TG-61 deals with: This part of the refresher course: Phantoms. Chambers. Practical Implementation of TG-61:

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1 Practical Implementation of TG-61: II. Guidelines for clinical implementation of TG-61 J.P. Seuntjens Medical Physics Unit McGill University, Montreal General Hospital Montréal, Canada TG-61 deals ith: Calibration of absolute output of orthovoltage x-ray units in terms of D Relative dosimetry of orthovoltage beams Clinical issues electron contamination dose in biological tissues This part of the refresher course: Aspects and pitfalls of absolute output calibration Peculiarities in relative dosimetry of kilovoltage beams Other clinical issues Absolute calibration: Summary of recommendations tube potential < 100 kv in-airmethodmandatory tube potential 100 kv in-phantommethodalloed choice for medium energies to be made based on the location of the point of interest (target volume) Chambers Chambers: lo energy tube potential < 70 kv: soft x-ray parallel plate chambers tube potential 70 kv: cylindrical chambers ith flat energy response medium energy cylindrical chambers ith flat energy response Phantoms no phantom for in-air method ater phantom for in-phantom reference dosimetry for relative dosimetry plastic phantoms for stability checks

2 I. Absolute calibration: a. In-air method Absolute Calibration: In-air method µ en D (0 cm) = MN K P stem,air B ρ air air M: corrected chamber reading N K : air-kerma calibration factor P stem,air : stem correction factor free-in-air µ en mass-energy absorption coefficient ρ ratio ater to air, free-in-air air air B : back-scatter factor In-air method: 2 conceptual steps In-air method: 2 conceptual steps Step 1: measure air-kerma in clinical beam get and interpolate N K from a standards dosimetry laboratory (ADCL s, NIST, NRCC) establish P stem,air K air (clinical beam) =MN K P stem,air Step 2: look-up conversion factor and backscatter factor µ en D K =K,air B = K air ρ air B air STEP 1: Getting a calibration factor from standards lab & Evaluating P stem,air Get N K from standards lab calibration in terms of air-kerma (for both in-air and in-phantom method): beam quality specification is in terms of both HVL and tube potential

3 NIST calibration qualities disseminated by ADCL s Beam Code First HVL Hom. Coeff. (mm Al) (mm Cu) (Al) L L M M M M M Energy dependence of chamber calibration factor?... calibration factors should not vary significantly beteen to calibration points so that the estimated uncertainty in the calibration factor for a clinical beam beteen the to calibration points is ithin 2%. Energy dependence: in practical terms chamber response should be knon approximately, e.g., from manufacturer <2% calibration for at least to radiation qualities that bracket the radiation quality used in the clinic N K (x-rays)/n K ( 60 Co) should be as expected

4 In-air method: evaluate P stem,air for cylindrical chambers, stem effect in-air is usually less than 1% so P stem,air <1% stem scatter for large body endindo or superficial therapy chambers can be appreciable and should be checked Grimbergen,1995 Measuring P stem,air comparison to chamber ith knon P stem,air M chamber reading, M ref reference chamber reading f c field size at calibration lab; f u field size in clinical beam Grimbergen,1995 Mf ( ) ref ( ) stem,air( ) c M f P f u u = Pstem,air( fc) Mf ( u) Mref ( fc) STEP 2: Data on mass-energy absorption coefficients & Backscatter factors ±1.5%

5 Backscatter factors B is a kerma based quantity: K,phantom B = K,free-air Based on Monte Carlo calculations TG61 adopted data sets from Grossendt (1990, 1993) Surface kerma is very difficult to measure ith chambers electron contamination chamber response issues Clinical issues of in-air method strain on accurate knoledge of energy dependence of chamber response clinical relevance of electron contamination at the surface validity of backscatter factors for small cones Overall uncertainty: In-air method In-air method: Uncertainty at the reference point Type of quantity or procedure Uncertainty N K from standards lab 0.7% Effect of beam-quality difference 2.0% Backscatter factor B 1.5% P stem,air 1.0% µ en 1.5% ρ air Free-air measurement in user s 1.5% beam Combined D,z=0 3.5%

6 Summary: In-phantom method I. Absolute Calibration: b. In-phantom method µ = MN K P sheath P en D (2 cm) Q,cham ρ air M: corrected in-phantom chamber reading N K : air-kerma calibration factor P sheath : sheath correction factor P Q,cham : chamber correction factor µ en mass-energy absorption coefficient ρ ratio ater to air, in-phantom air Background: In-phantom method Background: In-phantom method Step 1: measure air kerma in ater: get and interpolate N K from a standards laboratory (see: in-air method) perform in-phantom measurement M (2 cm) Step 2: lookup conversion factor, chamber correction factor, sheath correction factor K air ()= MN K D µ en K ( ) = K' air ( ) PQ, champsheath ρ air K air () Clinical issues of in-phantom method positioning uncertainties strain on accuracy of PDD if point of interest is more shallo than the calibration depth of 2 cm (i.e., errors get blon up )

7 In-phantom method: Uncertainty at the reference point Ma et al, 1998 In-phantom method Type of quantity or procedure Uncertainty N K from standards lab 0.7% Effect of beam-quality difference 2.0% Chamber correction factor P Q,cham 1.5% Sleeve correction factor P sheath 0.5% µ en 1.5% ρ air ater In-ater measurement in user s 2.0% beam Combined D,z=2cm 3.6% II. Relative Dosimetry Relative dosimetry - hat do e require hich detectors can one use to measure PDD and profiles? spatial resolution requirements energy dependence requirements µ D ( z) N ( ) P en = KMz Q, champsheath ( z) ρ air Ma and Seuntjens, 1997

8 Ma et al, 1998 Ma and Seuntjens, 1997 RK RK 110 NACP 100 NACP diode 90 diode Farmer Farmer 100 Spokas 80 Spokas TLD 70 TLD N N Li et al, depth (g/cm 2 ) Markus Capintec depth (g/cm 2 ) Li et al, 1999 Markus Capintec Dosimeters for relative dosimetry Phantoms Acceptable dosimeters At depth: cylindrical chambers ith favourable energy response Unacceptable dosimeters General: chambers ith bad in-phantom response characteristics At surface: plane parallel Chambers ith high-z electron chambers (tested: components in or near NACP, Markus) detection volume radiochromic film, diamond detectors, liquid ionization chambers Diodes, silver-based film, TLD? plastic phantom materials useful for QA of output NOT for absolute calibrations unless investigated

9 depth (g/cm 2 ) NACP/H2O Farmer/H2O NACP/Acrylic Farmer/MS11 NACP/MS11 NACP/Polyst. Li et al, 1999 Uncertainties in the dose at other points in ater Type of quantity or procedure Combined D,z=2cm (in-phantom) 3.6% Combined D,z=0cm (in-air) 3.5% Determination of dose at other points in ater Uncertainty 3.0% Overall 4.7% Surface dose and electron contamination Other clinical issues TG-61 is a kerma-based protocol, i.e, surface dose cannot be derived from an air-kerma protocol Surface dose, should be assessed using thin indo plane parallel chambers and dealt ith if clinically important Podgorsak et al, 1990 Podgorsak et al, 1990

10 Dose in biological tissues TG-61 provides a method to calculate dose at the surface of tissue phantoms med med B med µ en C = B ρ air Dose in biological tissues for soft tissues the ratio of the backscatter factors is ignored; for compact bone, a table is provided no recommendations on ho to calculate dose at depth in the patient Seuntjens and Ma, 1999 Seuntjens and Ma, 1999 Conclusions TG-61 is an air-kerma based protocol recommending in-air method (lo and medium energy if point of interest is at the surface) in-phantom method (medium energy if point of interest is at a depth in-phantom) We discussed: calibration issues relative dosimetry some clinical issues