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Purpose: This paper outlines and demonstrates a programmatic method to incorporate spatial information into a dose volume histogram (DVH) by adding vector data on the location of pixels in the dose array relative to structures in the plan to construct a vectorized dose distribution (VDD). With this data the DVH can be subgrouped according to a wide array of vector constraint sets, defining the spatial relationship of pixels to one or several structures to construct a vectorized DVH (VDVH) to reveal vector relationships of dose regions to structures., Methods: Mathematical models for construction of the VDD and VDVH are described and a dose-vector-histogram (DVctH) is introduced as a means of specifying the location of dose features such as "hot spots." Practical detail on a programmatic approach to implement the methods is provided. A set of tests utilizing phantom and SBRT lung image sets were carried out to demonstrate ability of VDVH and DVctH to reveal clinically relevant spatial detail in dose distributions., Results: The VDVH and DVctH enabled decomposing DVH curves to reveal the relative location of pixels contributing to dose points on the curve. The metrics enabled specificity in defining the location and magnitude of dose features relevant to treatment plan evaluation. The VDD, VDVH, and DVctH differ from other methods described in the literature as a result of using vector based constraints for each pixel, rather than focusing only on distance by construction of a set of shells on around or within a structure and then subgrouping pixels in the overlap region., Conclusions: The method is an effective means to combine spatial information with DVH metrics and provides a practical means of specifying the location of dose features with respect other structures in the treatment plan.

Volumetric imaging and planning for 3-dimensional (3D) conformal radiotherapy and intensity-modulated radiotherapy (IMRT) have highlighted the need to the oncology community to better understand the geometric uncertainties inherent in the radiotherapy delivery process, including setup error (interfraction) as well as organ motion during treatment (intrafraction). This has ushered in the development of emerging technologies and clinical processes, collectively referred to as image-guided radiotherapy (IGRT). The goal of IGRT is to provide the tools needed to manage both inter- and intrafraction motion to improve the accuracy of treatment delivery. Like IMRT, IGRT is a process involving all steps in the radiotherapy treatment process, including patient immobilization, computed tomography (CT) simulation, treatment planning, plan verification, patient setup verification and correction, delivery, and quality assurance. The technology and capability of the Dynamic Targeting IGRT system developed by Varian Medical Systems is presented. The core of this system is a Clinac or Trilogy accelerator equipped with a gantry-mounted imaging system known as the On-Board Imager (OBI). This includes a kilovoltage (kV) x-ray source, an amorphous silicon kV digital image detector, and 2 robotic arms that independently position the kV source and imager orthogonal to the treatment beam. A similar robotic arm positions the PortalVision megavoltage (MV) portal digital image detector, allowing both to be used in concert. The system is designed to support a variety of imaging modalities. The following applications and how they fit in the overall clinical process are described: kV and MV planar radiographic imaging for patient repositioning, kV volumetric cone beam CT imaging for patient repositioning, and kV planar fluoroscopic imaging for gating verification. Achieving image-guided motion management throughout the radiation oncology process requires not just a single product, but a suite of integrated products to manipulate all patient data, including images, efficiently and effectively.

Saturation currents and collection efficiencies in ionization chambers exposed to pulsed megavoltage photon and electron beams are determined assuming a linear relationship between 1/I and 1/V in the extreme near-saturation region, with I and V the chamber current and polarizing voltage, respectively. Careful measurements of chamber current against polarizing voltage in the extreme near-saturation region reveal a current rising faster than that predicted by the linear relationship. This excess current combined with conventional "two-voltage" technique for determination of collection efficiency may result in an up to 0.7% overestimate of the saturation current for standard radiation field sizes of 10X10 cm2. The measured excess current is attributed to charge multiplication in the chamber air volume and to radiation-induced conductivity in the stem of the chamber (stem effect). These effects may be accounted for by an exponential term used in conjunction with Boag's equation for collection efficiency in pulsed beams. The semiempirical model follows the experimental data well and accounts for both the charge recombination as well as for the charge multiplication effects and the chamber stem effect.

The procedure recommended by radiation dosimetry protocols for determining the collection efficiency f of an ionization chamber assumes the predominance of general recombination and ignores other charge loss mechanisms such as initial recombination and ionic diffusion. For continuous radiation beams, general recombination theory predicts that f can be determined from a linear relationship between 1/Q and 1/V2 in the near saturation region (f > 0.7), where Q is the measured charge and V the applied chamber potential. Measurements with Farmer-type cylindrical ionization chambers exposed to cobalt-60 gamma rays reveal that the assumed linear relationship between 1/Q and 1/V2 breaks down in the extreme near-saturation region (f > 0.99) where Q increases with V at a rate exceeding the predictions of general recombination theory. A comprehensive model is developed to describe the saturation characteristics of ionization chambers. The model accounts for dosimetric charge loss (initial recombination, ionic diffusion, and general recombination) and nondosimetric charge multiplication in an ionization chamber, and suggests that charge multiplication plays a significant role under typical chamber operating conditions (300 V) used in radiation dosimetry. Through exclusion of charge multiplication from the measured chamber signal Q, the model predicts the breakdown of the 1/Q vs 1/V2 relationship and shows that the final approach to saturation is governed by initial recombination and ionic diffusion which are characterized by a linear relationship between 1/Q and 1/V. Collection efficiencies calculated with this model differ by up to 0.4% from those determined through a rigorous application of general recombination theory alone.

A variable air-volume, parallel-plate extrapolation chamber forming an integral part of a Solid Water phantom was built to determine the absorbed dose in Solid Water directly. The sensitive air-volume of the extrapolation chamber is controlled through the movement of the chamber piston by means of a micrometer mounted to the phantom body. The relative displacement of the piston is monitored by a calibrated mechanical distance travel indicator with a precision on the order of 0.002 mm. Irradiations were carried out with cobalt-60 gamma rays, x-ray beams ranging from 4 to 18 MV, and electron beams between 6 and 22 MeV. The absorbed dose at a given depth in Solid Water is proportional to the ionization gradient measured in the Bragg-Gray cavity region with an extrapolation chamber embedded in the Solid Water phantom. The discrepancies between the doses determined in Solid Water with our uncalibrated extrapolation chamber and doses obtained with a calibrated standard thimble ionization chamber are at most 1% for photon and electron beams at all megavoltage clinical energies. Uncalibrated extrapolation chamber thus offer a simple and practical alternative to other techniques used in output measurements of megavoltage photon and electron machines.

The response of thermoluminescent dosimeters to electron irradiations depends on the radiation dose, mean electron energy at the position of the dosimeter in phantom, and the size of the dosimeter. In this paper the semi-empirical expression proposed by Holt et al. [Phys. Med. Biol. 20, 559-570 (1975)] is combined with the calculated electron dose fraction to determine the thermoluminescent dosimetry (TLD) response as a function of the mean electron energy and the dosimeter size. The electron and photon dose fractions, defined as the relative contributions of electrons and bremsstrahlung photons to the total dose for a clinical electron beam, are calculated with Monte Carlo techniques using EGS4. Agreement between the calculated and measured TLD response is very good. We show that the considerable reduction in TLD response per unit dose at low electron energies, i.e., at large depths in phantom, is offset by an ever-increasing relative contribution of bremsstrahlung photons to the total dose of clinical electron beams. This renders the TLD sufficiently reliable for dose measurements over the entire electron depth dose distribution despite the dependence of the TLD response on electron beam energy.