Intensity-modulated radiation therapy (IMRT) represents one of the most significant technical advances in radiation therapy since the advent of the medical linear accelerator. It allows the clinical implementation of highly conformal nonconvex dose distributions. This complex but promising treatment modality is rapidly proliferating in both academic and community practice settings. However, these advances do not come without a risk. IMRT is not just an add-on to the current radiation therapy process; it represents a new paradigm that requires the knowledge of multimodality imaging, setup uncertainties and internal organ motion, tumor control probabilities, normal tissue complication probabilities, three-dimensional (3-D) dose calculation and optimization, and dynamic beam delivery of nonuniform beam intensities. Therefore, the purpose of this report is to guide and assist the clinical medical physicist in developing and implementing a viable and safe IMRT program. The scope of the IMRT program is quite broad, encompassing multileaf-collimator-based IMRT delivery systems, goal-based inverse treatment planning, and clinical implementation of IMRT with patient-specific quality assurance. This report, while not prescribing specific procedures, provides the framework and guidance to allow clinical radiation oncology physicists to make judicious decisions in implementing a safe and efficient IMRT program in their clinics.

https://aapm.onlinelibrary.wiley.com/doi/epdf/10.1118/1.1591194

Guidance document on delivery, treatment planning, and clinical implementation of IMRT: Report of the IMRT subcommittee of the AAPM radiation therapy committee

Photon, electron and proton radiations are used extensively for medical purposes in diagnostic and therapeutic procedures. Dosimetry of these radiation sources can be performed with radiochromic films, devices that have the ability to produce a permanent visible colour change upon irradiation. Within the last 10 years, the use of radiochromic films has expanded rapidly in the medical world due to commercial products becoming more readily available, higher sensitivity films and technology advances in imaging which have allowed scientists to use two-dimensional (2D) dosimetry more accurately and inexpensively. Radiochromic film dosimeters are now available in formats, which have accurate dose measurement ranges from less than 1 Gy up to many kGy. A relatively energy independent dose response combined with automatic development of radiochromic film products has made these detectors most useful in medical radiation dosimetry.

/pdf/radiochromic-film-for-medical-radiation-dosimetry-3ivt1gv8ns.pdf

Radiochromic film for medical radiation dosimetry

In this paper we describe a concept for dosimetric treatment plan verification using two-dimensional ionization chamber arrays. Two different versions of the 2D-ARRAY (PTW-Freiburg, Germany) will be presented, a matrix of 16 x 16 chambers (chamber cross section 8 mm x 8 mm; the distance between chamber centers, 16 mm) and a matrix of 27 x 27 chambers (chamber cross section 5 mm x 5 mm; the distance between chamber centers is 10 mm). The two-dimensional response function of a single chamber is experimentally determined by scanning it with a slit beam. For dosimetric plan verification, the expected two-dimensional distribution of the array signals is calculated via convolution of the planned dose distribution, obtained from the treatment planning system, with the two-dimensional response function of a single chamber. By comparing the measured two-dimensional distribution of the array signals with the expected one, a distribution of deviations is obtained that can be subjected to verification criteria, such as the gamma index criterion. As an example, this verification method is discussed for one sequence of an IMRT plan. The error detection capability is demonstrated in a case study. Both versions of two-dimensional ionization chamber arrays, together with the developed treatment plan verification strategy, have been found to provide a suitable and easy-to-handle quality assurance instrument for IMRT.

Two-dimensional ionization chamber arrays for IMRT plan verification.

The suitability of radiochromic EBT film was studied for high-precision clinical quality assurance (QA) by identifying the dose response for a wide range of irradiation parameters typically modified in highly-conformal treatment techniques. In addition, uncertainties associated with varying irradiation conditions were determined. EBT can be used for dose assessment of absorbed dose levels as well as relative dosimetry when compared to absolute absorbed dose calibrated using ionization chamber results. For comparison, a silver halide film (Kodak EDR-2) representing the current standard in film dosimetry was included. As an initial step a measurement protocol yielding accurate and precise results was established for a flatbed transparency scanner (Epson Expression 1680 Pro) that was utilized as a film reading instrument. The light transmission measured by the scanner was found to depend on the position of the film on the scanner plate. For three film pieces irradiated with doses of 0 Gy, ~1 Gy and ~7 Gy, the pixel values measured in portrait or landscape mode differed by 4.7%, 6.2% and 10.0%, respectively. A study of 200 film pieces revealed an excellent sheet-to-sheet uniformity. On a long time scale, the optical development of irradiated EBT film consisted of a slow but steady increase of absorbance which was not observed to cease during 4 months. Sensitometric curves of EBT films obtained under reference conditions (SSD = 95 cm, FS = 5 × 5 cm2, d = 5 cm) for 6, 10 and 25 MV photon beams did not show any energy dependence. The average separation between all curves was only 0.7%. The variation of the depth d (range 2–25 cm) in the phantom did not affect the dose response of EBT film. Also the influence of the radiation field size (range 3 × 3–40 × 40 cm2) on the sensitometric curve was not significant. For EDR-2 films maximum differences between the calibration curves reached 7–8% for X6MV and X25MV. Radiochromic EBT film, in combination with a flatbed scanner, presents a versatile system for high-precision dosimetry in two dimensions, provided that the intrinsic behaviour of the film reading device is taken into account. EBT film itself presents substantial improvements on formerly available models of radiographic and a radiochromic film and its dosimetric characteristics allow us to measure absorbed dose levels in a large variety of situations with a single calibration curve.

https://iopscience.iop.org/article/10.1088/0031-9155/52/14/013/pdf

Dosimetric characterization of GafChromic EBT film and its implication on film dosimetry quality assurance

TG-69 is a task group report of the AAPM on the use of radiographic film for dosimetry. Radiographic films have been used for radiation dosimetry since the discovery of x-rays and have become an integral part of dose verification for both routine quality assurance and for complex treatments such as soft wedges (dynamic and virtual), intensity modulated radiation therapy (IMRT), image guided radiation therapy (IGRT), and small field dosimetry like stereotactic radiosurgery. Film is convenient to use, spatially accurate, and provides a permanent record of the integrated two dimensional dose distributions. However, there are several challenges to obtaining high quality dosimetric results with film, namely, the dependence of optical density on photon energy, field size, depth, film batch sensitivity differences, film orientation, processing conditions, and scanner performance. Prior to the clinical implementation of a film dosimetry program, the film, processor, and scanner need to be tested to characterize them with respect to these variables. Also, the physicist must understand the basic characteristics of all components of film dosimetry systems. The primary mission of this task group report is to provide guidelines for film selection, irradiation, processing, scanning, and interpretation to allow the physicist to accurately and precisely measure dose with film. Additionally, we present the basic principles and characteristics of film, processors, and scanners. Procedural recommendations are made for each of the steps required for film dosimetry and guidance is given regarding expected levels of accuracy. Finally, some clinical applications of film dosimetry are discussed.

https://aapm.onlinelibrary.wiley.com/doi/epdf/10.1118/1.2736779

TG-69: Radiographic film for megavoltage beam dosimetry

X-ray film has been used for the dosimetry of intensity modulated radiation therapy (IMRT). However, the over-response of the film to low-energy photons is a significant problem in photon beam dosimetry, especially in regions outside penumbra. In IMRT, the radiation field consists of multiple small fields and their outside-penumbra regions; thus, the film dosimetry, for it involves the source of over-response in its radiation field. In this study we aim to verify and possibly improve film dosimetry for IMRT. Two types of modulated beams were constructed by combining five to seven different static radiation fields using 6 MV x rays. For verifying film dosimetry, x-ray films and an ion chamber were used to measure dose profiles at various depths in a phantom. The film setups include both parallel and perpendicular arrangements against the beam incident direction. In addition, to reduce an over-response, we placed 0.01 in. (0.25 mm) thick lead filters on both sides of the film. Compared with ion-chamber measurement, measured dose profiles showed the film over-response at outside-penumbra and low-dose regions. The error increased with depths and approached 15% as a maximum for the field size of 15 cm x 15 cm at 10 cm depth. The use of filters reduced the error down to 3%. In this study we demonstrated that film dosimetry for IMRT involves sources of error due to its over-response to low-energy photons, with the error most transparent in the low-dose region. The use of filters could enhance the accuracy in film dosimetry for IMRT. In this regard, the use of an optimal filter condition is recommended.

Choi Bk

Papers

Film Dosimetry for Intensity Modulated Radiation Therapy: Dosimetric Evaluation.