Abbreviations: %dd(10) x , The photon component of the percent depth dose at 10 cm depth in water for a 10 cm 2 × 10 cm 2 field; L∕ w air , Restricted mass collision stopping power ratio of water to air; en ∕ , Spectrum-averaged mass energy-absorption coefficient; AAPM, American Association of Physicists in Medicine; CPE, Charged Particle Equilibrium; DLG, Dosimetric leaf gap; D f msr w,Q msr , Absorbed dose to water at the reference depth z ref in water in the absence of the detector in a field specified by f msr and beam quality Q msr .; f clin , Clinical (clin) non-reference radiation field; f msr , Machine-specific reference (msr) field; f ref , Reference field (ref) specified in dosimetry protocols for which the calibration coefficient of an ionization chamber in terms of absorbed dose to water is provided by a standards laboratory; FWHM, Full-width at half-maximum; GUM, Guide to the expression of Uncertainty in Measurements.; IAEA, International Atomic Energy Agency; ICRU, International Commission on Radiation Units and Measurements; IMRT, Intensity-modulated radiation therapy; k Q,Q 0 , The beam-quality correction factor, which corrects for the differences between the response of an ionization chamber in the reference beam of quality Q o used for calibrating the chamber and the beam of quality Q (defined as k Q . in TG-51 4 ); k f ref Q,Q 0 , Correction factor that accounts for the differences between the response of a detector in field f ref in a beam of quality Q and reference beam quality Q 0 as defined in TRS-483. 1 and Palmans et al 2 ; k fclin,fmsr Qclin,Q msr , The detector-specific correction factor that accounts for the difference between the responses of the detector in fields f clin in a beam of quality Q clin and in fields f msr in beam of quality Q msr as defined by Alfonso et al. 3 ; LCPE, Lateral charged particle equilibrium; M fmsr Qmsr , Detector reading in field f msr and beam quality Q msr corrected for influence of changes in pressure and temperature, incomplete charge collection, polarity effect and electrometer correction factor (TRS-483 1 ); MU, Monitor unit; N D,w,Q 0 , This is N D,w in TG-51, 4 and defined as the calibration coefficient in terms of absorbed dose to water for an ionization chamber at a reference beam of quality,Q 0 and field size f ref ; N f ref D,w,Q 0
Purpose-To quantify daily variations in the anatomy of patients undergoing radiation therapy for prostate carcinoma, to estimate their effect on dose distribution, and to evaluate the effectiveness of current standard planning and set-up approaches employed in proton therapy.Methods-We used series of CT data, which included the pre-treatment scan, and between 21 and 43 in-room scans acquired on different treatment days, from 10 patients treated with intensitymodulated radiation therapy at Morristown Memorial Hospital. Variations in femur rotation angles, thickness of subcutaneous adipose tissue, and physical depth to the distal surface of the prostate for lateral beam arrangement were recorded. Proton dose distributions were planned with the standard approach. Daily variations in the location of the prescription iso-dose were evaluated.Results-In all 10 datasets, substantial variation was observed in the lateral tissue thickness (standard deviation of 1.7-3.6 mm for individual patients, variations of over 5 mm from the planning CT observed in all series), and femur rotation angle (standard deviation between 1.3-4.8°, with the maximum excursion exceeding 10° in 6 out of 10 datasets). Shifts in the position of treated volume (98% iso-dose) were correlated with the variations in the lateral tissue thickness.Conclusions-Analysis suggests that, combined with image-guided set-up verification, the range compensator expansion technique prevents loss of dose to target due to femur rotation and soft tissue deformation, in the majority of cases. Anatomic changes coupled with the uncertainties of particle penetration in tissue restrict possibilities for margin reduction in proton therapy of prostate cancer.
In the step-and-shoot delivery of an IMRT plan with a Siemens Primus accelerator, radiation is turned off by desynchronizing the injector while the field parameters are being changed. When the machine is ready again a trigger pulse is sent to the injector to start the beam instantaneously. The objective of this study is to investigate the beam characteristics of the machine operating in the IMRT mode and to study the effect of the Initial Pulse Forming Network (IPEN) on the dark current. The central axis (CAX) output for a 10 x 10 cm2 field over the range 1-100 MU was measured with an ion chamber in a polystyrene phantom for both 6 and 15 MV x rays. Beam profiles were also measured over the range of 2-40 MU with the machine operating in the IMRT mode and compared with those in the normal mode. By adjusting the IPFN value, dark current radiation (DCR) was measured using ion chamber measurements. For both the normal and IMRT modes, dose versus MU is nonlinear in the range 1-5 MUs. Above 5 MU, dose varies linearly with MU for both 6 and 15 MV x rays. For stability of dose profiles, the 2 MU-IM group exhibit 20% variation from one subfield to another. The variation is about 5% for the 8 MU-IM group and <5% for 10 MU and higher. The results are similar in the normal treatment mode. With the IPFN at >80% of the PFN value, a spurious radiation associated with dark current at approximately 0.7% of the dose at isocenter for a 10 x 10 cm2 field is detected during the "PAUSE" state of the accelerator for 15 MV x rays. When the IPFN is lowered to <80% of the PFN value, no DCR is detected. For 6 MV x rays, no measurable DCR was detected regardless of the IPFN setting.
With all the advantages of film dosimetry in the megavoltage energy range, the use of film as a dosimeter is still limited due to the various difficulties associated with films such as energy dependence, film orientation, and sensitometric nonlinearity. Recently, therapy verification and localization films (CEA TVS and TLF films) from a Swedish manufacturer have become available in vacuum-sealed water-proof packaging in the US. The packaging renders the CEA films useful in a water phantom and ideal for photon and electron dosimetry. A systematic study has been carried out to investigate the potential of dosimetric application of the new films for high energy photon and electron beams. For the TVS films, the characteristic curve is generally energy independent but appears to be dependent on the source of the radiation, i.e., whether it is gamma rays or bremsstrahlung x rays. Compared to Kodak Readypack XV films, the CEA TVS film is linear in optical density over a much larger range of radiation dose. The inter- and intra-variation of the TVS films is less than 2%. For electrons, the characteristic curve is linear over a similar density range as photons but exhibit a slight energy dependence. TVS film is slightly directional dependent on the incident radiation for both photons and electrons. The perpendicular orientation results in higher optical density than the parallel orientation. The differences are within +/- 2% except in the buildup region for photons and in the exponential fall-off region of the electron beams where differences up to 4% are noted. For the CEA TLF film which is about three times faster than the TVS film, the characteristic curve is reasonably linear over the dose range of 0-15 cGy and energy independent within the experimental uncertainty (+/- 5%). Percent depth dose and isodose measurements with the TVS films are in good agreement with ion chamber results.
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