The dosimetry of the fields usually employed in radiosurgery requires the use of small detectors to measure Total Scatter Factor (Sc,p), Tissue Maximum Ratio (TMR), Percentage Depth Dose (PDD), and Off Axis Ratio (OAR). In this paper new dosimeters are investigated: a new type of radiochromic film, a micro parallel-plate chamber (filled with both air and tetramethylsilane, TMS), MOSFETs, and TLD-800 microcubes. Their behavior has been compared with the response of radiographic film and with the values obtained with BEAM Monte Carlo simulation. The experimental data confirm that dosimetry with radiochromic films and TLDs gives consistent results for all beam diameters. The parallel-plate micro chamber underestimates the Sc,p for the smallest field diameters (4.4 mm and 6.7 mm); MOSFETs show an over-estimation for the Sc,p of the 4.4 mm, 6.7 mm, and 10.5 mm field diameters. BEAM Monte Carlo simulation employing a parallel beam and a standard 6 MV x-ray spectrum has been used to obtain a correction factor as a function of the field size for both the parallel-plate micro chamber and MOSFETs. High accuracy measurements of PDD and TMR have been made in a water phantom both with radiochromic film and with the micro parallel-plate chamber and have been compared with the data computed by BEAM Monte Carlo simulation. The latter dosimeter is preferred because of the quicker and simpler use and because it gives immediate readout. Measurements of OAR made with radiochromic films and with radiographic films give differences in the 80%-20% penumbra width within 0.6 mm for field diameters ranging from 4.4 mm to 19 mm.

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The introduction of the CyberKnife extended the indication to 63 patients (>30%) who could not have been treated by single-session radiosurgical techniques. The procedure proved to be safe. Clinical improvement seems to be more frequently observed with the CyberKnife than in our previous linear accelerator experience.

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