Purpose The model used to calculate dose distributions in a radiotherapy treatment plan relies on the data entered during beam commissioning. The quality of these data heavily depends on the detector choice made, especially in small fields and in the buildup region. Therefore, it is necessary to identify suitable detectors for measurements in the buildup region of small fields. To aid the understanding of a detector's limitations, several factors that influence the detector signal are to be analyzed, for example, the volume effect due to the detector size, the response to electron contamination, the signal dependence on the polarity used, and the effective point of measurement chosen. Methods We tested the suitability of different small field detectors for measurements of depth dose curves with a special focus on the surface‐near area of dose buildup for fields sized between 10 × 10 and 0.6 × 0.6 cm2. Depth dose curves were measured with 14 different detectors including plane‐parallel chambers, thimble chambers of different types and sizes, shielded and unshielded diodes as well as a diamond detector. Those curves were compared with depth dose curves acquired on Gafchromic film. Additionally, the magnitude of geometric volume corrections was estimated from film profiles in different depths. Furthermore, a lead foil was inserted into the beam to reduce contaminating electrons and to study the resulting changes of the detector response. The role of the effective point of measurement was investigated by quantifying the changes occurring when shifting depth dose curves. Last, measurements for the small ionization chambers taken at opposing biasing voltages were compared to study polarity effects. Results Depth‐dependent correction factors for relative depth dose curves with different detectors were derived. Film, the Farmer chamber FC23, a 0.13 cm3 scanning chamber CC13 and a plane‐parallel chamber PPC05 agree very well in fields sized 4 × 4 and 10 × 10 cm2. For most detectors and in smaller fields, depth dose curves differ from the film. In general, shielded diodes require larger corrections than unshielded diodes. Neither the geometric volume effect nor the electron contamination can account for the detector differences. The biggest uncertainty arises from the positioning of a detector with respect to the water surface and from the choice of the detector's effective point of measurement. Depth dose curves acquired with small ionization chambers differ by over 15% in the buildup region depending on sign of the biasing voltage used. Conclusions A scanning chamber or a PPC40 chamber is suitable for fields larger than 4 × 4 cm2. Below that field size, the microDiamond or small ionization chambers perform best requiring the smallest corrections at depth as well as in the buildup region. Diode response changes considerably between the different types of detectors. The position of the effective point of measurement has a huge effect on the resulting curves, therefore detector specific rather than general shifts of half th...

PurposeInvestigation of a reduced source to target distance to improve organ at risk sparing during stereotactic irradiation (STX).MethodsThe authors present a planning study with perfectly target-volume adapted collimator compared with multi-leaf collimator (MLC) at reduced source to virtual isocentre distance (SVID) in contrast to normal source to isocentre distance (SID) for stereotactic applications. The role of MLC leaf width and 20–80% penumbra was examined concerning the healthy tissue sparing. Several prescription schemes and target diameters are considered.ResultsPaddick’s gradient index (GI) as well as comparison of the mean doses to spherical shells at several distances to the target is evaluated. Both emphasize the same results: the healthy tissue sparing in the high dose area around the planning target volume (PTV) is improved at reduced SVID ≤ 70 cm. The effect can be attributed more to steeper penumbra than to finer leaf resolution. Comparing circular collimators at different SVID just as MLC-shaped collimators, always the GI was reduced. Even MLC-shaped collimator at SVID 70 cm had better healthy tissue sparing than an optimal shaped circular collimator at SID 100 cm.Regarding penumbra changes due to varying SVID, the results of the planning study are underlined by film dosimetry measurements with Agility™ MLC.ConclusionPenumbra requires more attention in comparing studies, especially studies using different planning systems. Reduced SVID probably allows usage of conventional MLC for STX-like irradiations.Electronic supplementary materialThe online version of this article (doi:10.1186/s13014-017-0826-8) contains supplementary material, which is available to authorized users.

Purpose: The conventional plan verification strategy is delivering a plan to a QA‐phantom before the first treatment. Monitoring each fraction of the patient treatment in real‐time would improve patient safety. We evaluated how well a new detector, the IQM (iRT Systems, Germany), is capable of detecting errors we induced into IMRT plans of three different treatment regions. Results were compared to an established phantom. Methods: Clinical plans of a brain, prostate and head‐and‐neck patient were modified in the Pinnacle planning system, such that they resulted in either several percent lower prescribed doses to the target volume or several percent higher doses to relevant organs at risk. Unaltered plans were measured on three days, modified plans once, each with the IQM at an Elekta Synergy with an Agility MLC. All plans were also measured with the ArcCHECK with the cavity plug and a PTW semiflex 31010 ionization chamber inserted. Measurements were evaluated with SNC patient software. Results: Repeated IQM measurements of the original plans were reproducible, such that a 1% deviation from the mean as warning and 3% as action level as suggested by the manufacturer seemed reasonable. The IQM detected most of the simulated errors including wrong energy, a faulty leaf, wrong trial exported and a 2 mm shift of one leaf bank. Detection limits were reached for two plans ‐ a 2 mm field position error and a leaf bank offset combined with an MU change. ArcCHECK evaluation according to our current standards also left undetected errors. Ionization chamber evaluation alone would leave most errors undetected. Conclusion: The IQM detected most errors and performed as well as currently established phantoms with the advantage that it can be used throughout the whole treatment. Drawback is that it does not indicate the source of the error.

For stereotactic irradiation, both, penumbra and MLC leaf width make an impact on the sparing of healthy tissue around the target. Mostly, MLC design is regarded as the one influenceable parameter. However, also penumbra can be varied by choosing different distances between the source of radiation and the patient. The authors investigate the distance-dependent penumbra effects of idealized collimators as well as for real 5 mm MLCs. Test objects are small spherical targets of varying diameters to be irradiated under differing prescription conditions. A method to calculate exact stereotactic radial dose distributions from beam profiles or 2D dose distributions of single beams is developed for circular and MLC shaped targets. Also, a planning study is performed using a Pinnacle3™ planning system. Also, in a theoretical analysis perfect top hat profile beams and beams with varying penumbra are compared for better understanding of penumbra effects with respect to radial dose distributions. It is shown, that the penumbra changes for small targets are more relevant than the beam shaping by 5 mm MLCs. Quasi-isotropic irradiated MLC shaped (quadratic) beams at virtual SAD 700 mm produce steeper radial dose decrease than ideal circular beam shapes with a penumbra typical for SAD 1000 mm. A reduced source-to-patient distance allows better sparing of healthy tissue because of two reasons: The smaller effective leaf width but even more due to steeper penumbra. First, the authors suggest for future recommendations on stereotactic irradiations to specify not only MLC widths but also penumbra characteristics. Second, a so-called "virtual isocentre" could be useful to take advantage of the penumbra effect: Dependent on gantry angle and isocentric couch angle, the couch should be steered automatically in a way that the central axes of all beams always intersect in the same point at the same distance from the source.