IAEA Training Material on Radiation Protection in Radiotherapy

Radiation Protection in Radiotherapy

Part 2

Radiation Physics
Lecture 2: Dosimetry and Equipment

Rationale

Radiation dose delivered to the target and surrounding tissues is one of the major predictors of radiotherapy treatment outcome (compare part 3 of the course). It is generally assumed that the dose must be accurately delivered within +/-5% of the prescribed dose to ensure the treatment aims are met.
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Objectives

To understand the relevance of radiation dose and dosimetry for radiotherapy To be able to explain the difference between absolute and relative dosimetry To be able to discuss the features of the most common dosimeters in radiotherapy: ionization chambers, semiconductors, thermoluminescence dosimeters (TLD) and film

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Part 2, lecture 2: Dosimetry and equipment

Contents of lecture 2
1. Absolute and relative dosimetry 2. The dosimetric environment: phantoms 3. Dosimetric techniques
physical background practical realization

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1. Absolute and relative dosimetry

Absolute dosimetry is a technique that yields information directly on absorbed dose in Gy. This absolute dosimetric measurement is also referred to as calibration. All further measurements are then compared to this known dose under reference conditions. This means relative dosimetry is performed. In general no conversion coefficients or correction factors are required in relative dosimetry since it is only the comparison of two dosimeter readings, one of them being in reference conditions.

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Absolute dosimetry
Required for every radiation quality once Determination of absorbed dose (in Gy) at one reference point in a phantom Well defined geometry (example for a linear accelerator: measurements in water, at 100cm FSD, 10x10cm2 field size, depth 10cm Follows protocols (compare part 10)

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Absolute dosimetry
Required for every radiation quality once Determination of absolute dose (in Gy) at one reference point in a phantom Well defined geometry: Eg. water phantom, 100cm FSD, 10x10cm2 field size, depth 10cm Follows protocols (compare part 10)

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Quick Question

A dose of 1Gy delivers a huge quantity of energy to the patient - is it true or false?

Answer
FALSE 1Gy = 1J/kg. Delivering this amount of energy would raise the temperature of tissue by less than 0.001oC. Even for a 100kg person it is much less than the energy consumed with a bowl of muesli please note the amount of energy in food is often listed on the package.

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Relative dosimetry
Relates dose under non-reference conditions to the dose under reference conditions Typically at least two measurements are required:

one in conditions where the dose shall be determined one in conditions where the dose is known

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Examples for relative dosimetry

Characterization of a radiation beam

percentage depth dose, tissue maximum ratios or similar profiles

Determination of factors affecting output

field size factors, applicator factors filter factors, wedge factors patient specific factors (e.g. electron cutout)

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Percentage depth dose measurement

Variation of dose in a medium (typically water) with depth Includes attenuation and inverse square law components
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Percentage depth dose

Relates dose at different depths in water (or the patient) to the dose at the depth of dose maximum - note that the y axis is relative!!!

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TAR, TMR, TPR

Relative dosimetry for isocentric treatment set-up (compare part 5) All can be converted into percentage depth dose

TAR = ratio of dose in phantom with x cm overlaying tissue to dose at the same point in air TMR = ratio of dose with x cm overlaying tissue to dose at dose maximum (detector position fixed) TPR as TMR but as a ratio to dose at a reference point (e.g. 10cm overlaying tissue)
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TMR, TPR

Mimics isocentric conditions TMR is a special case of TPR where the reference phantom depth is depth of maximum dose
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PDD and TMR

Strong ISL dependence

Percentage depth dose (PDD) changes with distance of the patient to the source due to variations in the inverse square law (ISL), TAR, TMR and TPR do not.

Weak ISL dependence

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Output factors

Compare dose with dose under reference conditions

different field sizes wedge factor tray factor applicator factor electron cutout factor

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Example: wedge factor

Dose under reference conditions

Could also involve different field sizes and/or different depths of the detector in the phantom
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Quick Question

Is a Half Value Layer measurement for the determination of X Ray quality absolute or relative dosimetry?

Answer
Relative dosimetry: we relate the dose with different aluminium or copper filters in the beam to the dose without the filters to determine which filter thickness attenuates the beam to half its original intensity the result is independent of the actual dose given - we could measure for 10s or 20s or 60s each time, as long as we ensure the irradiation is identical for all measurements
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2. The dosimetric environment

Phantoms

A phantom represents the radiation properties of the patient and allows the introduction of a radiation detector into this environment, a task that would be difficult in a real patient. A very important example is the scanning water phantom. Alternatively, the phantom can be made of slabs of tissue mimicking material or even shaped as a human body (anthropomorphic).
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Scanning water phantom

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Slab phantoms

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Tissue equivalent materials

Many specifically manufactured materials such as solid water (previous slide), white water, plastic water, Polystyrene (good for megavoltage beams, not ideal for low energy photons) Perspex (other names: PMMA, Plexiglas) tissue equivalent composition, but with higher physical density - correction is necessary.

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Anthropomorphic phantom

Whole body phantom: ART

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Allows placement of radiation detectors in the phantom (shown here are TLDs)

Includes inhomogeneities
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RANDO phantom

torso

CT slice through lung Head with TLD holes

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Pediatric phantom

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Some remarks on phantoms

It is essential that they are tested prior to use

physical measurements - weight, dimensions radiation measurements - CT scan, attenuation checks

wax for shaping of humanoid phantoms cork as lung equivalent

Cheaper alternatives can also be used

As long as their properties and limitations are known - they are useful

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3. Radiation effects and dosimetry

Radiation effect Ionization in gases Ionization in liquids Ionization in solids Luminescence Fluorescence Chemical transitions Dosimetric method Ionization chamber Liquid filled ionization chamber Semiconductors Diamond detectors Thermoluminescence dosimetry Scintillators Radiographic film Chemical dosimetry NMR dosimetry Calorimetry Erythema Chromosome damage

Heat Biological effects

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Principles of radiation detection

Ionization chamber Geiger Mueller Counter Thermoluminescence dosimetry Film Semiconductors

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Detection of Ionization in Air

Ion chamber Adapted from Collins 2001

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Detection of Ionization in Air

Adapted from Metcalfe 1998

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Ionometric measurements
Ionization Chamber 200-400V Measures exposure which can be converted to dose not very sensitive Geiger Counter >700V Every ionization event is counted Counter of events not a dosimeter very sensitive

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Ionization Chambers
600cc chamber

Thimble chambers
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Cross section through a Farmer type chamber (from Metcalfe 1996)

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Ionization Chambers

Farmer 0.6 cc chamber and electrometer Most important chamber in radiotherapy dosimetry

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Electrometer

From the chamber

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Ionization chambers
Relatively large volume for small signal (1Gy produces approximately 36nC in 1cc of air) To improve spatial resolution at least in one dimension parallel plate type chambers are used.

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Parallel plate chambers

From Metcalfe et al 1996

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Parallel Plate Ionization Chambers

Used for
low energy X Rays (< 60 KV) Electrons of any energy but rated as the preferred method for energies < 10 MeV and essential for energies < 5 MeV

Many types available in different materials and sizes Often sold in combination with a suitable slab phantom

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Parallel Plate Ionization Chambers - examples

Markus chamber small designed for electrons

Holt chamber robust embedded in polystyrene slab

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Well type ionization chamber

For calibration of brachytherapy sources

Brachytherapy source

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Ionization chamber type survey meters

not as sensitive as G-M devices but not affected by pulsed beams such as occur with accelerators because of the above, this is the preferred device around high energy radiotherapy accelerators

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Geiger-Mueller Counter
Not a dosimeter - just a counter of radiation events Very sensitive Light weight and convenient to use Suitable for miniaturization

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Geiger-Mueller (G-M) Devices

Useful for
area monitoring room monitoring personnel monitoring

Care required in regions of high dose rate or pulsed beams as reading may be inaccurate
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Thermoluminescence dosimetry (TLD)

Small crystals Many different materials Passive dosimeter - no cables required Wide dosimetric range (Gy to 100s of Gy) Many different applications

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Various TLD types

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Simplified scheme of the TLD process

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TLD glow curves

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Glow curves
Allow research Are powerful QA tools - does the glow curve look OK? Can be used for further evaluation May improve the accuracy through glow curve deconvolution

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The role of different dopants

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Importance of thermal treatment

Determines the arrangement of impurities

sensitivity fading response to different radiation qualities

Maintain thermal treatment constant...

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Dose response of LiF:Mg,Ti:

wide dosimetric range watch supralinearity
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Variation of TLD response with radiation quality

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Materials: oh what a choice...

LiF:Mg,Ti (the gold standard) CaF2 (all natural, or with Mn, Dy or Tm) CaSO4 BeO Al2O3 :C (record sensitivity 1uGy) LiF:Mg,Cu,P (the new star?)

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TLD reader

photomultiplier based planchet and hot N2 gas heating available

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What can one expect...

Reproducibility: single chip 2% (0.1Gy, 1SD) Accuracy (4 chips standard, 2 chips measurement) 3% (0.1Gy, 95% confidence) about 30 minutes per measurement...

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Radiographic film
Reduction of silver halide to silver Requires processing ---> problems with reproducibility Two dimensional dosimeter High spatial resolution High atomic number ---> variations of response with radiation quality

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Radiographic film
Often prepacked for ease of use

Cross section

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Film: dose response

Evaluation of film via optical density OD = log (I0 / I) Densitometers are commercially available

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Radiographic film dosimetry in practice

Depends on excellent processor QA Commonly used for demonstration of dose distributions Problems with accuracy and variations in response with X Ray energy
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Radiochromic film
New development No developing Not (very) light sensitive Better tissue equivalence Expensive

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Semiconductor Devices
Diodes MOSFET detectors

Diodes for water phantom measurements

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Diodes
Mostly used like a photocell generating a voltage proportional to the dose received.

From Metcalfe et al. 1996

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Metal Oxide Semiconductor Field Effect Transistor

MOSFETs = extremely small sensitive volume

From Metcalfe et al. 1996

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1. irradiation

2. Charge carriers trapped in Si substrate

3. Current between source and drain altered

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Gate bias during irradiation: determines sensitivity

Readout after irradiation: gate bias required to maintain constant current

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Diodes and other Solid State Devices

Advantages

Disadvantages

direct reading sensitive small size waterproofing possible

temperature sensitive sensitivity may change --> recalibration necessary regular QA procedures need to be followed

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Summary of lecture 2
Advantages Ion chambers Well understood, accurate, variety of forms available Large, high voltage required Reference dosimetry, beam scanning Most common and important dosimetric technique Semiconductors Small, robust TLDs Small, no cables required Delayed readout, complex handling Dose verification, in vivo dosimetry Film Two dimensional, ease of use Not tissue equivalent, not very reproducible QA, assessment of dose distributions

Disadvantages

Temperature dependence Beam scanning, in vivo dosimetry

Common use

Comment

New developments (MOSFETs) may increase utility

Also used for dosimetric intercomparisons (audits)

New developments (radiochromic film) may increase utility

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General Summary: Physics

In radiotherapy, photons (X Rays and gamma rays) and electrons are the most important radiation types Accuracy of dose delivery is essential for good practice in radiotherapy Absolute dosimetry determines the absorbed dose in Gray at a well-defined reference point. Relative dosimetry relates then the dose in all other points or the dose under different irradiation conditions to this absolute measurement. There are many different techniques available for dosimetry - none is perfect and it requires training and experience to choose the most appropriate technique for a particular purpose and interpret the results
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Where to Get More Information

Medical physicists Textbooks:

Khan F. The physics of radiation therapy. 1994. Metcalfe P.; Kron T.; Hoban P. The physics of radiotherapy X-rays from linear accelerators. 1997. Cember H. Introduction to health physics. 1983 Williams J; Thwaites D. Radiotherapy Physics. 1993.

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Any questions?

Question:

Which radiation detectors could be useful for in vivo dosimetry and why?

In radiotherapy the dose delivered to the patient is typically too large for radiographic film which in addition to this is light sensitive. Ionisation chambers are often fragile and require high voltage, both not ideal when working with patients. Therefore, TLDs are often used as detectors for in vivo dosimetry. They are small, do not require cables for the measurement and there are materials which are virtually tissue equivalent. TLDs can be complemented by diodes if an immediate reading (= active dosimetry) is required. As TLDs, diodes are solid state dosimeters and therefore sensitive and small. Other detectors of interest in this group would be MOSFETs. A different class of in vivo dosimeters are exit dose detectors in the form of electronic portal imaging (compare part 5). They may prove very useful for on-line verification.
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