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Early works that used thermoluminescent dosimeters (TLDs) to measure absorbed dose from alpha particles reported relatively high variation (10%) between TLDs, which is undesirable for modern dosimetry applications. This work outlines a method to increase precision for absorbed dose measured using TLDs with alpha-emitting radionuclides by applying an alpha-specific chip factor (CF) that individually characterizes the TLD sensitivity to alpha particles. Variation between TLDs was reduced from 21.8% to 6.7% for the standard TLD chips and 7.9% to 3.3% for the thin TLD chips. It has been demonstrated by this work that TLD-100 can be calibrated to precisely measure the absorbed dose to water from alpha-emitting radionuclides., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Larry A. DeWerd reports a relationship with Standard Imaging Inc that includes: board membership and equity or stocks. Co-author is an editor for Applied Radiation and Isotopes - W.C. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Diffusing alpha-emitters radiation therapy (DaRT) is a novel brachytherapy technique that leverages the diffusive flow of 224 Ra progeny within the tumor volume over the course of the treatment. Cell killing is achieved by the emitted alpha particles that have a short range in tissue and high linear energy transfer. The current proposed absorbed dose calculation method for DaRT is based on a diffusion-leakage (DL) model that neglects absorbed dose from beta particles., Purpose: This work aimed to couple the DL model with dose point kernels (DPKs) to account for dose from beta particles as well as to consider the non-local deposition of energy., Methods: The DaRT seed was modeled using COMSOL multiphysics and the DL model was implemented to extract the spatial information of the diffusing daughters. Using Monte-Carlo (MC) methods, DPKs were generated for 212 Pb, 212 Bi, and their progenies since they were considered to be the dominant beta emitters in the 224 Ra radioactive decay chain. A convolution operation was performed between the integrated number densities of the diffusing daughters and DPKs to calculate the total absorbed dose over a 30-day treatment period. Both high-diffusion and low-diffusion cases were considered., Results: The calculated DPKs showed non-negligible energy deposition over several millimeters from the source location. An absorbed dose >10 Gy was deposited within a 1.8 mm radial distance for the low diffusion case and a 2.2 mm radial distance for the high diffusion case. When the DPK method was compared with the local energy deposition method that solely considered dose from alpha particles, differences above 1 Gy were found within 1.3 and 1.8 mm radial distances from the surface of the source for the low diffusion and high diffusion cases, respectively., Conclusions: The proposed method enhances the accuracy of the dose calculation method used for the DaRT technique., (© 2024 The Authors. Medical Physics published by Wiley Periodicals LLC on behalf of American Association of Physicists in Medicine.)

Purpose: The purpose of this study was to directly calculate [Formula: see text] correction factors for four cylindrical ICs for a 0.35 T MR-linac using the Monte Carlo (MC) method., Methods: A previously-validated TOPAS/GEANT4 MC head model of the 0.35 T MR-linac was employed. The MR-compatible Exradin A12, A1SL, A26, and A28 cylindrical ICs were modeled considering the dead volume in the air cavity. The [Formula: see text] correction factor was determined for initial electron energies of 5-7 MeV. The correction factor was calculated for all four angular orientations in the lateral plane. The impact of the 0.35 T magnetic field on the IC response was also investigated., Results: The maximum beam quality dependence in the [Formula: see text] exhibited by the A12, A1SL, A26, and A28 ICs was 1.10 %, 2.17 %, 0.81 %, and 1.75 %, respectively, considering all angular orientations. The magnetic field dependence was < 1 % and the maximum [Formula: see text] correction was < 2 % when the detector was aligned along the direction of the magnetic field at 0° and 180° angles. The A12 IC over-responded up to 5.40 % for the orthogonal orientation. An asymmetry in the response of up to 8.30 % was noted for the A28 IC aligned at 90° and 270° angles., Conclusions: A parallel orientation for the IC, with respect to the magnetic field, is recommended for reference dosimetry in MRgRT. Both over and under-response in the IC signal was noted for the orthogonal orientations, which is highly dependent on the cavity diameter, cavity length, and the dead volume., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Associazione Italiana di Fisica Medica e Sanitaria. Published by Elsevier Ltd. All rights reserved.)

The cornerstones of science advancement are rigor in performing scientific research, reproducibility of research findings and unbiased reporting of design and results of the experiments. For radiation research, this requires rigor in describing experimental details as well as the irradiation protocols for accurate, precise and reproducible dosimetry. Most institutions conducting radiation biology research in in vitro or animal models do not have describe experimental irradiation protocols in sufficient details to allow for balanced review of their publication nor for other investigators to replicate published experiments. The need to increase and improve dosimetry standards, traceability to National Institute of Standards and Technology (NIST) standard beamlines, and to provide dosimetry harmonization within the radiation biology community has been noted for over a decade both within the United States and France. To address this requirement subject matter experts have outlined minimum reporting standards that should be included in published literature for preclinical irradiators and dosimetry.

Purpose: The purpose of this work was to provide guidance for the lack of an air-kerma rate standard for the S7600 Xoft Axxent® source by providing a correction factor to apply to the National Institute of Standards and Technology (NIST) traceable S7500 well chamber (WC) calibration coefficient before the development of an S7600 standard at NIST., Methods and Materials: The Attix free air chamber (FAC) at the University of Wisconsin Medical Radiation Research Center was used to measure the air-kerma rate at 50 cm for six S7500 and six S7600 sources. These same sources were then measured using five standard imaging HDR1000+ WCs. The measurements made with the FAC were used to calculate source-specific WC calibration coefficients for the S7500 and S7600 source. These results were compared to the NIST traceable calibration coefficients for the S7500 source. The average results for each WC were then averaged together, and a ratio of the S7600 to S7500 WC calibration coefficients was determined., Results: The average S7600 air-kerma rate measurement with the FAC was 7% lower than the average air-kerma rate measurements of the S7500 source. On average, the S7500 determined WC calibration coefficients agreed within ±1% of the NIST traceable S7500 values. The S7600 WC calibration coefficients were up to 16% less than the NIST traceable S7500 values. The final correction factor determined to be applied to the NIST traceable S7500 value was 0.8415 with an associated uncertainty of ±8.1% at k = 2., Conclusions: This work provides a suggested correction factor for the S7600 Xoft Axxent source such that the sources can be accurately implemented in the clinical setting., Competing Interests: Declaration of Competing Interest This manuscript describes original work and is not under consideration by any other journal. It was funded in part by Xoft, a subsidiary of iCAD, Inc. (MSN262697). Larry DeWerd is an owner of Standard Imaging Inc. who manufactured the chambers and electrometer used in this work. Autumn Walter does not have any conflicts of interest., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Low-energy X-ray sources that operate in the kilovoltage energy range have been shown to induce more cellular damage when compared to their megavoltage counterparts. However, low-energy X-ray sources are more susceptible to the effects of filtration on the beam spectrum. This work sought to characterize the biological effects of the Xoft Axxent® source, a low-energy therapeutic X-ray source, both with and without the titanium vaginal applicator in place. It was hypothesized that there would be an increase in relative biological effectiveness (RBE) of the Axxent® source compared to 60Co and that the source in the titanium vaginal applicator (SIA) would have decreased biological effects compared to the bare source (BS). This hypothesis was drawn from linear energy transfer (LET) simulations performed using the TOPAS Monte Carlo user code as well a reduction in dose rate of the SIA compared to the BS. A HeLa cell line was maintained and used to evaluate these effects. Clonogenic survival assays were performed to evaluate differences in the RBE between the BS and SIA using 60Co as the reference beam quality. Neutral comet assay was used to assess induction of DNA strand damage by each beam to estimate differences in RBE. Quantification of mitotic errors was used to evaluate differences in chromosomal instability (CIN) induced by the three beam qualities. The BS was responsible for the greatest quantity of cell death due to a greater number of DNA double strand breaks (DSB) and CIN observed in the cells. The differences observed in the BS and SIA surviving fractions and RBE values were consistent with the 13% difference in LET as well as the factor of 3.5 reduction in dose rate of the SIA. Results from the comet and CIN assays were consistent with these results as well. The use of the titanium applicator results in a reduction in the biological effects observed with these sources, but still provides an advantage over megavoltage beam qualities. © 2023 by Radiation Research Society., (©2023 by Radiation Research Society. All rights of reproduction in any form reserved.)

Purpose: The purpose of this work is to provide measured data for the modified TG43 parameters [DeWerd et al.] for the newest, Galden-cooled S7600 Xoft Axxent source model., Methods: The measurement of radial dose distributions at distances of 1 cm to 4 cm from the source was performed using TLD100 microcubes, EBT3 film, and an Exradin A26 microionization chamber. The overall uncertainty and reproducibility of each dosimeter was evaluated for its use in determining the radial dose function and dose rate conversion coefficient. An acrylic phantom developed in house for previous works was used to measure the polar anisotropy function using TLD100 microcubes at distances of 1 cm, 2 cm, and 5 cm from the source., Results: The Exradin A26 chamber was deemed most suitable for measuring the radial dose function. Values determined had a maximum k = 1 uncertainty of 1.4%. The dose rate conversion coefficient measured with the chamber was found to be 9.33 ± 0.21cGy/hrμGy/min. TLD100 microcube measurements of the polar anisotropy had average uncertainties of 6%, 3%, and 2.5% at 1 cm, 2 cm, and 5 cm, respectively., Conclusions: The modified TG43 parameters for the bare source were measured with reasonable uncertainty. The values determined will aid with the clinical implementation of the source for breast and endometrial cancer applications., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

Purpose: To develop an independent log file-based intensity-modulated radiation therapy (IMRT) quality assurance (QA) tool for the 0.35 T magnetic resonance-linac (MR-linac) and investigate the ability of various IMRT plan complexity metrics to predict the QA results. Complexity metrics related to tissue heterogeneity were also introduced., Methods: The tool for particle simulation (TOPAS) Monte Carlo code was utilized with a previously validated linac head model. A cohort of 29 treatment plans was selected for IMRT QA using the developed QA tool and the vendor-supplied adaptive QA (AQA) tool. For 27 independent patient cases, various IMRT plan complexity metrics were calculated to assess the deliverability of these plans. A correlation between the gamma pass rates (GPRs) from the AQA results and calculated IMRT complexity metrics was determined using the Pearson correlation coefficients. Tissue heterogeneity complexity metrics were calculated based on the gradient of the Hounsfield units., Results: The median and interquartile range for the TOPAS GPRs (3%/3 mm criteria) were 97.24% and 3.75%, respectively, and were 99.54% and 0.36% for the AQA tool, respectively. The computational time for TOPAS ranged from 4 to 8 h to achieve a statistical uncertainty of <1.5%, whereas the AQA tool had an average calculation time of a few minutes. Of the 23 calculated IMRT plan complexity metrics, the AQA GPRs had correlations with 7 out of 23 of the calculated metrics. Strong correlations (|r| > 0.7) were found between the GPRs and the heterogeneity complexity metrics introduced in this work., Conclusions: An independent MC and log file-based IMRT QA tool was successfully developed and can be clinically deployed for offline QA. The complexity metrics will supplement QA reports and provide information regarding plan complexity., (© 2022 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, LLC on behalf of The American Association of Physicists in Medicine.)

Background: In a recent study, we reported beam quality correction factors, f Q , in carbon ion beams using Monte Carlo (MC) methods for a cylindrical and a parallel-plate ionization chamber (IC). A non-negligible perturbation effect was observed; however, the magnitude of the perturbation correction due to the specific IC subcomponents was not included. Furthermore, the stopping power data presented in the International Commission on Radiation Units and Measurements (ICRU) report 73 were used, whereas the latest stopping power data have been reported in the ICRU report 90., Purpose: The aim of this study was to extend our previous work by computing f Q correction factors using the ICRU 90 stopping power data and by reporting IC-specific perturbation correction factors. Possible energy or linear energy transfer (LET) dependence of the f Q correction factor was investigated by simulating both pristine beams and spread-out Bragg peaks (SOBPs)., Methods: The TOol for PArticle Simulation (TOPAS)/GEANT4 MC code was used in this study. A 30 × 30 × 50 cm 3 water phantom was simulated with a uniform 10 × 10 cm 2 parallel beam incident on the surface. A Farmer-type cylindrical IC (Exradin A12) and two parallel-plate ICs (Exradin P11 and A11) were simulated in TOPAS using the manufacturer-provided geometrical drawings. The f Q correction factor was calculated in pristine carbon ion beams in the 150-450 MeV/u energy range at 2 cm depth and in the middle of the flat region of four SOBPs. The k Q correction factor was calculated by simulating the f Qo correction factor in a 60 Co beam at 5 cm depth. The perturbation correction factors due to the presence of the individual IC subcomponents, such as the displacement effect in the air cavity, collecting electrode, chamber wall, and chamber stem, were calculated at 2 cm depth for monoenergetic beams only. Additionally, the mean dose-averaged and track-averaged LET was calculated at the depths at which the f Q was calculated., Results: The ICRU 90 f Q correction factors were reported. The p dis correction factor was found to be significant for the cylindrical IC with magnitudes up to 1.70%. The individual perturbation corrections for the parallel-plate ICs were <1.0% except for the A11 p cel correction at the lowest energy. The f Q correction for the P11 IC exhibited an energy dependence of >1.00% and displayed differences up to 0.87% between pristine beams and SOBPs. Conversely, the f Q for A11 and A12 displayed a minimal energy dependence of <0.50%. The energy dependence was found to manifest in the LET dependence for the P11 IC. A statistically significant LET dependence was found only for the P11 IC in pristine beams only with a magnitude of <1.10%., Conclusions: The perturbation and k Q correction factor should be calculated for the specific IC to be used in carbon ion beam reference dosimetry as a function of beam quality., (© 2022 The Authors. Medical Physics published by Wiley Periodicals LLC on behalf of American Association of Physicists in Medicine.)

Objective. To present and quantify the variability in the acceptance testing data for the imaging component of the 0.35 T magnetic resonance-linear accelerator (MR-linac). Approach. The current acceptance testing protocol by the MR-linac vendor was described along with the equipment and scanner parameters utilized throughout the process. The B o field homogeneity, SNR/uniformity of the combined and individual receiver coils, American College of Radiology (ACR) image quality testing, and spatial integrity of the imaging data were collected from twelve different institutions. The variability in the results was accentuated and the ramifications of the results were discussed in the context of MR-guided radiation therapy. Main Results. The B o field homogeneity was found to have a large gantry dependence with the median values being <4 ppm for all gantry angles. The SNR and uniformity were found to be well above the vendor-specified thresholds with a relatively small institutional-dependence. All institutions passed the ACR image uniformity tests. The largest institutional variability was noted to be for the slice positional accuracy test. The spatial fidelity was calculated to be <1.0 and <2.1 mm within a 100 and a 175 mm radius from the isocenter. Significance. The results from this study can be used to set the tolerances and formal guidelines for MR-linacs imaging quality assurance. Additionally, the multi-institutional data reported in this work will aid in future MR-linac acceptance and commissioning., (© 2022 Institute of Physics and Engineering in Medicine.)

The vast majority of radiotherapy departments in Europe using brachytherapy (BT) perform temporary implants of high- or pulsed-dose rate (HDR-PDR) sources with photon energies higher than 50 keV. Such techniques are successfully applied to diverse pathologies and clinical scenarios. These recommendations are the result of Working Package 21 (WP-21) initiated within the BRAchytherapy PHYsics Quality Assurance System (BRAPHYQS) GEC-ESTRO working group with a focus on HDR-PDR source calibration. They provide guidance on the calibration of such sources, including practical aspects and issues not specifically accounted for in well-accepted societal recommendations, complementing the BRAPHYQS WP-18 Report dedicated to low energy BT photon emitting sources (seeds). The aim of this report is to provide a European-wide standard in HDR-PDR BT source calibration at the hospital level to maintain high quality patient treatments., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.)

Purpose: The purpose of this work was to evaluate differences in air-kerma rate of the older, S7500 water-cooled Xoft Axxent source and newer, S7600 Galden-cooled source., Methods and Materials: The Attix Free Air Chamber (FAC) at the UWMRRC was used to measure the air-kerma rate at 50 cm for six S7600 Xoft Axxent sources. The average measured air-kerma of the S7600 sources was compared with the measured average air-kerma rate from five S7500 sources. The air-kerma rates of the S7500 sources were measured in a Standard Imaging HDR 1000+ well chamber. The FAC measurements were used to determine a well chamber calibration coefficient for the S7600 source. The S7500 calibration coefficients were incorrectly applied to the S7600 sources to indicate the magnitude of error that can occur if the incorrect calibration coefficient is used., Results: A 10.3% difference was observed between the average air-kerma rates of the two sources although a 17% difference was observed between their calibration coefficients. The application of the S7500 calibration coefficient to the S7600 sources resulted in measured air-kerma rates that were 20% greater than the true value., Conclusions: This work indicates the need for a new air-kerma rate standard for the S7600 sources, and the results presented in this work are indicative of values that would be obtained at National Institute of Standards and Technology., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective. Computed tomography dose index (CTDI) calculations based on measurements made with CT ionization chambers require characterization of two chamber properties: radiation sensitivity and effective length. The sensitivity of a CT ionization chamber is currently determined in some countries by calibration in an x-ray field that irradiates the entire chamber. Determination of the effective length is left to the user, and this value is frequently assumed to be equivalent to the nominal length-typically 100 mm-stated by the manufacturer. This assumption undermines the intention and usefulness of CTDI calculation. Thus, a slit-based calibration, N KL , of the CT ionization chambers was proposed by collimating the x-ray beam to a well-defined aperture width. The aim of this work is to compare the two methods. Approach. Four different CT ionization chambers (Standard Imaging Exradin A101, Radcal 10x5-3CT, Victoreen 500-100, and Capintec PC-4P) are investigated in this work. Sensitivity profiles were measured for all four chambers and effective/rated chamber lengths were calculated. A novel Monte-Carlo based correction was proposed to account for the presence of the aperture. CTDI was calculated and compared for two calibration beams as well as for a commercial CT scanner using Exradin A101 and Radcal 10x5-3CT chambers. Main results. The nominal chamber length was found to deviate up to 21% compared to the effective length. Correction for the aperture depended on the aperture opening size. CTDI calculation results illustrate the potential 17% error in CTDI calculation that can be caused by assuming the effective chamber length is equivalent to the manufacturer's stated nominal length. CTDI calculations with CT ionization chambers calibrated with an air-kerma length calibration method yield the smallest variation in the CTDI regardless of the chamber model. Significance. To avoid an erroneous CTDI, information regarding the chamber's effective length must be included in the calibration or stated by the manufacturer. Alternatively, a slit-based calibration can be performed., (© 2022 Institute of Physics and Engineering in Medicine.)

Objective. A comparison of percent depth dose (PDD) curves, lateral beam profiles, output factors (OFs), multileaf collimator (MLC) leakage, and couch transmission factors was performed between ten institutes for a commercial 0.35 T MR-linac. Approach. The measured data was collected during acceptance testing of the MR-linac. The PDD curves were measured for the 3.32 × 3.32 cm 2 , 9.96 × 9.96 cm 2 , and 27.20 × 24.07 cm 2 field sizes. The lateral beam profiles were acquired for a 27.20 × 24.07 cm 2 field size using an ion chamber array and penumbra was defined as the distance between 80% of the maximum dose and 20% of the maximum dose after normalizing the profiles to the dose at the inflection points. The OFs were measured using solid-state dosimeters, whereas radiochromic films were utilized to measure radiation leakage through the MLC stacks. The relative couch transmission factors were measured for various gantry angles. The variation in the multi-institutional data was quantified using the percent standard deviation metric. Main results. Minimal variations (<1%) were found between the PDD data, except for the build-up region and the deeper regions of the PDD curve. The in-field region of the lateral beam profiles varied <1.5% between different institutions and a small variation (<0.7 mm) in penumbra was observed. A variation of <1% was observed in the OF data for field sizes above 1.66 × 1.66 cm 2 , whereas large variations were shown for small-field sizes. The average and maximum MLC leakage was calculated to be <0.3% and <0.6%, which was well below the international electrotechnical commission (IEC) leakage thresholds. The couch transmission was smallest for oblique beams and ranged from 0.83 to 0.87. Significance. The variation in the data was found to be relatively small and the different 0.35 T MR-linacs were concluded to have similar dosimetric characteristics., (© 2022 Institute of Physics and Engineering in Medicine.)

This work seeks to develop standard X-ray beams that are matched to radiobiology X-ray irradiators. The calibration of detectors used for dose determination of these irradiators is performed with a set of standard X rays that are more heavily filtered and/or lower energy, which leads to a higher uncertainty in the dose measurement. Models of the XRad320, SARRP, and the X-ray tube at the University of Wisconsin Medical Radiation Research Center (UWMRRC) were created using the BEAMnrc user code of the EGSnrc Monte Carlo code system. These models were validated against measurements, and the resultant modeled spectra were used to determine the amount of added filtration needed to match the X-ray beams at the UWMRRC to those of the XRad320 and SARRP. The depth profiles and half-value layer (HVL) simulations performed using BEAMnrc agreed to measurements within 3% and 3.6%, respectively. A primary measurement device, a free-air chamber, was developed to measure air kerma in the medium energy range of X rays. The resultant spectra of the matched beams had HVL's that matched the HVL's of the radiobiology irradiators well within the 3% criteria recommended by the International Atomic Energy Agency (IAEA) and the average energies agreed within 2.4%. In conclusion, three standard X-ray beams were developed at the UWMRRC with spectra that more closely match the spectra of the XRad320 and SARRP radiobiology irradiators, which will aid in a more accurate dose determination during calibration of these irradiators., (©2022 by Radiation Research Society. All rights of reproduction in any form reserved.)

Objective . Synchrony ® is a motion management system on the Radixact ® that uses planar kV radiographs to locate the target during treatment. The purpose of this work is to quantify the visibility of fiducials on these radiographs. Approach . A custom acrylic slab was machined to hold 8 gold fiducials of various lengths, diameters, and orientations with respect to the imaging axis. The slab was placed on the couch at the imaging isocenter and planar radiographs were acquired perpendicular to the custom slab with varying thicknesses of acrylic on each side. Fiducial signal to noise ratio (SNR) and detected fiducial position error in millimeters were quantified. Main Results . The minimum output protocol (100 kVp, 0.8 mAs) was sufficient to detect all fiducials on both Radixact configurations when the thickness of the phantom was 20 cm. However, no fiducials for any protocol were detected when the phantom was 50 cm thick. The algorithm accurately detected fiducials on the image when the SNR was larger than 4. The MV beam was observed to cause RFI artifacts on the kV images and to decrease SNR by an average of 10%. Significance . This work provides the first data on fiducial visibility on kV radiographs from Radixact Synchrony treatments. The Synchrony fiducial detection algorithm was determined to be very accurate when sufficient SNR is achieved. However, a higher output protocol may need to be added for use with larger patients. This work provided groundwork for investigating visibility of fiducial-free solid targets in future studies and provided a direct comparison of fiducial visibility on the two Radixact configurations, which will allow for intercomparison of results between configurations., (© 2022 IOP Publishing Ltd.)

Purpose: Accurate radiation dose is required to ensure reproducibility in establishing the radiobiological effect in biological systems among institutions. The dose should be the most precise and accurate parameter of the entire process. The goal is a system to provide uniform radiation dose verification among institutions that is traceable to the National Institute of Standards and Technology (NIST) through an Accredited Dosimetry Calibration Laboratory., Methods and Materials: Radiobiological beams are not NIST traceable but can be approximated based on the radiograph's half value layer. Phantoms have been developed containing detectors to measure the dose from total body irradiation of mice and others. Ionization chambers calibrated to NIST-traceable beams are the best detectors for precise and accurate dose determinations. However, thermoluminescent dosimeters have been mostly used for this application for comparison between institutions., Results: A comparison of thermoluminescent dosimeters results among surveyed institutions showed a large variation in delivered dose. The range of radiograph doses that were measured deviated from the standard dose by 12% to 42%. The results have an uncertainty of 2.5% at 1 standard deviation. The surveyed radionuclide irradiators demonstrated a dose range variation of 1.6% to 13.5% from target dose. There is less variation among high energy (linacs) because a calibrated ionization chamber is generally used by personnel (eg, medical physicist) and the output is determined for radiation therapy applications as well., Conclusions: Radiobiological dosimetry is lacking with respect to its precision and accuracy. The accuracy of radiograph calibrations for radiobiology can be estimated to be approximately 5%, because there are no NIST-traceable beams. However, among institutions, the variations can be up to 42%. Intercomparisons between institutions is important to have a clear understanding of the transference of dose between given studies., (Copyright © 2021. Published by Elsevier Inc.)

A Fano cavity test was implemented in GEANT4 Monte Carlo code to evaluate the alpha particle transport algorithm. GEANT4 alpha emission data for 212 Pb, 223 Ra, 227 Th, and 225 Ac was compared with the MIRD and RADAR decay databases. Optimal electromagnetic transport parameters (dRover of 0.1 and final range of 1 μm) were recommended since the calculated results with the default parameters differed up to 4.7% from the theoretical results. Good agreement was found between the three decay databases besides a few discrepancies., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Purpose: Previous publications have described how the standard temperature and pressure correction will overcorrect measurements with a low-energy photon low-dose rate brachytherapy source at low ambient air pressures. To account for this effect, an additional correction factor is applied after the standard temperature and pressure correction. This additional correction is dependent on the source being measured and the chamber it is measured in. Well chamber corrections for two sources and findings regarding aspects that may affect the altitude response of the sources are presented., Methods: A purpose-built pressure vessel was constructed previously, which could achieve pressures ranging from 74.661 to 106.66 kPa (560-800 mmHg). Three Cesium Blu sources ( 131 Cs) from Isoray Inc. and three CivaDots ( 103 Pd) from CivaTech Oncology Inc. were tested over this pressure range in increments of 2.7 kPa (20 mmHg) in three HDR 1000 Plus chambers, and the Cesium Blu sources were also tested in two IVB 1000 chambers. Both chamber models are air communicating well-type ionization chambers produced by Standard Imaging Inc. Multiple runs of each source/chamber combination were completed, corrected with the standard temperature and pressure correction, normalized to the result at 101.325 kPa, and averaged with runs of the same combination. The chamber response was also simulated using MCNP6 to validate the experimental results., Results: Measurements of both sources in all chambers followed the expected power dependence on ambient pressure as seen in previous studies. The Cesium Blu source, however, demonstrated a significant difference in response in the HDR 1000 Plus chamber versus the IVB 1000 chamber. For an altitude correction factor of the form, P A  = k 1 (P) k 2 , new coefficients are proposed for both sources for pressure units of kPa and mmHg. The Monte Carlo calculated chamber response agreed with the experimental results within 2% for all sources and chambers at all pressures., Conclusions: Altitude correction coefficients for two new low-energy photon low-dose rate brachytherapy sources are provided. The directional dependence of the CivaDot has no bearing on its dependence on pressure; however, the difference in construction materials from other 103 Pd sources leads to unique correction coefficients. The higher energy of the Cesium Blu source with respect to 103 Pd and 125 I sources yields a difference in correction factors depending on which model chamber is used for air-kerma strength calculations. Clinics must be careful to select the correct pair of coefficients for the chamber model they used., (© 2021 American Association of Physicists in Medicine.)

The accuracy of electromagnetic transport in the GEANT4 Monte Carlo (MC) code was investigated for carbon ion beams and ionization chamber (IC)-specific beam quality correction factors were calculated. This work implemented a Fano cavity test for carbon ion beams in the 100-450 MeV/u energy range to assess the accuracy of the default electromagnetic physics parameters. The Urban and the Wentzel-VI multiple Coulomb scattering models were evaluated and the impact of maxStep , dRover, and final range parameters on the accuracy of the transport algorithm was investigated. The optimal production thresholds for an accurate calculation offQvalues, which is the product of the water-to-air stopping power ratio and the IC-specific perturbation correction factor, were also studied. ThefQcorrection factors were calculated for a cylindrical and a parallel-plate IC using carbon ions in the 150-450 MeV/u energy range. Modifying the default electromagnetic physics parameters resulted in a maximum deviation from theory of 0.3%. Therefore, the default EM parameters were used for the remainder of this work. ThefQfactors were found to converge for both ICs with decreasing production threshold distance below 5 μ m. ThefQvalues obtained in this work agreed with the TRS-398 stopping power ratios and other previously reported results within uncertainty. This study highlights an accurate MC-based technique to calculate the combined stopping power ratio and the perturbation correction factor for any IC in carbon ion beams., (© 2021 Institute of Physics and Engineering in Medicine.)

Kilovoltage radiographs are acquired during motion-synchronized treatments on Radixact to localize the tumor during the treatment. Several previous publications have provided estimates of patient dose from these planar radiographs. However, a recent hardware update changed several aspects of the kV imaging system, including a new X-ray tube, an extended source-to-axis distance (SAD), and a larger field size. This is denoted the extended configuration. The purpose of this work was to assess the impact of the configuration change on patient dose from these procedures. Point doses in water were measured using the TG-61 protocol for tube potentials between 100 and 140 kVp for both the standard and extended configurations under the same water tank setup. Comparisons were made for equal mAs since the same protocols (kVp, mAs) will be used for both configurations. In comparison to the standard configuration, doses per mAs from the extended configuration were found to be ~66% less and falloff less steep due to the increased SAD. However, a larger volume of tissue is irradiated due to the larger field size. Beam quality for a given tube potential was the same as determined by half-value layer measurements. Both kV configurations are available from the vendor, therefore, the values in this work can be used to compare values previously published in the literature for the standard configuration or to intercompare doses from these two system configurations., (© 2021 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals LLC on behalf of American Association of Physicists in Medicine.)

Mesenchymal stromal cells (MSCs) are being tested as a cell therapy in clinical trials for dozens of inflammatory disorders, with varying levels of efficacy reported. Suitable and robust preclinical animal models for testing the safety and efficacy of different types of MSC products before use in clinical trials are rare. We here introduce two highly robust animal models of immune pathology: 1) acute radiation syndrome (ARS) and 2) graft versus host disease (GvHD), in conjunction with studying the immunomodulatory effect of well-characterized Interferon gamma (IFNγ) primed bone marrow derived MSCs. The animal model of ARS is based on clinical grade dosimetry precision and bioluminescence imaging. We found that allogeneic MSCs exhibit lower persistence in naïve compared to irradiated animals, and that intraperitoneal infusion of IFNγ prelicensed allogeneic MSCs protected animals from radiation induced lethality by day 30. In direct comparison, we also investigated the effect of IFNγ prelicensed allogeneic MSCs in modulating acute GvHD in an animal model of MHC major mismatched bone marrow transplantation. Infusion of IFNγ prelicensed allogeneic MSCs failed to mitigate acute GvHD. Altogether our results demonstrate that infused IFNγ prelicensed allogeneic MSCs protect against lethality from ARS, but not GvHD, thus providing important insights on the dichotomy of IFNγ prelicensed allogenic MSCs in well characterized and robust animal models of acute tissue injury., Competing Interests: CC receives honorarium from Nektar Therapeutics. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Chinnadurai, Bates, Kunugi, Nickel, DeWerd, Capitini, Galipeau and Kimple.)

The American Association of Physicists in Medicine (AAPM) formed Task Group 178 (TG-178) to perform the following tasks: review in-phantom and in-air calibration protocols for gamma stereotactic radiosurgery (GSR), suggest a dose rate calibration protocol that can be successfully utilized with all gamma stereotactic radiosurgery (GSR) devices, and update quality assurance (QA) protocols in TG-42 (AAPM Report 54, 1995) for static GSR devices. The TG-178 report recommends a GSR dose rate calibration formalism and provides tabulated data to implement it for ionization chambers commonly used in GSR dosimetry. The report also describes routine mechanical, dosimetric, and safety checks for GSR devices, and provides treatment process quality assurance recommendations. Sample worksheets, checklists, and practical suggestions regarding some QA procedures are given in appendices. The overall goal of the report is to make recommendations that help standardize GSR physics practices and promote the safe implementation of GSR technologies., (© 2021 American Association of Physicists in Medicine.)

Purpose: The aim of this work was to develop and benchmark a magnetic resonance (MR)-guided linear accelerator head model using the GEANT4 Monte Carlo (MC) code. The validated model was compared to the treatment planning system (TPS) and was also used to quantify the electron return effect (ERE) at a lung-water interface., Methods: The average energy, including the spread in the energy distribution, and the radial intensity distribution of the incident electron beam were iteratively optimized in order to match the simulated beam profiles and percent depth dose (PDD) data to measured data. The GEANT4 MC model was then compared to the TPS model using several photon beam tests including oblique beams, an off-axis aperture, and heterogeneous phantoms. The benchmarked MC model was utilized to compute output factors (OFs) with the 0.35 T magnetic field turned on and off. The ERE was quantified at a lung-water interface by simulating PDD curves with and without the magnetic field for 6.6 × 6.6  cm 2 and 2.5 × 2.5  cm 2 field sizes. A 2%/2 mm gamma criterion was used to compare the MC model with the TPS data throughout this study., Results: The final incident electron beam parameters were 6.0 MeV average energy with a 1.5 MeV full width at half maximum (FWHM) Gaussian energy spread and a 1.0 mm FWHM Gaussian radial intensity distribution. The MC-simulated OFs were found to be in agreement with the TPS-calculated and measured OFs, and no statistical difference was observed between the 0.35 T and 0.0 T OFs. Good agreement was observed between the TPS-calculated and MC-simulated data for the photon beam tests with gamma pass rates ranging from 96% to 100%. An increase of 4.3% in the ERE was observed for the 6.6 × 6.6  cm 2 field size relative to the 2.5 × 2.5  cm 2 field size. The ratio of the 0.35 T PDD to the 0.0 T PDD was found to be up to 1.098 near lung-water interfaces for the 6.6 × 6.6  cm 2 field size using the MC model., Conclusions: A vendor-independent Monte Carlo model has been developed and benchmarked for a 0.35 T/6 MV MR-linac. Good agreement was obtained between the GEANT4 and TPS models except near heterogeneity interfaces., (© 2021 The Authors. Medical Physics published by Wiley Periodicals LLC on behalf of American Association of Physicists in Medicine.)

Background: Density-based dose point kernel (DPK) scaling accuracy was investigated in various homogeneous tissue media. Methods: Using GEometry ANd Tracking 4 Monte Carlo code, DPKs were generated for 5, 8 MeV monoenergetic α particles and 223 Ra, 225 Ac, and 227 Th. Dose was scored in 1 μm thick concentric shells and DPKs were scaled based on the tissue's mass density and compared with the water DPK. Results: Scaled kernels agreed within ±5% except near the Bragg peaks, where they differed up to 25%. Conclusions: The authors conclude that kernel scaling based on mass density of the transport medium can be utilized accurately up to 5%, excluding Bragg peak regions.

Purpose: It is important to check stability of ionization chambers in between regular calibration cycles. Stability checks can include individual 60 Co irradiations, use of a beta-emitting check source, or redundant measurements in megavoltage photon beams. While 60 Co irradiators are considered stable, they are rarely found in the clinical setting. Thus, this study seeks to compare the precision and efficiency in monitoring chamber stability using 90 Sr check sources and linear accelerator beams which are both commonly found in the clinical setting, and compare these sources to 60 Co., Methods: Measurements were made with a 90 Sr beta-emitting check source and a 6 MV photon beam using a Constancy Check Phantom with three custom inserts to hold the ionization chambers. A comparison of both methods was performed with an Exradin A28 scanning chamber, Wellhofer IC69 Farmer-type chamber, and Exradin A12 Farmer-type chamber. Chamber stability was evaluated with individual charge readings and charge ratios among the three chambers. Results were compared to measurements taken in 60 Co with three Farmer-type chambers: the NEL 2571, PTW N30001G, and Exradin A12., Results: Stability of individual charge reading was found to be within ±1.0% for 90 Sr source measurements and ±0.5% for external beam measurements, including the 60 Co comparison. Additionally, the standard deviation of the mean charge ratios ranged from 0.15% to 0.40% for 90 Sr measurements and from 0.10% to 0.30% for the external beam measurements., Conclusions: This work provides a comparison of techniques used to assess stability of ionization chambers in order to better inform the clinical physicist., (Copyright © 2020 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.)

Purpose: To investigate the variability and stability of brachytherapy source strength calibration coefficients for air-communicating and pressurized well-type ionization chambers among high-dose rate (HDR), low-dose rate (LDR), and electronic brachytherapy (EBT) source qualities. These qualities of an ionization chamber are important features to assess given their role in maintaining traceability to a primary national standards laboratory and facilitating efficacious patient care in brachytherapy., Methods: The calibration records from the University of Wisconsin Accredited Dosimetry Calibration Laboratory (UWADCL) customer well-type ionization chamber database were retrospectively analyzed for calibrations performed between 1996 and 2019. A statistical analysis was performed and differentiated among calibration type to quantify the distribution of chamber calibration coefficients among several chamber models. Distributions were quantified based on their moments and by quantile analysis. For LDR calibrations, chamber response was further differentiated by seed type to study the variability in seed dependence within and across chamber models. In addition to these metrics, the calibration lineage at the UWADCL was used to assess the stability of these calibration coefficients among chamber model and source type based on the ratio of subsequent calibration coefficients., Results: The distribution of brachytherapy source strength calibration coefficients for a particular chamber model is not necessarily normally distributed and is sensitive to changes in the machining tolerances or design of the chamber model. Calibration source quality also influenced the distributions of calibration coefficients for a chamber model; the air-kerma rate calibration coefficients for EBT sources were the most variable followed by LDR and then HDR source types. The stability of a chamber's source strength calibration coefficient exhibited a similar dependence on the source quality. Air-communicating and pressurized chambers exhibited an average stability between subsequent calibrations of 0.2% and 3.0%, respectively, for HDR calibrations, but could exhibit more than double this variability characteristic of their leptokurtic distributions. For LDR calibrations, the spread and stability in a model's calibration ratio toward another seed type is extensive and notable. For some seed types and chamber models exhibit variations of <0.5% while others exceeded 2.0%. Furthermore, the magnitude of this dependence is outside the variability of the source's source strength due to manufacturing, which was determined from the manufacturer and NIST source strength intercomparison records at the UWADCL. As a result, establishing and disseminating calibration conversion factors among different source and chamber models is not advised as it would substantially increase the uncertainty in a clinical user's determination of source strength., Conclusions: The calibration of a well-type ionization chamber is unique to the chamber, source, and source holder. Attempting to generalize source strength calibration coefficients among chambers of the same model or source type is impractical given the variation in response observed across the calibration history of the UWADCL. Attempting to quantitate and transfer calibration coefficients in such a relative sense may significantly degrade the uncertainty relative to specifically calibrating a chamber for an individual source., (© 2020 American Association of Physicists in Medicine.)

Purpose: The aim of this work was to characterize the dosimetric properties of the PTW microDiamond (60019) single crystal synthetic diamond detector (DD) in kilovoltage x-ray beams. The following characteristics were addressed in this study: required preirradiation dose, dose-rate linearity, energy dependence, and percent depth dose response of the DD., Methods: UWADCL x-ray beams, characterized by NIST-traceable ionization chambers, were used in this study. Preirradiation dose required by the DD, in order to stabilize the detector's response to within 0.1%, was quantitated. Dose-rate dependence was also investigated using the UW250-M and UW50-M beams, where the dose rate was varied by changing the tube current. N k and N D , w calibration coefficients for all the available M series beams at UWADCL were obtained to determine the energy dependence of the DD, Diode E, Diode P, and P11 parallel-plate ionization chamber. A custom-built water tank was utilized to measure the percent depth dose (PDD) response of the DD, Diode E, Diode P, and P11 chamber in UW250-M, UW100-M, and UW50-M beams. The measured PDD response of the detectors was compared with the simulated PDD data using EGSnrc Monte Carlo code., Results: A 1.5 Gy dose-to-water or air-kerma was found to be sufficient for the given DD's response to stabilize to within 0.1% in all of the beams used in this study. The dose-rate dependence parameter, Δ, was found to be 1.00 ± 0.02 and 1.016 ± 0.05 for the UW250-M and UW50-M beams, respectively. Relative to the 60 Co calibration coefficients, the DD was found to under-respond relative to calculated absorbed dose to water response and over-respond relative to the calculated air-kerma response in the M-series beams. Agreement of 1.5% was found between the measured PDD values and Monte Carlo simulated PDD values for UW250-M, UW100-M, and UW50-M beams., Conclusions: In order to stabilize the response, the DD needs a preirradiation dose, which is unique to every DD. A linear relationship between detector response and dose rate was found within the evaluated uncertainty. An energy dependence of the DD was studied, which is more pronounced in the low-energy beams and can be partially attributed to the metal contact material around the sensitive volume of the DD. Overall, the DD was found to be suitable for kilovoltage x-ray dosimetry., (© 2020 American Association of Physicists in Medicine.)

Purpose: Accurate liver tumor delineation is crucial for radiation therapy, but liver tumor volumes are difficult to visualize with conventional single-energy CT. This work investigates the use of split-filter dual-energy CT (DECT) for liver tumor visibility by quantifying contrast and contrast-to-noise ratio (CNR)., Methods: Split-filter DECT contrast-enhanced scans of 20 liver tumors including cholangiocarcinomas, hepatocellular carcinomas, and liver metastases were acquired. Analysis was performed on the arterial and venous phases of mixed 120 kVp-equivalent images and VMIs at 57 keV and 40 keV gross target volume (GTV) contrast and CNR were calculated., Results: For the arterial phase, liver GTV contrast was 12.1 ± 10.0 HU and 43.1 ± 32.3 HU (P < 0.001) for the mixed images and 40 keV VMIs. Image noise increased on average by 116% for the 40 keV VMIs compared to the mixed images. The average CNR did not change significantly (1.6 ± 1.5, 1.7 ± 1.4, 2.4 ± 1.7 for the mixed, 57 keV and 40 keV VMIs (P > 0.141)). For individual cases, however, CNR increases of up to 607% were measured for the 40 keV VMIs compared to the mixed image. Venous phase 40 keV VMIs demonstrated an average increase of 35.4 HU in GTV contrast and 121% increase in image noise. Average CNR values were also not statistically different, but for individual cases CNR increases of up to 554% were measured for the 40 keV VMIs compared to the mixed image., Conclusions: Liver tumor contrast was significantly improved using split-filter DECT 40 keV VMIs compared to mixed images. On average, there was no statistical difference in CNR between the mixed images and VMIs, but for individual cases, CNR was greatly increased for the 57 keV and 40 keV VMIs. Therefore, although not universally successful for our patient cohort, split-filter DECT VMIs may provide substantial gains in tumor visibility of certain liver cases for radiation therapy treatment planning., (© 2020 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, Inc. on behalf of American Association of Physicists in Medicine.)

Purpose: The plan-class specific reference field concept could theoretically improve the calibration of radiation detectors in a beam environment much closer to clinical deliveries than existing broad beam dosimetry protocols. Due to a lack of quantitative guidelines and representative data, however, the pcsr field concept has not yet been widely implemented. This work utilizes quantitative plan complexity metrics from modulated clinical treatments in order to investigate the establishment of potential plan classes using two different clustering methodologies. The utility of these potential plan clusters is then further explored by analyzing their relevance to actual dosimetric correction factors., Methods: Two clinical databases containing several hundred modulated plans originally delivered on two Varian linear accelerators were analyzed using 21 plan complexity metrics. In the first approach, each database's plans were further subdivided into groups based on the anatomic site of treatment and then compared to one another using a series of nonparametric statistical tests. In the second approach, objective clustering algorithms were used to seek potential plan clusters in the multidimensional complexity-metric space. Concurrently, beam- and detector-specific dosimetric corrections for a subset of the modulated clinical plans were determined using Monte Carlo for three different ionization chambers. The distributions of the dosimetric correction factors were compared to the derived plan clusters to see which plan clusters, if any, could help predict the correction factor magnitudes. Ultimately, a simplified volume averaging metric (SVAM) is shown to be much more relevant to the total dosimetric correction factor than the established plan clusters., Results: Plan groups based on the site of treatment did not show noticeable distinction from one another in the context of the metrics investigated. An objective clustering algorithm was able to discriminate volumetric modulated arc therapy (VMAT) plans from step-and-shoot intensity-modulated radiation therapy plans with an accuracy of 90.8%, but no clusters were found to exist at any level more specific than delivery modality. Monte Carlo determined correction factors for the modulated plans ranged from 0.970 to 1.104, 0.983 to 1.027, and 0.986 to 1.009 for the A12, A1SL, and A26 chambers, respectively, and were highly variable even within the treatment modality plan clusters. The magnitudes of these correction factors were explained almost entirely by volume averaging with SVAM demonstrating positive correlation with all Monte Carlo established total correction factors., Conclusions: Plan complexity metrics do provide some quantitative basis for the investigation of plan clusters, but an objective clustering algorithm demonstrated that quantifiable differences could only be found between VMAT and step-and-shoot beams delivered on the same treatment machine. The inherent variability of the Monte Carlo determined correction factors could not be explained solely by the modality of the treatment but were instead almost entirely dependent upon the volume averaging correction, which itself depends on the detector position within the dose distribution, dose gradients, and other factors. Considering the continued difficulty of determining a relevant plan metric to base plan clusters on, case-by-case corrections may instead obviate the need for the pcsr field concept in the future., (© 2020 American Association of Physicists in Medicine.)

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 nanoDot TM dosimeters because of their prevalence in clinical practice., (© 2019 American Association of Physicists in Medicine.)

Understanding the dynamic nature of tumor hypoxia is vital for cancer therapy. The presence of oxygen within a tumor during radiation therapy increases the likelihood of local control. We used a novel interstitial diffuse optical probe to make real-time measurements of blood volume fraction and hemoglobin oxygen saturation within a tumor at a high temporal resolution. This device was initially characterized and benchmarked using a customized vessel designed to control hemoglobin oxygen saturation and blood volume in a solution of blood with different concentrations of an oxygen scavenger, tetrakis (hydroxymethyl) phosphonium chloride. The optical device was found to consistently monitor the changes in oxygen saturation and these changes correlated to the concentration of the oxygen scavenger added. In near-simultaneous measurements of blood volume and oxygen saturation in tumor-bearing mice, the changes in blood volume fraction and oxygen saturation measured with the interstitial diffuse optical probe were benchmarked against photoacoustic imaging system to track and compare temporal dynamics of oxygen saturation and blood volume in a patient-derived xenograft model of hypopharyngeal carcinoma. Positive correlations between our device and photoacoustic imaging in measuring blood volume and oxygen saturation were observed.

Purpose: To establish a method of accurate dosimetry required to quantify the expected linear energy transfer (LET) quenching effect of EBT3 film used to benchmark the dose distribution for a given treatment field and specified measurement depth. In order to facilitate this technique, a full analysis of film calibration which considers LET variability at the plane of measurement and as a function of proton beam quality is demonstrated. Additionally, the corresponding uncertainty from the process was quantified for several measurement scenarios., Materials and Methods: The net change in optical density (OD) from a single version of Gafchromic TM EBT3 film was measured using an Epson flatbed scanner and NIST-traceable OD filters. Film OD response was characterized with respect to the known dose to water at the point of measurement for both a NIST-traceable 60 Co beam at the UWADCL and several clinical single-energy and spread-out Bragg peak (SOBP) proton beam qualities at the Northwestern Medicine Chicago Proton Center. Increasing proton LET environments were acquired by placing film at increasing depths of Gammex HE Solid Water® whose water-equivalent thickness was characterized prior to measurement., Results: A strong LET dependence was observed near the Bragg peak (BP) consistent with previous studies performed with earlier versions of EBT3 film. The influence of range straggling on the film's LET response appears to have a uniform effect toward the BP regardless of the nominal beam energy. Proximal to this depth, the film's response decreased with decreasing energy at the same dose-average LET. The opposite trend was observed for depths past the BP. Changes in the SOBP energy modulation showed a linear relationship between the film's relative response and dose-averaged LET. Relative effectiveness factors (RE) were observed to range between 2%-7% depending on the width of the SOBP and depth of the film. Using the field-specific calibration technique, a total k = 1 uncertainty in the absorbed dose to water was estimated to range from 4.68%-5.21%., Conclusion: While EBT3 film's strong LET dependence is a common problem in proton beam dosimetry, this work has shown that the LET dependence can be taken into account by carefully considering the depth and energy modulation across the film using field-specific corrections. RE factors were determined with a combined k = 1 uncertainty of 3.57% for SOBP environments and between 3.17%-4.69% for uniform, monoenergetic fields proximal to the distal 80% of the BP., (© 2019 American Association of Physicists in Medicine.)

Purpose: A convex windowless extrapolation chamber was developed as a primary measurement device to determine surface dose rate from curved 106 Ru/ 106 Rh episcleral plaques., Methods: A convex extrapolation chamber without an entrance window was constructed for this work, and surface dose rate measurements were performed with two curved CCB-type 106 Ru/ 106 Rh plaques (S/N 2545 and 2596) manufactured by Eckert & Ziegler BEBIG. FARO ® Gage measurements were performed to verify the radius of curvature for the convex electrode and the concave plaque surface. Furthermore, the collecting electrode area was verified through capacitance measurements. Chamber correction factors for divergence and backscatter were generated using the EGSnrc cavity user code. For each source, surface dose rate was measured with the convex extrapolation chamber and compared with on-contact measurements made with curved un-laminated EBT3 film strips. A Monte Carlo correction was generated for radiochromic film measurements to account for volume averaging within the active layer and effects of phantom scatter. Additionally, extrapolation chamber results for each plaque were compared with scintillation detector measurements performed by the manufacturer. For the second source (S/N 2596), a comparison was also made with the Monte Carlo-corrected surface dose rate measured at the National Physical Laboratory (NPL) using cylindrical alanine pellets. Finally, source measurements were performed using conventional ionization chambers (Exradin A26, A1SL, and A20) within a custom fixture to investigate the transfer of extrapolation chamber surface dose rate to clinics., Results: For the first 106 Ru/ 106 Rh plaque (S/N 2545), average surface dose rate from the convex windowless extrapolation chamber was found to be 1.5% higher than the corresponding value from curved un-laminated EBT3 film measurements and 5.6% lower than the manufacturer value. For the second source (S/N 2596), the extrapolation chamber surface dose rate was 2.5% higher than the un-laminated EBT3 film result, 4.5% lower than the manufacturer value, and 3.9% higher compared to corrected alanine measurements made at NPL. Total uncertainty in the extrapolation chamber measurement was estimated to be approximately  ± 7.0% (k = 2). For the plaque measurements made using conventional ionization chambers with a custom fixture, surface dose rate from the transfer technique was found to agree within 3.8% with the expected convex extrapolation chamber result for S/N 2596., Conclusions: A convex windowless extrapolation chamber was developed as a primary measurement device for 106 Ru/ 106 Rh plaques. Through comparison with the extrapolation chamber, the accuracy of surface dose rate measurements from current dosimetry techniques was assessed and agreement was seen within 5.6%. Finally, it was found that conventional ionization chambers could be calibrated with a reference 106 Ru/ 106 Rh plaque in order to transfer the extrapolation chamber result for surface dose rate to clinics., (© 2019 American Association of Physicists in Medicine.)

Purpose: The determination of absorbed dose to water from external beam radiotherapy using radiation detectors is currently rooted in calibration protocols that do not account for modulations encountered in patient-specific deliveries. Detector response in composite clinical fields has not been extensively studied due to the time and effort required to determine these corrections on a case-by-case basis. To help bridge this gap in knowledge, corrections for the Exradin A1SL scanning chamber were determined in a large number of composite clinical fields using Monte Carlo methods. The chamber-specific perturbations that contribute the most to the overall correction factor were also determined., Methods: A total of 131 patient deliveries comprised of 834 beams from a Varian C-arm linear accelerator were converted to EGSnrc Monte Carlo inputs. A validated BEAMnrc 21EX linear accelerator model was used as a particle source throughout the EGSnrc simulations. Composite field dose distributions were compared against a commercial treatment planning system for validation. The simulation geometry consisted of a cylindrically symmetric water-equivalent phantom with the Exradin A1SL scanning chamber embedded inside. Various chamber perturbation factors were investigated in the egs&#95;chamber user code of EGSnrc and were compared to reference field conditions to determine the plan-specific correction factor., Results: The simulation results indicated that the Exradin A1SL scanning chamber is suitable to use as an absolute dosimeter within a high-dose and low-gradient target region in most nonstandard composite fields; however, there are still individual cases that require larger delivery-specific corrections. The volume averaging and replacement perturbations showed the largest impact on the overall plan-specific correction factor for the Exradin A1SL scanning chamber, and both volumetric modulated arc therapy (VMAT) and step-and-shoot beams demonstrated similar correction factor magnitudes among the data investigated. Total correction magnitudes greater than 2% were required by 9.1% of step-and-shoot beams and 14.5% of VMAT beams. When examining full composite plan deliveries as opposed to individual beams, 0.0% of composite step-and-shoot plans and 2.6% of composite VMAT plans required correction magnitudes greater than 2%., Conclusions: The A1SL scanning chamber was found to be suitable to use for absolute dosimetry in high-dose and low-gradient dose regions of composite IMRT plans but even if a composite dose distribution is large compared to the detector used, a correction-free absorbed dose-to-water measurement is not guaranteed., (© 2018 American Association of Physicists in Medicine.)

Purpose: This work seeks to investigate new methods to determine the absorbed dose to water from kilovoltage x rays. Current methods are based on measurements in air and rely on correction factors in order to account for differences between the photon spectrum in air and at depth in phantom, between the photon spectra of the calibration beam and the beam of interest, or in the radiation absorption properties of air and water. This work aims to determine the absorbed dose to water in the NIST-matched x-ray beams at the University of Wisconsin Accredited Dosimetry Calibration Laboratory (UWADCL). This will facilitate the use of detectors in terms of dose to water, which will allow for a simpler determination of dose to water in clinical kilovoltage x-ray beams., Materials and Methods: A model of the moderately filtered x-ray beams at the UWADCL was created using the BEAMnrc user code of the EGSnrc Monte Carlo code system. This model was validated against measurements and the dose to water per unit air kerma was calculated in a custom built water tank. Using this value and the highly precise measurement of the air kerma made by the UWADCL, the dose to water was determined in the water tank for the x-ray beams of interest. The dose to water was also determined using the formalism defined in the report of AAPM Task Group 61 and using a method that makes use of a 60 Co absorbed dose-to-water calibration coefficient and a beam quality correction factor to account for differences in beam quality between the 60 Co calibration and kilovoltage x-ray beam of interest. The dose to water values as determined by these different methods was then compared., Results: The BEAMnrc models used in this work produced simulations of transverse and depth dose profiles that agreed with measurements with a 2%/2 mm criteria gamma test. The dose to water as determined from the different methods used here agreed within 3.5% at the surface of the water tank and agreed within 1.8% at a depth of 2 cm in phantom. The dose-to-water values all agreed within the associated uncertainties of the methods used in this work. Both the Monte Carlo-based method and the 60 Co-based method had a lower uncertainty than the TG-61 methodology for all of the x-ray beams used in this work., Conclusion: Two new dose determination methods were used to determine the dose to water in the NIST-matched x-ray beams at the UWADCL and they showed good agreement with previously established techniques. Due to the improved Monte Carlo calculation techniques used in this work, both of the methods have lower uncertainties compared to TG-61. The methods presented in this work compare favorably with calorimetry-based standards established at other institutions., (© 2018 American Association of Physicists in Medicine.)

Purpose: Tumor delineation using conventional CT images can be a challenge for pancreatic adenocarcinoma where contrast between the tumor and surrounding healthy tissue is low. This work investigates the ability of a split-filter dual-energy CT (DECT) system to improve pancreatic tumor contrast and contrast-to-noise ratio (CNR) for radiation therapy treatment planning., Materials and Methods: Multiphasic scans of 20 pancreatic tumors were acquired using a split-filter DECT technique with iodinated contrast medium, OMNIPAQUE TM . Analysis was performed on the pancreatic and portal venous phases for several types of DECT images. Pancreatic gross target volume (GTV) contrast and CNR were calculated and analyzed from mixed 120 kVp-equivalent images and virtual monoenergetic images (VMI) at 57 and 40 keV. The role of iterative reconstruction on DECT images was also investigated. Paired t-tests were used to assess the difference in GTV contrast and CNR among the different images., Results: The VMIs at 40 keV had a 110% greater image noise compared to the mixed 120 kVp-equivalent images (P < 0.0001). VMIs at 40 keV increased GTV contrast from 15.9 ± 19.9 HU to 93.7 ± 49.6 HU and CNR from 1.37 ± 2.05 to 3.86 ± 2.78 in comparison to the mixed 120 kVp-equivalent images. The iterative reconstruction algorithm investigated decreased noise in the VMIs by about 20% and improved CNR by about 30%., Conclusions: Pancreatic tumor contrast and CNR were significantly improved using VMIs reconstructed from the split-filter DECT technique, and the use of iterative reconstruction further improved CNR. This gain in tumor contrast may lead to more accurate tumor delineation for radiation therapy treatment planning., (© 2018 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, Inc. on behalf of American Association of Physicists in Medicine.)

Purpose: To characterize response changes of various light guides used in megavoltage (MV) photon beam scintillation dosimetry as a function of irradiation conditions. Particular emphasis was placed on quantifying the impact of response changes on the Čerenkov light ratio (CLR)., Methods: Intensity and spectral response measurements as a function of dose, depth, and fiber-beam angle were performed with a commercial scintillation detector stripped of its scintillation material and five different custom-made light guides. The core materials of the light guides investigated consisted of polymethyl methacrylate (PMMA), low- and high-hydroxyl content silica, and polystyrene. Dose levels ranging from 50 monitor units (MU) to 1000 MU, depths ranging from 1 to 20 cm, and fiber-beam angles ranging from 10° to 90° were investigated. All measurements were performed at a photon beam energy of 6 MV. The CLR was calculated by taking the ratio of the responses in the blue to green spectral regions., Results: There was no significant change in the CLR measured with the modified commercial scintillation detector as a function of delivered dose. In addition, increases in the CLR as functions of depth and fiber-beam angle were observed where the maximum changes were 4.2% and 3.6%, respectively. The spectrum measurements showed no observable changes in spectral shape with depth except for the low-hydroxyl content silica fiber. Variations in the measured spectral shape with fiber-beam angle were observed for all fibers investigated. The magnitude of the changes in the spectral shape varied with fiber type, where the silica fibers exhibited the largest changes and the plastic fibers exhibited the smallest changes. Increases in the CLR were observed for the silica fibers with depth and for all fibers with fiber-beam angle. The plastic fibers showed no significant change in the CLR as a function of depth. Increases of 3.1% and 9.5% in the CLR were observed for the high- and low-hydroxyl content silica fibers, respectively, over the range of depths investigated. Variations of 2.3%, 6.1%, 5.1% and 11.9% were observed for the PMMA, polystyrene, high-hydroxyl, and low-hydroxyl content silica fiber CLR values as a function of fiber-beam angle, respectively., Conclusions: The insignificant change in the CLR with delivered dose indicates that a single CLR value over the investigated dose range is sufficient for accurate Čerenkov subtraction. Variations in the stem-effect spectrum shape can occur with changes in irradiation geometry. The magnitude of the changes are governed by the fiber construction and the optical properties of the fiber. The observed spectral shape changes can be explained by a combination of variations in optical path length through the fiber and the fiber fluorescent signal contribution to the stem-effect. These spectral shape variations directly influence the calculated CLR values. This work confirms that careful characterization of scintillation detectors is important as changes in the stem-effect spectrum can cause changes in the CLR. If the CLR changes between the reference and measurement conditions, this could result in an incorrect stem-effect subtraction and reduced measurement accuracy., (© 2018 American Association of Physicists in Medicine.)

Purpose: CivaTech Oncology Inc. (Durham, NC) has developed a novel low-dose rate (LDR) brachytherapy source called the CivaSheet. TM The source is a planar array of discrete elements ("CivaDots") which are directional in nature. The CivaDot geometry and design are considerably different than conventional LDR cylindrically symmetric sources. Thus, a thorough investigation is required to ascertain the dosimetric characteristics of the source. This work investigates the repeatability and reproducibility of a primary source strength standard for the CivaDot and characterizes the CivaDot dose distribution by performing in-phantom measurements and Monte Carlo (MC) simulations. Existing dosimetric formalisms were adapted to accommodate a directional source, and other distinguishing characteristics including the presence of gold shield x-ray fluorescence were addressed in this investigation., Methods: Primary air-kerma strength (S K ) measurements of the CivaDots were performed using two free-air chambers namely, the Variable-Aperture Free-Air Chamber (VAFAC) at the University of Wisconsin Medical Radiation Research Center (UWMRRC) and the National Institute of Standards and Technology (NIST) Wide-Angle Free-Air Chamber (WAFAC). An intercomparison of the two free-air chamber measurements was performed along with a comparison of the different assumed CivaDot energy spectra and associated correction factors. Dose distribution measurements of the source were performed in a custom polymethylmethacrylate (PMMA) phantom using Gafchromic TM EBT3 film and thermoluminescent dosimeter (TLD) microcubes. Monte Carlo simulations of the source and the measurement setup were performed using MCNP6 radiation transport code., Results: The CivaDot S K was determined using the two free-air chambers for eight sources with an agreement of better than 1.1% for all sources. The NIST measured CivaDot energy spectrum intensity peaks were within 1.8% of the MC-predicted spectrum intensity peaks. The difference in the net source-specific correction factor determined for the CivaDot free-air chamber measurements for the NIST WAFAC and UW VAFAC was 0.7%. The dose-rate constant analog was determined to be 0.555 cGy h -1 U -1 . The average difference observed in the estimated CivaDot dose-rate constant analog using measurements and MCNP6-predicted value (0.558 cGy h -1 U -1 ) was 0.6% ± 2.3% for eight CivaDot sources using EBT3 film, and -2.6% ± 1.7% using TLD microcube measurements. The CivaDot two-dimensional dose-to-water distribution measured in phantom was compared to the corresponding MC predictions at six depths. The observed difference using a pixel-by-pixel subtraction map of the measured and the predicted dose-to-water distribution was generally within 2-3%, with maximum differences up to 5% of the dose prescribed at the depth of 1 cm., Conclusion: Primary S K measurements of the CivaDot demonstrated good repeatability and reproducibility of the free-air chamber measurements. Measurements of the CivaDot dose distribution using the EBT3 film stack phantom and its subsequent comparison to Monte Carlo-predicted dose distributions were encouraging, given the overall uncertainties. This work will aid in the eventual realization of a clinically viable dosimetric framework for the CivaSheet based on the CivaDot dose distribution., (© 2018 American Association of Physicists in Medicine.)