The Monte Carlo (MC) method has been shown through many research studies to calculate accurate dose distributions for clinical radiotherapy, particularly in heterogeneous patient tissues where the effects of electron transport cannot be accurately handled with conventional, deterministic dose algorithms. Despite its proven accuracy and the potential for improved dose distributions to influence treatment outcomes, the long calculation times previously associated with MC simulation rendered this method impractical for routine clinical treatment planning. However, the development of faster codes optimized for radiotherapy calculations and improvements in computer processor technology have substantially reduced calculation times to, in some instances, within minutes on a single processor. These advances have motivated several major treatment planning system vendors to embark upon the path of MC techniques. Several commercial vendors have already released or are currently in the process of releasing MC algorithms for photon and/or electron beam treatment planning. Consequently, the accessibility and use of MC treatment planning algorithms may well become widespread in the radiotherapy community. With MC simulation, dose is computed stochastically using first principles; this method is therefore quite different from conventional dose algorithms. Issues such as statistical uncertainties, the use of variance reduction techniques, the ability to account for geometric details in the accelerator treatment head simulation, and other features, are all unique components of a MC treatment planning algorithm. Successful implementation by the clinical physicist of such a system will require an understanding of the basic principles of MC techniques. The purpose of this report, while providing education and review on the use of MC simulation in radiotherapy planning, is to set out, for both users and developers, the salient issues associated with clinical implementation and experimental verification of MC dose algorithms. As the MC method is an emerging technology, this report is not meant to be prescriptive. Rather, it is intended as a preliminary report to review the tenets of the MC method and to provide the framework upon which to build a comprehensive program for commissioning and routine quality assurance of MC-based treatment planning systems.

GafChromic MD-55 is a fairly new, thin film dosimeter that develops a blue color (lambda max = 676 nm) when irradiated with ionizing radiation. The increase in absorbance is roughly proportional to the absorbed dose. In this study, GafChromic MD-55 was irradiated with 60Co gamma rays. A double irradiation method was used in which a dosimeter is given an unknown dose followed by a known, calibration dose. With this method, GafChromic MD-55 was used to measure doses in the vicinity of 6 Gy with an uncertainty of less than 1%. It was found that the measured optical density of GafChromic MD-55, as presently fabricated, is affected by the polarization of the analyzing light, an important consideration when using GafChromic MD-55 as a precision dosimeter. GafChromic MD-55 was found to consist of seven layers. The response to polarized light was measured for the whole dosimeter and for the three Mylar films which form part of the dosimeter.

A new type of direct reading semiconductor dosimeter has been investigated as a radiation detector for photon and electron therapy beams of various energies. The operation of this device is based on the measurement of the threshold voltage shift in a custom-built metal oxide-silicon semiconductor field effect transistor (MOSFET). This voltage is a linear function of absorbed dose. The extent of the linearity region is dependent on the voltage controlled operation during irradiation. Operating two MOSFETS at two different biases simultaneously during irradiation will result in sensitivity (V/Gy) reproducibility better than +/- 3% over a range in dose of 100 Gy and at a dose per fraction greater than 20 x 10(-2) Gy. The modes of operation give this device many advantages, such as continuous monitoring during irradiation, immediate reading, and permanent storage of total dose after irradiation. The availability and ease of use of these MOSFET detectors make them very promising in clinical dosimetry.

Thermoluminescent dosimeters (TLD) and optically stimulated luminescent dosimeters (OSLD) are practical, accurate, and precise tools for point dosimetry in medical physics applications. The charges of Task Group 191 were to detail the methodologies for practical and optimal luminescence dosimetry in a clinical setting. This includes: (a) to review the variety of TLD/OSLD materials available, including features and limitations of each; (b) to outline the optimal steps to achieve accurate and precise dosimetry with luminescent detectors and to evaluate the uncertainty induced when less rigorous procedures are used; (c) to develop consensus guidelines on the optimal use of luminescent dosimeters for clinical practice; and (d) to develop guidelines for special medically relevant uses of TLDs/OSLDs such as mixed photon/neutron field dosimetry, particle beam dosimetry, and skin dosimetry. While this report provides general guidelines for TLD and OSLD processes, the report provides specific details for TLD‐100 and nanoDotTM dosimeters because of their prevalence in clinical practice.

In vivo dosimetry (IVD) has been used in brachytherapy (BT) for decades with a number of different detectors and measurement technologies. However, IVD in BT has been subject to certain difficulties and complexities, in particular due to challenges of the high-gradient BT dose distribution and the large range of dose and dose rate. Due to these challenges, the sensitivity and specificity toward error detection has been limited, and IVD has mainly been restricted to detection of gross errors. Given these factors, routine use of IVD is currently limited in many departments. Although the impact of potential errors may be detrimental since treatments are typically administered in large fractions and with high-gradient-dose-distributions, BT is usually delivered without independent verification of the treatment delivery. This Vision 20/20 paper encourages improvements within BT safety by developments of IVD into an effective method of independent treatment verification.