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In vivo dosimetry

In vivo dosimetry. Eirik Malinen Eva Stabell Bergstrand Dag Rune Olsen. error. Probalility. Prescribed dose. In vivo dosimetry. In vivo : In the living Dosimetry: Estimates of radiation dose by theory and measurement Verification of delivered dose to individual patients

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In vivo dosimetry

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  1. In vivo dosimetry Eirik Malinen Eva Stabell Bergstrand Dag Rune Olsen

  2. error Probalility Prescribed dose In vivo dosimetry • In vivo: In the living • Dosimetry: Estimates of radiation dose by theory and measurement • Verification of delivered • dose to individual patients • Radiotherapy requires • accurate dose delivery

  3. Errors in patient dose • Patient contour / planning basis (CT images) • Patient motion • Organ motion • Dose calculations (inhomogeneities, scatter) • Patient positioning • Transfer of treatment data from simulator to linac • Linac settings (energy, monitor units, field size) and calibration • Beam modifiers (blocks, wedges)

  4. Dose characteristics

  5. Dose measurements Point detector beam Entrance dose: wedge 2D detector array Output, SSD Wedge, curvature Patient curvature Exit dose: Thickness, density

  6. High accuracy Low precision Low accuracy High precision Desired in vivo dosimeter characteristics • Accurate and precise • Multiple readouts • Reusability • No cables • Non-destructive readout

  7. In vivo dosimetry principles • Point detector: • Semiconductors (diodes) • Thermoluminescent crystals • EPR (electron paramagnetic resonance) sensitive materials • …. • 2D detector, (electronic) portal imaging device; EPID: • Film • Arrays (ion chambers, semiconductors)

  8. Dosimeter reading → absorbed dose • Absorbed dose, D: • R: dosimeter reading • ND: calibration factor • Ci: correction factor

  9. Calibration • Under reference conditions: beam dosimeter Rcal dmax ion chamber Dcal water phantom

  10. Example – diodes spherical droplet

  11. Buildup cap

  12. Correction factors • Dosimeter reading may depend on: • Temperature • (Accumulated) Dose • Dose rate • Beam energy • Field size • ... • Accuracy may be reduced if dependence is not corrected

  13. Temperature and sensitivity, diodes Detector temperature after placing on patient Sensitivity dependence

  14. Accumulated dose and sensitivity, diodes • Regular calibration must be performed

  15. Field size and sensitivity, diodes 8 or 18 MV photons Entrance (in) or exit (out)

  16. Supralinearity, TLD

  17. Energy dependence, TLD

  18. Comparison

  19. Action level • Relative dose difference: • At what dose difference level should the treatment be revised? 1% ? 2.5 % ? 5 %? • Depends on: • dosimetric accuracy and precision • non-systematic errors • …

  20. Clinical example

  21. Methods Portal image profile

  22. Measured dose / prescribed dose Action level: 2.5% measured dose dose after correction

  23. Frequency distribution of relative dose

  24. Treatment planning algorithm Portal image Collapsed cone algorithm Location of normalization point 2D dose maps

  25. Novel methods – ”dose guided radiotherapy” prescribed isodose target Backprojection of filtered dose image into patient image →OK →correction dose image

  26. Corrections Novel methods – ”dose guided radiotherapy” bladder prostate rectum

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