The purpose of this study was the investigation of perturbation factors for microionization chambers in small field dosimetry and the influence of penumbra for different spot sizes. To this purpose, correlated sampling was implemented in the EGSnrc Monte Carlo (MC) user code cavity: CScavity. CScavity was first benchmarked against results in the literature for an NE2571 chamber. An efficiency increase of 17 was attained for the calculation of a realistic chamber perturbation factor in a water phantom. Calculations have been performed for microionization chambers of type PinPoint 31006 and PinPoint 31016 in full BEAMnrc linac simulations. Investigating the physical backgrounds of the differences for these small field settings, perturbation factors have been split up into (1) central electrode perturbation, (2) wall perturbation, (3) air-to-water perturbation (chamber volume air-to-water) and (4) water volume perturbation (water chamber volume to 1 mm(3) voxel). The influence of different spot sizes, position in penumbra, measuring depth and detector geometry on these perturbation factors has been investigated, in a 0.8 x 0.8 cm(2) field setting. p(cel) for the PP31006 steel electrode shows a variation of up to 1% in the lateral position, but only 0.4% for the PP31016 with an Al electrode. The air-to-water perturbation in the optimal scanning direction for both profiles and depth is most influenced by the radiation field, and only to a small extent the chamber geometry. The PP31016 geometry (shorter, larger radius) requires less total perturbation within the central axis of the field, but results in slightly larger variations off axis in the optimal scanning direction. Smaller spot sizes (0.6 mm FWHM) and sharper penumbras, compared to larger spot sizes (2 mm FWHM), result in larger perturbation starting in the penumbra. The longer geometries of the PP31006/14/15 exhibit in the non-optimal scanning direction large variations in total perturbation (p(tot) 1.201(4) (0.6 mm spot, 3 mm off axis, type A MC uncertainty) to 0.803(4) (5 mm off axis)) mainly due to volume perturbation. Therefore in IMRT settings, when the detector is not always in the optimal scanning direction, the PP31016 geometry requires less extreme perturbation (max p(tot) 1.130(3)) and shows less variation. However, these results suggest that small variations in positioning, spot size or MLC result in large differences in perturbation factors. Therefore even these 0.016 cm(3) ionization chambers are limited in their use for a field setting of 0.8 x 0.8 cm(2), as used in this investigation.

Background and purpose: Conversion factors between dose to medium (D m,m) and dose to water (D w,w) provided by treatment planning systems that model the patient as water with variable electron density are currently based on stopping power ratios. In the current paper it will be illustrated that this conversion method is not correct. Materials and methods: Monte Carlo calculations were performed in a phantom consisting of a 2 cm bone layer surrounded by water. D w,w was obtained by modelling the bone layer as water with the electron density of bone. Conversion factors between D w,w and D m,m were obtained and compared to stopping power ratios and ratios of mass-energy absorption coefficients in regions of electronic equilibrium and interfaces. Calculations were performed for 6 MV and 20 MV photon beams. Results: In the region of electronic equilibrium the stopping power ratio of water to bone (1.11) largely overestimates the conversion obtained using the Monte Carlo calculations (1.06). In that region the MC dose conversion corresponds to the ratio of mass energy absorption coefficients. Near the water to bone interface, the MC ratio cannot be determined from stopping powers or mass energy absorption coefficients. Conclusion: Stopping power ratios cannot be used for conversion from D m,m to D w,w provided by treatment planning systems that model the patient as water with variable electron density, either in regions of electronic equilibrium or near interfaces. In regions of electronic equilibrium mass energy absorption coefficient ratios should be used. Conversions at interfaces require detailed MC calculations.

A surface imaging system, Catalyst (C‐Rad), was compared with laser‐based positioning and daily mega voltage computed tomography (MVCT) setup for breast patients with nodal involvement treated by helical TomoTherapy. Catalyst‐based positioning performed better than laser‐based positioning. The respective modalities resulted in a standard deviation (SD), 68% confidence interval (CI) of positioning of left–right, craniocaudal, anterior–posterior, roll: 2.4 mm, 2.7 mm, 2.4 mm, 0.9° for Catalyst positioning, and 6.1 mm, 3.8 mm, 4.9 mm, 1.1° for laser‐based positioning, respectively. MVCT‐based precision is a combination of the interoperator variability for MVCT fusion and the patient movement during the time it takes for MVCT and fusion. The MVCT fusion interoperator variability for breast patients was evaluated at one SD left–right, craniocaudal, ant–post, roll as: 1.4 mm, 1.8 mm, 1.3 mm, 1.0°.There was no statistically significant difference between the automatic MVCT registration result and the manual adjustment; the automatic fusion results were within the 95% CI of the mean result of 10 users, except for one specific case where the patient was positioned with large yaw. We found that users add variability to the roll correction as the automatic registration was more consistent.The patient position uncertainty confidence interval was evaluated as 1.9 mm, 2.2 mm, 1.6 mm, 0.9° after 4 min, and 2.3 mm, 2.8 mm, 2.2 mm, 1° after 10 min. The combination of this patient movement with MVCT fusion interoperator variability results in total standard deviations of patient position when treatment starts 4 or 10 min after initial positioning of, respectively: 2.3 mm, 2.8 mm, 2.0 mm, 1.3° and 2.7 mm, 3.3 mm, 2.6 mm, 1.4°.Surface based positioning arrives at the same precision when taking into account the time required for MVCT imaging and fusion. These results can be used on a patient‐per‐patient basis to decide which positioning system performs the best after the first 5 fractions and when daily MVCT can be omitted. Ideally, real‐time monitoring is required to reduce important intrafraction movement.PACS number(s): 87.53.Jw, 87.53.Kn, 87.56.Da, 87.63.L‐, 81.70.Tx

Liquid ionization chambers (LICs) offer an interesting tool in the field of small beam dosimetry, allowing better spatial resolution and reduced perturbation effects. However, some aspects remain to be addressed, such as the higher recombination and the effects from the materials of the detector. Our aim was to investigate these issues and their impact. The first step was the evaluation of the recombination effects. Measurements were performed at different SSDs to vary the dose per pulse, and the collection efficiency was obtained. The BEAMnrc code was then used to model the Cyberknife head. Finally, the liquid ionization chamber itself was modelled using the EGSnrc-based code Cavity allowing the evaluation of the influence of the volume and the chamber materials. The liquid ionization charge collection efficiency is approximately 0.98 at 1.5 mGy pulse(-1), the highest dose per pulse that we have measured. Its impact on the accuracy of output factors is less than half a per cent. The detector modelling showed a significant contribution from the graphite electrode, up to 6% for the 5 mm collimator. The dependence of the average electronic mass collision stopping power of iso-octane with beam collimation is negligible and thus has no influence on output factor measurements. Finally, the volume effect reaches 5% for the small 5 mm collimator and becomes much smaller (<0.5%) for diameters above 10 mm. LICs can effectively be used for small beam relative dosimetry as long as adequate correction factors are applied, especially for the electrode and volume effects.