Small Field Dosimetry: Overview of AAPM TG-155 and the IAEA-AAPM Code of Practice (Therapy) What is a Small Field? Indra J. Das/ Small Fields (Page-1)
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1 Indra J. Das/ Small Fields (Page-1) Small Field Dosimetry: Overview of AAP TG-155 and the IAEA-AAP Code of Practice (Therapy) Indra J. Das, PhD, FAAP, FACR, FASTRO Department of Radiation Oncology Indiana University School of edicine IJDas (1) Indianapolis, Indiana, USA Wildflower, Panama IJDas (2) Small Field Dosimetry Problem Cone Factor (St) Total scatter factor from different institutions 15 12% diff Cone Diameter (mm) WEH U-Arizona Temple U U Penn Erlanger Serago et al. Fan et al. Zhu et al. Das et al, J Radiosurgery, 3, , Institutional variability in 6 V Radionics SRS dosimetry Dosimetric Variation with Detectors What is a Small Field? Cone Factor (St) Total scatter factor with various detectors 14% Diamond CEA (Film) Koda(Film) TLD Pinpoint(par) Pinpoint(per) 0.125ion(par) 0.125ion(per) C(1mm) C(5mm) Lac of charged particle Dependent on the range of secondary electrons Photon energy Collimator setting that obstructs the source size Detector is comparable to the field size IJDas (3) Cone Diameter (mm) Das et al, J Radiosurgery, 3, , IJDas (4) Definition of Small Fields Energy Fluence Penumbra/Output Source sizes cm EnergyFluenceSc normalized Large field x x1.0 cm 0.5x0.5 cm x cm x cm IJDas (5) Das et al, ed. Phys. 35, , 2008 IJDas (6) Nyholm et al Radiother Oncol 78, 347, 2006 and Phys ed Biol 51,6245, 2006
2 Indra J. Das/ Small Fields (Page-2) Source Size Source Size, odern achines 6 V Varian TrueBeam T1 T2 T3 Dimensions x, y (mm) 0.9, V FFF 0.8, V 0.9, 0.9 IJDas (7) 90%, 70%, 50%, 30%, 10% iso-intensity line Jaffray et al, ed Phys 20, (1993) IJDas (8) 10 V FFF Sawey et al, ed Phys, 40, 332, , 0.8 IJDas (9) IAEA/AAP Proposed Pathway Alfonso, et al. ed Phys 35, (2008) IJDas (10) Why So uch of Fuss? Reference (ref) conditions cannot be achieved for most SRS devices (cybernife, gammanife, tomotherapy etc) achine Specific reference () needs to be lined to ref Ratio of reading (PDD, TR, Output etc) is not the same as ratio of dose D1 D2 D 1 1, f clin, D IJDas (11) f Dw, clin Relative Dosimetry clin f N DW, o, o Dw, / ( Output) clin w, clin rel Dw, / w, (Re ading rel, clin, ), clin, ( S ( S w, air Dw, clin clin D / ) w, air w, ) f, f, ref / clin, f clin, P P IJDas (12) eaning of in icro-chambers
3 Indra J. Das/ Small Fields (Page-3) Stopping Power Ratio Radiological Parameters IJDas (13) IJDas (14) Sanchez-Deblado et al, Phy. ed. Biol., 48, 2081, 2003 Cyber Knife Dosimetry Correction Factors 0.5% Correction Factor depends on: Field size Source size (FWH) Detector type IJDas (15) F. Arai, ed. Phys. 33, (2006). IJDas (16) Francescon, et al ed Phys 35, 504, 2008 Correction factor Published data on 1.16 Siemens; PTW diode Eleta; PTW diode Siemens; Exradin A16 Eleta; Exradin A Siemens; Sun Nuclear Dedge 1.08 "Eleta; Sun Nuclear Dedge" Siemens; PTW Pinpoint Eleta; PTW Pinpoint Siemens; PTW microlion Eleta; PTW microlion Field size (mm) IJDas (17) Francescon et al ed Phys,38, 6513, 2011 IJDas (18) ed. Phys. 38 (12), 6992, 2011 of Linear Accelerators (Varian)
4 Indra J. Das/ Small Fields (Page-4) of Linear Accelerators Cyber Knife ed. Phys. 38 (12), , 2011 IJDas (19) Radiotherapy and Oncology 100 (2011) IJDas (20) Pantelis et al, ed Phy. 37, , 2010 CyberKnife data Uncorrected output difference (%) with C mm cone PinPoint Diamond(old) EBT2 icrotld IBA-SFD PTW Diode SN-Edge IJDas (21) oignier et al, ed Phys 41(7), , 2014 IJDas (22) ed Phys, 41(4), , 2014 Newer Data on Benmahlouf et al, ed Phys, 41(4), , 2014 IJDas (23) IJDas (24)
5 Indra J. Das/ Small Fields (Page-5) New Published data From IAEA Correction Factors IJDas (25) IJDas (26) Correction in Profile (OAR) 5 mm cone 25 mm cone IJDas (27) IJDas (28) Francescon et al, ed Phys, 41(10), , 2014 Depth Dose & Source Size Good News with odern icrodetectors IJDas (29) Sham et al, ed Phys, 35, , 2008 Papaconstadopoulos, et al, Phys. ed. Biol. 59 (2014) , IJDas (30)
6 Indra J. Das/ Small Fields (Page-6) achine, Cone & Depth? Radiotherapy Oncology, 112, , 2014 IJDas (31) IJDas (32) Validity of Proposed ethod Summary IJDas (33) Relative dose at d max Field Size (cm) IJDas (34) Understand the limit of small field Focal spot issues Detectors that are water equivalent lie, icrolion, icrodiamond and Plastic Scintillators are best suited Use proper correction factors to correct detector response to correct for the dose Watch for IAEA and TG-155 guidelines when they are published IJDas (35) Thans
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