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 Table of Contents    
TECHNICAL NOTE
Year : 2021  |  Volume : 46  |  Issue : 1  |  Page : 47-51
 

Repeatability of small field output factor measurements with various detectors


Department of Physics, University of the Witwatersrand, Johannesburg, South Africa

Date of Submission05-Oct-2020
Date of Decision08-Jan-2021
Date of Acceptance24-Jan-2021
Date of Web Publication5-May-2021

Correspondence Address:
Dr. Zakithi Lungile Mpumelelo Msimang
Private Bag X34, Lynnwood Ridge, 0040
South Africa
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jmp.JMP_93_20

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   Abstract 

There are well established dosimetry reference standards for broad beams; however, there are no reference standards that can be used for both broad and small fields. The variation of the equivalent square fields and field output factors in small static photon fields when using a synthetic diamond, an electron diode, and ionization chambers (pin point, semiflex, and liquid filled) was investigated over time. Data from this study were compared to the data from other hospitals in the country and standard data sets, i.e., the British Journal of Radiology Supplement No. 25 of 1996 (BJR25) and the Radiological Physics Centre (RPC) 2012 data. The results showed that reliance on one detector and one measurement session, could yield incorrect field output factors (FOFs) for small fields. At least one of the detectors should be a solid state type with published field output correction factors and at least three measurement sessions should be performed for each FOF data point. Comparing measured data with published datasets, like RPC, will assist in verifying data. BJR25 datasets should not be used for Sclin ≤4 cm.


Keywords: Accurate, equivalent square field, field output factor, reference dosimetry


How to cite this article:
Msimang ZL, der Merwe Dv, Maphumulo N. Repeatability of small field output factor measurements with various detectors. J Med Phys 2021;46:47-51

How to cite this URL:
Msimang ZL, der Merwe Dv, Maphumulo N. Repeatability of small field output factor measurements with various detectors. J Med Phys [serial online] 2021 [cited 2021 Jun 21];46:47-51. Available from: https://www.jmp.org.in/text.asp?2021/46/1/47/315511



   Introduction Top


There are three conditions that characterize a small field. Two of these are related to the beam and the third to the detector used.[1] One or more of these must be fulfilled for a field to be classified as a small field. These are: Loss of lateral charged particle equilibrium; partial occlusion of the primary photon source on the beam axis by the collimating devices; and volume averaging of the detector.[2]

Small fields were implemented in radiotherapy for many years before there was an international code of practice published. There was no coordinated guidance and medical physicists, therefore, relied on manufacturers' recommendations and published data. As a result, data showed significant differences, for example, Das, et al. reported differences of up to 12% for output factors measured in collimated photon beams for field diameters of 20 mm,[3] Derreumaux, et al. reported variations of 5% to 10% in output factors for field sizes ≥12 mm × 12 mm and around 30% for the smallest field size of 6 mm × 6 mm,[4],[5] and Li, et al. reported differences in measured percentage depth dose for 6 mm × 6 mm fields >5%.[6] The differences observed could have been due to the lack of harmonized dosimetry for small fields and to the use of detectors that might not have been suitable for small fields.[4],[5]

The International Atomic Energy Agency (IAEA) in collaboration with the American Association of Physicists in Medicine (AAPM) published a dosimetry Code of Practice for small static fields in 2017,[7] referred to as the IAEA TRS 483 in this paper. With this publication, more consistency in the implementation of the dosimetry for small static fields is expected. Furthermore, guidance is available for centers to accurately determine the dosimetry in small fields.

There are well-established reference standards for broad beams, however, there is no reference standard that can be used for broad and small fields. EBT3 film may be ideal, but considerable expertise and time is needed for accurate and reproducible results.[8] The variation in the field output factor (FOF) data from several independent measurement sessions using different detectors (two solid-state, one liquid-filled ionization chamber and one air ionization chamber), was investigated.


   Materials and Methods Top


FOFs are defined as the detector response at a reference depth in a nonreference field divided by the detector response in a reference field at the same reference depth.[7],[9],[10] This only holds true when the detector response is independent of the dosimetric quantities like for broad beams. In small fields, the dosimetric quantities such as perturbation factors, have a field size and energy dependency. A field output correction factor (FOCF),, is therefore needed to correct for the detector response in small field and this is shown in equation 1:[7],[10]



is the electrometer reading in the clinical small field corrected for all relevant influence quantities (temperature, pressure, humidity, polarity, ion collection efficiency, etc);

is the electrometer reading in the reference field corrected for all relevant influence quantities (temperature, pressure, humidity, polarity, ion collection efficiency, etc); and

is a correction factor for the variation in the response of the detector in a reference field, fref, with beam quality Qref, compared with that in the clinical small field with beam quality Qclin.

A Siemens Primus with a multileaf collimator (MLC) of 82 leaves of 1 cm projection width at the isocentric plane in the X-axis (cross-plane) direction, and a conventional asymmetric collimator in the Y-axis (in plane) direction, was used. The central leaf pair was centered on the cross-plane major axis. Small photon fields were produced using the MLC and jaw in a 6 MV flattened photon beam. The settings of the gantry and the collimator were verified using a spirit level and confirmed with cross-plane profile measurements. Measurements were performed in set field sizes of 10 cm × 10 cm, 6 cm × 6 cm, 4 cm × 4 cm, 3 cm × 3 cm, 2 cm × 2 cm, 1 cm × 1 cm and 0.6 cm × 0.6 cm.

A motorized PTW MP3 water phantom with a moving mechanism driven by three high-speed stepper motors was used for data acquisition. The precision stepper motors allowed for movement of the detector with a speed of 50 mm/s and positioning accuracy of ± 0.1 mm. The water tank was visually aligned with the gantry and the alignment of the scanning arm was confirmed using a spirit level when the tank was filled with water.

The details on the detectors that were used are given in [Table 1] and [Table 2]. All the detectors used in the study were mounted in the water phantom with the chamber stem parallel to the beam axis. The effective point of measurement was positioned in the water phantom using the engineering diagrams provided by the manufacturer. An isocentric technique, at a source axis distance of 100 cm, and a depth of 10 cm in water, was used with the gantry and collimator at 0o for all measurements in this study.
Table 1: Specifications of the ionization chambers used during the study as provided by the manufacturer

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Table 2: Specifications of the solid-state detectors used during the study as provided by the manufacturer

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The full width half maximum was determined from the cross- and in-plane beam profiles and the equivalent square field size (Sclin), was calculated. Sclin was calculated using the method suggested by Cranmer-Sargison[11] which was adopted by the IAEA TRS 483.[7] Sclin was determined using all detectors in three measurement sessions over a period of 3 months, and FOF data were also collected. The FOFs were calculated using equation 1 and the FOCFs that are published in the IAEA TRS 483.[7]

A desktop audit was performed of measured and calculated small field FOFs for 6 MV (with flattening filter) MLC beams, obtained from two hospitals in the country. The data were compared to standard data sets, i.e., British Journal of Radiology Supplement No. 25 of 1996 (BJR25)[12] and Radiological Physics Centre (RPC).[13]

Associated measurement uncertainties were estimated following the Guide to the Expression of Uncertainty in Measurement, JCGM 100:2008 BIPM JCGM.[14],[15] All the measurement uncertainties quoted are for k = 2, equal to a confidence level of 95%.


   Results Top


Sclin were measured using different detector types in three different sessions over a period of 3 months. The water phantom was set up once for each session. Session one measurements were performed 3 days after MLC recalibration using the PTW 60012, 60019, and 31021 detectors. The PTW 60012, 31018, and 31021 detectors were used in the second session, which was 66 days after MLC recalibration. The third session was 84 days after MLC recalibration and the PTW 60012, 60019, 31016, 31018, and 31021 detectors were used. The results using each detector are shown in [Table 3] including the session associated standard deviation. The session standard deviation was determined from measurements obtained using the detectors in that session.
Table 3: Sclin measured in three measurement sessions using PTW 60012, 60019, 31016, 31018, and 31021 detectors

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FOF data were also measured and the results including the associated session standard deviation, are shown in [Table 4]. The session standard deviation was determined from measurements obtained using the detectors in that session. In the first session the PTW 60012, 60019, and 31021 were used, in the second session the PTW 60012 and 31018 were used and in the third session, the PTW 60012, 60019, 31016, 31018, and 31021 were used. The session dates coincided with those of the Sclin measurements.
Table 4: Field output factor derived from three measurement sessions using PTW 60012, 60019, 31016, 31018, and 31021 detectors, as a function of set field size

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[Figure 1] shows the FOF plotted against Sclin for session three. An analytical method suggested by Sauer and adopted in the IAEA TRS 483 was used to determine the FOF for the predetermined Sclin.[7],[16]
Figure 1: Field output factor versus Sclin for the third session

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[Figure 2] shows measured (E-M) and treatment planning system (TPS) (D and E) FOF data for 6 MV flattened beams from ELEKTA Synergy linacs obtained from two other hospitals (D and E) in the country. Data from center D were measured before the publication of the IAEA TRS 483.[7] An average of the data measured in this study (A) was used for this comparison. Data from BJR25[12] and the RPC[13] are also shown in the figure. An analytical method suggested by Sauer and adopted in the IAEA TRS 483 was also used to determine the FOF for the predetermined Sclin.[16] The FOF data submitted by center D were down to Sclin of 1 cm, whereas center E submitted data down to Sclin of 2 cm. Data from RPC were down to Sclin of 2 cm whereas the BJR data were down to 4 cm.
Figure 2: Field output factor versus equivalent square field (Sclin), from this study (a), other centres (D, E and E-M), and published data from British Journal of Radiology Supplement No. 25 of 1996[12] and Radiological Physics Centre (Siemens, Varian and Elekta)[13]

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   Discussion Top


The Sclin data, given in [Table 3], for all the three sessions were in agreement to within the measurement uncertainty of 0.06 cm except for the data collected using the PTW 31021, which varied significantly with those using other detectors, especially for Sclin of 0.6 cm. Comparing data without the PTW 31021 for different sessions, a standard deviation ≤0.03 cm was calculated. The difference in the data collected using all detectors in session one is attributed to an error in the positioning of the 31021 during the setup, as the result was not reproducible. This highlights the importance of doing more than one measurement session and using more than one detector to collect small field data. The highest variation in FOF data given in [Table 4] and in [Figure 1] was for Sclin ≤1 cm. For Sclin of 0.6 cm, comparing the data collected using each detector showed that the highest variation was up to 12% for the PTW 31021. Similarly, in session three a difference of up to 22% was observed. When comparing all other detectors used here, the variation was ≤3%. The highest variation is therefore attributed to the size and perturbation effect produced by the PTW 31021 at this Sclin. The PTW 31021 is therefore not recommended for use at Sclin ≤1 cm.

From the data shown in [Figure 2], the percentage standard deviation was 0.7% when comparing data from the three hospitals for Sclin ≥2 cm. Variations of more than 6% were observed at the Sclin of 4 cm when comparing data from this study to that of the BJR25.[12] Therefore, the BJR25 dataset for 6 MV should not be used for small FOFs. Comparing the data from each hospital to the data published by RPC,[13] the differences observed for the Siemens machine were 3% and 4% for Sclin of 3 cm and 2 cm respectively. For the Elekta machine at hospital D, the difference in the FOF was 0.3% and 1% for the Sclin of 3 cm and 2 cm, respectively and at hospital E, the difference was 1.0% for the measured data and 0.1% and 0.04% for the TPS data for Sclin of 3 cm and 2 cm, respectively. A 7% difference was observed at Sclin of 1 cm when comparing data from centers A and D. This is indicative of the use of a solid-state detector by center D which may explain the overestimation in the FOF. FOCF were not applied by center D as data were collected before the publication of the IAEA TRS 483. The differences observed between centers A, D, and E could also be due to the differences attributed to the collimator design as also observed by Godson et al.[17] Locally measured data should be checked against the RPC dataset or similar datasets for the specific machine model from the same manufacturer.[13] The AAPM TG 142 recommends that the machine FOF tolerance be 2% for field size <4 cm × 4 cm.[18]


   Conclusion Top


Reliance on one detector and one session for performing measurements in small fields could yield incorrect FOFs, especially for Sclin ≤1 cm. One of the detectors should be a solid-state type with already published FOCF. At least three measurement sessions should be performed for each FOF data point. Comparing measured data with published datasets, for example, RPC, will assist in verification. BJR25 data sets should not be used for Sclin ≤4 cm. Centers that collected small fields FOF data before the publication of the IAEA TRS 483 and are using them for treatment, need to remeasure their data, particularly for Sclin <2 cm.

Acknowledgments

Mr Lazola Nobecu is acknowledged for his assistance with operating the equipment and for the valuable discussions on dosimetry. The Charlotte Maxeke Johannesburg Academic Hospital is acknowledged for the use of their equipment; PTW for the loan of several detectors; and the University of the Witwatersrand and the National Metrology Institute of South Africa (NMISA) for supporting this work

Financial support and sponsorship

  • PTW for loaning detectors
  • National Metrology Institute of South Africa for funding my studies
  • Charlotte Maxeke Johannesburg Academic Hospital for allowing for the use of their equipment.


Conflicts of interest

PTW for the loan of several detectors.

 
   References Top

1.
Alfonso R, Andreo P, Capote R, Huq MS, Kilby W, Kjäll P, et al. A new formalism for reference dosimetry of small and nonstandard fields. Med Phys 2008;35:5179-86.  Back to cited text no. 1
    
2.
Institute of Physics and Engineering in Medicine. Small Field MV Photon Dosimetry. IPEM Rep. 103. York: IPEM; 2010.  Back to cited text no. 2
    
3.
Das IJ, Ding GX, Ahnesjö A. Small fields: Nonequilibrium radiation dosimetry. Med Phys 2008;35:206-15.  Back to cited text no. 3
    
4.
Derreumaux S, Etard C, Huet C, Trompier F, Clairand I, Bottollier-Depois JF, et al. Lessons from recent accidents in radiation therapy in France. Radiat Prot Dosimetry 2008;131:130-5.  Back to cited text no. 4
    
5.
Derreumaux S, Boisserie G, Brunet G, Buchheit I, Sarrazin T. Concerns in France about the dose delivered to the patients in stereotactic radiation therapy. In: Standards, Applications and Quality Assurance in Medical Radiation Dosimetry (IDOS) (Proc. Int. Symp. Vienna, 2010), Vol. 1. Vienna: IAEA; 2011. p. 273-86.  Back to cited text no. 5
    
6.
Li S, Medin P, Pillai S, Solberg T. Analysis of photon beam data from multiple institutions: An argument for reference data. Med Phys 2006;33:1991.  Back to cited text no. 6
    
7.
IAEA, International Atomic Energy Agency. Dosimetry of Small Static Fields used in External Beam Radiotherapy: An IAEA AAPM International Code of Practice for Reference and Relative Dose Determination, Technical Report Series No. 483. Vienna: IAEA; 2017.  Back to cited text no. 7
    
8.
Casar B, Gershkevitsh E, Mendez I, Jurković S, Huq MS. A novel method for the determination of field output factors and output correction factors for small static fields for six diodes and a microdiamond detector in megavoltage photon beams. Med Phys 2019;46:944-63.  Back to cited text no. 8
    
9.
Mayles P, Nahum A, Rosenwald JC. Handbook of Radiotherapy Physics: Theory and Practice. 1st ed. Taylor & Francis Group, LLC; 2007.  Back to cited text no. 9
    
10.
Andreo P, Burns DT, Nahum AE, Seuntjens J, Attix FH. Fundamentals of Ionizing Radiation Dosimetry. 1st ed. Germany: Wiley-VCH Verlag GmbH & Co. KGaA; 2017.  Back to cited text no. 10
    
11.
Cranmer-Sargison G, Charles PH, Trapp JV, Thwaites DI. A methodological approach to reporting corrected small field relative outputs. Radiother Oncol 2013;109:350-5.  Back to cited text no. 11
    
12.
British Institute of Radiology. Central axis Depth Dose Data for Use in Radiotherapy. London: The British Institute of Radiology; 1996.  Back to cited text no. 12
    
13.
Followill DS, Kry SF, Qin L, Lowenstein J, Molineu A, Alvarez P, et al. The Radiological Physics Center's standard dataset for small field size output factors. J Appl Clin Med Phys 2012;13:3962.  Back to cited text no. 13
    
14.
BIPM JCGM, Bureau International des Poids et Mesures Joint Committee for Guides in Metrology. In: Evaluation of Measurement Data: Guide to the Expression of Uncertainty in Measurement (GUM). JCGM 100. Sévres: BIPM; 2008.  Back to cited text no. 14
    
15.
BIPM JCGM, Bureau International des Poids et Mesures Joint Committee for Guides in Metrology. In: Evaluation of Measurement Data – An Introduction to the “Guide to the Expression of Uncertainty in Measurement” and Related Documents, JCGM 104. Sévres: BIPM; 2009.  Back to cited text no. 15
    
16.
Sauer OA, Wilbert J. Measurement of output factors for small photon beams. Med Phys 2007;34:1983-8.  Back to cited text no. 16
    
17.
Klein EE, Hanley J, Bayouth J, Yin FF, Simon W, Dresser S, et al. Task Group 142 report: Quality assurance of medical accelerators. Med Phys 2009;36:4197-212.  Back to cited text no. 17
    
18.
Godson HF, Ravikumar M, Ganesh KM, Sathiyan S, Retna Ponmalar Y. Small field output factors: Comparison of measurements with various detectors and effects of detector orientation with primary jaw setting. Rad Meas 2016;85:99-110.  Back to cited text no. 18
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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