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  • Author: Freek Cp du Plessis x
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Patients undergoing computerized tomography (CT) scans for tumor localization and treatment planning are frequently scanned using pre-set customized exposure protocols for optimal imaging of different anatomical sites. The question arises if these scanning protocols will produce a deviation in the Hounsfield number for a given tissue that can afterwards be used to predict the resulting dose calculation deviation due to this. The question is also if the deviation in the Hounsfield number of a tissue is large enough to affect dose calculation clinically significant.

A study was devised in which a RMI phantom was scanned with five different scanning protocols and two CT beam energies at 120 and 135 kV. To assess the effect of insert configuration, Hounsfield number measurements were repeated for high density RMI inserts in the center and outer rings in the phantom. For each material insert the standard deviation of the Hounsfield number was calculated. To assist in dose prediction a series of DOSXYZnrc Monte Carlo calculations were carried out for beam qualities between 6 and 16 MV for a range of Hounsfield numbers calculated for bone and water. This provided information on how the depth dose varied as a function of Hounsfield number variation. Lastly, a series of treatment plans were setup for absorbed dose calculation using the RMI insert electron densities vs Hounsfield relations measured above. The absorbed dose of corresponding plans with the largest Hounsfield number variation were subtracted to find the dose discrepancies.

It was found that the dose discrepancies in tissue types could be indicated by the deviation of the Hounsfield number due to different scanning protocols. The calculated dose difference were in all cases within 3%.


Monte Carlo (MC) simulation is the gold standard for dose calculation. An accurate mathematical source model can be used for the radiation beams. Source models can consist of sub-sources or fewer sources with data that need to be measured. This can speed up treatment plan verification without the need for a full simulation of the radiation treatment machine.

Aims: This study aimed to construct a novel hybrid source model for 6 MV photon beams for an Elekta Synergy accelerator and to commission it against measured beam data and treatments plans.

Methods and Material: The model comprised of a circular photon and planar electron contamination source. The modified Schiff formula provided off-axis variable bremsstrahlung spectra. Collimation and scatter were modelled with error functions. An exponential function modelled the transmitted fluence through the collimators. The source model was commissioned by comparing simulated and measured MC data. Dose data included profiles, depth dose and film measurements in a Rando phantom. Field sizes ranged from 1 × 1 cm2 to 40 × 40 cm2.

Results: Regular, wedged and asymmetrical fields could be modelled within 1.5% or 1.5 mm. More than 95% of all points lie within 3% or 3 mm for the multi-leaf collimators contours data. A gamma criterion of 3% or 3 mm was met for a complex treatment case.

Conclusions: The two sub-source model replicated clinical 6 MV Elekta Synergy photons beams and could calculate the dose accurately for conformal treatments in complex geometries such as a head-and-neck case.


Introduction: Small fields photon dosimetry is associated with many problems. Using the right detector for measurement plays a fundamental role. This study investigated the measurement of relative output for small photon fields with different detectors. It was investigated for three-photon beam energies at SSDs of 90, 95, 100 and 110 cm. As a benchmark, the Monte Carlo simulation was done to calculate the relative output of these small photon beams for the dose in water.

Materials and Methods: 6, 10 and 15 MV beams were delivered from a Synergy LINAC equipped with an Agility 160 multileaf collimator (MLC). A CC01 ion chamber, EFD-3G diode, PTW60019 microdiamond, EBT2 radiochromic film, and EDR2 radiographic film were used to measure the relative output of the linac. Measurements were taken in water for the CC01 ion chamber, EFD-3G diode, and the PTW60019. Films were measured in water equivalent RW3 phantom slabs. Measurements were made for 1 × 1, 2 × 2, 3 × 3, 4 × 4, 5 × 5 and a reference field of 10 × 10 cm2. Field sizes were defined at 100cm SSD. Relative output factors were also compared with Monte Carlo (MC) simulation of the LINAC and a water phantom model. The influence of voxel size was also investigated for relative output measurement. Results and Discussion: The relative output factor (ROF) increased with energy for all fields large enough to have lateral electronic equilibrium (LEE). This relation broke down as the field sizes decreased due to the onset of lateral electronic disequilibrium (LED). The high-density detector, PTW60019 gave the highest ROF for the different energies, with the less dense CC01 giving the lowest ROFs.

Conclusion: These are results compared to MC simulation, higher density detectors give higher ROF values. Relative to water, the ROF measured with the air-chamber remained virtually unchanged. The ROFs, as measured in this study showed little variation due to increased SSDs. The effect of voxel size for the Monte Carlo calculations in water does not lead to significant ROF variation over the small fields studied.