Population Effectiveness of Dolutegravir Implementation in Uganda - A Prospective Observational Cohort Study (DISCO): 48-week Results.

BACKGROUND: Tenofovir/lamivudine/dolutegravir (TLD) is the preferred first-line antiretroviral therapy (ART) regimen for people with HIV (PWH), including those who were previously virologically suppressed on non-nucleoside reverse transcriptase inhibitors (NNRTIs). We sought to estimate the real-world effectiveness of the TLD transition in Ugandan public-sector clinics. METHODS: We conducted a prospective cohort study of PWH ≥18 years who were transitioned from NNRTI-based ART to TLD. Study visits were conducted on the day of TLD transition and 24- and 48- weeks later. The primary endpoint was viral suppression (<200 copies/mL) at 48-weeks. We collected blood for retrospective viral load (VL) assessment and conducted genotypic resistance tests for specimens with VL >500 copies/mL. RESULTS: We enrolled 500 participants (median age of 47 years; 41% women). At 48-weeks after TLD transition, 94% of participants were in care with a VL <200 copies/mL (n = 469/500); 2% (n = 11/500) were lost from care or died; and only 2% (n = 9/500) had a VL >500 copies/mL. No incident resistance to DTG was identified. Few participants (2%, n = 9/500) discontinued TLD due to adverse events. CONCLUSIONS: High rates of viral suppression, high tolerability, and lack of emergent drug resistance support use of TLD as the preferred first-line regimen in the region.

Experimental Testing on Tuned Liquid Dampers for Implementation in Industrial Chimneys.

A TLD is a passive damping device that works by dissipating energy through the sloshing of the liquid and the effect of wave breaking, thereby controlling the vibrations of the structure. One of the applications where TLDs are of great interest is in the case of industrial chimneys since these structures often have a very low natural frequency, which can be easily achieved in a control device of this type. The main objective of this study is to evaluate the behaviour of an annular TLD composed of multiple cells through laboratory tests and investigate if it is adequate to design it as an agglomeration of smaller rectangular TLDs. The influence of the amplitude of displacement on the behaviour of the annular TLD will also be analysed. The tests were performed on a shaking table and recurring with pendulums of the same length but of different masses. Three reservoirs were studied as TLDs: a rectangular one, a cell of an annular TLD and a quarter-ring of an annular TLD. This study concluded that the analytical methods developed in previous studies were, in general, adequate for the design of a rectangular TLD and that it was reasonable to design the annular TLD studied as a combination of rectangular ones, as its cells were a close match to a rectangle of similar dimensions. It was also concluded that a compartmentalised annular TLD is an adequate solution for the vibration control of structures with high displacements.

Using Biological Photophysics to Map the Excited-State Topology of Molecular Photosensitizers for Photodynamic Therapy.

This study employs TLD1433, a RuII -based photodynamic therapy (PDT) agent in human clinical trials, as a benchmark to establish protocols for studying the excited-state dynamics of photosensitizers (PSs) in cellulo, in the local environment provided by human cancer cells. Very little is known about the excited-state properties of any PS in live cells, and for TLD1433, it is terra incognita. This contribution targets a general problem in phototherapy, which is how to interrogate the light-triggered, function-determining processes of the PSs in the relevant biological environment, and establishes methodological advances to study the ultrafast photoinduced processes for TLD1433 when taken up by MCF7 cells. We generalize the methodological developments and results in terms of molecular physics by applying them to TLD1433's analogue TLD1633, making this study a benchmark to investigate the excited-state dynamics of phototoxic compounds in the complex biological environment.

Transitioning women to first-line preferred TLD regimen is lagging in Sub-Saharan Africa.

INTRODUCTION: In 2019, the World Health Organization (WHO) recommended tenofovir disoproxil fumarate-lamivudine-dolutegravir (TLD) as the preferred first line regimen for adults and adolescents regardless of childbearing status. Nevertheless, final eligibility is determined by local policies which may vary from WHO recommendations. We examined TLD transition by gender across five PEPFAR-supported HIV care programs in sub-Saharan Africa. METHODS: The African Cohort Study (AFRICOS) enrolls people living with HIV (PLWH) engaged in care in Uganda, Kenya (South Rift Valley and Kisumu West), Tanzania and Nigeria. PLWH with at least one study visit after the country introduced TLD were included. We generated Kaplan-Meier (KM) curves to compare TLD transition by gender from 1) time countries' introduction of TLD and 2) time of TLD eligibility according to local policies. RESULTS: Among 2.476 participants enrolled through September 2021 at 4 sites in sub-Saharan Africa and eligible to transition to TLD, fewer women (68%) compared to men (80%, p < 0.001) were taking TLD. Kaplan-Meier analysis showed time to transition varied by site, with women in Tanzania transitioning at the same rate as men. In Nigeria, women initially had a slower transition but caught up to men. After adjusting for local policies, women[1] in Kisumu West transitioned at the same rate as men. In South Rift Valley and Uganda, women were less likely to be transitioned. CONCLUSIONS: Despite TLD being the WHO's preferred regimen since 2019, transition of women to potentially lifesaving TLD has been slower than men at certain clinical sites even after accounting for local eligibility criteria.

3D in vivo dosimetry of HDR gynecological brachytherapy using micro silica bead TLDs.

PURPOSE: This study aimed to evaluate the feasibility of defining an in vivo dosimetry (IVD) protocol as a patient-specific quality assurance (PSQA) using the bead thermoluminescent dosimeters (TLDs) for point and 3D IVD during brachytherapy (BT) of gynecological (GYN) cancer using 60 Co high-dose-rate (HDR) source. METHODS: The 3D in vivo absorbed dose verification within the rectum and bladder as organs-at-risk was performed by bead TLDs for 30 GYN cancer patients. For rectal wall dosimetry, 80 TLDs were placed in axial arrangements around a rectal tube covered with a layer of gel. Ten beads were placed inside the Foley catheter to get the bladder-absorbed dose. Beads TLDs were localized and defined as control points in the treatment planning system (TPS) using CT images of the patients. Patients were planned and treated using the routine BT protocol. The experimentally obtained absorbed dose map of the rectal wall and the point dose of the bladder were compared to the TPSs predicted absorbed dose at these control points. RESULTS: Relative difference between TPS and TLDs results were -8.3% ± 19.5% and -7.2% ± 14.6% (1SD) for rectum- and bladder-absorbed dose, respectively. Gamma analysis was used to compare the calculated with the measured absorbed dose maps. Mean gamma passing rates of 84.1%, 90.8%, and 92.5% using the criteria of 3%/2 mm, 3%/3 mm, and 4%/2 mm were obtained, respectively. Eventually, a "considering level" of at least 85% as pass rate with 4%/2-mm criteria was recommended. CONCLUSIONS: A 3D IVD protocol employing bead TLDs was presented to measure absorbed doses delivered to the rectum and bladder during GYN HDR-BT as a reliable PSQA method. 3D rectal absorbed dose measurements were performed. Differences between experimentally measured and planned absorbed dose maps were presented in the form of a gamma index, which may be used as a warning for corrective action.

Characterization of Thermoluminescent Dosimeters for Neutron Dosimetry at High Altitudes.

Neutrons constitute a significant component of the secondary cosmic rays and are one of the most important contributors to natural cosmic ray radiation background dose. The study of the cosmic ray neutrons' contribution to the dose equivalent received by humans is an interesting and challenging task for the scientific community. In addition, international regulations demand assessing the biological risk due to radiation exposure for both workers and the general population. Because the dose rate due to cosmic radiation increases significantly with altitude, the objective of this work was to characterize the thermoluminescent dosimeter (TLDs) from the perspective of exposing them at high altitudes for longtime neutron dose monitoring. The pair of TLD-700 and TLD-600 is amply used to obtain the information on gamma and neutron dose in mixed neutron-gamma fields due to the present difference in 6Li isotope concentration. A thermoluminescence dosimeter system based on pair of TLD-600/700 was characterized to enable it for neutron dosimetry in the thermal energy range. The system was calibrated in terms of neutron ambient dose equivalent in an experimental setup using a 241Am-B radionuclide neutron source coated by a moderator material, polyethylene, creating a thermalized neutron field. Afterward, the pair of TLD-600/700 was exposed at the CERN-EU High-Energy Reference Field (CERF) facility in Geneva, which delivers a neutron field with a spectrum similar to that of secondary cosmic rays. The dosimetric system provided a dose value comparable with the calculated one demonstrating a good performance for neutron dosimetry.

Treatment-Limiting Decisions in Patients with Spontaneous Intracerebral Hemorrhage.

Background and Objectives: Treatment-limiting decisions (TLDs) are employed to actively withhold treatment/invasive interventions from patients in whom clinicians feel they would derive little to no benefit and/or suffer detrimental effects. Data regarding the employment of TLDs in patients with spontaneous intracerebral hemorrhage (ICH) remain sparse. Accordingly, this study sought to investigate both the prevalence of TLDs and factors driving TLDs in patients suffering from spontaneous ICH. Materials and Methods: This was a retrospective study of 249 consecutive patients with ICH treated from 2018−2019 at the Neurovascular Center of the University Hospital Bonn. Reasons deemed critical in the decision-making process with regard to TLD were ultimately extracted/examined via chart review of qualifying patients. Results: A total of 249 patients with ICH were included within the final analyses. During the time period examined, 49 patients (20%) had advanced directives in place, whereas in 53 patients (21%) consultation with relatives or acquaintances was employed before further treatment decisions. Overall, TLD ultimately manifested in 104 patients (42%). TLD was reached within 6 h after admission in 52 patients (50%). Congruent with severity of injury and expected outcomes, TLDs were more likely in patients with signs of cerebral herniation and an ICH score > 3 (p < 0.001). Conclusions: The present study examines details associated with TLDs in patients with spontaneous ICH. These data provide insight into key decisional processes and reinforce the need for further structured investigations in an effort to help guide patients and their families.

A thermoluminescent method for the evaluation of the 131I effective half-life in the thyroid when treating Graves' disease.

When planning treatment for Graves' disease with 131I, the effective half-life (Teff) should be estimated individually as it depends on biological characteristics such as iodine uptake and excretion, which differ from an individual to another (Berg et al. 1996). All the methods to quantify Teff described in the literature are quite complex and are difficult to be used in clinical routine. With the aim of optimizing this process, a simplified method is proposed here to evaluate Teff of 131I during treatment of Graves' disease. The present study suggests improving the method of determining Teff based on thermoluminescence dosimetry. This involves implementing a new method and includes reduction of TLD (Thermoluminescent Dosimeter) measurements. The proposed method was validated on patients with Graves' disease. The radiation dose delivered to the patients was determined using the MIRD (Medical Internal Radiation Dosimetry) formalism. The relative difference between Teff obtained based on seven measurement intervals at [0-24 h, 24-48 h, 48-72 h, 72-96 h, 96-120 h, 120-144 h, 144-168 h] and based on three measurement intervals at [0-24 h, 72-96 h, 144-168 h] and [0-24 h, 120-144 h, 144-168 h] was 1.9% and 3.81%, respectively. Comparison of doses obtained based on a general Teff and on a personalized Teff gave a statistically significant difference with a correlation coefficient R2of 0.44. The Teff obtained from just three measurements was found to be sufficiently accurate and easily applicable. The results obtained demonstrate the need to determine and use personalized Teff values instead of using a fixed value of 7 days.

Modelling and measurements of distributions in an adult human phantom undergoing proton scanning beam radiotherapy: lung- and prostate-located tumours.

Proton radiotherapy has been shown to offer a significant dosimetric advantage in cancer patients, in comparison to conventional radiotherapy, with a decrease in dose to healthy tissue and organs at risk, because the bulk of the beam energy is deposited in the Bragg peak to be located within a tumour. However, it should be kept in mind that radiotherapy of cancer is still accompanied by adverse side effects, and a better understanding and improvement of radiotherapy can extend the life expectancy of patients following the treatment of malignant tumours. In this study, the dose distributions measured with thermoluminescent detectors (TLDs) inside a tissue-equivalent adult human phantom exposed for lung and prostate cancer using the modern proton beam scanning radiotherapy technique were compared. Since the TLD detection efficiency depends on the ionization density of the radiation to be detected, and since this efficiency is detector specific, four different types of TLDs were used to compare their response in the mixed radiation fields. Additionally, the dose distributions from two different cancer treatment modalities were compared using the selected detectors. The measured dose values were benchmarked against Monte Carlo simulations and available literature data. The results indicate an increase in the lateral dose with an increase of the primary proton energy. However, the radiation quality factor of the mixed radiation increases by 20% in the vicinity to the target for the lower initial proton energy, due to the production of secondary charged particles of low-energy and short range. For the cases presented here the MTS-N TLD detector seems to be the most optimal tool for dose measurements within the target volume, while the MCP-N TLD detector, due to an interplay of its enhanced thermal neutron response and decreased detection efficiency to highly ionising radiation, is a better choice for the out-of-field measurements. The pairs of MTS-6 and MTS-7 TLDs used also in this study allowed for a direct measurement of the neutron dose equivalent. Before it can be concluded that they offer an alternative to the time-consuming nuclear track detectors, however, more research is needed to unambiguously confirm whether this observation was just accidental or whether it only applies to certain cases. Since there is no universal detector, which would allow the determination of the dosimetric quantities relevant for risk estimation, this work expands the knowledge necessary to improve the quality of dosimetry data and might help scientists and clinicians in choosing the right tools to measure radiation doses in mixed radiation fields.

Response of TLD-600/TLD-700 and CR-39 to neutrons for medical dosimetry.

In this study, thermoluminescence detectors (TLD)-600 and TLD-700 were used under different conditions to study neutron dosimetry for its application in medical dosimetry as albedo dosimeters. 6 LiF has a high cross-section for neutrons and is more sensitive to neutrons than to gamma radiation. Conversely, TLD-700 showed a better response to gamma radiation. Therefore, to obtain the response for neutrons, the responses for TLD-600 and TLD-700 were subtracted. A cadmium sheet was used to absorb incident thermal neutrons so that detector measured only backscattered neutrons from the albedo dosimeter. A Perspex sheet was used as a moderator to thermalize the fast neutron source Am-Be used in the experiment. CR-39 was used to detect fast neutrons and act as an albedo dosimeter when covered with a 10 B disc. Both TLD and CR-39 dosimeters were successful in detecting scattered neutrons in radiotherapy rooms.

Recent developments in phosphate materials for their thermoluminescence dosimeter (TLD) applications.

The use of phosphate-based thermoluminescence dosimeter (TLD) materials in current scenarios is presented here, particularly for the field of low dosimetry. TLD materials are currently researched for their use in for example environmental dosimetry, personal dosimetry, and medical dosimetry. There are several TLD materials available such as: sulphates, borates, fluorides, and sulphides, including some metal oxides and perovskites, which are the most used and have been widely explored. In the present scenario, new interest is being focused on the need for thermoluminescent materials for application in material science and radiation dosimetry for low-dose dosimetry. These doped TLDs are prepared using different techniques including solid-state reaction methods, combustion methods, wet chemical methods, and sol gel methods. Therefore, among the above stated TLDs, phosphates have opened a new door in radiation dosimetry, particularly in low-dose dosimetry over the last few years. This paper mainly deals with a review of various phosphate-based TLD materials and recent advancements in phosphates for TL dosimetry.

Multipoint Wave Measurement in Tuned Liquid Damper Using Laser Doppler Vibrometer and Stepwise Rotating Galvanometer Scanner.

Liquid dampers, such as tuned liquid dampers (TLDs), are employed to improve serviceability by reducing wind-affected building vibrations. In order to maximize the vibration suppression efficiency of the liquid damper, the tuning frequency of the liquid damper should match the natural frequency of the building. Experimental evaluation of the tuning frequency of a liquid damper performed in a factory prior to installation in a building is a critical task to ensure correct performance, and for this, multipoint measurement of the TLD is required. In this study, a novel liquid level measurement system combining Laser Doppler Vibrometer (LDV) and a stepwise rotating galvanometer scanner was developed to observe liquid sloshing in TLD. The proposed system can measure the liquid level at multiple points simultaneously with a single laser point. In the experimental phase, the liquid damper's natural frequency and mode shape are experimentally evaluated utilizing the developed system. The performance of the proposed system was verified by comparison with the video sensing system.

Skin dose measurement and estimating the dosimetric effect of applicator misplacement in gynecological brachytherapy: A patient and phantom study.

OBJECTIVES: To evaluate skin dose differences between TPS (treatment planning system) calculations and TLD (thermo-luminescent dosimeters) measurements along with the dosimetric effect of applicator misplacement for patients diagnosed with gynecological (GYN) cancers undergoing brachytherapy. METHODS: The skin doses were measured using TLDs attached in different locations on patients' skin in pelvic regions (anterior, left, and right) for 20 patients, as well as on a phantom. In addition, the applicator surface dose was calculated with TLDs attached to the applicator. The measured doses were compared with TPS calculations to find TPS accuracy. For the phantom, different applicator shifts were applied to find the effect of applicator misplacement on the surface dose. RESULTS: The mean absolute dose differences between the TPS and TLDs results for anterior, left, and right points were 3.14±1.03, 6.25±1.88, and 6.20±1.97 %, respectively. The mean difference on the applicator surface was obtained 1.92±0.46 %. Applicator misplacements of 0.5, 2, and 4 cm (average of three locations) resulted in 9, 36, and 61%, dose errors respectively. CONCLUSIONS: The surface/skin differences between the calculations and measurements are higher in the left and right regions, which relate to the higher uncertainty of TPS dose calculation in these regions. Furthermore, applicator misplacements can result in high skin dose variations, therefore it can be an appropriate quality assurance method for future research.

Thymineless Death Lives On: New Insights into a Classic Phenomenon.

The primary mechanisms by which bacteria lose viability when deprived of thymine have been elusive for over half a century. Early research focused on stalled replication forks and the deleterious effects of uracil incorporation into DNA from thymidine-deficient nucleotide pools. The initiation of the replication cycle and origin-proximal DNA degradation during thymine starvation have now been quantified via whole-genome microarrays and other approaches. These advances have fostered innovative models and informative experiments in bacteria since this topic was last reviewed. Given that thymineless death is similar in mammalian cells and that certain antibacterial and chemotherapeutic drugs elicit thymine deficiency, a mechanistic understanding of this phenomenon might have valuable biomedical applications.

A method for the simultaneous measurement of radon and thoron PAEC concentrations in air using a TLD monitor.

The idea of using a device with thermo-luminescent detectors (TLD) for the simultaneous measurement of radon (Rn-222) and thoron (Rn-220) decay products' concentrations was invented and developed in the Silesian Centre for Environmental Radioactivity at the Central Mining Institute, Katowice, Poland. The results of a preliminary analysis of the technical applicability, the required minimum period of air sampling and the optimised time schedule proved that such measurements can provide information about the potential alpha energy concentrations (PAECs) of radon and thoron decay products (TnDP).Following the analysis, preliminary measurements were performed at several locations-in a thoron chamber, in dwellings and even outdoors. Surprisingly, the maximum PAEC of the TnDP in the basement of a twin house in the Upper Silesia region was as high as 0.68 ± 0.15µJ m-3. This paper presents the results of those measurements.

The role of SSDL in quality assurance in radiotherapy.

This paper describes the role of the Polish Secondary Standard Dosimetry Laboratory (SSDL) in quality assurance in radiotherapy by means of providing calibration of ionisation chambers, TLD postal dosimetry audits and end-to-end audits for radiation therapy. A historical review of the methods and results are presented. The influence of the SSDL in Warsaw on radiation protection of patients in Poland is discussed. The International Atomic Energy Agency together with World Health Organisation (IAEA/WHO), through its network of SSDLs around the world, propagates newly developed methods for calibration and auditing. Suitable high quality equipment was provided by the IAEA, as well as special materials and technical support to the SSDL in Warsaw. The activity of the SSDL and the services provided for Polish radiotherapy centres have resulted in a reduction of discrepancies between planned doses and doses delivered to patients. The newly tested IAEA methods of end-to-end on-site dosimetry audits allow for monitoring and improving the quality of IMRT in Poland. The traceability of standards used for the calibration of therapy level dosimeters from Polish radiotherapy centres is assured by the IAEA dosimetry laboratory. The consistency of methods performed in the Polish SSDL with the ISO:17025 norm is supervised by the Polish Centre for Accreditation - a member of International Laboratory Accreditation Cooperation (ILAC), for calibration and testing. Due to the rapid technological development of radiotherapy, special attention has to be paid to newly developed methods for dosimetry auditing and institutions which provide services for assuring radiation safety of patients.

Absolute dose verification of static intensity modulated radiation therapy (IMRT) with ion chambers of various volumes and TLD detectors.

AIM: This study aims at examining absolute dose verification of step-and-shoot intensity modulated radiation treatment (IMRT) of prostate and brain patients by use of ion chambers of two different volumes and thermoluminescent detectors (TLD). BACKGROUND: The volume of the ion chamber (IC) is very important for absolute dose verification of IMRT plans since the IC has a volume average effect. With TLD detectors absolute dose verification can be done measuring the dose of multiple points simultaneously. MATERIALS AND METHODS: Ion chambers FC65-P of volume 0.65 cc and semiflex of volume 0.125 cc as well as TLDs were used to measure the central axis absolute dose of IMRT quality assurance (QA) plans. The results were compared with doses calculated by a treatment planning system (TPS). The absolute doses of off axis points located 2 cm and 4 cm away from the isocenter were measured with TLDs. RESULTS: The measurements of the 0.125 cc ion chamber were found to be closer to TPS calculations compared to the 0.65 cc ion chamber, for both patient groups. For both groups the root mean square (RMS) differences between doses of the TPS and the TLD detectors are within 3.0% for the central axis and points 2 cm away from the isocenter of each axis. Larger deviations were found at the field edges, which have steep dose gradient. CONCLUSIONS: The 0.125 cc ion chamber measures the absolute dose of the isocenter more accurately compared to the 0.65 cc chamber. TLDs have good accuracy (within 3.0%) for absolute dose measurements of in-field points.

The Impact of Inspiratory Flow Rate on Drug Delivery to the Lungs with Dry Powder Inhalers.

Current marketed dry powder inhalers utilize the energy from patient inspiration to fluidize and disperse bulk powder agglomerates into respirable particles. Variations in patient inspiratory flow profiles can lead to marked differences in total lung dose (TLD), and ultimately patient outcomes for an inhaled therapeutic. The present review aims to quantitate the flow rate dependence in TLD observed for a number of drug/device combinations using a new metric termed the Q index. With this data in hand, the review explores key attributes in the design of the formulation and device that impact flow rate dependence. The review also proposes alternative in vitro methods to assess flow rate dependence that more closely align with in vivo observations. Finally, the impact of variations in flow rate on lung function for inhaled bronchodilators is summarized.

TLD and OSLD dosimetry systems for remote audits of radiotherapy external beam calibration.

The Imaging and Radiation Oncology Core QA Center in Houston (IROC-H) performs remote dosimetry audits of more than 20,000 megavoltage photon and electron beams each year. Both a thermoluminescent dosimeter (TLD-100) and optically stimulated luminescent dosimeter (OSLD; nanoDot) system are commissioned for this task, with the OSLD system being predominant due to the more time-efficient read-out process. The measurement apparatus includes 3 TLD or 2 OSLD in an acrylic mini-phantom, which are irradiated by the institution under reference geometry. Dosimetry systems are calibrated based on the signal-to-dose conversion established with reference dosimeters irradiated in a Co-60 beam, using a reference dose of 300 cGy for TLD and 100 cGy for OSLD. The uncertainty in the dose determination is 1.3% for TLD and 1.6% for OSLD at the one sigma level. This accuracy allows for a tolerance of ±5% to be used.

Design and implementation of a "cheese" phantom-based Tomotherapy TLD dose intercomparison.

BACKGROUND: The unique beam-delivery technique of Tomotherapy machines (Accuray Inc., Sunnyvale, Calif.) necessitates tailored quality assurance. This requirement also applies to external dose intercomparisons. Therefore, the aim of the 2014 SSRMP (Swiss Society of Radiobiology and Medical Physics) dosimetry intercomparison was to compare two set-ups with different phantoms. MATERIALS AND METHODS: A small cylindrical Perspex phantom, which is similar to the IROC phantom (Imaging and Radiation Oncology Core, Houston, Tex.), and the "cheese" phantom, which is provided by the Tomotherapy manufacturer to all institutions, were used. The standard calibration plans for the TomoHelical and TomoDirect irradiation techniques were applied. These plans are routinely used for dose output calibration in Tomotherapy institutions. We tested 20 Tomotherapy machines in Germany and Switzerland. The ratio of the measured (Dm) to the calculated (Dc) dose was assessed for both phantoms and irradiation techniques. The Dm/Dc distributions were determined to compare the suitability of the measurement set-ups investigated. RESULTS: The standard deviations of the TLD-measured (thermoluminescent dosimetry) Dm/Dc ratios for the "cheese" phantom were 1.9 % for the TomoHelical (19 measurements) and 1.2 % (11 measurements) for the TomoDirect irradiation techniques. The corresponding ratios for the Perspex phantom were 2.8 % (18 measurements) and 1.8 % (11 measurements). CONCLUSION: Compared with the Perspex phantom-based set-up, the "cheese" phantom-based set-up without individual planning was demonstrated to be more suitable for Tomotherapy dose checks. Future SSRMP dosimetry intercomparisons for Tomotherapy machines will therefore be based on the "cheese" phantom set-up.