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    SRS SRT Dosimetry - Sonja Dieterich PDF

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    This document summarizes a presentation on small field reference dosimetry. It describes the learning objectives, which are to describe basic small field dosimetry concepts, know appropriate detectors, learn questions for radiation therapy plans, and be aware of whole body dose. It also discusses several topics in small field dosimetry including reference dose definitions, dosimetric accuracy and spatial accuracy considerations, suitable detectors, and algorithms for dose calculation.

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    SRS SRT Dosimetry - Sonja Dieterich PDF

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    vane75362-1
    119 views43 pages
    This document summarizes a presentation on small field reference dosimetry. It describes the learning objectives, which are to describe basic small field dosimetry concepts, know appropriate detectors, learn questions for radiation therapy plans, and be aware of whole body dose. It also discusses several topics in small field dosimetry including reference dose definitions, dosimetric accuracy and spatial accuracy considerations, suitable detectors, and algorithms for dose calculation.

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    This document summarizes a presentation on small field reference dosimetry. It describes the learning objectives, which are to describe basic small field dosimetry concepts, know appropriate detectors, learn questions for radiation therapy plans, and be aware of whole body dose. It also discusses several topics in small field dosimetry including reference dose definitions, dosimetric accuracy and spatial accuracy considerations, suitable detectors, and algorithms for dose calculation.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    119 views43 pages

    SRS SRT Dosimetry - Sonja Dieterich PDF

    Uploaded by

    vane75362-1
    This document summarizes a presentation on small field reference dosimetry. It describes the learning objectives, which are to describe basic small field dosimetry concepts, know appropriate detectors, learn questions for radiation therapy plans, and be aware of whole body dose. It also discusses several topics in small field dosimetry including reference dose definitions, dosimetric accuracy and spatial accuracy considerations, suitable detectors, and algorithms for dose calculation.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 43

    SonjaDieterich,PhD,DABR

    StanfordUniversityHospital
    EllenWilcox,PhD
    StFrancisHospital,CT
    CarloCavedon,D.S.
    Ospedale SanBartolo,Vicenza,Italy
    WithslidesfromRemyDurand,Huaying Ji,JosephNovotny

    ConflictofInterest
    SonjaDieterich hasaconsultingagreementwith

    Cyberheart Inc.

    LearningObjectives
    Describethebasicconceptsofsmallfieldreference

    dosimetry
    Knowwhichdetectorsareappropriatetouse
    Learntherightquestionstoaskwhenyouseeaplan
    Beawareofwholebodydose

    90% of attention goes to:


    90%ofattentiongoesto:
    SpatialAccuracy
    Robotpointingaccuracy(calibrationverification):0.2mm

    0.3mm
    Closertoclinicalreality:Endtoend(E2E)
    ManufacturerE2Espec:<0.95mm
    Myclinic:0.3mm 0.7mm
    IstarttoinvestigateifE2E>0.7mm
    OlderpaperbyYuetal (E2E
    (E2E=1.1mm)
    1.1mm)

    had2mmslice thickness
    Knowndependencyofspatialaccuracyvs.slicethickness

    1mmor1.25mmiscurrentlystandardslicethickness

    Thinkofdosimetricaccuracyas
    y
    shiftingisodoselines

    WhyisDosimetryimportant?
    Inthebrain:
    PreSRSAVMembolizationwithOnyxorglue
    Nearcavitiesorsuperficialtumors
    SRShasmovedoutsidethebrain:
    Lung
    L
    Tspine
    OurSmallFieldsaregettingsmaller
    WhatistheWBdosefor85(!)lesions?

    T bl f C
    TableofContents
    ReferenceDosimetry
    Whatisasmallfield?
    ThenewIAEAframeworkforSRSfields
    Relative(Patient)Dosimetry
    Dosecalculationalgorithms
    Invivodosimetry
    v vo dos et y
    Wholebodydose

    WhatisaSmallField?
    Smallchangeswithtime:
    Nolaterale equilibrium(quick:whatisthatfor6MV?)
    <10mm
    <4mm?
    Challenges:
    Ch ll
    Howtobuildacollimator
    Focalspotsizelargecomparedtocollimator
    Inversesquarelawbreakingdown
    Detectorresolution

    WhyMicrobeams?
    Functionaltargets:
    Epilepsy,Parkinsons(fornon
    DBScandidates))
    Neurology:Facetblocks,
    hyperhydrosis
    Intractablepain(palliative,
    capsulotomy)
    ObsessiveCompulsiveDisorder
    Intractable,severedepression
    Intractable severedepression
    (fMRI:hyperactivityofBrodmann
    25)
    Smallanimalapplications

    R f
    d
    f
    d d fi ld
    Referencedosefornonstandardfields
    TG51presentations: Musthave10cmx10cmfield
    Gammaknife?Cyberknife?Tomotherapy?
    y
    py
    Thesefieldsarenotflatoverdetectorvolume
    IAEAandAAPMtaskgroupsonsmallfielddosimetry

    The IAEA concept


    TheIAEAconcept

    (TG51)60mmconeforCK
    Standardbeamdataacquisition(TPR,OCR)forCK:

    80cmSAD

    Howtoobtain100cmSSD?
    Easy:moverobotup(byhowmuch?)

    HowtoobtainkQ?
    Noflatteningfilter
    N fl tt i filt noproblem(seeDWORogers)
    bl ( DWOR
    )
    Howtohandlegradientcorrections?

    TG51output=1.0153cGy/MUatdmax
    TG21output=1.0162cGy/MUatd
    p
    y/
    y
    max sameday
    15

    EffectsofDetectorSizeon
    ReferenceDosimetry
    1.2

    0.8

    plan

    0.6

    BeamData

    0.4

    0.2

    0
    30

    -20

    -10

    10

    No flattening filter: round edges


    Length of Farmer ~ 2 cm

    20

    30

    PracticalProcedure(1)
    MoverobotuptoextendSSDto100cm.
    Eqv
    q square=0.9
    q
    9 Eqv
    q circle*
    Eqv square=0.9 6 100/80=6.75cm@100cmSSD
    Measure%dd(10,6.75,100)withCyberKnife.
    %dd(
    )
    h b
    f
    Compare%dd(10,6.75,100)withlocalorreferencedata

    (e.g.BJRsup25
    (e
    g BJRsup25)
    *

    Day MJ & Aird EGA in BJR sup 25, 1996, p138-153

    Jordan TJ in in BJR sup 25, 1996, p62 - 110


    17

    PracticalProcedure(2)
    Takethecorresponding%dd(10,10,100)fromthe

    referencedataset.
    ObtainkQ with%dd(10,10,100).
    ObtainPgr(10,10,100)fromreferencedata.
    (10 10 100)fromreferencedata
    ChangecalibrationconditiontoCyberKnife calibration

    condition(SSDsetuptoSADsetup).
    condition(SSDsetuptoSADsetup)

    18

    PracticalProcedure(3)
    PerformmeasurementbaseduponstandardTG51

    procedure.
    MeasurePgr(CK)atthemeasurementpoint.
    (CK)atthemeasurementpoint
    Calculatedosetodmax:

    DwQ

    M N DQ, w
    %dd

    or TPR

    M M raw P

    Q
    D,w

    Co 60
    D,w

    kQ

    Pgr (CK )
    Pgr (10,10,100)

    19

    Example
    1.
    2.
    3
    3.
    4.
    5.
    6.
    7.
    8.
    9.

    100cmSSD60mmcone,%dd(10,6.75,100)=64.02%.
    SSD6

    %dd( 6
    ) 6
    %
    %dd(10,10,100)=65.4%*.
    Withthis%dd(10 10 100) kQ=0.9928.
    Withthis%dd(10,10,100),k
    =0 9928
    Pgr(10,10,100)=0.9897*.
    78.5cmSSD,60mmcone,%dd(10,5.3,78.5)=59.43%.
    78.5
    c SS , 60
    co e, %dd( 0,5.3,78.5) 59.43%.
    Pgr(10,5.3,78.5)=0.9878
    CyberKnife newkQ =0.9909
    TG51output=1.0153cGy/MUatdmax
    TG21output=1.0162cGy/MUatdmax sameday
    * Calculated from BJR data.
    20

    Back to: The IAEA concept


    Backto:TheIAEAconcept

    Example for a device: GK


    Exampleforadevice:GK

    Measuringeachfieldnotpossible
    EvenwithPerfexion,8segments
    Planclass:Isocentric,allbeams,defined
    ,
    ,

    collimator

    GKPlanClassSpecificReference
    p
    Calibration

    VerificationofDoseCalculation

    SuitableDetectors?
    Plus:
    Plus
    BANGgels
    Diamond
    OLD

    UncertaintiesforOutputFactors
    Errorbarsgettinglarger
    below20mm
    MCofbeam
    MC f b
    MCofdetectors

    Fi ld
    D
    Si
    Fieldvs.DetectorSize
    1.000

    1.5cm
    1 5cm depth
    0.800

    0.600

    Widthofa
    Wid h f

    5c

    7.5c

    10c

    12.5c

    15c

    site 5c

    site 7.5c

    site 10c

    site 12.5c

    site 15c

    0.400

    0.200

    0 000
    0.000
    0.0

    2.0

    4.0

    6.0

    8.0

    10.0

    12.0

    14.0

    PTW60012diode
    comparedtosmall
    collimatorOARs

    Al ith i ( ld ) C i l SRS
    Algorithmsin(older)CranialSRS
    y
    Aheadisverysimilartoa
    sphere(surface
    corrections!)
    Fairlyhomogeneous
    Nasopharynx
    AVMembolizations

    Densitycanbe

    approximatedbyH
    i t db H2O
    (hencenoCTusedon
    GammaKnife)

    NeedforbetteralgorithmsinSRS
    Mostsystemsusedpathlengthcorrection
    Narrowbeams:
    fielddimensionssmallerthenmaximumrangeof
    secondaryelectrons
    Steepdosegradients
    Getsexacerbatedbytissueheterogeneity
    Betteralternative:
    Collapsedconeconvolutionsuperposition
    MonteCarlo

    Example:
    Example:
    6MVPhotonMonteCarlo
    UseMCinalllungcases,Tspine,Head&Neck
    Brain:supraorbital,pituitary,<1.5cmtoskin,embolized

    AVM
    Recalculationorreoptimization
    Older(e.g.Raytracing)algorithms:
    +8%14%offforRPClungphantom(RTOG0236)
    Dosedifferencemaybemuchhigherforsmalllesions
    D diff

    b
    hhi h f
    lll i
    ( t %!)
    (upto40%!)
    Dosedifferenceofvarying%knownissueforall olderTx planning

    algorithmsincombinationwithsmallbeams,not limitedto
    C b k if
    Cyberknife

    ExampleI:DosimetryforSBRT
    a p e : os et y o S

    ExampleII:DosimetryforSBRT
    a p e : os et y o S

    Independent verification of MC
    IndependentverificationofMC

    RecentlygotapprovedforRTOG0618
    RTOG0618=RTOG0236+inhomogeneity
    3
    g
    y

    corrections
    Doneonamotionplatform
    June 11, 2009

    9th ISRS Congress, Seoul, Korea 2009

    WhyInVivoDosimetry?
    Why?

    Challenges?

    FramelessSRS

    Fieldsize:noexitfieldfor

    di d l
    diodeplacement
    SBRT:
    Imaging:NospaceforEPID
    Gating/ABC
    (GammaKnife)
    Motion
    Motionadaptivewith
    adaptivewith
    Synchrony
    Nonisocentricity
    (Cyberknife)
    Motionadaptivewithmoving
    MLC
    C
    Fieldmatchingfor
    retreatments

    Justoneideaforinvivo
    Antennaisverysimilartoagoldseed
    Invasiveproceduretoimplantmarker
    Implantable Dosimeter

    11.25
    25 mm CT slice thickness
    Looks like two closely placed
    fiducials!
    Not uncommon in patients

    01/26/2007

    6th Annual Cyberknife Users Meeting

    39

    Whyisitimportant?
    Wearetreatingbenign&functionalcases
    Longsurvival
    Pediatrics(protons!)
    MUperdelivereddose
    Theissues:
    Whatistheerrorbaronsecondarycancerrisk?
    Absolutevs.relativerisk
    Absolutevs relativerisk
    Delayedradiationresponse
    Riskoftreatingvs.notreatment/othertreatments
    Differenceinrisktolerance(e.g.RadOnc
    Diff
    i i k l
    ( R dO vs.Neurosurgeon)
    N
    )

    GK: Extracranial DoseforSingle


    Dose for Single
    GK:Extracranial
    Isocenter

    Travel home safely!


    Travelhomesafely!

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