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Recent use of very small photon beams (down to 4 mm) in stereotactic radiotherapy requires new detectors to accurately determine the delivered dose. Diamond detectors have been presented in the literature as an attractive candidate for this application, due to their small detection volume and the diamond atomic number (Z=6) which is close to water effective atomic number (Zeff∼7.42). However, diamond exhibits a density 3.51 times greater than that of water and recent studies using Monte Carlo simulations have demonstrated the drawback of a high-density detector on small beam output factors. The current study focuses on geometrical parameters of diamond detector, namely, the diamond dimensions and the electrode geometry, in order to solve the dosimetric issues still observed in small photon beams with diamond detectors. To give better insights to these open questions, we have used both computational method and experimental analysis. This study highlighted that reducing diamond dimensions is crucial for small beam output factor measurements and to limit the influence of its high density. Furthermore, electrodes covering the whole diamond surface were essential for a dose rate independence of the diamond detector. The optimal dosimeter derived from this work presented small diamond dimensions of approximately 1-1-0.15mm3, with diamond-like-carbon electrodes covering the whole diamond surface. A dose rate independence of this diamond detector (better than 0.5% over a wide range of dose rates available on a stereotactic dedicated facility) was obtained due to the electrode geometry. Concerning the output factor measurements, a good agreement (better than 1.1%) was observed between this carbon material detector and two types of passive dosimeters (LiF microcubes and EBT2 radiochromic films) for all beam sizes except the smallest field of 0.6-0.6 cm2 with a deviation of 2.6%. This new study showed the high performance of this diamond detector in small photon beams, in comparison with various commercially available passive and active dosimeters. [ABSTRACT FROM AUTHOR]

Gafchromic™ films have become popular due to their ease of use and their near water equivalence. This last property is crucial for stereotactic small beam dosimetry as demonstrated in recent papers. An accurate bi-dimensional dose measurement with Gafchromic™ films is very challenging mainly because of the non-uniformity response of flatbed scanners (used for films digitalization) and their own non-uniformity. The first proposal of this work is to develop bi-dimensional protocol for small beams and evaluate the associated uncertainty. The second proposal is to validate this protocol for the bi-dimensional measurements of treatment plans performed with the CyberKnife ® system. First, the uniformity of an Epson V700 flatbed scanner and a batch of EBT3 Gafchromic™ films has been investigated. A “four films” dosimeter was designed to reduce the errors (statistic and systematic) due to their non-uniformity. Then, the “four films” dosimeter protocol in both a homogeneous (RW3 material) and heterogeneous (RW3, lung-like and bone-like materials) phantoms has been used to measure the bi-dimensional dose distributions of three simple CyberKnife ® treatment plans. Two tumor locations (middle of the lung and near lung/bone interface) were considered for the heterogeneous phantom. These plans were achieved with the 10 mm fixed collimator and modeled with the PENELOPE Monte Carlo code in order to calculate accurate dose distributions. Finally, the “four films” bi-dimensional dose distributions were compared to the PENELOPE Monte Carlo simulations. Regarding the uncertainty associated to the bi-dimensional dose measurement protocol, the relative standard deviation σ D on the dose was 1.2% in the range from 0.5 to 4.0 Gy. Regarding the protocol validation on CyberKnife ® treatment plans, a very good agreement was found with all measurement points passing the {3% - 3 mm} Gamma Index criteria. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the optimal use of XR-RV3 GafChromic® films to assess patient skin dose in interventional radiology while addressing the means to reduce uncertainties in dose assessment. Methods: XR-Type R GafChromic films have been shown to represent the most efficient and suitable solution to determine patient skin dose in interventional procedures. As film dosimetry can be associated with high uncertainty, this paper presents the EURADOS WG 12 initiative to carry out a comprehensive study of film characteristics with a multisite approach. The considered sources of uncertainties include scanner, film, and fitting-related errors. The work focused on studying film behavior with clinical high-dose-rate pulsed beams (previously unavailable in the literature) together with reference standard laboratory beams. Results: First, the performance analysis of six different scanner models has shown that scan uniformity perpendicular to the lamp motion axis and that long term stability are the main sources of scanner-related uncertainties. These could induce errors of up to 7% on the film readings unless regularly checked and corrected. Typically, scan uniformity correction matrices and reading normalization to the scanner-specific and daily background reading should be done. In addition, the analysis on multiple film batches has shown that XR-RV3 films have generally good uniformity within one batch (<1.5%), require 24 h to stabilize after the irradiation and their response is roughly independent of dose rate (<5%). However, XR-RV3 films showed large variations (up to 15%) with radiation quality both in standard laboratory and in clinical conditions. As such, and prior to conducting patient skin dose measurements, it is mandatory to choose the appropriate calibration beam quality depending on the characteristics of the x-ray systems that will be used clinically. In addition, yellow side film irradiations should be preferentially used since they showed a lower dependence on beam parameters compared to white side film irradiations. Finally, among the six different fit equations tested in this work, typically used third order polynomials and more rational and simplistic equations, of the form dose inversely proportional to pixel value, were both found to provide satisfactory results. Fitting-related uncertainty was clearly identified as a major contributor to the overall film dosimetry uncertainty with up to 40% error on the dose estimate. Conclusions: The overall uncertainty associated with the use of XR-RV3 films to determine skin dose in the interventional environment can realistically be estimated to be around 20% (k = 1). This uncertainty can be reduced to within 5% if carefully monitoring scanner, film, and fitting-related errors or it can easily increase to over 40% if minimal care is not taken. This work demonstrates the importance of appropriate calibration, reading, fitting, and other film-related and scan-related processes, which will help improve the accuracy of skin dose measurements in interventional procedures. [ABSTRACT FROM AUTHOR]

Radiochromic film dosimetry is a promising technique, but at this time there are some artefacts, including non-uniformity, energy dependence and scanner artefacts. Accurate dosimetry with radiochromic films requires characterizing the film as well as the scanning and analysis procedures. In this work, the performance of the EBT3 films in combination with the EPSON Dual Lens Perfection V700 scanner for dose distribution measurements in stereotactic radiotherapy has been evaluated. It has been shown that it was necessary to perform 20 blank scans to obtain the stability of the scanner. In order to reduce the uncertainties due to the non-uniformity of the scan field, it was then decided to use the 12 × 12 cm 2 central part of the scanner bed. Regarding EBT3 films, intra-sheet and inter-sheet uniformity of unexposed EBT3 films in terms of pixel value has been found to be respectively 0.27% (1 SD) and 0.15% (1 SD). No significant energy dependence has been observed above 30 keV and no angular dependence has been found. [ABSTRACT FROM AUTHOR]

Recent developments of new therapy techniques using small photon beams, such as stereotactic radiotherapy, require suitable detectors to determine the delivered dose with a high accuracy. The dosimeter has to be as close as possible to tissue equivalence and to exhibit a small detection volume compared to the size of the irradiation field, because of the lack of lateral electronic equilibrium in small beam. Characteristics of single crystal diamond (tissue equivalent material Z = 6, high density) make it an ideal candidate to fulfil most of small beam dosimetry requirements. A commercially available Element Six electronic grade synthetic diamond was used to develop a single crystal diamond dosimeter (SCDDo) with a small detection volume (0.165 mm3). Long term stability was studied by irradiating the SCDDo in a 60Co beam over 14 h. A good stability (deviation less than ± 0.1%) was observed. Repeatability, dose linearity, dose rate dependence and energy dependence were studied in a 10 × 10 cm2 beam produced by a Varian Clinac 2100 C linear accelerator. SCDDo lateral dose profile, depth dose curve and output factor (OF) measurements were performed for small photon beams with a micro multileaf collimator m3 (BrainLab) attached to the linac. This study is focused on the comparison of SCDDo measurements to those obtained with different commercially available active detectors: an unshielded silicon diode (PTW 60017), a shielded silicon diode (Sun Nuclear EDGE), a PinPoint ionization chamber (PTW 31014) and two natural diamond detectors (PTW 60003). SCDDo presents an excellent spatial resolution for dose profile measurements, due to its small detection volume. Low energy dependence (variation of 1.2% between 6 and 18 MV photon beam) and low dose rate dependence of the SCDDo (variation of 1% between 0.53 and 2.64 Gy min−1) are obtained, explaining the good agreement between the SCDDo and the efficient unshielded diode (PTW 60017) in depth dose curve measurements. For field sizes ranging from 0.6 × 0.6 to 10 × 10 cm2, OFs obtained with the SCDDo are between the OFs measured with the PinPoint ionization chamber and the Sun Nuclear EDGE diode that are known to respectively underestimate and overestimate OF values in small beam, due to the large detection volume of the chamber and the non-water equivalence of both detectors. [ABSTRACT FROM AUTHOR]

Abstract: The accurate determination of absorbed dose in small photon beams, especially for stereotactic radiation therapy, is a difficult task with commercially available detectors. As these small fields are characterized by high dose gradients, a lack of lateral particle equilibrium and a variation of energy spectra with beam sizes, a dosimeter with high resolution, tissue-equivalence and high precision is required. The new radiochromic film EBT2, which meets these criteria, was fully characterized in Institut de Radioprotection et Sûreté Nucléaire (IRSN) for this application. This type of film was tested with the reading system EPSON Dual Lens Perfection V700 flatbed scanner in transmission mode. Warm-up effects of the scanner were studied as well as the influence of the scanner light. Uniformity of unirradiated and irradiated EBT2 films in terms of pixel value was found to be respectively 0.3% (1 SD) and 0.5% (1 SD). An original, accurate and efficient radiochromic film dosimetry protocol was established. The overall uncertainty for dose measurement with EBT2 films using this protocol was estimated at less than 2% (1 SD). Encouraging measurements of output factors were performed on a Novalis system. [Copyright &y& Elsevier]

Many accidents in radiotherapy have been reported in France over the last years. This is due to the recent legal obligation to declare to the national safety authorities any significant incident relative to the use of ionising radiation including medical applications. The causes and consequences of the most serious events in radiotherapy are presented in this paper. Lessons can be learned from possible technical dysfunctions, from human errors or organisational weaknesses as to how such events can be prevented. The technical aspects are addressed here: in particular, dosimetric issues. [ABSTRACT FROM AUTHOR]

According to the United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR 1993), the dose due to the inhalation of radon decay products represents almost 50% of the total natural radiation dose to the general population. The scientific community is interested in the assessment of the risk induced by domestic radon exposure. The dosimetric models used to estimate the dose are very sensitive to unattached fraction and size distributions, which makes the characterization of the indoor radon decay products aerosol necessary. For this purpose, longterm measurements of unattached fraction (f[sub p]) and equilibrium factor (F) were taken in a dwelling under typical indoor domestic aerosol conditions. An original device consisting of an annular diffusion channel set in parallel with an open filter was developed and calibrated to continuously measure the unattached fraction. Moreover, radon activity concentration and particle concentration were simultaneously monitored. With aged aerosol, particle concentration was found to be very low (between 500 and 5000 cm[sup -3]), radon activity concentration ranged from 240 to 2800 Bq m[sup -3], and the mean values of f[sub p] and F were, respectively, 0.31 (0.08-0.67) and 0.16 (0.04-0.45). With aerosol sources, the high increase in particle concentration led to a negligible unattached fraction and raised the equilibrium factor. A correlation relationship was determined between these two parameters under different aerosol conditions. Finally,our experimental results were compared to results obtained with the PRADDO model; this comparison showed a good agreement between these two different approaches. [ABSTRACT FROM AUTHOR]

A severe irradiation accident involving a victim occurred in April 2009 in South America. The victim has found a 192Ir source fallen from a gammagraphy device and has put it in the left pocket of his pants. Very quickly, an erythema and a blister appeared on the left leg of the victim involving hospitalisation. Following the request of the IAEA assistance, the Ionizing Radiation Dosimetry Laboratory of IRSN was asked to perform a numerical dosimetric reconstruction. A personalised voxel phantom of the victim has been constructed thanks to the Simulation of External Source Accident with Medical images tool developed by the laboratory, and a calculation of the dose with the MCNPX computer code allowed to determine the boundary of the necrotic dose at 25 Gy. On the basis of these calculations, the physicians have performed exeresis of the necrotic region on the left leg on 4 May 2009. Associated with mesenchymal stem cell injection, the leg of the victim was healthy on December 2009. [ABSTRACT FROM PUBLISHER]

Purpose: The use of small photon fields is now an established practice in stereotactic radiosurgery and radiotherapy. However, due to a lack of lateral electron equilibrium and high dose gradients, it is difficult to accurately measure the dosimetric quantities required for the commissioning of such systems. Moreover, there is still no metrological dosimetric reference for this kind of beam today. In this context, the first objective of this work was to determine and to compare small fields output factors (OF) measured with different types of active detectors and passive dosimeters for three types of facilities: a CyberKnife® system, a dedicated medical linear accelerator (Novalis) equipped with m3 microMLC and circular cones, and an adaptive medical linear accelerator (Clinac 2100) equipped with an additional m3 microMLC. The second one was to determine the kQclin,Qmsrfclin,fmsr correction factors introduced in a recently proposed small field dosimetry formalism for different active detectors. Methods: Small field sizes were defined either by microMLC down to 6 × 6 mm2 or by circular cones down to 4 mm in diameter. OF measurements were performed with several commercially available active detectors dedicated to measurements in small fields (high resolution diodes: IBA SFD, Sun Nuclear EDGE, PTW 60016, PTW 60017; ionizing chambers: PTW 31014 PinPoint chamber, PTW 31018 microLion liquid chamber, and PTW 60003 natural diamond). Two types of passive dosimeters were used: LiF microcubes and EBT2 radiochromic films. Results: Significant differences between the results obtained by several dosimetric systems were observed, particularly for the smallest field size for which the difference in the measured OF reaches more than 20%. For passive dosimeters, an excellent agreement was observed (better than 2%) between EBT2 and LiF microcubes for all OF measurements. Moreover, it has been shown that these passive dosimeters do not require correction factors and can then be used as reference dosimeters. Correction factors for the active detectors have then been determined from the mean experimental OF measured by the passive dosimeters. Conclusions: Four sets of correction factors needed to apply the new small field dosimetry formalism are provided for several active detectors. A protocol for small photon beams OF determination based on passive dosimeters measurements has been recently proposed to French radiotherapy treatment centers. [ABSTRACT FROM AUTHOR]