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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 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 • Radiotherapy requires • accurate dose delivery
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)
Dose measurements Point detector beam Entrance dose: wedge 2D detector array Output, SSD Wedge, curvature Patient curvature Exit dose: Thickness, density
High accuracy Low precision Low accuracy High precision Desired in vivo dosimeter characteristics • Accurate and precise • Multiple readouts • Reusability • No cables • Non-destructive readout
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)
Dosimeter reading → absorbed dose • Absorbed dose, D: • R: dosimeter reading • ND: calibration factor • Ci: correction factor
Calibration • Under reference conditions: beam dosimeter Rcal dmax ion chamber Dcal water phantom
Example – diodes spherical droplet
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
Temperature and sensitivity, diodes Detector temperature after placing on patient Sensitivity dependence
Accumulated dose and sensitivity, diodes • Regular calibration must be performed
Field size and sensitivity, diodes 8 or 18 MV photons Entrance (in) or exit (out)
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 • …
Methods Portal image profile
Measured dose / prescribed dose Action level: 2.5% measured dose dose after correction
Treatment planning algorithm Portal image Collapsed cone algorithm Location of normalization point 2D dose maps
Novel methods – ”dose guided radiotherapy” prescribed isodose target Backprojection of filtered dose image into patient image →OK →correction dose image
Corrections Novel methods – ”dose guided radiotherapy” bladder prostate rectum