Development of an Absorbed Dose Calorimeter for use in IMRT and Small Field External Beam Radiotherapy

S Duane, M Bailey, S Galer, F Graber

Background
The aim of this work is to improve photon dosimetry in composite fields, such as those involved in the delivery of IMRT. In a typical IMRT treatment, the total dose at a point in the PTV arises from an appropriately weighted combination of in-field, out-of-field and penumbral contributions. Measurement with an ion chamber needs to take account of its varying sensitivity to these contributions and the potential for electron disequilibrium: an effective electronic equilibrium may only be achieved when the contributions from all fields are combined. There are two aspects: the absolute measurement of absorbed dose is considered here, and a proposed beam quality parameter to support the transfer of absorbed dose calibration from one nonstandard field to another is addressed in the associated poster [1]. The formalism proposed by Alfonso et al. [2] introduces a plan-class specific reference field for measurements which are as relevant as possible to the clinical treatment field. The calorimeter described here is intended to make an absolute measurement of absorbed dose, and so support direct calibration of an ion chamber in this planclass specific reference field. The quantity absorbed dose at a point is defined mathematically as a limit in which the detector sensitive volume is reduced to zero. In practice, primary standards [3] have a sensitive volume which remains non-zero and this places a lower limit on the field size in which it is feasible to measure absorbed dose at a point, for example, on the beam central axis. In smaller fields the uncertainty of field non-uniformity correction becomes unacceptably large, and standard reference conditions are chosen to be well away from this limit. Although the primary standard measurement is reported as absorbed dose at a point, the underlying measurement involves a volume average. In validating an IMRT treatment, the planned dose distribution is compared with the measured distribution obtained, for example, by a relative measurement of the distribution and a separate measurement of its normalisation, e.g. using an ion chamber. Although we usually think in terms of a normalisation point, and therefore try to measure dose at a point, this is not necessary and instead one can normalise to the average dose over a specified volume. The natural volume to consider would be the sensitive volume of the ion chamber as considered in [4], and the most relevant calibration for the chamber would be one based on an absolute measurement of absorbed dose, averaged over the same volume and made in a field sufficiently similar to the IMRT treatment. We consider making this absolute measurement with a calorimeter designed for the purpose, i.e. an IMRT calorimeter.

calorimeter response relates to a weighted average dose in which the sensitive volume is not well delineated, and whose effective size increases with the duration of the measurement. So water would not be the preferred absorbing medium. A graphite calorimeter offers the option of thermostatic operation, in which calorimeter component temperatures are actively controlled. Heat transfers between components occur but are minimised and, provided the core and its surrounding jacket are both made of graphite, may be determined from measured temperature differences. In thermostatic mode, the calorimeter measurement is one of dose rate (by substitution of radiation heating for electrical heating) and absorbed dose for the IMRT treatment is obtained by integration over time. The sensitive volume is unambiguously defined, and for these reasons graphite was chosen, though only for the absorbing core and its surrounding jacket. The engineering plastic PEEK was chosen for the remaining structural components, to enable operation under vacuum and immersion in a water phantom, while minimising the perturbation due to water inequivalent materials. A graphite in water calorimeter has previously been described [5], although that device was not designed specifically for use in composite fields.

IMRT calorimeter: sensing and operation

In the initial prototype, each component (the core and each half of the jacket) is equipped with one sensing and one heating thermistor. The core is suspended inside the jacket by a thin, shaped polystyrene support. The core and jacket assembly are located inside an evacuated outer envelope. The electrical power to each heating thermistor is monitored continuously and independent control systems adjust the powers, in thermostatic mode, to maintain a constant temperature for each component. The calorimeter is used in a water phantom whose temperature is not closely controlled, and it proves necessary to generalise thermostatic mode somewhat, so that the target temperature for each component drifts linearly with time. The rate of linear drift is set by adjusting the background constant electrical powers, and dose rate is measured by substitution of radiation heating for electrical heating.

IMRT calorimeter: calibration and corrections

The raw calorimeter response is corrected to give absorbed dose to graphite, averaged over the core volume, in the inhomogeneous phantom. By Monte Carlo simulation, it is possible to calculate the factor to convert this to dose to water, averaged over the corresponding volume, in a homogeneous water phantom. This conversion factor is required for each field in which the IMRT calorimeter is used, and allows it to be used as an absolute dosimeter. Alternatively, traceable calibration of the calorimeter is possible when it is used in a conventional reference field. Thus the device can be used to transfer an absorbed dose standard from a conventional reference field to a composite field, with a field-dependent correction factor given by the ratio of Monte Carlo-calculated conversion factors.

IMRT calorimeter: core and jacket dimensions

A case can be made for choosing a core almost as large as the PTV, however the high density of graphite (around 1.8 g.cm-3) would cause a significant perturbation of the dose distribution in water. Accordingly the first prototype was specified to have a small core, i.e. a sphere 5 mm in diameter, separated by a 1 mm vacuum gap from a 1 mm thick jacket. The scale is comparable to the sensitive volume of the NE2611 chambers used as a reference standard of absorbed dose to water. Spherical geometry was chosen to give an approximately isotropic response.

IMRT calorimeter: water or graphite?

Water should be the preferred medium but, during an IMRT delivery, dose rate in the volume of interest may vary quite rapidly in 4D. The resulting temperature gradients drive heat diffusion, which require correction before temperature rise can be converted to absorbed dose. Since the temperature rise is only obtained by the extrapolation of preand post-heating drifts, this correction is likely to introduce appreciable uncertainty. A more fundamental difficulty is that water

Figure 1: Exploded view of the initial prototype IMRT calorimeter design.

References
1] DUANE, S., et al., Application of Dose Area Product and DAP Ratio to Dosimetry in IMRT and Small Field External Beam Radiotherapy, poster CN182-222, IDOS Symposium, Vienna, 9-12 November 2010. [2] ALFONSO, R.., et al., A new formalism for reference dosimetry of small and nonstandard fields, Med. Phys. 35 (2008) 5179-5186. [3] SEUNTJENS, J., et al., Photon absorbed dose standards, Metrologia 46 (2008), S39-S58. [4] BOUCHARD, H., et al., Ionization chamber gradient effects in nonstandard beam configurations, Med. Phys. 36 (2009) 4654-4663. [5] BERLYAND, V.A., et al., Portable calorimeter for measuring absorbed doses of x-rays and electrons from accelerators, Measurement Techniques 34 (1992) 1179-1184.

National Physical Laboratory, Hampton Road, Teddington, Middlesex, United Kingdom, TW11 0LW dosimetry@npl.co.uk