Evaluation of silicon strip detectors in transmission mode for online beam monitoring in microbeam radiation therapy at the Australian Synchrotron.

Successful transition of synchrotron-based microbeam radiation therapy (MRT) from pre-clinical animal studies to human trials is dependent upon ensuring that there are sufficient and adequate measures in place for quality assurance purposes. Transmission detectors provide researchers and clinicians with a real-time quality assurance and beam-monitoring instrument to ensure safe and accurate dose delivery. In this work, the effect of transmission detectors of different thicknesses (10 and 375 µm) upon the photon energy spectra and dose deposition of spatially fractionated synchrotron radiation is quantified experimentally and by means of a dedicated Geant4 simulation study. The simulation and experimental results confirm that the presence of the 375 µm thick transmission detector results in an approximately 1-6% decrease in broad-beam and microbeam peak dose. The capability to account for the reduction in dose and change to the peak-to-valley dose ratio justifies the use of transmission detectors as thick as 375 µm in MRT provided that treatment planning systems are able to account for their presence. The simulation and experimental results confirm that the presence of the 10 µm thick transmission detector shows a negligible impact (<0.5%) on the photon energy spectra, dose delivery and microbeam structure for both broad-beam and microbeam cases. Whilst the use of 375 µm thick detectors would certainly be appropriate, based upon the idea of best practice the authors recommend that 10 µm thick transmission detectors of this sort be utilized as a real-time quality assurance and beam-monitoring tool during MRT.

Small spot size versus large spot size: Effect on plan quality for lung cancer in pencil beam scanning proton therapy.

PURPOSE: The purpose of the current study was to evaluate the impact of spot size on the interplay effect, plan robustness, and dose to the organs at risk for lung cancer plans in pencil beam scanning (PBS) proton therapy METHODS: The current retrospective study included 13 lung cancer patients. For each patient, small spot (∼3 mm) plans and large spot (∼8 mm) plans were generated. The Monte Carlo algorithm was used for both robust plan optimization and final dose calculations. Each plan was normalized, such that 99% of the clinical target volume (CTV) received 99% of the prescription dose. Interplay effect was evaluated for treatment delivery starting in two different breathing phases (T0 and T50). Plan robustness was investigated for 12 perturbed scenarios, which combined the isocenter shift and range uncertainty. The nominal and worst-case scenario (WCS) results were recorded for each treatment plan. Equivalent uniform dose (EUD) and normal tissue complication probability (NTCP) were evaluated for the total lung, heart, and esophagus. RESULTS: In comparison to large spot plans, the WCS values of small spot plans at CTV D95% , D96% , D97% , D98% , and D99% were higher with the average differences of 2.2% (range, 0.3%-3.7%), 2.3% (range, 0.5%-4.0%), 2.6% (range, 0.6%-4.4%), 2.7% (range, 0.9%-5.2%), and 2.7% (range, 0.3%-6.0%), respectively. The nominal and WCS mean dose and EUD for the esophagus, heart, and total lung were higher in large spot plans. The difference in NTCP between large spot and small spot plans was up to 1.9% for the total lung, up to 0.3% for the heart, and up to 32.8% for the esophagus. For robustness acceptance criteria of CTV D95% ≥ 98% of the prescription dose, seven small spot plans had all 12 perturbed scenarios meeting the criteria, whereas, for 13 large spot plans, there were ≥2 scenarios failing to meet the criteria. Interplay results showed that, on average, the target coverage in large spot plans was higher by 1.5% and 0.4% in non-volumetric and volumetric repainting plans, respectively. CONCLUSION: For robustly optimized PBS lung cancer plans in our study, a small spot machine resulted in a more robust CTV against the setup and range errors when compared to a large spot machine. In the absence of volumetric repainting, large spot PBS lung plans were more robust against the interplay effect. The use of a volumetric repainting technique in both small and large spot PBS lung plans led to comparable interplay target coverage.

Detection of rotational errors in single-isocenter multiple-target radiosurgery: Is a routine off-axis Winston-Lutz test necessary?

PURPOSE: Recently the use of linear accelerator (linac)-based stereotactic radiosurgery (SRS) has increased, including single-isocenter multiple-target SRS. The workload of medical physicists has grown as a result and so has the necessity of maximizing the efficiency of quality assurance (QA). This study aimed to determine if measurement-based patient-specific QA with a high-spatial-resolution dosimeter is sensitive to rotational errors, potentially reducing the need for routine off-axis Winston-Lutz (WL) testing. METHODS: The impact of rotational errors along gantry, couch, and collimator axes on dose coverage of the gross tumor volume (GTV) and planning target volume (PTV) was determined with a 1-mm GTV/PTV expansion margin. Two techniques, the off-axis WL test using the StereoPHAN MultiMet-WL Cube (Sun Nuclear Corporation, Melbourne, Florida, USA) and patient-specific QA using the SRS MapCHECK (Sun Nuclear Corporation, Melbourne, Florida, USA), were assessed on their ability to detect introduced errors before target coverage was compromised. These findings were also considered in the context of routine machine QA of rotational axis calibrations. RESULTS: Rotational errors significantly impacted PTV dose coverage, especially in the couch angle. GTV dose coverage remained unaffected except for with large couch angle errors (≥1.5°). The off-axis WL test was shown to be sensitive to rotational errors with results consistently exceeding tolerance levels when or before coverage fell below departmentally accepted limits. Although patient-specific QA using the SRS MapCHECK was previously validated for SRS, this study showed inconsistency in detection of rotational errors. CONCLUSIONS: It is recommended that off-axis WL testing be conducted regularly to supplement routine monthly machine QA, as it is sensitive to errors that patient-specific QA may not detect. This frequency should be determined by individual departments, with consideration of GTV-PTV margins used, limitations on target off-axis distances, and routine mechanical QA results for particular linacs.

Characterizing magnetically focused contamination electrons by off-axis irradiation on an inline MRI-Linac.

PURPOSE: The aim of this study is to investigate off-axis irradiation on the Australian MRI-Linac using experiments and Monte Carlo simulations. Simulations are used to verify experimental measurements and to determine the minimum offset distance required to separate electron contamination from the photon field. METHODS: Dosimetric measurements were performed using a microDiamond detector, Gafchromic® EBT3 film, and MOSkinTM . Three field sizes were investigated including 1.9 × 1.9, 5.8 × 5.8, and 9.7 × 9.6 cm2 . Each field was offset a maximum distance, approximately 10 cm, from the central magnetic axis (isocenter). Percentage depth doses (PDDs) were collected at a source-to-surface distance (SSD) of 1.8 m for fields collimated centrally and off-axis. PDD measurements were also acquired at isocenter for each off-axis field to measure electron contamination. Monte Carlo simulations were used to verify experimental measurements, determine the minimum field offset distance, and demonstrate the use of a spoiler to absorb electron contamination. RESULTS: Off-axis irradiation separates the majority of electron contamination from an x-ray beam and was found to significantly reduce in-field surface dose. For the 1.9 × 1.9, 5.8 × 5.8, and 9.7 × 9.6 cm2 field, surface dose was reduced from 120.9% to 24.9%, 229.7% to 39.2%, and 355.3% to 47.3%, respectively. Monte Carlo simulations generally were within experimental error to MOSkinTM and microDiamond, and used to determine the minimum offset distance, 2.1 cm, from the field edge to isocenter. A water spoiler 2 cm thick was shown to reduce electron contamination dose to near zero. CONCLUSIONS: Experimental and simulation data were acquired for a range of field sizes to investigate off-axis irradiation on an inline MRI-Linac. The skin sparing effect was observed with off-axis irradiation, a feature that cannot be achieved to the same extent with other methods, such as bolusing, for beams at isocenter.

Towards high spatial resolution tissue-equivalent dosimetry for microbeam radiation therapy using organic semiconductors.

Spatially fractionated ultra-high-dose-rate beams used during microbeam radiation therapy (MRT) have been shown to increase the differential response between normal and tumour tissue. Quality assurance of MRT requires a dosimeter that possesses tissue equivalence, high radiation tolerance and spatial resolution. This is currently an unsolved challenge. This work explored the use of a 500 nm thick organic semiconductor for MRT dosimetry on the Imaging and Medical Beamline at the Australian Synchrotron. Three beam filters were used to irradiate the device with peak energies of 48, 76 and 88 keV with respective dose rates of 3668, 500 and 209 Gy s-1. The response of the device stabilized to 30% efficiency after an irradiation dose of 30 kGy, with a 0.5% variation at doses of 35 kGy and higher. The calibration factor after pre-irradiation was determined to be 1.02 ±â€…0.005 µGy per count across all three X-ray energy spectra, demonstrating the unique advantage of using tissue-equivalent materials for dosimetry. The percentage depth dose curve was within ±5% of the PTW microDiamond detector. The broad beam was fractionated into 50 microbeams (50 µm FHWM and 400 µm centre-to-centre distance). For each beam filter, the FWHMs of all 50 microbeams were measured to be 51 ±â€…1.4, 53 ±â€…1.4 and 69 ±â€…1.9 µm, for the highest to lowest dose rate, respectively. The variation in response suggested the photodetector possessed dose-rate dependence. However, its ability to reconstruct the microbeam profile was affected by the presence of additional dose peaks adjacent to the one generated by the X-ray microbeam. Geant4 simulations proved that the additional peaks were due to optical photons generated in the barrier film coupled to the sensitive volume. The simulations also confirmed that the amplitude of the additional peak in comparison with the microbeam decreased for spectra with lower peak energies, as observed in the experimental data. The material packaging can be optimized during fabrication by solution processing onto a flexible substrate with a non-fluorescent barrier film. With these improvements, organic photodetectors show promising prospects as a cost-effective high spatial resolution tissue-equivalent flexible dosimeter for synchrotron radiation fields.

Impact of errors in spot size and spot position in robustly optimized pencil beam scanning proton-based stereotactic body radiation therapy (SBRT) lung plans.

PURPOSE: The purpose of the current study was threefold: (a) investigate the impact of the variations (errors) in spot sizes in robustly optimized pencil beam scanning (PBS) proton-based stereotactic body radiation therapy (SBRT) lung plans, (b) evaluate the impact of spot sizes and position errors simultaneously, and (c) assess the overall effect of spot size and position errors occurring simultaneously in conjunction with either setup or range errors. METHODS: In this retrospective study, computed tomography (CT) data set of five lung patients was selected. Treatment plans were regenerated for a total dose of 5000 cGy(RBE) in 5 fractions using a single-field optimization (SFO) technique. Monte Carlo was used for the plan optimization and final dose calculations. Nominal plans were normalized such that 99% of the clinical target volume (CTV) received the prescription dose. The analysis was divided into three groups. Group 1: The increasing and decreasing spot sizes were evaluated for ±10%, ±15%, and ±20% errors. Group 2: Errors in spot size and spot positions were evaluated simultaneously (spot size: ±10%; spot position: ±1 and ±2 mm). Group 3: Simulated plans from Group 2 were evaluated for the setup (±5 mm) and range (±3.5%) errors. RESULTS: Group 1: For the spot size errors of ±10%, the average reduction in D99% for -10% and +10% errors was 0.7% and 1.1%, respectively. For -15% and +15% spot size errors, the average reduction in D99% was 1.4% and 1.9%, respectively. The average reduction in D99% was 2.1% for -20% error and 2.8% for +20% error. The hot spot evaluation showed that, for the same magnitude of error, the decreasing spot sizes resulted in a positive difference (hotter plan) when compared with the increasing spot sizes. Group 2: For a 10% increase in spot size in conjunction with a -1 mm (+1 mm) shift in spot position, the average reduction in D99% was 1.5% (1.8%). For a 10% decrease in spot size in conjunction with a -1 mm (+1 mm) shift in spot position, the reduction in D99% was 0.8% (0.9%). For the spot size errors of ±10% and spot position errors of ±2 mm, the average reduction in D99% was 2.4%. Group 3: Based on the results from 160 plans (4 plans for spot size [±10%] and position [±1 mm] errors × 8 scenarios × 5 patients), the average D99% was 4748 cGy(RBE) with the average reduction of 5.0%. The isocentric shift in the superior-inferior direction yielded the least homogenous dose distributions inside the target volume. CONCLUSION: The increasing spot sizes resulted in decreased target coverage and dose homogeneity. Similarly, the decreasing spot sizes led to a loss of target coverage, overdosage, and degradation of dose homogeneity. The addition of spot size and position errors to plan robustness parameters (setup and range uncertainties) increased the target coverage loss and decreased the dose homogeneity.

Investigating volumetric repainting to mitigate interplay effect on 4D robustly optimized lung cancer plans in pencil beam scanning proton therapy.

PURPOSE: The interplay effect between dynamic pencil proton beams and motion of the lung tumor presents a challenge in treating lung cancer patients in pencil beam scanning (PBS) proton therapy. The main purpose of the current study was to investigate the interplay effect on the volumetric repainting lung plans with beam delivery in alternating order ("down" and "up" directions), and explore the number of volumetric repaintings needed to achieve acceptable lung cancer PBS proton plan. METHOD: The current retrospective study included ten lung cancer patients. The total dose prescription to the clinical target volume (CTV) was 70 Gy(RBE) with a fractional dose of 2 Gy(RBE). All treatment plans were robustly optimized on all ten phases in the 4DCT data set. The Monte Carlo algorithm was used for the 4D robust optimization, as well as for the final dose calculation. The interplay effect was evaluated for both the nominal (i.e., without repainting) as well as volumetric repainting plans. The interplay evaluation was carried out for each of the ten different phases as the starting phases. Several dosimetric metrics were included to evaluate the worst-case scenario (WCS) and bandwidth based on the results obtained from treatment delivery starting in ten different breathing phases. RESULTS: The number of repaintings needed to meet the criteria 1 (CR1) of target coverage (D95%  ≥ 98% and D99%  ≥ 97%) ranged from 2 to 10. The number of repaintings needed to meet the CR1 of maximum dose (ΔD1%  < 1.5%) ranged from 2 to 7. Similarly, the number of repaintings needed to meet CR1 of homogeneity index (ΔHI < 0.03) ranged from 3 to 10. For the target coverage region, the number of repaintings needed to meet CR1 of bandwidth (<100 cGy) ranged from 3 to 10, whereas for the high-dose region, the number of repaintings needed to meet CR1 of bandwidth (<100 cGy) ranged from 1 to 7. Based on the overall plan evaluation criteria proposed in the current study, acceptable plans were achieved for nine patients, whereas one patient had acceptable plan with a minor deviation. CONCLUSION: The number of repaintings required to mitigate the interplay effect in PBS lung cancer (tumor motion < 15 mm) was found to be highly patient dependent. For the volumetric repainting with an alternating order, a patient-specific interplay evaluation strategy must be adopted. Determining the optimal number of repaintings based on the bandwidth and WCS approach could mitigate the interplay effect in PBS lung cancer treatment.

Consistency of small-field dosimetry, on and off axis, in beam-matched linacs used for stereotactic radiosurgery.

PURPOSE: Stereotactic radiosurgery (SRS) can be delivered with a standard linear accelerator (linac). At institutions having more than one linac, beam matching is common practice. In the literature, there are indications that machine central axis (CAX) matching for broad fields does not guarantee matching of small fields with side ≤2 cm. There is no indication on how matching for broad fields on axis translates to matching small fields off axis. These are of interest to multitarget single-isocenter (MTSI) SRS planning and the present work addresses that gap in the literature. METHODS: We used 6 MV flattening filter free (FFF) beams from four Elekta VersaHD® linacs equipped with an Agility™ multileaf collimator (MLC). The linacs were strictly matched for broad fields on CAX. We compared output factors (OPFs) and effective field size, measured concurrently using a novel 2D solid-state dosimeter "Duo" with a spatial resolution of 0.2 mm, in square and rectangular static fields with sides from 0.5 to 2 cm, either on axis or away from it by 5 to 15 cm. RESULTS: Among the four linacs, OPF for fields ≥1 × 1 cm2 ranged 1.3% on CAX, whereas off axis a maximum range of 1.9% was observed at 15 cm. A larger variability in OPF was noted for the 0.5 × 0.5 cm2 field, with a range of 5.9% on CAX, which improved to a maximum of 2.3% moving off axis. Two linacs showed greater consistency with a range of 1.4% on CAX and 2.2% at 15 cm off axis. Between linacs, the effective field size varied by <0.04 cm in most cases, both on and off axis. Tighter matching was observed for linacs with a similar focal spot position. CONCLUSIONS: Verification of small-field consistency for matched linacs used for SRS is an important task for dosimetric validation. A significant benefit of concurrent measurement of field size and OPF allowed for a comprehensive assessment using a novel diode array. Our study showed the four linacs, strictly matched for broad fields on CAX, were still matched down to a field size of 1 x 1 cm2 on and off axis.

The use of collimator angle optimization and jaw tracking for VMAT-based single-isocenter multiple-target stereotactic radiosurgery for up to six targets in the Varian Eclipse treatment planning system.

PURPOSE: Island blocking occurs in single-isocenter multiple-target (SIMT) stereotactic radiotherapy (SRS) whenever targets share multi-leaf collimator (MLC) leaf pairs. This study investigated the effect on plan quality and delivery, of reducing island blocking through collimator angle optimization (CAO). In addition, the effect of jaw tracking in this context was also investigated. METHODS: For CAO, an algorithm was created that selects the collimator angle resulting in the lowest level of island blocking, for each beam in any given plan. Then, four volume-modulated arc therapy (VMAT) SIMT SRS plans each were generated for 10 retrospective patients: two CAO plans, with and without jaw tracking, and two plans with manually selected collimator angles, with and without jaw tracking. Plans were then assessed and compared using typical quality assurance procedures. RESULTS: There were no substantial differences between plans with and without CAO. Jaw tracking produced statistically significant reduction in low-dose level parameters; healthy brain V10% and mean dose were reduced by 9.66% and 15.58%, respectively. However, quantitative values (108 cc for V10% and 0.35 Gy for mean dose) were relatively small in relation to clinical relevance. Though there were no statistically significant changes in plan deliverability, there was a notable trend of plans with jaw tracking having lower gamma analysis pass rates. CONCLUSION: These findings suggest that CAO has limited benefit in VMAT SIMT SRS of 2-6 targets when using a low-dose penalty to the healthy brain during plan optimization in Eclipse. As clinical benefits of jaw tracking were found to be minimal and plan deliverability was potentially reduced, a cautious approach would be to exclude jaw tracking in SIMT SRS plans.

Impact of magnetic field regulation in conjunction with the volumetric repainting technique on the spot positions and beam range in pencil beam scanning proton therapy.

PURPOSE: The objective of this study was to evaluate the impact of the magnetic field regulation in conjunction with the volumetric repainting technique on the spot positions and range in pencil beam scanning proton therapy. METHODS: "Field regulation" - a feature to reduce the switching time between layers by applying a magnetic field setpoint (instead of a current setpoint) has been implemented on the proton beam delivery system at the Miami Cancer Institute. To investigate the impact of field regulation for the volumetric repainting technique, several spot maps were generated with beam delivery sequence in both directions, that is, irradiating from the deepest layer to the most proximal layer ("down" direction) as well as irradiating from the most proximal layer to the deepest layer ("up" direction). Range measurements were performed using a multi-layer ionization chamber array. Spot positions were measured using two-dimensional and three-dimensional scintillation detectors. For range and central-axis spot position, spot maps were delivered for energies ranging from 70-225 MeV. For off-axis spot positions, the maps were delivered for high-, medium, and low-energies at eight different gantry angles. The results were then compared between the "up" and "down" directions. RESULTS: The average difference in range for given energy between "up" and "down" directions was 0.0 ± 0.1 mm. The off-axis spot position results showed that 846/864 of the spots were within ±1 mm, and all off-axis spot positions were within ±1.2 mm. For spots (n = 126) at the isocenter, the evaluation between "up" and "down" directions for given energy showed the spot position difference within ±0.25 mm. At the nozzle entrance, the average differences in X and Y positions for given energy were 0.0 ± 0.2 mm and -0.0 ± 0.4 mm, respectively. At the nozzle exit, the average differences in X and Y positions for given energy were 0.0 ± 0.1 mm and -0.1 ± 0.1 mm, respectively. CONCLUSION: The volumetric repainting technique in magnetic field regulation mode resulted in acceptable spot position and range differences for our beam delivery system. The range differences were found to be within ±1 mm (TG224). For the spot positions (TG224: ±1 mm), the central axis measurements were within ±1 mm, whereas for the off-axis measurements, 97.9% of the spots were within ±1 mm, and all spots were within ±1.2 mm.

Evaluation of the PTW microDiamond in edge-on orientation for dosimetry in small fields.

PURPOSE: The PTW microDiamond has an enhanced spatial resolution when operated in an edge-on orientation but is not typically utilized in this orientation due to the specifications of the IAEA TRS-483 code of practice for small field dosimetry. In this work the suitability of an edge-on orientation and advantages over the recommended face-on orientation will be presented. METHODS: The PTW microDiamond in both orientations was compared on a Varian TrueBeam linac for: machine output factor (OF), percentage depth dose (PDD), and beam profile measurements from 10 × 10 cm2 to a 0.5 × 0.5 cm2 field size for 6X and 6FFF beam energies in a water tank. A quantification of the stem effect was performed in edge-on orientation along with tissue to phantom ratio (TPR) measurements. An extensive angular dependence study for the two orientations was also undertaken within two custom PMMA plastic cylindrical phantoms. RESULTS: The OF of the PTW microDiamond in both orientations agrees within 1% down to the 2 × 2 cm2 field size. The edge-on orientation overresponds in the build-up region but provides improved penumbra and has a maximum observed stem effect of 1%. In the edge-on orientation there is an angular independent response with a maximum of 2% variation down to a 2 × 2 cm2 field. The PTW microDiamond in edge-on orientation for TPR measurements agreed to the CC01 ionization chamber within 1% for all field sizes. CONCLUSIONS: The microDiamond was shown to be suitable for small field dosimetry when operated in edge-on orientation. When edge-on, a significantly reduced angular dependence is observed with no significant stem effect, making it a more versatile QA instrument for rotational delivery techniques.

Two-dimensional solid-state array detectors: A technique for in vivo dose verification in a variable effective area.

PURPOSE: We introduce a technique that employs a 2D detector in transmission mode (TM) to verify dose maps at a depth of dmax in Solid Water. TM measurements, when taken at a different surface-to-detector distance (SDD), allow for the area at dmax (in which the dose map is calculated) to be adjusted. METHODS: We considered the detector prototype "MP512" (an array of 512 diode-sensitive volumes, 2 mm spatial resolution). Measurements in transmission mode were taken at SDDs in the range from 0.3 to 24 cm. Dose mode (DM) measurements were made at dmax in Solid Water. We considered radiation fields in the range from 2 × 2 cm2 to 10 × 10 cm2 , produced by 6 MV flattened photon beams; we derived a relationship between DM and TM measurements as a function of SDD and field size. The relationship was used to calculate, from TM measurements at 4 and 24 cm SDD, dose maps at dmax in fields of 1 × 1 cm2 and 4 × 4 cm2 , and in IMRT fields. Calculations were cross-checked (gamma analysis) with the treatment planning system and with measurements (MP512, films, ionization chamber). RESULTS: In the square fields, calculations agreed with measurements to within ±2.36%. In the IMRT fields, using acceptance criteria of 3%/3 mm, 2%/2 mm, 1%/1 mm, calculations had respective gamma passing rates greater than 96.89%, 90.50%, 62.20% (for a 4 cm SSD); and greater than 97.22%, 93.80%, 59.00% (for a 24 cm SSD). Lower rates (1%/1 mm criterion) can be explained by submillimeter misalignments, dose averaging in calculations, noise artifacts in film dosimetry. CONCLUSIONS: It is possible to perform TM measurements at the SSD which produces the best fit between the area at dmax in which the dose map is calculated and the size of the monitored target.

Quality assurance of Cyberknife robotic stereotactic radiosurgery using an angularly independent silicon detector.

PURPOSE: The aim of this work was to evaluate the use of an angularly independent silicon detector (edgeless diodes) developed for dosimetry in megavoltage radiotherapy for Cyberknife in a phantom and for patient quality assurance (QA). METHOD: The characterization of the edgeless diodes has been performed on Cyberknife with fixed and IRIS collimators. The edgeless diode probes were tested in terms of basic QA parameters such as measurements of tissue-phantom ratio (TPR), output factor and off-axis ratio. The measurements were performed in both water and water-equivalent phantoms. In addition, three patient-specific plans have been delivered to a lung phantom with and without motion and dose measurements have been performed to verify the ability of the diodes to work as patient-specific QA devices. The data obtained by the edgeless diodes have been compared to PTW 60016, SN edge, PinPoint ionization chamber, Gafchromic EBT3 film, and treatment planning system (TPS). RESULTS: The TPR measurement performed by the edgeless diodes show agreement within 2.2% with data obtained with PTW 60016 diode for all the field sizes. Output factor agrees within 2.6% with that measured by SN EDGE diodes corrected for their field size dependence. The beam profiles' measurements of edgeless diodes match SN EDGE diodes with a measured full width half maximum (FWHM) within 2.3% and penumbra widths within 0.148 mm. Patient-specific QA measurements demonstrate an agreement within 4.72% in comparison with TPS. CONCLUSION: The edgeless diodes have been proved to be an excellent candidate for machine and patient QA for Cyberknife reproducing commercial dosimetry device measurements without need of angular dependence corrections. However, further investigation is required to evaluate the effect of their dose rate dependence on complex brain cancer dose verification.

Synchrotron X-ray microbeam dosimetry with a 20†micrometre resolution scintillator fibre-optic dosimeter.

Cancer is one of the leading causes of death worldwide. External beam radiation therapy is one of the most important modalities for the treatment of cancers. Synchrotron microbeam radiation therapy (MRT) is a novel pre-clinical therapy that uses highly spatially fractionated X-ray beams to target tumours, allowing doses much higher than conventional radiotherapies to be delivered. A dosimeter with a high spatial resolution is required to provide the appropriate quality assurance for MRT. This work presents a plastic scintillator fibre optic dosimeter with a one-dimensional spatial resolution of 20 µm, an improvement on the dosimeter with a resolution of 50 µm that was demonstrated in previous work. The ability of this probe to resolve microbeams of width 50 µm has been demonstrated. The major limitations of this method were identified, most notably the low-light signal resulting from the small sensitive volume, which made valley dose measurements very challenging. A titanium-based reflective paint was used as a coating on the probe to improve the light collection, but a possible effect of the high-Z material on the probes water-equivalence has been identified. The effect of the reflective paint was a 28.5 ±â€…4.6% increase in the total light collected; it did not affect the shape of the depth-dose profile, nor did it explain an over-response observed when used to probe at low depths, when compared with an ionization chamber. With improvements to the data acquisition, this probe design has the potential to provide a water-equivalent, inexpensive dosimetry tool for MRT.

HDR brachytherapy in vivo source position verification using a 2D diode array: A Monte Carlo study.

PURPOSE: This study aims to assess the accuracy of source position verification during high-dose rate (HDR) prostate brachytherapy using a novel, in-house developed two-dimensional (2D) diode array (the Magic Plate), embedded exactly below the patient within a carbon fiber couch. The effect of tissue inhomogeneities on source localization accuracy is examined. METHOD: Monte Carlo (MC) simulations of 12 source positions from a HDR prostate brachytherapy treatment were performed using the Geant4 toolkit. An Ir-192 Flexisource (Isodose Control, Veenendaal, the Netherlands) was simulated inside a voxelized patient geometry, and the dose deposited in each detector of the Magic Plate evaluated. The dose deposited in each detector was then used to localize the source position using a proprietary reconstruction algorithm. RESULTS: The accuracy of source position verification using the Magic Plate embedded in the patient couch was found to be affected by the tissue inhomogeneities within the patient, with an average difference of 2.1 ± 0.8 mm (k = 1) between the Magic Plate predicted and known source positions. Recalculation of the simulations with all voxels assigned a density of water improved this verification accuracy to within 1 mm. CONCLUSION: Source position verification using the Magic Plate during a HDR prostate brachytherapy treatment was examined using MC simulations. In a homogenous geometry (water), the Magic Plate was able to localize the source to within 1 mm, however, the verification accuracy was negatively affected by inhomogeneities; this can be corrected for by using density information obtained from CT, making the proposed tool attractive for use as a real-time in vivo quality assurance (QA) device in HDR brachytherapy for prostate cancer.

"Characterization of ELEKTA SRS cone collimator using high spatial resolution monolithic silicon detector array".

PURPOSE: To investigate the accuracy of the dosimetry of radiation fields produced by small ELEKTA cone collimators used for stereotactic radiosurgery treatments (SRS) using commercially available detectors EBT3 GafchromicTM film, IBA Stereotactic diode (SFD), and the recently developed detector DUO, which is a monolithic silicon orthogonal linear diode array detector. METHODS: These three detectors were used for the measurement of beam profiles, output factors, and percentage depth dose for SRS cone collimators with cone sizes ranging from 5 to 50 mm diameter. The measurements were performed at 10 cm depth and 90 cm SSD. RESULTS: The SRS cone beam profiles measured with DUO, EBT3 film, and IBA SFD agreed well, results being in agreement within ±0.5 mm in the FWHM, and ±0.7 mm in the penumbra region. The output factor measured by DUO with 0.5 mm air gap above agrees within ±1% with EBT3. The OF measured by IBA SFD (corrected for the over-response) agreed with both EBT3 and DUO within ±2%. All three detectors agree within ±2% for PDD measurements for all SRS cones. CONCLUSIONS: The characteristics of the ELEKTA SRS cone collimator have been evaluated by using a monolithic silicon high spatial resolution detector DUO, EBT3, and IBA SFD diode. The DUO detector is suitable for fast real-time quality assurance dosimetry in small radiation fields typical for SRS/SRT. This has been demonstrated by its good agreement of measured doses with EBT 3 films.

CyberKnife® fixed cone and Iris™ defined small radiation fields: Assessment with a high-resolution solid-state detector array.

PURPOSE: The challenges of accurate dosimetry for stereotactic radiotherapy (SRT) with small unflattened radiation fields have been widely reported in the literature. In this case, suitable dosimeters would have to offer a submillimeter spatial resolution. The CyberKnife® (Accuray Inc., Sunnyvale, CA, USA) is an SRT-dedicated linear accelerator (linac), which can deliver treatments with submillimeter positional accuracy using circular fields. Beams are delivered with the desired field size using fixed cones, the InCise™ multileaf collimator or a dynamic variable-aperture Iris™ collimator. The latter, allowing for field sizes to be varied during treatment delivery, has the potential to decrease treatment time, but its reproducibility in terms of output factors (OFs) and dose profiles (DPs) needs to be verified. METHODS: A 2D monolithic silicon array detector, the "Octa", was evaluated for dosimetric quality assurance (QA) for a CyberKnife system. OFs, DPs, percentage depth-dose (PDD) and tissue maximum ratio (TMR) were investigated, and results were benchmarked against the PTW SRS diode. Cross-plane, in-plane and 2 diagonal dose profiles were measured simultaneously with high spatial resolution (0.3 mm). Monte Carlo (MC) simulations with a GEANT4 (GEometry ANd Tracking 4) tool-kit were added to the study to support the experimental characterization of the detector response. RESULTS: For fixed cones and the Iris, for all field sizes investigated in the range between 5 and 60 mm diameter, OFs, PDDs, TMRs, and DPs in terms of FWHM measured by the Octa were accurate within 3% when benchmarked against the SRS diode and MC calculations. CONCLUSIONS: The Octa was shown to be an accurate dosimeter for measurements with a 6 MV FFF beam delivered with a CyberKnife system. The detector enabled real-time dosimetric verification for the variable aperture Iris collimator, yielding OFs and DPs consistent with those obtained with alternative methods.

Real-time high spatial resolution dose verification in stereotactic motion adaptive arc radiotherapy.

PURPOSE: Radiation treatments delivered with real-time multileaf collimator (MLC) tracking currently lack fast pretreatment or real-time quality assurance. The purpose of this study is to test a 2D silicon detector, MagicPlate-512 (MP512), in a complex clinical environment involving real-time reconfiguration of the MLC leaves during target tracking. METHODS: MP512 was placed in the center of a solid water phantom and mounted on a motion platform used to simulate three different patient motions. Electromagnetic target tracking was implemented using the Calypso system (Varian Medical Systems, Palo Alto, CA, USA) and an MLC tracking software. A two-arc VMAT plan was delivered and 2D dose distributions were reconstructed by MP512, EBT3 film, and the Eclipse treatment planning system (TPS). Dose maps were compared using gamma analysis with 2%/2 mm and 3%/3 mm acceptance criteria. Dose profiles were generated in sup-inf and lateral directions to show the agreement of MP512 to EBT3 and to highlight the efficacy of the MLC tracking system in mitigating the effect of the simulated patient motion. RESULTS: Using a 3%/3 mm acceptance criterion for 2D gamma analysis, MP512 to EBT3 film agreement was 99% and MP512 to TPS agreement was 100%. For a 2%/2 mm criterion, the agreement was 95% and 98%, respectively. Full width at half maximum and 80%/20% penumbral width of the MP512 and EBT3 dose profiles agreed within 1 mm and 0.5 mm, respectively. Patient motion increased the measured dose profile penumbral width by nearly 2 mm (with respect to the no-motion case); however, the MLC tracking strategy was able to mitigate 80% of this effect. CONCLUSIONS: MP512 is capable of high spatial resolution 2D dose reconstruction during adaptive MLC tracking, including arc deliveries. It shows potential as an effective tool for 2D small field dosimetry and pretreatment quality assurance for MLC tracking modalities. These results provide confidence that detector-based pretreatment dosimetry is clinically feasible despite fast real-time MLC reconfigurations.

Comparison of phantom materials for use in quality assurance of microbeam radiation therapy.

Microbeam radiation therapy (MRT) is a promising radiotherapy modality that uses arrays of spatially fractionated micrometre-sized beams of synchrotron radiation to irradiate tumours. Routine dosimetry quality assurance (QA) prior to treatment is necessary to identify any changes in beam condition from the treatment plan, and is undertaken using solid homogeneous phantoms. Solid phantoms are designed for, and routinely used in, megavoltage X-ray beam radiation therapy. These solid phantoms are not necessarily designed to be water-equivalent at low X-ray energies, and therefore may not be suitable for MRT QA. This work quantitatively determines the most appropriate solid phantom to use in dosimetric MRT QA. Simulated dose profiles of various phantom materials were compared with those calculated in water under the same conditions. The phantoms under consideration were RMI457 Solid Water (Gammex-RMI, Middleton, WI, USA), Plastic Water (CIRS, Norfolk, VA, USA), Plastic Water DT (CIRS, Norfolk, VA, USA), PAGAT (CIRS, Norfolk, VA, USA), RW3 Solid Phantom (PTW Freiburg, Freiburg, Germany), PMMA, Virtual Water (Med-Cal, Verona, WI, USA) and Perspex. RMI457 Solid Water and Virtual Water were found to be the best approximations for water in MRT dosimetry (within ±3% deviation in peak and 6% in valley). RW3 and Plastic Water DT approximate the relative dose distribution in water (within ±3% deviation in the peak and 5% in the valley). PAGAT, PMMA, Perspex and Plastic Water are not recommended to be used as phantoms for MRT QA, due to dosimetric discrepancies greater than 5%.

X-Tream quality assurance in synchrotron X-ray microbeam radiation therapy.

Microbeam radiation therapy (MRT) is a novel irradiation technique for brain tumours treatment currently under development at the European Synchrotron Radiation Facility in Grenoble, France. The technique is based on the spatial fractionation of a highly brilliant synchrotron X-ray beam into an array of microbeams using a multi-slit collimator (MSC). After promising pre-clinical results, veterinary trials have recently commenced requiring the need for dedicated quality assurance (QA) procedures. The quality of MRT treatment demands reproducible and precise spatial fractionation of the incoming synchrotron beam. The intensity profile of the microbeams must also be quickly and quantitatively characterized prior to each treatment for comparison with that used for input to the dose-planning calculations. The Centre for Medical Radiation Physics (University of Wollongong, Australia) has developed an X-ray treatment monitoring system (X-Tream) which incorporates a high-spatial-resolution silicon strip detector (SSD) specifically designed for MRT. In-air measurements of the horizontal profile of the intrinsic microbeam X-ray field in order to determine the relative intensity of each microbeam are presented, and the alignment of the MSC is also assessed. The results show that the SSD is able to resolve individual microbeams which therefore provides invaluable QA of the horizontal field size and microbeam number and shape. They also demonstrate that the SSD used in the X-Tream system is very sensitive to any small misalignment of the MSC. In order to allow as rapid QA as possible, a fast alignment procedure of the SSD based on X-ray imaging with a low-intensity low-energy beam has been developed and is presented in this publication.