Search

PURPOSE: The aim of this study is to investigate overdose to organs at risk (OARs) observed in dosimetry audits in Monte Carlo (MC) algorithms and Linear Boltzmann Transport Equation (LBTE) algorithms. The impact of penumbra modeling on OAR dose was assessed with the adjustment of MC modeling parameters and the clinical relevance of the audit cases was explored with a planning study of spine and head and neck (H&N) patient cases. METHODS: Dosimetric audits performed by the Australian Clinical Dosimetry Service (ACDS) of 43 anthropomorphic spine plans and 1318 C-shaped target plans compared the planned dose to doses measured with ion chamber, microdiamond, film, and ion chamber array. An MC EGSnrc model was created to simulate the C-shape target case. The electron cut-off energy Ecut(kinetic) was set at 500, 200, and 10 keV, and differences between 1 and 3 mm voxel were calculated. A planning study with 10 patient stereotactic body radiotherapy (SBRT) spine plans and 10 patient H&N plans was calculated in both Acuros XB (AXB) v15.6.06 and Anisotropic Analytical Algorithm (AAA) v15.6.06. The patient contour was overridden to water as only the penumbral differences between the two different algorithms were under investigation. RESULTS: The dosimetry audit results show that for the SBRT spine case, plans calculated in AXB are colder than what is measured in the spinal cord by 5%-10%. This was also observed for other audit cases where a C-shape target is wrapped around an OAR where the plans were colder by 3%-10%. Plans calculated with Monaco MC were colder than measurements by approximately 7% with the OAR surround by a C-shape target, but these differences were not noted in the SBRT spine case. Results from the clinical patient plans showed that the AXB was on average 7.4% colder than AAA when comparing the minimum dose in the spinal cord OAR. This average difference between AXB and AAA reduced to 4.5% when using the more clinically relevant metric of maximum dose in the spinal cord. For the H&N plans, AXB was cooler on average than AAA in the spinal cord OAR (1.1%), left parotid (1.7%), and right parotid (2.3%). The EGSnrc investigation also noted similar, but smaller differences. The beam penumbra modeled by Ecut(kinetic) = 500 keV was steeper than the beam penumbra modeled by Ecut(kinetic) = 10 keV as the full scatter is not accounted for, which resulted in less dose being calculated in a central OAR region where the penumbra contributes much of the dose. The dose difference when using 2.5 mm voxels of the center of the OAR between 500 and 10 keV was 3%, reducing to 1% between 200 and 10 keV. CONCLUSIONS: Lack of full penumbral modeling due to approximations in the algorithms in MC based or LBTE algorithms are a contributing factor as to why these algorithms under-predict the dose to OAR when the treatment volume is wrapped around the OAR. The penumbra modeling approximations also contribute to AXB plans predicting colder doses than AAA in areas that are in the vicinity of beam penumbra. This effect is magnified in regions where there are many beam penumbras, for example in the spinal cord for spine SBRT cases.

Purpose Current quality assurance of radiotherapy involving bony regions generally utilises homogeneous phantoms and dose calculations, ignoring the challenges of heterogeneities with dosimetry problems likely occurring around bone. Anthropomorphic phantoms with synthetic bony materials enable realistic end-to-end testing in clinical scenarios. This work reports on measurements and calculated corrections required to directly report dose in bony materials in the context of comprehensive end-to-end dosimetry audit measurements (63 plans, 6 planning systems). Materials and methods Radiochromic film and microDiamond measurements were performed in an anthropomorphic spine phantom containing bone equivalent materials. Medium dependent correction factors, kmed, were established using 6 MV and 10 MV Linear Accelerator Monte Carlo simulations to account for the detectors being calibrated in water, but measuring in regions of bony material. Both cortical and trabecular bony material were investigated for verification of dose calculations in dose-to-medium (Dm,m) and dose-to-water (Dw,w) scenarios. Results For Dm,m calculations, modelled correction factors for cortical and trabecular bone in film measurements, and for trabecular bone in microDiamond measurements were 0.875(±0.1%), 0.953(±0.3%) and 0.962(±0.4%), respectively. For Dw,w calculations, the corrections were 0.920(±0.1%), 0.982(±0.3%) and 0.993(±0.4%), respectively. In the audit, application of the correction factors improves the mean agreement between treatment plans and measured microDiamond dose from −2.4%(±3.9%) to 0.4%(±3.7%). Conclusion Monte Carlo simulations provide a method for correcting the dose measured in bony materials allowing more accurate comparison with treatment planning system doses. In verification measurements, algorithm specific correction factors should be applied to account for variations in bony material for calculations based on Dm,m and Dw,w.

Purpose Dosimetry of ionizing radiation in the presence of strong magnetic fields is gaining increased relevance in light of advances for MRI‐guided radiation therapy. While the impact of strong magnetic fields on the overall response of ionization chambers has been simulated and measured before, this work investigates the local impact of the magnetic field on dose response in an ion chamber. High‐resolution 1D and 2D response maps have been created for two small clinical thimble ionization chambers, the PinPoint chambers 31006 and 31014 (Physikalisch Technische Werkstaetten Freiburg, Germany). Methods Working on the Imaging and Medical Beam Line of the Australian Synchrotron an intense kilovoltage radiation beam with very low divergence, collimated to 0.1 mm was used to scan the chambers by moving them on a 2D motion platform. Measured current and beam position were correlated to create the response maps. Small neodymium magnets were used to create a field of about 0.25 T. Chamber axis, magnetic field, and beam direction were perpendicular to each other. Measurements were performed with both orientations of the magnetic field as well as without it. Chamber biases of 5 and 250 V in both polarities were used. Results The local distribution of the response of small thimble‐type ionization chambers was found to be impacted by a magnetic field. Depending on the orientation of the magnetic field, the chamber response near the stem was either enhanced or reduced with the response near the tip behaving the opposite way. Local changes were in the order of up to 40% compared to measurements without the magnetic field present. Bending of the central electrode was observed for the chamber with the steel electrode. The size of the volume of reduced collection near the guard electrode was impacted by the magnetic field. As the here investigated beam and field parameters differ from those of clinical systems, quantitatively different results would be expected for the latter. However, the gyroradii encountered here were similar to those of a 6–7 MV MRI linac with a 1.5 T magnet. Conclusions Magnetic fields impact the performance of ionization chambers also on a local level. For practical measurements this might mean a change in the effective point of measurement, in addition to any global corrections. Further knowledge about the local response will help in selecting or constructing optimized chambers for use in magnetic fields.

The Australasian College of Physical Scientists and Engineers in Medicine (ACPSEM) Radiation Oncology Specialty Group (ROSG) formed a series of working groups to develop recommendations for guidance of radiation oncology medical physics practice within the Australasian setting. These recommendations provide a standard for safe work practices and quality control. It is the responsibility of the medical physicist to ensure that locally available equipment and procedures are sufficiently sensitive to establish compliance. The recommendations are endorsed by the ROSG, have been subject to independent expert reviews and have also been approved by the ACPSEM Council. For the Australian audience, these recommendations should be read in conjunction with the Tripartite Radiation Oncology Practice Standards and should be read in conjunction with relevant national, state or territory legislation which take precedence over the ACPSEM publication Radiation Oncology Reform Implementation Committee (RORIC) Quality Working Group, RANZCR, 2011a; Kron et al. Clin Oncol 27(6):325-329, 2015; Radiation Oncology Reform Implementation Committee (RORIC) Quality Working Group, RANZCR, 2018a, b).

Experimental measurement of Synchrotron Radiotherapy (SyncRT) doses is challenging, especially for Microbeam Radiotherapy (MRT), which is characterised by very high dynamic ranges with spatial resolutions on the micrometer scale. Monte Carlo (MC) simulation is considered a gold standard for accurate dose calculation in radiotherapy, and is therefore routinely relied upon to produce verification data. We present a MC model for Australian Synchrotron's Imaging and Medical Beamline (IMBL), which is capable of generating accurate dosimetry data to inform and/or verify SyncRT experiments. Our MC model showed excellent agreement with dosimetric measurement for Synchrotron Broadbeam Radiotherapy (SBBR). Our MC model is also the first to achieve validation for MRT, using two methods of dosimetry, to within clinical tolerances of 5% for a 20×20 mm2 field size, except for surface measurements at 5 mm depth, which remained to within good agreement of 7.5%. Our experimental methodology has allowed us to control measurement uncertainties for MRT doses to within 5-6%, which has also not been previously achieved, and provides a confidence which until now has been lacking in MRT validation studies. The MC model is suitable for SyncRT dose calculation of clinically relevant field sizes at the IMBL, and can be extended to include medical beamlines at other Synchrotron facilities as well. The presented MC model will be used as a validation tool for treatment planning dose calculation algorithms, and is an important step towards veterinary SyncRT trials at the Australian Synchrotron.

Highlights • End-to-end radiotherapy audits have been performed on 94 occasions in Australia. • Conformal fields were assessed on an anthropomorphic thorax phantom. • Dose after lung measured low for analytical anisotropic algorithm (AAA) calculations. • AAA also overestimated dose in tangential fields as used in breast cancer treatments. • AAA underestimated dose to points inside lung inhomogeneities. • Superposition and convolution algorithms had problems with large angle wedges., Background and purpose Independent dosimetry audits improve quality and safety of radiation therapy. This work reports on design and findings of a comprehensive 3D conformal radiotherapy (3D-CRT) Level III audit. Materials and methods The audit was conducted as onsite audit using an anthropomorphic thorax phantom in an end-to-end test by the Australian Clinical Dosimetry Service (ACDS). Absolute dose point measurements were performed with Farmer-type ionization chambers. The audited treatment plans included open and half blocked fields, wedges and lung inhomogeneities. Audit results were determined as Pass Optimal Level (deviations within 3.3%), Pass Action Level (greater than 3.3% but within 5%) and Out of Tolerance (beyond 5%), as well as Reported Not Scored (RNS). The audit has been performed between July 2012 and January 2018 on 94 occasions, covering approximately 90% of all Australian facilities. Results The audit pass rate was 87% (53% optimal). Fifty recommendations were given, mainly related to planning system commissioning. Dose overestimation behind low density inhomogeneities by the analytical anisotropic algorithm (AAA) was identified across facilities and found to extend to beam setups which resemble a typical breast cancer treatment beam placement. RNS measurements inside lung showed a variation in the opposite direction: AAA under-dosed a target beyond lung and over-dosed the lung upstream and downstream of the target. Results also highlighted shortcomings of some superposition and convolution algorithms in modelling large angle wedges. Conclusions This audit showed that 3D-CRT dosimetry audits remain relevant and can identify fundamental global and local problems that also affect advanced treatments.

Quality assurance (QA) for clinical trials is important. Lack of compliance can affect trial outcome. Clinical trial QA groups have different methods of dose distribution verification and analysis, all with the ultimate aim of ensuring trial compliance. The aim of this study was to gain a better understanding of different processes to inform future dosimetry audit reciprocity.Six clinical trial QA groups participated. Intensity modulated treatment plans were generated for three different cases. A range of 17 virtual 'measurements' were generated by introducing a variety of simulated perturbations (such as MLC position deviations, dose differences, gantry rotation errors, Gaussian noise) to three different treatment plan cases. Participants were blinded to the 'measured' data details. Each group analysed the datasets using their own gamma index (γ) technique and using standardised parameters for passing criteria, lower dose threshold, γ normalisation and global γ.For the same virtual 'measured' datasets, different results were observed using local techniques. For the standardised γ, differences in the percentage of points passing with γ 1 were also found, however these differences were less pronounced than for each clinical trial QA group's analysis. These variations may be due to different software implementations of γ.This virtual dosimetry audit has been an informative step in understanding differences in the verification of measured dose distributions between different clinical trial QA groups. This work lays the foundations for audit reciprocity between groups, particularly with more clinical trials being open to international recruitment.

PURPOSE Consistency between different international quality assurance groups is important in the progress toward similar standards and expectations in radiotherapy dosimetry around the world, and in the context of consistent clinical trial data from international trial participants. This study compares the dosimetry audit methodology and results of two international quality assurance groups performing a side-by-side comparison at the same radiotherapy department, and interrogates the ability of the audits to detect deliberately introduced errors. METHODS A comparison of the core dosimetry components of reference and non-reference audits was conducted by the Imaging and Radiation Oncology Core (IROC, Houston, USA) and the Australian Clinical Dosimetry Service (ACDS, Melbourne, Australia). A set of measurements were conducted over 2 days at an Australian radiation therapy facility in Melbourne. Each group evaluated the reference dosimetry, output factors, small field output factors, percentage depth dose (PDD), wedge, and off-axis factors according to their standard protocols. IROC additionally investigated the Electron PDD and the ACDS investigated the effect of heterogeneities. In order to evaluate and compare the performance of these audits under suboptimal conditions, artificial errors in percentage depth dose (PDD), EDW, and small field output factors were introduced into the 6 MV beam model to simulate potential commissioning/modeling errors and both audits were tested for their sensitivity in detecting these errors. RESULTS With the plans from the clinical beam model, almost all results were within tolerance and at an optimal pass level. Good consistency was found between the two audits as almost all findings were consistent between them. Only two results were different between the results of IROC and the ACDS. The measurements of reference FFF photons showed a discrepancy of 0.7% between ACDS and IROC due to the inclusion of a 0.5% nonuniformity correction by the ACDS. The second difference between IROC and the ACDS was seen with the lung phantom. The asymmetric field behind lung measured by the ACDS was slightly (0.3%) above the ACDS's pass (optimal) level of 3.3%. IROC did not detect this issue because their measurements were all assessed in a homogeneous phantom. When errors were deliberately introduced neither audit was sensitive enough to pick up a 2% change to the small field output factors. The introduced PDD change was flagged by both audits. Similarly, the introduced error of using 25° wedge instead of 30° wedge was detectible in both audits as out of tolerance. CONCLUSIONS Despite different equipment, approach, and scope of measurements in on-site audits, there were clear similarities between the results from the two groups. This finding is encouraging in the context of a global harmonized approach to radiotherapy quality assurance and dosimetry audit.

Dosimetry protocols for external beam radiotherapy currently in use, such as the IAEA TRS-398 and AAPM TG-51, were written for conventional linear accelerators. In these accelerators, a flattening filter is used to produce a beam which is uniform at water depths where the ionization chamber is used to measure the absorbed dose. Recently, clinical linacs have been implemented without the flattening filter, and published theoretical analysis suggested that with these beams a dosimetric error of order 0.6% could be expected for IAEA TRS-398, because the TPR20,10 beam quality index does not accurately predict the stopping power ratio (water to air) for the softer flattening-filter-free (FFF) beam spectra. We measured doses on eleven FFF linacs at 6 MV and 10 MV using both dosimetry protocols and found average differences of 0.2% or less. The expected shift due to stopping powers was not observed. We present Monte Carlo k Q calculations which show a much smaller difference between FFF and flattened beams than originally predicted. These results are explained by the inclusion of the added backscatter plates and build-up filters used in modern clinical FFF linacs, compared to a Monte Carlo model of an FFF linac in which the flattening filter is removed and no additional build-up or backscatter plate is added.

Background and purpose: Remote beam output audits, which independently measure an institution’s machine calibration, are a common component of independent radiotherapy peer review. This work reviews the results and trends of these audit results across several organisations and geographical regions. Materials and methods: Beam output audit results from the Australian Clinical Dosimetry Services, International Atomic Energy Agency, Imaging and Radiation Oncology Core, and Radiation Dosimetry Services were evaluated from 2010 to the present. The rate of audit results outside a ±5% tolerance was evaluated for photon and electron beams as a function of the year of irradiation and nominal beam energy. Additionally, examples of confirmed calibration errors were examined to provide guidance to clinical physicists and auditing bodies. Results: Of the 210,167 audit results, 1323 (0.63%) were outside of tolerance. There was a clear trend of improved audit performance for more recent dates, and while all photon energies generally showed uniform rates of results out of tolerance, low (6 MeV) and high (≥18 MeV) energy electron beams showed significantly elevated rates. Twenty nine confirmed calibration errors were explored and attributed to a range of issues, such as equipment failures, errors in setup, and errors in performing the clinical reference calibration. Forty-two percent of these confirmed errors were detected during ongoing periodic monitoring, and not at the time of the first audit of the machine. Conclusions: Remote beam output audits have identified, and continue to identify, numerous and often substantial beam calibration errors. Keywords: Global harmonization group, Remote beam output audit, Dosimetry audit, Calibration, QA

Movement of zinc ions across cellular membranes is achieved mainly by two families of zinc transport genes encoding multi-transmembrane domain proteins. Members of the Zip family generally transport zinc into the cytosol, either from outside the cell or from the lumen of subcellular organelles such as the endoplasmic reticulum, Golgi, endosomes or storage vacuoles. ZnT proteins move zinc in the opposite direction, resulting in efflux from the cell or uptake into organelles. Zinc homeostasis at both the cellular and systemic level is achieved by the coordinated action of numerous Zip and ZnT proteins, twenty-four in mammals and seventeen in the vinegar fly Drosophila melanogaster. Previously, we have identified a zinc toxicity phenotype in the Drosophila eye, caused by targeted over expression of dZip42C.1 (dZip1) combined with knockdown of dZnT63C (dZnT1). In general, this phenotype was rescued by increased zinc efflux or decreased uptake and was exacerbated by decreased efflux or increased uptake. Now we have identified three additional zinc dyshomeostasis phenotypes caused by over expression of dZnT86D, dZnT86D(eGFP) and dZip71B(FLAG). Genetic and dietary manipulation experiments showed that these three phenotypes all differ both from each other and from our original zinc toxicity phenotype. Based on these data and the approximate subcellular localization of each zinc transport protein, we propose that each phenotype represents a different redistribution of zinc within these cells, resulting in a Golgi zinc toxicity, a Golgi zinc deficiency and a combined Golgi/other organelle zinc toxicity respectively. We are able to group the remaining Drosophila Zip and ZnT genes into several functional categories based on their interaction with the three novel zinc dyshomeostasis phenotypes, allowing the role of each zinc transport protein to be defined in greater detail. This research highlights the differential effects that redistribution of zinc can have within a particular tissue and identifies the Golgi as being particularly sensitive to both excess and insufficient zinc.

The Australian Radiation Protection and Nuclear Safety Agency (ARPANSA) has established a method for ionisation chamber calibrations using megavoltage photon reference beams. The new method will reduce the calibration uncertainty compared to a (60)Co calibration combined with the TRS-398 energy correction factor. The calibration method employs a graphite calorimeter and a Monte Carlo (MC) conversion factor to convert the absolute dose to graphite to absorbed dose to water. EGSnrc is used to model the linac head and doses in the calorimeter and water phantom. The linac model is validated by comparing measured and modelled PDDs and profiles. The relative standard uncertainties in the calibration factors at the ARPANSA beam qualities were found to be 0.47% at 6 MV, 0.51% at 10 MV and 0.46% for the 18 MV beam. A comparison with the Bureau International des Poids et Mesures (BIPM) as part of the key comparison BIPM.RI(I)-K6 gave results of 0.9965(55), 0.9924(60) and 0.9932(59) for the 6, 10 and 18 MV beams, respectively, with all beams within 1σ of the participant average. The measured kQ values for an NE2571 Farmer chamber were found to be lower than those in TRS-398 but are consistent with published measured and modelled values. Users can expect a shift in the calibration factor at user energies of an NE2571 chamber between 0.4-1.1% across the range of calibration energies compared to the current calibration method.

The Australian Radiation Protection and Nuclear Safety Agency (ARPANSA) maintains the Australian primary standard of absorbed dose. Until recently, the standard was used to calibrate ionisation chambers only in (60)Co gamma rays. These chambers are then used by radiotherapy clinics to determine linac output, using a correction factor (k Q) to take into account the different spectra of (60)Co and the linac. Over the period 2010-2013, ARPANSA adapted the primary standard to work in megavoltage linac beams, and has developed a calibration service at three photon beams (6, 10 and 18 MV) from an Elekta Synergy linac. We describe the details of the new calibration service, the method validation and the use of the new calibration factors with the International Atomic Energy Agency's TRS-398 dosimetry Code of Practice. The expected changes in absorbed dose measurements in the clinic when shifting from (60)Co to the direct calibration are determined. For a Farmer chamber (model 2571), the measured chamber calibration coefficient is expected to be reduced by 0.4, 1.0 and 1.1 % respectively for these three beams when compared to the factor derived from (60)Co. These results are in overall agreement with international absorbed dose standards and calculations by Muir and Rogers in 2010 of k Q factors using Monte Carlo techniques. The reasons for and against moving to the new service are discussed in the light of the requirements of clinical dosimetry.

The Australian Clinical Dosimetry Service (ACDS) is a government initiative to provide all radiation therapy centers in Australia with access to free and independent dosimetric audit services. Based out of the Australian Radiation Protection and Nuclear Safety Agency, the ACDS commenced audit operations in 2010. Aim The objective of this work was to commission Optically Stimulated Luminescence Dosimeters (OSLDs) as a replacement for Thermoluminescence Dosimeters (TLD) for use in the ACDS's remote auditing program, with a view to extending their application to higher level dosimetry in anthropomorphic phantoms. Materials and Method The In-Light nanoDots™ OSLD system from Landauer Inc. was commissioned using both the Australian National Linear Accelerator, an Elekta Synergy II, and an Eldorado Co-60 unit. The linearity, signal depletion, fading, energy dependence, reproducibility and resetting of nanoDot™ dosimeters were determined for clinical photon and electron beams. Results NanoDots™ OSLDs demonstrate; supralinearity dependent on the overall accumulated dose. Little signal depletion per readout (0.03% per read). Reproducible fading, characterised by an initial transient signal decay over a period of 16 min post irradiation, followed by a predictable logarithmic decay resulting in signal decrease of 3% over several months. Little dependence on energy or modality over the clinical range. Optical resetting tests show negligible change in sensitivity post reset for up to five cycles. Conclusion Modern OSLDs such as the nanoDots™ dosimeters provide a viable alternative to the established TLD technology with comparable accuracy and greater efficiency. The efficiency, reusability and accuracy of nanoDot™ dosimeters makes them an ideal candidate for the large-scale dosimetry operations currently undertaken by the ACDS.

Members of the ZIP (SLC39A) and ZnT (SLC30A) families of transmembrane domain proteins are predicted to transport the essential transition metal zinc across membranes, regulating cellular zinc content and distribution via uptake and efflux at the outer plasma and organellar membranes. Twenty-four ZIP and ZnT proteins are encoded in mammalian genomes, raising questions of whether all actually transport zinc, whether several function together in the same tissues/cell types, and how the activity of these transporters is coordinated. To address these questions, we have taken advantage of the ability to manipulate several genes simultaneously in targeted cell types in Drosophila. Previously we reported zinc toxicity phenotypes caused by combining overexpression of a zinc uptake gene, dZip42C.1, with suppression of a zinc efflux gene, dZnT63C. Here we show that these phenotypes can be used as a sensitized in vivo system to detect subtle alterations in zinc transport activity that would be buffered in healthy cells. Using two adult tissues, the fly eye and midline (thorax/abdomen), we find that when overexpressed, most of the 17 Drosophila Zip and ZnT genes modify the zinc toxicity phenotypes in a manner consistent with their predicted zinc transport activity. In most cases, we can reconcile that activity with the cellular localization of an enhanced green fluorescent protein tagged version of the protein. Additionally, targeted suppression of each gene by RNA interference reveals several of the fly Zip and ZnT genes are required in the eye, indicating that numerous independent zinc transport genes are acting together in a single tissue.

The absolute dose delivered to a dynamically scanned sample in the Imaging and Medical Beamline (IMBL) on the Australian Synchrotron was measured with a graphite calorimeter anticipated to be established as a primary standard for synchrotron dosimetry. The calorimetry was compared to measurements using a free-air chamber (FAC), a PTW 31 014 Pinpoint ionization chamber, and a PTW 34 001 Roos ionization chamber. The IMBL beam height is limited to approximately 2 mm. To produce clinically useful beams of a few centimetres the beam must be scanned in the vertical direction. In practice it is the patient/detector that is scanned and the scanning velocity defines the dose that is delivered. The calorimeter, FAC, and Roos chamber measure the dose area product which is then converted to central axis dose with the scanned beam area derived from Monte Carlo (MC) simulations and film measurements. The Pinpoint chamber measures the central axis dose directly and does not require beam area measurements. The calorimeter and FAC measure dose from first principles. The calorimetry requires conversion of the measured absorbed dose to graphite to absorbed dose to water using MC calculations with the EGSnrc code. Air kerma measurements from the free air chamber were converted to absorbed dose to water using the AAPM TG-61 protocol. The two ionization chambers are secondary standards requiring calibration with kilovoltage x-ray tubes. The Roos and Pinpoint chambers were calibrated against the Australian primary standard for air kerma at the Australian Radiation Protection and Nuclear Safety Agency (ARPANSA). Agreement of order 2% or better was obtained between the calorimetry and ionization chambers. The FAC measured a dose 3-5% higher than the calorimetry, within the stated uncertainties.

A critical early phase for any synchrotron beamline involves detailed testing, characterization and commissioning; this is especially true of a beamline as ambitious and complex as the Imaging & Medical Beamline (IMBL) at the Australian Synchrotron. IMBL staff and expert users have been performing precise experiments aimed at quantitative characterization of the primary polychromatic and monochromatic X-ray beams, with particular emphasis placed on the wiggler insertion devices (IDs), the primary-slit system and any in vacuo and ex vacuo filters. The findings from these studies will be described herein. These results will benefit IMBL and other users in the future, especially those for whom detailed knowledge of the X-ray beam spectrum (or `quality') and flux density is important. This information is critical for radiotherapy and radiobiology users, who ultimately need to know (to better than 5%) what X-ray dose or dose rate is being delivered to their samples. Various correction factors associated with ionization-chamber (IC) dosimetry have been accounted for, e.g. ion recombination, electron-loss effects. A new and innovative approach has been developed in this regard, which can provide confirmation of key parameter values such as the magnetic field in the wiggler and the effective thickness of key filters. IMBL commenced operation in December 2008 with an Advanced Photon Source (APS) wiggler as the (interim) ID. A superconducting multi-pole wiggler was installed and operational in January 2013. Results are obtained for both of these IDs and useful comparisons are made. A comprehensive model of the IMBL has been developed, embodied in a new computer program named spec.exe, which has been validated against a variety of experimental measurements. Having demonstrated the reliability and robustness of the model, it is then possible to use it in a practical and predictive manner. It is hoped that spec.exe will prove to be a useful resource for synchrotron science in general, and for hard X-ray beamlines, whether they are based on bending magnets or insertion devices, in particular. In due course, it is planned to make spec.exe freely available to other synchrotron scientists.

Alanine dosimeters from the National Physical Laboratory (NPL) in the UK were irradiated using kilovoltage synchrotron radiation at the imaging and medical beam line (IMBL) at the Australian Synchrotron. A 20 × 20 mm2 area was irradiated by scanning the phantom containing the alanine through the 1 mm × 20 mm beam at a constant velocity. The polychromatic beam had an average energy of 95 keV and nominal absorbed dose to water rate of 250 Gy/s. The absorbed dose to water in the solid water phantom was first determined using a PTW Model 31014 PinPoint ionization chamber traceable to a graphite calorimeter. The alanine was read out at NPL using correction factors determined for 60Co, traceable to NPL standards, and a published energy correction was applied to correct for the effect of the synchrotron beam quality. The ratio of the doses determined by alanine at NPL and those determined at the synchrotron was 0.975 (standard uncertainty 0.042) when alanine energy correction factors published by Waldeland et al. (Waldeland E, Hole E O, Sagstuen E and Malinen E, Med. Phys. 2010, 37, 3569) were used, and 0.996 (standard uncertainty 0.031) when factors by Anton et al. (Anton M, Buermann L., Phys Med Biol. 2015 60 6113–29) were used. The results provide additional verification of the IMBL dosimetry.

The ARPANSA calibration service for 60Co gamma rays is based on a primary standard graphite calorimeter that measures absorbed dose to graphite. Measurements with the calorimeter are converted to the absorbed dose to water using the calculation of the ratio of the absorbed dose in the calorimeter to the absorbed dose in a water phantom. ARPANSA has recently changed the basis of this calculation from a photon fluence scaling method to a direct Monte Carlo (MC) calculation. The MC conversion uses an EGSnrc model of the cobalt source that has been validated against water tank and graphite phantom measurements, a step that is required to quantify uncertainties in the underlying interaction coefficients in the MC code. A comparison with the Bureau International des Poids et Mesures (BIPM) as part of the key comparison BIPM.RI(I)-K4 showed an agreement of 0.9973 (53).

The Australian Clinical Dosimetry Service, ACDS, is a voluntary national auditing service for radiotherapy centers. Provided free of charge the ACDS is now little over one and a half years old. While an independent audit service has been desired by the radiotherapy professions, (Radiation Oncology, Medical Physics and Radiotherapy) for a few decades, the dosimetry incidents at Adelaide and Coffs Harbor stimulated all levels of government in Australia. While not very significant in comparison to international incidents, they were important in convincing the Government to act. One outcome was a formal agreement for the Australian Department of Health and Ageing (DoHA), to fund a 3 year trial program of an Australia-wide radiotherapy dosimetry audit program. In 2010, the Australian Radiation and Nuclear Safety Agency (ARPANSA), signed a Memorandum of Understanding (MoU) with DoHA to establish the auditing service (ACDS). This article is intended to be the first of an annual communication from the ACDS to the radiotherapy professions informing them about the methods and rationale behind the ACDS’ actions. This article focuses on the initial setup of the ACDS, the design of the audit structure, discussion points arising from the audits performed so far and our immediate goals. It is also an invitation for comment and discussion about the ACDS procedures and function, and its future. In February 2011, the Australian government formally launched the Australian Clinical Dosimetry Service, a radiotherapy auditing service unique in its scope, oversight and assessment: Scope Over an initial three year trial period dosimetric audits will be provided free of charge to all public and private radiotherapy providers in Australia. Participation is voluntary. Over the 3 years, the ACDS must develop a three level audit program and capture 80 % of the existing Linacs in Australia and at least 50 % of all new Linac installations.

Purpose: To investigate and quantify electron contamination from the lead cutouts used in kilovoltage x-ray radiotherapy. Methods: The lead cutouts were modeled with the Monte Carlo EGSnrc user codes DOSXYZnrc and DOSRZnrc for x-ray beams ranging from 50 to 300 kV p . The results from the model were confirmed with Gafchromic film measurements. The model and measurements investigated the dose distribution with and without gladwrap™ shielding under the lead, and dose distributions with round, square, and serrated edge cutouts. Results: Large dose enhancement near the edges of the lead was observed due to electron contamination. At the epidermal/dermal border, there is double the dose at the edge of the lead compared to the central dose due to electron contamination for a 150 kV p beam and three times the dose for a 300 kV p beam. gladwrap™ shielding effectively removes the contaminantdose enhancement using ten and four layers for 300 and 150 kV p beams, respectively. Conclusions: The contaminantdose enhancement is undesirable as it could cause unnecessary erythema and hyperpigmentation at the border of the treated and untreated skin and lead to a poorer cosmetic outcome. The contamination is easily removed by gladwrap™ shielding placed under or around the lead cutout.

ARPANSA has calculated new Monte Carlo corrections for their low and medium energy x-ray free-air chambers. The new calculations include a diverging beam and details of the limiting aperture. The diverging beam simulations are compared with previous parallel beam simulations. The electron loss, scattering and fluorescence corrections do not change when beam divergence is included, even for the short source?detector distance of 30?cm used in post-2008 low energy calibrations. Transmission and scattering from the aperture are significant for both free-air chambers and dependent on the beam divergence. The constancy of the correction factors with changing air path length was investigated at low energies. In the extreme conditions of 100?kV and a distance of 30?cm the correction factors showed significant deviation.

Nicotiana glauca (Argentinean tree tobacco) is atypical within the genus Nicotiana, accumulating predominantly anabasine rather than nicotine and/or nornicotine as the main component of its leaf pyridine alkaloid fraction. The current study examines the role of the A622 gene from N. glauca (NgA622) in alkaloid production and utilises an RNAi approach to down-regulate gene expression and diminish levels of A622 protein in transgenic tissues. Results indicate that RNAi-mediated reduction in A622 transcript levels markedly reduces the capacity of N. glauca to produce anabasine resulting in plants with scarcely any pyridine alkaloids in leaf tissues, even after damage to apical tissues. In addition, analysis of hairy roots containing the NgA622-RNAi construct shows a substantial reduction in both anabasine and nicotine levels within these tissues, even if stimulated with methyl jasmonate, indicating a role for the A622 enzyme in the synthesis of both alkaloids in roots of N. glauca. Feeding of Nicotinic Acid (NA) to hairy roots of N. glauca containing the NgA622-RNAi construct did not restore capacity for synthesis of anabasine or nicotine. Moreover, treatment of these hairy root lines with NA did not lead to an increase in anatabine levels, unlike controls. Together, these results strongly suggest that A622 is an integral component of the final enzyme complex responsible for biosynthesis of all three pyridine alkaloids in Nicotiana.

This work presents the Australian Clinical Dosimetry Service's (ACDS) findings of an investigation of systematic discrepancies between treatment planning system (TPS) calculated and measured audit doses. Specifically, a comparison between the Anisotropic Analytic Algorithm (AAA) and other common dose-calculation algorithms in regions downstream (� 2 cm) from low-density material in anthropomorphic and slab phantom geometries is presented. Two measurement setups involving rectilinear slabphantoms (ACDS Level II audit) and anthropomorphic geometries (ACDS Level III audit) were used in conjunction with ion chamber (planar 2D array and Farmer-type) measurements. Measured doses were compared to calculated doses for a variety of cases, with and without the presence of inhomogeneities and beam-modifiers in 71 audits. Results demonstrate a systematic AAA underdose with an average discrepancy of 2.9 ± 1.2% when the AAA algorithm is implemented in regions distal from lung-tissue interfaces, when lateral beams are used with anthropomorphic phantoms. This systemic discrepancy was found for all Level III audits of facilities using the AAA algorithm. This discrepancy is not seen when identical measurements are compared for other common dose-calculation algorithms (average discrepancy � 0.4 ± 1.7%), including the Acuros XB algorithm also available with the Eclipse TPS. For slab phantom geometries (Level II audits), with similar measurement points downstream from inhomogeneities this discrepancy is also not seen. Crown Copyright © 2015 Published by Elsevier Ltd on behalf of Associazione Italiana di Fisica Medica. This is an open access article under the CC BY-NC-SA license (http://creativecommons.org/licenses/by

The Australian Radiation Protection and Nuclear Safety Agency (ARPANSA) maintains a (60)Co teletherapy source primarily for the calibration of therapy dosemeters. The source and encapsulating head were replaced in early 2010 with an Eldorado 78 head and new (60)Co source. In this article we present the results of ongoing accuracy and stability measurements since the replacement. A number of formal and informal indirect comparisons have been carried out with laboratories holding primary and secondary standards for (60)Co. ARPANSA chambers have also been calibrated at international primary standard laboratories allowing comparison of calibration coefficients and thus (60)Co absorbed dose standards. (60)Co calibration coefficients supplied by manufacturers of chambers were compared to those measured at the ARPANSA when this calibration was traceable to a primary standard. ARPANSA also participates in an annual international mailed dosimetry audit conducted by the International Atomic Energy Agency. The results thus far demonstrate that the absorbed doses to water delivered by the new ARPANSA (60)Co source are consistent with international doses within the stated uncertainties.

The Australian Clinical Dosimetry Service (ACDS) has implemented a new method of a nonreference condition Level II type dosimetric audit of radiotherapy services to increase measurement accuracy and patient safety within Australia. The aim of this work is to describe the methodology, tolerances, and outcomes from the new audit.The ACDS Level II audit measures the dose delivered in 2D planes using an ionization chamber based array positioned at multiple depths. Measurements are made in rectilinear homogeneous and inhomogeneous phantoms composed of slabs of solid water and lung. Computer generated computed tomography data sets of the rectilinear phantoms are supplied to the facility prior to audit for planning of a range of cases including reference fields, asymmetric fields, and wedged fields. The audit assesses 3D planning with 6 MV photons with a static (zero degree) gantry. Scoring is performed using local dose differences between the planned and measured dose within 80% of the field width. The overall audit result is determined by the maximum dose difference over all scoring points, cases, and planes. Pass (Optimal Level) is defined as maximum dose difference ≤3.3%, Pass (Action Level) is ≤5.0%, and Fail (Out of Tolerance) is5.0%.At close of 2013, the ACDS had performed 24 Level II audits. 63% of the audits passed, 33% failed, and the remaining audit was not assessable. Of the 15 audits that passed, 3 were at Pass (Action Level). The high fail rate is largely due to a systemic issue with modeling asymmetric 60° wedges which caused a delivered overdose of 5%-8%.The ACDS has implemented a nonreference condition Level II type audit, based on ion chamber 2D array measurements in an inhomogeneous slab phantom. The powerful diagnostic ability of this audit has allowed the ACDS to rigorously test the treatment planning systems implemented in Australian radiotherapy facilities. Recommendations from audits have led to facilities modifying clinical practice and changing planning protocols.

On 1 July 2012, the Australian Clinical Dosimetry Service (ACDS) released its Optically Stimulated Luminescent Dosimeter (OSLD) Level I audit, replacing the previous TLD based audit. The aim of this work is to present the results from this new service and the complete uncertainty analysis on which the audit tolerances are based.The audit release was preceded by a rigorous evaluation of the InLight® nanoDot OSLD system from Landauer (Landauer, Inc., Glenwood, IL). Energy dependence, signal fading from multiple irradiations, batch variation, reader variation, and dose response factors were identified and quantified for each individual OSLD. The detectors are mailed to the facility in small PMMA blocks, based on the design of the existing Radiological Physics Centre audit. Modeling and measurement were used to determine a factor that could convert the dose measured in the PMMA block, to dose in water for the facility's reference conditions. This factor is dependent on the beam spectrum. The TPR20,10 was used as the beam quality index to determine the specific block factor for a beam being audited. The audit tolerance was defined using a rigorous uncertainty calculation. The audit outcome is then determined using a scientifically based two tiered action level approach. Audit outcomes within two standard deviations were defined as Pass (Optimal Level), within three standard deviations as Pass (Action Level), and outside of three standard deviations the outcome is Fail (Out of Tolerance).To-date the ACDS has audited 108 photon beams with TLD and 162 photon beams with OSLD. The TLD audit results had an average deviation from ACDS of 0.0% and a standard deviation of 1.8%. The OSLD audit results had an average deviation of -0.2% and a standard deviation of 1.4%. The relative combined standard uncertainty was calculated to be 1.3% (1σ). Pass (Optimal Level) was reduced to ≤2.6% (2σ), and Fail (Out of Tolerance) was reduced to3.9% (3σ) for the new OSLD audit. Previously with the TLD audit the Pass (Optimal Level) and Fail (Out of Tolerance) were set at ≤4.0% (2σ) and6.0% (3σ).The calculated standard uncertainty of 1.3% at one standard deviation is consistent with the measured standard deviation of 1.4% from the audits and confirming the suitability of the uncertainty budget derived audit tolerances. The OSLD audit shows greater accuracy than the previous TLD audit, justifying the reduction in audit tolerances. In the TLD audit, all outcomes were Pass (Optimal Level) suggesting that the tolerances were too conservative. In the OSLD audit 94% of the audits have resulted in Pass (Optimal level) and 6% of the audits have resulted in Pass (Action Level). All Pass (Action level) results have been resolved with a repeat OSLD audit, or an on-site ion chamber measurement.

The Australian Radiation Protection and Nuclear Safety Agency (ARPANSA) has installed an Elekta Synergy platform linac to establish a direct megavoltage primary standard calibration service, instead of relying on calibrations derived from (60)Co. One of the 6 MV beams of the ARPANSA linac has been approximately matched to the Varian high energy platform 6 MV photon beam. The electron beam energy was adjusted to match the percentage depth dose (PDD) curve and TPR(20,10). This work calculates the error introduced when using a calibration factor from this Elekta Synergy Platform linac on a Varian high-energy platform beam at 6 MV. Monte Carlo models of the Varian and matched Elekta accelerator accurately predict the measured PDDs and profiles, but show significantly different energy spectra, resulting mainly from differences in target thickness between the two accelerators. Monte Carlo modelling of the energy correction factor k(Q) of a secondary standard NE2561 chamber shows a difference of 0.4% between the Varian and the Varian-matched Elekta beams. Although small, this is a significant discrepancy for primary standard calibrations. Similar variations are expected for chambers of similar construction, and additional variations may occur with other linac manufacturers. The work has also investigated the design of a custom flattening filter to precisely match the energy spectrum of the Varian beam on the Elekta platform.