 5179-5186 (2008)] described a new formalism introducing msr factors k(Q(msr),Q(o) ) (f(msr),f(o) ) for reference dosimetry, applicable to static TomoTherapy beams. In this study, those factors were computed directly using MC simulations for Q(0) corresponding to a simplified (60)Co beam in TRS-398 reference conditions (at 10 cm depth). The msr conditions were a 10 × 5 cm(2) TomoTherapy beam, source-surface distance of 85 cm and 10 cm depth. The chambers were modeled according to technical drawings using the egs++ package and the MC simulations were run with the egs_chamber user code. Phase-space files used as the source input were produced using PENELOPE after simulation of a simplified (60)Co beam and the TomoTherapy treatment head modeled according to technical drawings. Correlated sampling, intermediate phase-space storage, and photon cross-section enhancement variance reduction techniques were used. The simulations were stopped when the combined standard uncertainty was below 0.2%. RESULTS: Computed k(Q(msr),Q(o) ) (f(msr),f(o) ) values were all close to one, in a range from 0.991 for the PinPoint chamber to 1.000 for the Exradin A12 with a statistical uncertainty below 0.2%. Considering a beam quality Q defined as the TPR(20,10) for a 6 MV Elekta photon beam (0.661), the additional correction k(Q(msr,)Q) (f(msr,)f(ref) ) to k(Q,Q(o) ) defined in Alfonso et al. [Med. Phys. 35, 5179-5186 (2008)] formalism was in a range from 0.997 to 1.004. CONCLUSION: The MC computed factors in this study are in agreement with measured factors for chamber types already studied in literature. This work provides msr correction factors for additional chambers used in reference dosimetry. All of them were close to one (within 1%).

On the relationships between electron spot size, focal spot size, and virtual source position in Monte Carlo simulations.

PURPOSE: Every year, new radiotherapy techniques including stereotactic radiosurgery using linear accelerators give rise to new applications of Monte Carlo (MC) modeling. Accurate modeling requires knowing the size of the electron spot, one of the few parameters to tune in MC models. The resolution of integrated megavoltage imaging systems, such as the tomotherapy system, strongly depends on the photon spot size which is closely related to the electron spot. The aim of this article is to clarify the relationship between the electron spot size and the photon spot size (i.e., the focal spot size) for typical incident electron beam energies and target thicknesses. METHODS: Three electron energies (3, 5.5, and 18 MeV), four electron spot sizes (FWHM = 0, 0.5, 1, and 1.5 mm), and two tungsten target thicknesses (0.15 and 1 cm) were considered. The formation of the photon beam within the target was analyzed through electron energy deposition with depth, as well as photon production at several phase-space planes placed perpendicular to the beam axis, where only photons recorded for the first time were accounted for. Photon production was considered for "newborn" photons intersecting a 45 x 45 cm2 plane at the isocenter (85 cm from source). Finally, virtual source position and "effective" focal spot size were computed by back-projecting all the photons from the bottom of the target intersecting a 45 x 45 cm2 plane. The virtual source position and focal spot size were estimated at the plane position where the latter is minimal. RESULTS: In the relevant case of considering only photons intersecting the 45 x 45 cm2 plane, the results unambiguously showed that the effective photon spot is created within the first 0.25 mm of the target and that electron and focal spots may be assumed to be equal within 3-4%. CONCLUSIONS: In a good approximation photon spot size equals electron spot size for high energy X-ray treatments delivered by linear accelerators.

Reference dosimetry for helical tomotherapy: practical implementation and a multicenter validation.

PURPOSE: The aim of this study was to implement a protocol for reference dosimetry in tomotherapy and to validate the beam output measurements with an independent dosimetry system. METHODS: Beam output was measured at the reference depth of 10 cm in water for the following three cases: (1) a 5 × 10 cm(2) static machine specific reference field (MSR), (2) a rotational 5 × 10 cm(2) field without modulation and no tabletop in the beam, (3) a plan class specific reference (PCSR) field defined as a rotational homogeneous dose delivery to a cylindrical shaped target volume: plan with modulation and table-top movement. The formalism for reference dosimetry of small and nonstandard fields [Med.Phys.35: 5179-5186, 2008] and QA recommendations [Med.Phys.37: 4817-4853, 2010] were adopted in the dose measurement protocol. All ionization chamber measurements were verified independently using alanine∕EPR dosimetry. As a pilot study, the beam output was measured on tomotherapy Hi-art systems at three other centers and directly compared to the centers specifications and to alanine dosimetry. RESULTS: For the four centers, the mean static output at a depth of 10 cm in water and SAD = 85 cm, measured with an A1SL chamber following the TG-148 report was 6.238 Gy∕min ± 0.058 (1 SD); the rotational output was 6.255 Gy∕min ± 0.069 (1 SD). The dose stated by the center was found in good agreement with the measurements of the visiting team: D(center)∕D(visit) = 1.000 ± 0.003 (1 SD). The A1SL chamber measurements were all in good agreement with Alanine∕EPR dosimetry. Going from the static reference field to the rotational ∕ non modulated field the dose rate remains constant within 0.2% except for one center where a deviation of 1.3% was detected. CONCLUSIONS: Following the TG-148 report, beam output measurements in water at the reference depth using a local protocol, as developed at different centers, was verified. The measurements were found in good agreement with alanine∕EPR dosimetry. The presented methodology may provide a good concept for reference dosimetry.

Monte Carlo-based simulation of dynamic jaws tomotherapy.

PURPOSE: Original TomoTherapy systems may involve a trade-off between conformity and treatment speed, the user being limited to three slice widths (1.0, 2.5, and 5.0 cm). This could be overcome by allowing the jaws to define arbitrary fields, including very small slice widths (<1 cm), which are challenging for a beam model. The aim of this work was to incorporate the dynamic jaws feature into a Monte Carlo (MC) model called TomoPen, based on the MC code PENELOPE, previously validated for the original TomoTherapy system. METHODS: To keep the general structure of TomoPen and its efficiency, the simulation strategy introduces several techniques: (1) weight modifiers to account for any jaw settings using only the 5 cm phase-space file; (2) a simplified MC based model called FastStatic to compute the modifiers faster than pure MC; (3) actual simulation of dynamic jaws. Weight modifiers computed with both FastStatic and pure MC were compared. Dynamic jaws simulations were compared with the convolution∕superposition (C∕S) of TomoTherapy in the "cheese" phantom for a plan with two targets longitudinally separated by a gap of 3 cm. Optimization was performed in two modes: asymmetric jaws-constant couch speed ("running start stop," RSS) and symmetric jaws-variable couch speed ("symmetric running start stop," SRSS). Measurements with EDR2 films were also performed for RSS for the formal validation of TomoPen with dynamic jaws. RESULTS: Weight modifiers computed with FastStatic were equivalent to pure MC within statistical uncertainties (0.5% for three standard deviations). Excellent agreement was achieved between TomoPen and C∕S for both asymmetric jaw opening∕constant couch speed and symmetric jaw opening∕variable couch speed, with deviations well within 2%∕2 mm. For RSS procedure, agreement between C∕S and measurements was within 2%∕2 mm for 95% of the points and 3%∕3 mm for 98% of the points, where dose is greater than 30% of the prescription dose (gamma analysis). Dose profiles acquired in transverse and longitudinal directions through the center of the phantom were also compared with excellent agreement (2%∕2 mm) between all modalities. CONCLUSIONS: The combination of weights modifiers and interpolation allowed implementing efficiently dynamic jaws and dynamic couch features into TomoPen at a minimal cost in terms of efficiency (simulation around 8 h on a single CPU).

Experimental and theoretical dosimetry of a new polymer encapsulated iodine-125 source--SmartSeed: dosimetric impact of fluorescence x rays.

PURPOSE: The detailed study of a new permanent iodine-125 brachytherapy source, SmartSeed, is presented in this article. It is the first iodine seed made with biocompatible polymer and is manufactured by the IBt-Bebig group. METHODS: Three dosimetric studies have been performed: The first one used thermoluminescent detectors in a solid water phantom with NIST (National Institute of Standards and Technology, USA) calibrated seeds, and two separate studies were of Monte Carlo photon transport calculations (MCNP5 code). The TG-43U1 protocol was applied to derive dosimetric parameters for clinical applications. RESULTS: The radial dose function g(r) was determined at different distances ranging from 0.5 to 10 cm; and the anisotropy function F(r, theta) at angles ranging from 0 degrees to 350 degrees in 10 degrees increments. Monte Carlo calculations were performed in liquid water to obtain values for lambda, g(r), F(r, theta), and phi(an)(r) as recommended by the TG-43U1 protocol for use in treatment planning system software. SmartSeed's biocompatible polymer capsule permits fluorescence x rays (3, 5, and 12 keV), generated by lead glass marker, to be present in the emission spectrum, influencing the dose rate constant. The impact on near field dosimetry in water from these x rays was also investigated and reported. The capsule also attenuates iodine-125 energies much less than typical titanium encased sources, resulting in a highly isotropic source. CONCLUSIONS: SmartSeed has a dose rate constant of 0.895 +/- 7.3% cGy h(-1) U(-1), a radial dose function nearly identical to the IBt-Bebig model I25.S06 seed, and a highly isotropic dose distribution. Fluorescence x rays account for the relatively low value of lambda, yet their variable contribution to dosimetry arising from seed dimensional uncertainties is estimated to be < 0.2%.

Ion recombination for ionization chamber dosimetry in a helical tomotherapy unit.

PURPOSE: Ion recombination for ionization chambers in pulsed high-energy photon beams is a well-studied phenomenon. Despite this, the correction for ion recombination is often determined inaccurately due to the inappropriate combination of using a high polarizing voltage and the simple two-voltage method. An additional complication arises in new treatment modalities such as IMRT and tomotherapy, where the dosimetry of a superposition of many constituting fields becomes more relevant than of single static fields. For these treatment modalities, the irradiation of the ion chamber geometry can be instantaneously inhomogeneous and time dependent. METHODS: This article presents a study of ion recombination in ionization chambers used for dosimetry in a helical tomotherapy beam. Models are presented for studying the recombination correction factors in a continuous beam, in pulsed large and small fields, and in helical fields. Measurements using Exradin A1SL, NE2571, and NE2611 type chambers and Monte Carlo simulations using PENELOPE are performed in support of these models. RESULTS: Initial recombination and charge multiplication are found to be the same in 60Co and in the pulsed high-energy photon beam for the chambers and operating voltages used in this study. Applying the two-voltage technique for the A1SL chamber at its recommended operating voltage of 300 V leads to an overestimation of the recombination. Operating at a voltage of 100 V yields larger but more accurate values for the recombination correction. The recombination correction measured for this chamber in the TomoTherapy HiArt unit is lower than the 1% applied in the routine dosimetry for this treatment unit. For a helical dose delivery with a small slice width, lateral electron scatter in the cavity makes that the recombination is smaller than for an open beam delivering the same total dose. In a Farmer type chamber, a helical delivery with a 1 cm slice field results in a time and spatially integrated volume recombination of 55% of that with a 2.5 cm slice field. The relative recombination corrections for different slice widths and different field offsets with respect to the chamber center obtained from the developed models are in good agreement with experimental data. CONCLUSIONS: Because of the presence of charge multiplication, it is more accurate to determine the recombination correction at lower operating voltages than are often applied using the two-voltage method. Models and experiments for partial irradiation conditions of the ion chamber show that resulting recombination corrections are reduced compared to those for an open field. A model for helical dose deliveries results in recombination corrections that get lower with smaller slice widths. This model could be adapted to any IMRT delivery where the ion chamber is instantaneously partial and/or inhomogeneously irradiated, and could provide a practical procedure to calculate the recombination for complex deliveries for which it is difficult to be measured.

Experimental determination of the radial dose distribution in high gradient regions around 192Ir wires: comparison of electron paramagnetic resonance imaging, films, and Monte Carlo simulations.

PURPOSE: The experimental determination of doses at proximal distances from radioactive sources is difficult because of the steepness of the dose gradient. The goal of this study was to determine the relative radial dose distribution for a low dose rate 192Ir wire source using electron paramagnetic resonance imaging (EPRI) and to compare the results to those obtained using Gafchromic EBT film dosimetry and Monte Carlo (MC) simulations. METHODS: Lithium formate and ammonium formate were chosen as the EPR dosimetric materials and were used to form cylindrical phantoms. The dose distribution of the stable radiation-induced free radicals in the lithium formate and ammonium formate phantoms was assessed by EPRI. EBT films were also inserted inside in ammonium formate phantoms for comparison. MC simulation was performed using the MCNP4C2 software code. RESULTS: The radical signal in irradiated ammonium formate is contained in a single narrow EPR line, with an EPR peak-to-peak linewidth narrower than that of lithium formate (approximately 0.64 and 1.4 mT, respectively). The spatial resolution of EPR images was enhanced by a factor of 2.3 using ammonium formate compared to lithium formate because its linewidth is about 0.75 mT narrower than that of lithium formate. The EPRI results were consistent to within 1% with those of Gafchromic EBT films and MC simulations at distances from 1.0 to 2.9 mm. The radial dose values obtained by EPRI were about 4% lower at distances from 2.9 to 4.0 mm than those determined by MC simulation and EBT film dosimetry. CONCLUSIONS: Ammonium formate is a suitable material under certain conditions for use in brachytherapy dosimetry using EPRI. In this study, the authors demonstrated that the EPRI technique allows the estimation of the relative radial dose distribution at short distances for a 192Ir wire source.

Three-voltage linear method to determine ion recombination in proton and light-ion beams.

A new practical method to determine the ion recombination correction factor (k s ) for plane-parallel and Farmer-type cylindrical chambers in particle beams is investigated. Experimental data were acquired in passively scattered and scanned particle beams and compared with theoretical models developed by Boag and/or Jaffé. The new method, named the three-voltage linear method (3VL-method), is simple and consists of determining the saturation current using the current measured at three voltages in a linear region and dividing it by the current at the operating voltage (V) (even if it is not in the linear region) to obtain k s . For plane-parallel chambers, comparing k s -values obtained by model fits to values obtained using the 3VL-method, an excellent agreement is found. For cylindrical chambers, recombination is due to volume recombination only. At low voltages, volume recombination is too large and Boag's models are not applicable. However, for Farmer-type chambers (NE2571), using a smaller voltage range, limited down to 100 V, we observe a linear variation of k s with 1/V 2 or 1/V for continuous or pulsed beams, respectively. This linearity trend allows applying the 3VL-method to determine k s at any polarizing voltage. For the particle beams used, the 3VL-method gives an accurate determination of k s at any polarizing voltage. The choice of the three voltages must to be done with care to ensure to be in a linear region. For Roos-type or Markus-type chambers (i.e. chambers with an electrode spacing of 2 mm) and NE2571 chambers, the use of the 3VL-method with 300 V, 200 V and 150 V is adequate. A difference with the 2V-method and some 3V-methods in the literature is that in the 3VL-method the operational voltage does not have to be one of the three voltages. An advantage over a 2V-method is that the 3VL-method can inherently verify if the linearity condition is fulfilled.

Monte Carlo evaluation of the convolution/superposition algorithm of Hi-Art tomotherapy in heterogeneous phantoms and clinical cases.

The reliability of the convolution/superposition (C/S) algorithm of the Hi-Art tomotherapy system is evaluated by using the Monte Carlo model TomoPen, which has been already validated for homogeneous phantoms. The study was performed in three stages. First, measurements with EBT Gafchromic film for a 1.25 x 2.5 cm2 field in a heterogeneous phantom consisting of two slabs of polystyrene separated with Styrofoam were compared to simulation results from TomoPen. The excellent agreement found in this comparison justifies the use of TomoPen as the reference for the remaining parts of this work. Second, to allow analysis and interpretation of the results in clinical cases, dose distributions calculated with TomoPen and C/S were compared for a similar phantom geometry, with multiple slabs of various densities. Even in conditions of lack of lateral electronic equilibrium, overall good agreement was obtained between C/S and TomoPen results, with deviations within 3%/2 mm, showing that the C/S algorithm accounts for modifications in secondary electron transport due to the presence of a low density medium. Finally, calculations were performed with TomoPen and C/S of dose distributions in various clinical cases, from large bilateral head and neck tumors to small lung tumors with diameter of < 3 cm. To ensure a "fair" comparison, identical dose calculation grid and dose-volume histogram calculator were used. Very good agreement was obtained for most of the cases, with no significant differences between the DVHs obtained from both calculations. However, deviations of up to 4% for the dose received by 95% of the target volume were found for the small lung tumors. Therefore, the approximations in the C/S algorithm slightly influence the accuracy in small lung tumors even though the C/S algorithm of the tomotherapy system shows very good overall behavior.

Evaluation of a commercial VMC++ Monte Carlo based treatment planning system for electron beams using EGSnrc/BEAMnrc simulations and measurements.

In the present work, Monte Carlo (MC) models of electron beams (energies 4, 12 and 18MeV) from an Elekta SL25 medical linear accelerator were simulated using EGSnrc/BEAMnrc user code. The calculated dose distributions were benchmarked by comparison with measurements made in a water phantom for a wide range of open field sizes and insert combinations, at a single source-to-surface distance (SSD) of 100cm. These BEAMnrc models were used to evaluate the accuracy of a commercial MC dose calculation engine for electron beam treatment planning (Oncentra MasterPlan Treament Planning System (OMTPS) version 1.4, Nucletron) for two energies, 4 and 12MeV. Output factors were furthermore measured in the water phantom and compared to BEAMnrc and OMTPS. The overall agreement between predicted and measured output factors was comparable for both BEAMnrc and OMTPS, except for a few asymmetric and/or small insert cutouts, where larger deviations between measurements and the values predicted from BEAMnrc as well as OMTPS computations were recorded. However, in the heterogeneous phantom, differences between BEAMnrc and measurements ranged from 0.5 to 2.0% between two ribs and 0.6-1.0% below the ribs, whereas the range difference between OMTPS and measurements was the same (0.5-4.0%) in both areas. With respect to output factors, the overall agreement between BEAMnrc and measurements was usually within 1.0% whereas differences up to nearly 3.0% were observed for OMTPS. This paper focuses on a comparison for clinical cases, including the effects of electron beam attenuations in a heterogeneous phantom. It, therefore, complements previously reported data (only based on measurements) in one other paper on commissioning of the VMC++ dose calculation engine. These results demonstrate that the VMC++ algorithm is more robust in predicting dose distribution than Pencil beam based algorithms for the electron beams investigated.

An experimental palladium-103 seed (OptiSeedexp) in a biocompatible polymer without a gold marker: characterization of dosimetric parameters including the interseed effect.

Permanent implantation of 125I (iodine) or 103Pd (palladium) sources is a popular treatment option in the management of early stage prostate cancer. New sources are being developed, some of which are being marketed for different clinical applications. A new technique of adjuvant stereotactic permanent seed breast implant, similar to that used in the treatment of prostate cancer, has been proposed by [N. Jansen et al., Int. J. Radiat. Oncol. Biol. Phys. 67, 1052-1058 (2007)] with encouraging results. The presence of artifacts from the metallic seeds, however, can disturb follow-up imaging. The development of plastic seeds has reduced these artifacts. This paper presents a feasibility study of the advantages of palladium-103 seeds, encapsulated with a biocompatible polymer, for future clinical applications, and on the effect of the gold marker on the dosimetric characteristics of such seeds. Experimental palladium seeds, OptiSeedexp, were manufactured by International Brachytherapy (IBt), Seneffe, Belgium, from a biocompatible polymer, including the marker. Apart from the absence of a gold marker, the studied seed has an identical design to the OptiSeed103 [Phys. Med. Biol. 50, 1493-1504 (2005)]; [Appl. Radiat. Isot. 63, 311-321 (2005)]. Polymer encapsulation was preferred by IBt in order to reduce the quantity of radioactive material needed for a given dose rate and to reduce the anisotropy of the radiation field around the seed. In addition, this design is intended to decrease the interseed effects that can occur as a result of the marker and the encapsulation. Dosimetric measurements were performed using LiF thermoluminescent dosimeters (1 mm3) in solid water phantoms (WT1). Measured data were compared to Monte Carlo simulated data in solid water using the MCNP code, version 4C. Updated cross sections [Med. Phys. 30, 701-711 (2003)] were used. As the measured and calculated data were in agreement, Monte Carlo calculations were then performed in liquid water to obtain relevant dosimetric data as required by TG-43U1 recommendations. Comparison of the results with previous studies of OptiSeed103 [Phys. Med. Biol. 50, 1493-1504 (2005)]; [Appl. Radiat. Isot. 63, 311-321 (2005)], and of InterSource103 [Appl. Radiat. Isot. 57, 805-811 (2002)] showed very good agreement for the dose rate constant and for the radial dose function. With respect to the anisotropy function, the relative dose (anisotropy value relative to 90 degrees) from the polymer seed at a distance of 3 cm was close to unity (105%) at 0 degrees, whereas the relative values for the OptiSeed103 with a gold marker and the titanium-encapsulated InterSource103 seed decreased to 70% and 40%, respectively. The interseed effect from one seed was negligible and in the order of calculation uncertainty, making calculation of the dose rate distribution of the studied seeds, according to TG43U1 recommendations, more accurate and closer to reality. This feasibility study shows that due to the low energy of palladium-103, the negligible interseed effect and the reduced artifacts in postimplant medical imaging, this experimental plastic seed would be a good source for breast brachytherapy. This feasibility study was carried out in collaboration with IBt and will be continued with a study of its visibility in different tissues.

Monte Carlo simulation of helical tomotherapy with PENELOPE.

Helical tomotherapy (HT) delivers intensity-modulated radiation therapy (IMRT) using the simultaneous movement of the couch, the gantry and the binary multileaf collimator (MLC), a procedure that differs from conventional dynamic or step-and-shoot IMRT. A Monte Carlo (MC) simulation of HT in the helical mode therefore requires a new approach. Using validated phase-space files (PSFs) obtained through the MC simulation of the static mode with PENELOPE, an analytical model of the binary MLC, called the 'transfer function' (TF), was first devised to perform the transport of particles through the MLC much faster than time-consuming MC simulation and with no significant loss of accuracy. Second, a new tool, called TomoPen, was designed to simulate the helical mode by rotating and translating the initial coordinates and directions of the particles in the PSF according to the instantaneous position of the machine, transporting the particles through the MLC (in the instantaneous configuration defined by the sinogram), and computing the dose distribution in the CT structure using PENELOPE. Good agreement with measurements and with the treatment planning system of tomotherapy was obtained, with deviations generally well within 2%/1 mm, for the simulation of the helical mode for two commissioning procedures and a clinical plan calculated and measured in homogeneous conditions.

Monte carlo evaluation of the AAA treatment planning algorithm in a heterogeneous multilayer phantom and IMRT clinical treatments for an Elekta SL25 linear accelerator.

The Anisotropic Analytical Algorithm (AAA) is a new pencil beam convolution/superposition algorithm proposed by Varian for photon dose calculations. The configuration of AAA depends on linear accelerator design and specifications. The purpose of this study was to investigate the accuracy of AAA for an Elekta SL25 linear accelerator for small fields and intensity modulated radiation therapy (IMRT) treatments in inhomogeneous media. The accuracy of AAA was evaluated in two studies. First, AAA was compared both with Monte Carlo (MC) and the measurements in an inhomogeneous phantom simulating lung equivalent tissues and bone ribs. The algorithm was tested under lateral electronic disequilibrium conditions, using small fields (2 x 2 cm(2)). Good agreement was generally achieved for depth dose and profiles, with deviations generally below 3% in lung inhomogeneities and below 5% at interfaces. However, the effects of attenuation and scattering close to the bone ribs were not fully taken into account by AAA, and small inhomogeneities may lead to planning errors. Second, AAA and MC were compared for IMRT plans in clinical conditions, i.e., dose calculations in a computed tomography scan of a patient. One ethmoid tumor, one orophaxynx and two lung tumors are presented in this paper. Small differences were found between the dose volume histograms. For instance, a 1.7% difference for the mean planning target volume dose was obtained for the ethmoid case. Since better agreement was achieved for the same plans but in homogeneous conditions, these differences must be attributed to the handling of inhomogeneities by AAA. Therefore, inherent assumptions of the algorithm, principally the assumption of independent depth and lateral directions in the scaling of the kernels, were slightly influencing AAA's validity in inhomogeneities. However, AAA showed a good accuracy overall and a great ability to handle small fields in inhomogeneous media compared to other pencil beam convolution algorithms.

Ion recombination correction factor in scanned light-ion beams for absolute dose measurement using plane-parallel ionisation chambers.

Based on international reference dosimetry protocols for light-ion beams, a correction factor (k s) has to be applied to the response of a plane-parallel ionisation chamber, to account for recombination of negative and positive charges in its air cavity before these charges can be collected on the electrodes. In this work, k s for IBA PPC40 Roos-type chambers is investigated in four scanned light-ion beams (proton, helium, carbon and oxygen). To take into account the high dose-rates used with scanned beams and LET-values, experimental results are compared to a model combining two theories. One theory, developed by Jaffé, describes the variation of k s with the ionization density within the ion track (initial recombination) and the other theory, developed by Boag, describes the variation of k s with the dose rate (volume recombination). Excellent agreement is found between experimental and theoretical k s-values. All results confirm that k s cannot be neglected. The solution to minimise k s is to use the ionisation chamber at high voltage. However, one must be aware that charge multiplication may complicate the interpretation of the measurement. For the chamber tested, it was found that a voltage of 300 V can be used without further complication. As the initial recombination has a logarithmic variation as a function of 1/V, the two-voltage method is not applicable to these scanned beams.

Experimental assessment of proton dose calculation accuracy in inhomogeneous media.

PURPOSE: Proton therapy with Pencil Beam Scanning (PBS) has the potential to improve radiotherapy treatments. Unfortunately, its promises are jeopardized by the sensitivity of the dose distributions to uncertainties, including dose calculation accuracy in inhomogeneous media. Monte Carlo dose engines (MC) are expected to handle heterogeneities better than analytical algorithms like the pencil-beam convolution algorithm (PBA). In this study, an experimental phantom has been devised to maximize the effect of heterogeneities and to quantify the capability of several dose engines (MC and PBA) to handle these. METHODS: An inhomogeneous phantom made of water surrounding a long insert of bone tissue substitute (1×10×10 cm3) was irradiated with a mono-energetic PBS field (10×10 cm2). A 2D ion chamber array (MatriXX, IBA Dosimetry GmbH) lied right behind the bone. The beam energy was such that the expected range of the protons exceeded the detector position in water and did not attain it in bone. The measurement was compared to the following engines: Geant4.9.5, PENH, MCsquare, as well as the MC and PBA algorithms of RayStation (RaySearch Laboratories AB). RESULTS: For a γ-index criteria of 2%/2mm, the passing rates are 93.8% for Geant4.9.5, 97.4% for PENH, 93.4% for MCsquare, 95.9% for RayStation MC, and 44.7% for PBA. The differences in γ-index passing rates between MC and RayStation PBA calculations can exceed 50%. CONCLUSION: The performance of dose calculation algorithms in highly inhomogeneous media was evaluated in a dedicated experiment. MC dose engines performed overall satisfactorily while large deviations were observed with PBA as expected.

Under-response of a PTW-60019 microDiamond detector in the Bragg peak of a 62 MeV/n carbon ion beam.

To investigate the linear energy transfer (LET) dependence of the response of a PTW-60019 Freiburg microDiamond detector, its response was compared to the response of a plane-parallel Markus chamber in a 62 MeV/n mono-energetic carbon ion beam. Results obtained with two different experimental setups are in agreement. As recommended by IAEA TRS-398, the response of the Markus chamber was corrected for temperature, pressure, polarity effects and ion recombination. No correction was applied to the response of the microDiamond detector. The ratio of the response of the Markus chamber to the response of the microDiamond is close to unity in the plateau region. In the Bragg peak region, a significant increase of the ratio is observed, which increases to 1.2 in the distal edge region. Results indicate a correlation between the under-response of the microDiamond detector and high LET values. The combined relative standard uncertainty of the results is estimated to be 2.38% in the plateau region and 12% in the distal edge region. These values are dominated by the uncertainty of alignment in the non-uniform beam and the uncertainty of range determination.

Development and application of a water calorimeter for the absolute dosimetry of short-range particle beams.

In this work, we describe a new design of water calorimeter built to measure absorbed dose in non-standard radiation fields with reference depths in the range of 6-20 mm, and its initial testing in clinical electron and proton beams. A functioning calorimeter prototype with a total water equivalent thickness of less than 30 mm was constructed in-house and used to obtain measurements in clinical accelerator-based 6 MeV and 8 MeV electron beams and cyclotron-based 60 MeV monoenergetic and modulated proton beams. Corrections for the conductive heat transfer due to dose gradients and non-water materials was also accounted for using a commercial finite element method software package. Absorbed dose to water was measured with an associated type A standard uncertainty of approximately 0.4% and 0.2% for the electron and proton beam experiments, respectively. In terms of thermal stability, drifts were on the order of a couple of hundred µK min-1, with a short-term variation of 5-10 µK. Heat transfer correction factors ranged between 1.021 and 1.049. The overall combined standard uncertainty on the absorbed dose to water was estimated to be 0.6% for the 6 MeV and 8 MeV electron beams, as well as for the 60 MeV monoenergetic protons, and 0.7% for the modulated 60 MeV proton beam. This study establishes the feasibility of developing an absorbed dose transfer standard for short-range clinical electrons and protons and forms the basis for a transportable dose standard for direct calibration of ionization chambers in the user's beam. The largest contributions to the combined standard uncertainty were the positioning (⩽0.5%) and the correction due to conductive heat transfer (⩽0.4%). This is the first time that water calorimetry has been used in such a low energy proton beam.

LET dependence of the response of a PTW-60019 microDiamond detector in a 62MeV proton beam.

This study was initiated following conclusions from earlier experimental work, performed in a low-energy carbon ion beam, indicating a significant LET dependence of the response of a PTW-60019 microDiamond detector. The purpose of this paper is to present a comparison between the response of the same PTW-60019 microDiamond detector and an IBA Roos-type ionization chamber as a function of depth in a 62MeV proton beam. Even though proton beams are considered as low linear energy transfer (LET) beams, the LET value increases slightly in the Bragg peak region. Contrary to the observations made in the carbon ion beam, in the 62MeV proton beam good agreement is found between both detectors in both the plateau and the distal edge region. No significant LET dependent response of the PTW-60019 microDiamond detector is observed consistent with other findings for proton beams in the literature, despite this particular detector exhibiting a substantial LET dependence in a carbon ion beam.