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Purpose: Gafchromic film and ionometric calibration procedures for HDR 192Ir brachytherapy sources in terms of dose rate to water are presented and the experimental results are compared to the TG-43 protocol as well as with the absolute dose measurement results from a water calorimetry-based primary standard. Methods: EBT-1 Gafchromic films, an A1SL Exradin miniature Shonka thimble type chamber, and an SI HDR 1000 Plus well-type chamber (Standard Imaging, Inc., Middleton, WI) with an ADCL traceable Sk calibration coefficient (following the AAPM TG-43 protocol) were used. The Farmer chamber and Gafchromic film measurements were performed directly in water. All results were compared to direct and absolute absorbed dose to water measurements from a 4 °C stagnant water calorimeter. Results: Based on water calorimetry, the authors measured the dose rate to water to be 361±7 μGy/(h U) at a 55 mm source-to-detector separation. The dose rate normalized to air-kerma strength for all the techniques agree with the water calorimetry results to within 0.83%. The overall 1-sigma uncertainty on water calorimetry, ionization chamber, Gafchromic film, and TG-43 dose rate measurement amounts to 1.90%, 1.44%, 1.78%, and 2.50%, respectively. Conclusions: This work allows us to build a more realistic uncertainty estimate for absorbed dose to water determination using the TG-43 protocol. Furthermore, it provides the framework necessary for a shift from indirect HDR 192Ir brachytherapy dosimetry to a more accurate, direct, and absolute measurement of absorbed dose to water.

Purpose: Determine the effective point of measurement (EPOM) of 12 thimble ion chambers, including miniature chambers and three models widely used for clinical reference dosimetry. The EPOM is the point at which the measured dose would arise in the measurement medium in the absence of the probe: For cylindrical chambers, it is shifted upstream relative to the central axis of the chamber. Although current dosimetry protocols prescribe a blanket upstream EPOM shift of 0.6r, with r as the chamber cavity radius, it has been shown in recent years that the EPOM does, in fact, depend on every detail of the chamber design and on the beam characteristics. In the wake of this finding, the authors undertake a comprehensive study of the EPOM for a series of chambers in water.

In this work, an investigation of efficiency enhancing methods and cross-section data in the BEAMnrc Monte Carlo (MC) code system is presented. Additionally, BEAMnrc was compared with VMC++, another special-purpose MC code system that has recently been enhanced for the simulation of the entire treatment head. BEAMnrc and VMC++ were used to simulate a 6 MV photon beam from a Siemens Primus linear accelerator (linac) and phase space (PHSP) files were generated at 100 cm source-to-surface distance for the 10 x 10 and 40 x 40 cm2 field sizes. The BEAMnrc parameters/techniques under investigation were grouped by (i) photon and bremsstrahlung cross sections, (ii) approximate efficiency improving techniques (AEITs), (iii) variance reduction techniques (VRTs), and (iv) a VRT (bremsstrahlung photon splitting) in combination with an AEIT (charged particle range rejection). The BEAMnrc PHSP file obtained without the efficiency enhancing techniques under study or, when not possible, with their default values (e.g., EXACT algorithm for the boundary crossing algorithm) and with the default cross-section data (PEGS4 and Bethe-Heitler) was used as the "base line" for accuracy verification of the PHSP files generated from the different groups described previously. Subsequently, a selection of the PHSP files was used as input for DOSXYZnrc-based water phantom dose calculations, which were verified against measurements. The performance of the different VRTs and AEITs available in BEAMnrc and of VMC++ was specified by the relative efficiency, i.e., by the efficiency of the MC simulation relative to that of the BEAMnrc base-line calculation. The highest relative efficiencies were approximately 935 (approximately 111 min on a single 2.6 GHz processor) and approximately 200 (approximately 45 min on a single processor) for the 10 x 10 field size with 50 million histories and 40 x 40 cm2 field size with 100 million histories, respectively, using the VRT directional bremsstrahlung splitting (DBS) with no electron splitting. When DBS was used with electron splitting and combined with augmented charged particle range rejection, a technique recently introduced in BEAMnrc, relative efficiencies were approximately 420 (approximately 253 min on a single processor) and approximately 175 (approximately 58 min on a single processor) for the 10 x 10 and 40 x 40 cm2 field sizes, respectively. Calculations of the Siemens Primus treatment head with VMC++ produced relative efficiencies of approximately 1400 (approximately 6 min on a single processor) and approximately 60 (approximately 4 min on a single processor) for the 10 x 10 and 40 x 40 cm2 field sizes, respectively. BEAMnrc PHSP calculations with DBS alone or DBS in combination with charged particle range rejection were more efficient than the other efficiency enhancing techniques used. Using VMC++, accurate simulations of the entire linac treatment head were performed within minutes on a single processor. Noteworthy differences (+/- 1%-3%) in the mean energy, planar fluence, and angular and spectral distributions were observed with the NIST bremsstrahlung cross sections compared with those of Bethe-Heitler (BEAMnrc default bremsstrahlung cross section). However, MC calculated dose distributions in water phantoms (using combinations of VRTs/AEITs and cross-section data) agreed within 2% of measurements. Furthermore, MC calculated dose distributions in a simulated water/air/water phantom, using NIST cross sections, were within 2% agreement with the BEAMnrc Bethe-Heitler default case.

Purpose: For the purpose of nonstandard beam reference dosimetry, the current concept of reporting absorbed dose at a point in water located at a representative position in the chamber volume is investigated in detail. As new nonstandard beam reference dosimetry protocols are under development, an evaluation of the role played by the definition of point of measurement could lead to conceptual improvements prior to establishing measurement procedures. Methods: The present study uses the current definition of reporting absorbed dose to calculate ionization chamber perturbation factors for two cylindrical chamber models [Exradin A12 and A14] using the Monte Carlo method. The EGSnrc based user-code EGS_chamber is used to calculate chamber dose responses of 14 IMRT beams chosen to cause considerable dose gradients over the chamber volume as previously used by Bouchard and Seuntjens [“Ionization chamber-based reference dosimetry of intensity modulated radiation beams,” Med. Phys. 31(9), 2454–5465 (2004)]. Results: The study shows conclusively the relative importance of each physical effect involved in the nonstandard beam correction factors of 14 IMRT beams. Of all correction factors involved in the dosimetry of the beams studied, the gradient perturbation correction factor has the highest magnitude, on average, 11% higher compared to reference conditions for the Exradin A12 chamber and about 5% higher for the Extradin A14 chamber. Other perturbation correction factors (i.e., Pwall, Pstem, and Pcel) are, on average, less than 0.8% different from reference conditions for the chambers and beams studied. The current approach of reporting measured absorbed dose at a point in water coinciding with the location of the centroid of the chamber is the main factor responsible for large correction factors in nonstandard beam deliveries (e.g., intensity modulated radiation therapy) reported in literature. Conclusions: To reduce or eliminate the magnitude of perturbation correction factors in nonstandard beam reference dosimetry, two possible ways to report absorbed dose are suggested: (1) Reporting average dose to the sensitive volume of the chamber filled with water, combined with removing the reference field implicit gradient effect when measuring output factors, and (2) reporting average dose to the chamber itself during output factor verifications. The first option could be adopted if clinical beam correction factors are negligible. The second option could simplify quality assurance procedures when correction factors are not negligible and have to be calculated using Monte Carlo simulations.

Radiochromic film is a dosimeter of choice in applications requiring high spatial resolution, two dimensional measurements, or minimum perturbation of the beam fluence. Since the measurement uncertainty in Gafchromic film dosimetry is thought to be significant compared to that of ionization chambers, a rigorous method to evaluate measurement uncertainties is desired. This article provides a method that takes into account the correlation between fit parameters as well as single dose values in order to obtain accurate uncertainties in absolute and relative measurements. A complete portrait of all sources of uncertainty in Gafchromic film dosimetry is given. The parametrization of variance as a function of the number of averaged pixels is obtained in order to accurately predict the uncertainty as a function of the size of the region of interest. The choice of functional form for the sensitometric curve is based on four criteria and a convergence of global net optical density uncertainty to 0.0013 is demonstrated. A minimum number of 12 points is recommended to characterize the sensitometric curve to a sufficient precision on the uncertainty estimation. Uncertainty levels of 0.9% on absolute dose measurements and 0.45% on relative measurements are achieved using a 12-point calibration curve with 220 cGy and repeating measurements five times. Uncertainties of 0.8% and 0.4% are achievable when using 35 points during film characterization. Ignoring covariance terms is shown to lead to errors in the estimation of uncertainty.