Experimentally determined three-dimensional dose distributions in small complex targets.

OBJECT: The purpose of the paper is to describe a workable three-dimensional dosimetry system for use in quality assurance programs of departments in which radiosurgery is performed. METHODS: A system was developed on the basis of radiochromatic films. The experimental findings of the measured dose distributions for small complex-shaped targets, within a specially designed phantom, are described and compared with the same parameters calculated from the corresponding dose plan. The following parameters were determined for 83 patients with irregularly shaped targets who underwent gamma knife radiosurgery (GKS): target volume; dose-volume histograms of the target; 12-Gy, 15-Gy, and 18-Gy volumes; dose plan conformity; dose fall profiles in all dimensions to 50% of the prescription dose; and a quality factor (QF) to evaluate the adequacy of a GKS plan or treatment. The precise function and accuracy of the developed measuring device is shown and it demonstrated the expected steep dose falloff outside the irregularly shaped targets in all directions. The dose falloff was of the order of > 3 Gy/mm and the values of the QF were in the range between 0.5 and 0.9. CONCLUSIONS: A comparison with data from the literature shows that at least for small targets (< 2 cm3 and < 2.5 cm3) simulated within a head phantom, the dose gradient is significantly steeper in all directions than when using alternative treatment devices in radiosurgery and the overall QF is superior in most of the cases.

[Quality assurance in stereotactic space. Determination of the accuracy of aim and dose in single dose radiosurgery]. / Qualitätssicherung im stereotaktischen RaumBestimmung der Genauigkeit von Ort und Dosis bei Ein-Zeit-Bestrahlungen.

BACKGROUND: Single dose irradiation techniques require methods of quality assurance of high precision. The complete operational sequence of a treatment from imaging over irradiation planning up to the patient irradiation has to be controlled and verified in a phantom (Figure 2). These demands receive special topicality by the E-DIN 6875-1 [38], which will appear soon. MATERIAL AND METHODS: A quality assurance package was developed to meet the requirements of the E-DIN 6875-1 [38]. It consists of versatile usable precision phantom (Figure 1), a dose measuring system for the tissue equivalent radiochromic film GAFCHROMIC trade mark type MD 55 II using a high-quality scanner, and a software for standardized test routines (Figures 2 to 4). Correction routines for film fog, darkening, temperature effect as well as for film inhomogeneities (double exposure technology) are implemented. RESULTS: The measuring system permits routine dosimetry with inaccuracies typically < 5%, for the double exposure procedure typically < 3% with local dissolutions of approx. 1/100 mm in film plane, perpendicularly to it the film stack density and the film thickness (0.3 mm) are determining. The measuring system is designed to simulate the complete three-dimensional treatment of a patient (Figure 4). CONCLUSIONS: The procedure achieves a high quality standard for all steps in radiosurgery. The simple handling permits the employment for the daily routine (according to E-DIN 6875-1 [38]), in addition, for the modelling of complicated 3-d of scattering conditions, e. g. close to risk structures.