RADT214 – Radiotherapy Physics,

Technology and Radiobiology 3

Directorate of Radiotherapy
School of Health Sciences

Dosimetry 3 (Mike Kirby)

Chain of Traceability; On site (hospital) dosimetry, Reference Dosimetry

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Module aims
This module aims to equip students with
the necessary physics and radiobiology
knowledge and understanding of how
radiation dose to the patient is
standardised and measured, and the
biological effects of treatment. The
module also aims to prepare students for
more advanced radiotherapy practices,
such as particle beam therapy
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Learning Outcomes
 (LO1) Identify and explain key principles and concepts for
ionising radiation interactions for dosimetry and radiobiology
 (LO2) Demonstrate an understanding of radiobiological
principles, dose-response models and calculations by
evaluating different treatment regimes
 (LO3) Demonstrate an understanding of radiation dosimetry
standardisation and practices by comparing and contrasting
different methods used in clinical radiotherapy
 (LO4) Apply knowledge of charged particle characteristics
and interactions to demonstrate key principles of particle
beam therapy delivery and in vivo dosimetry by evaluating
their efficacy and practicality

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Radiation Dosimetry

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Key areas for Radiation Dosimetry
 Rationale for Radiation Dosimetry
 Concepts and Definitions
◦ Absolute Dosimetry
◦ Reference Dosimetry
◦ Relative Dosimetry Dosimetry 2
◦ In Vivo Dosimetry (IVD)
 Measurement of Dose (Linacs)
◦ General Points
◦ Ionisation Chambers
 How to deliver the same treatment in Manchester, Liverpool, Preston
◦ CHAIN OF TRACEABILITY
 On site (hospital) dosimetry Dosimetry 3
 Reference Dosimetry – Calibrating dosemeters and Linacs;
◦ DEFINITIVE CALIBRATION
◦ Monitor Instruments - Daily measures; IVD
 Measurement of Dose (On Patients)
◦ In vivo Dosimetry (IVD)
◦ Diode and MOSFET (IVD) Dosimetry 4, 5, 6 and 7
◦ TLD and Film (IVD)
◦ EPID (IVD)
◦ In vivo Dosimetry Overview 5
Let’s start....
 Begin to consider reference dosimetry in the hospital
 Examine the ‘Chain of Traceability’ and
standardisation in radiotherapy dosimetry
◦ Concentrate on MV x-ray photon beam energy calibration
and measurement
◦ Concepts of Primary, Reference Standards (NPL) and
Secondary Standard (Hospital)
 Consider Definitive Calibration of
◦ Hospital Field Instrument Dosemeters for calibrating the
Linacs
◦ The Linac itself using ion chamber field instruments
 IVD dosemeters as Monitor Instruments
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Reference Dosimetry – transferring the dose standard from
the National laboratory to the hospital – so we can calibrate
the linac

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Absolute and reference dosimetry – the
‘Chain of Traceability’; so Manchester =
London = Inverness!

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ALL methods follow a principle of
‘intercomparison’ or ‘cross-comparison’
 Simple principle….
◦ Use a calibrated instrument to measure the absorbed dose from
radiation source (e.g.. Linac) under carefully controlled/known
conditions (e.g.. precise depth, SSD, fieldsize,
stable/reproducible radiation beam, carefully measured
temperature and pressure)
◦ Then.....
 Either replace the instrument with the one to be calibrated and give the
same amount of radiation under exact same conditions or
 Irradiate the two instruments simultaneously
◦ Can then derive a calibration factor for the instrument being
calibrated
◦ This principle occurs throughout the entire chain of traceability
and standardisation…..all the way back to the primary standard

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Intercomparison – substitution method
Source  Calibrated dosemeter
◦ Deliver series of 100
MU exposures (e.g.)
 Replace with un-
calibrated dosemeter
SSD Fieldsize
(Jaw setting) ◦ Deliver same series of
100 MU exposures
Dosemeter to be
calibrated
Depth

Calibrated
Dosemeter 10
Intercomparison – simultaneous method
 Calibrated dosemeter
Source
alongside un-calibrated
dosemeter
◦ Deliver same series of 100
MU exposures
◦ Must be same conditions in
SSD Fieldsize both parts of the radiation
(Jaw setting) field – ensure this by
swapping the two after a
series of exposures
Dosemeter to be
calibrated
Depth

Calibrated
Dosemeter 11
Starting point – the national standards
laboratory (Absolute Dosimetry)

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In the UK, The National Physical
Laboratory (NPL) in Teddington is
our National Standards Laboratory

It is here we have our Primary

Standard for MV Radiation Dosimetry

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 Chain of Traceability – types of dosemeter
(NPL)

Graphite
Calorimeter

Thimble
Ionisation
Chambers

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Starting at the NPL, on its Clinical MV
X-ray Linac (a specialised Elekta
Linac)
Seven separate MV
X-ray beam energies
◦ 4 MV to 25 MV

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At the NPL…..under very accurate,
precise and controlled conditions!

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NPL instruments
Primary standard – 3 Reference
Graphite Calorimeter Standards – Highly
accurate Graphite
thimble ionisation
chambers

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Getting from the primary standard to the
hospital
The Hospital Secondary Standard
◦ Thimble ionisation chamber (Farmer Type)
◦ One maintained in each hospital (cancer centre)
◦ Only used for calibrating further dosemeters
(ionisation chambers) – never used in ordinary,
routine measurements
◦ Sent to the NPL every three years for re-calibration
 Re-calibration is intercomparison against the NPL Reference
standard ionisation chambers
◦ Routinely use a constancy check (Sr check) every
month to ensure that the secondary standard is still
correct; i.e. its calibration is still valid
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Hospital secondary Thimble
Ionisation
standard instrument Chamber

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Hospital instruments – secondary
standards
Sent to NPL every
three years
Comes back with a
calibration certificate
for the MV x-ray
beam energies at
which it has been
calibrated

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Hospital secondary standard
NEVER used to Secondary standard
calibrate a clinical is Strontium checked
machine periodically to ensure
it is stable and
ONLY used to operating
calibrate other appropriately
instruments (field ◦ This assures us that its
calibration certificate
instruments) which remains valid
are then used on a
more routine basis

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Checking constancy – the strontium check

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Hospital field instruments

FOR X-RAYs:
Thimble Ionisation
Chambers
FOR ELECTRONS:
Parallel Plate Ionisation
Chamber

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Typical hospital field instruments – ion
chambers

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Hospital can now calibrate its field
instruments
 Definitive
Calibration  Tocalculate field
of Dosemeters (Field instrument calibration
Instruments) factors
◦ Part of the law (IRR17) ◦ Based upon the
◦ Performed on a yearly intercomparison with the
basis; equivalent Secondary
◦ Two different physicists Standard ONLY and its
Calibration Factor (Cf) to
◦ Two independent sets of
dose in water
measurements
 Or performed when a
◦ Two independent analyses
of the results and field instrument is
calculations of the broken or its Strontium
calibration factors check is out of tolerance
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Intercomparison – hospital ion chamber
field instruments
Source
 Calibrated dosemeter
alongside un-calibrated
dosemeter
◦ Deliver same series of 100
MU exposures
SSD Fieldsize ◦ Must be same conditions in
(Jaw setting) both parts of the radiation
field – ensure this by
swapping the two after a
series of exposures
Field instrument
Depth Dosemeter to be
calibrated

Hospital
Secondary
Standard 26
The Linac can now be definitively
calibrated
 For a brand new machine
being put into first clinical use
◦ In this instance, another
department, with their own
dosemeters (related to a different
secondary standard) will come
and audit the calibration
 When major changes are made
to the Linac that are likely to
affect the output
 Done routinely at least
annually
 Process:
◦ Two suitably qualified and
experienced physicists,
◦ Two different calibrated field
instrument dosemeters
(which can relate to the same
secondary standard)
◦ Independent set-up and
measurement on the Linac
◦ In water or water equivalent
material
◦ Full accurately
controlled/monitored
conditions (temperature,
pressure etc.)
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Definitive Calibration of the
Source
Linac
 Most common point for
calibrating the Linac (in most
different centres)
◦ 100 cm SSD
◦ 10 x 10 cm field 100 cm Fieldsize
◦ Depth of maximum dose for the SSD 10x10 cm
relevant beam energy, on the (Jaw setting)
central axis
◦ Linac calibrated so that 1 MU
delivers 1 cGy (0.01 Gy) to this
point Dmax
 So, 100MU delivers 1 Gy to this
point
 Practically we actually
measure the dose at about 5
cm deep and correct back to
dmax using a depth dose curve

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When to definitively calibrate....taken from
IPEM 81/MDGN/IRR17. Definitive Calibration MUST be done

 External-beam radiotherapy treatment machines

 To determine the radiation output per monitor unit or per unit time:
◦ (i) as part of the commissioning procedure of a new linear accelerator, cobalt
machine or other external beam radiotherapy treatment machine;
◦ (ii) following major repair or modification to external beam radiotherapy
equipment which might reasonably be expected to affect its calibration, for
example, when a new dose monitor is installed in a treatment machine in which
dose delivery is controlled by that monitor;
◦ (iii) following the replacement of radioactive sources in cobalt or similar
teletherapy equipment.
 IPEM 81 2nd Edition (2018)
◦ A Medical Physics Expert (MPE) (appropriately trained and experienced
in RT Physics) must take overall responsibility and authorise written
procedures for the definitive calibration process
◦ Responsibility for performing a definitive calibration must be vested in an
appropriately trained and experienced (in RT Physics) HCPC registered
clinical scientist – normally s/he would be an MPE
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Linac Definitive Calibration

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 For MV X-rays – A Thimble
Summary - Chain of Ionisation Chamber
For Electrons – A Parallel Plate
Traceability Ionisation Chamber

Hospital (Cancer
NPL
Centre)

Graphite
Calorimeter

FOR X-RAYs:
Thimble Ionisation
Thimble
Chambers
Ionisation
FOR ELECTRONS:
Chambers
Parallel Plate Ionisation
Chamber

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Hospital - other instruments; Daily
Check Devices; In Vivo Dosemeters

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Monitor Instruments – e.g. those used
for daily/weekly checks
Daily

These (and those for IVD) are intercompared

annually or when necessary against hospital field
instrument ion chambers
CANNOT be used to Definitively calibrate the Linac
◦ Since they are not calibrated against the Hospital’s
Secondary Standard AND
◦ Because they are not as accurate as Ion Chambers 33
Monitor Instruments – e.g. those used
for IVD

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In Summary….
 Began to consider reference dosimetry in the hospital -
considered what this is
 Examined the ‘Chain of Traceability’ and standardisation in
radiotherapy dosimetry
◦ Concentrated on MV x-ray photon beam energy calibration and
measurement - Summarised
◦ Concepts of Primary, Reference Standards (NPL) and Secondary
Standard (Hospital) – Described and Illustrated
 Considered Definitive Calibration of
◦ Hospital Field Instrument Dosemeters for calibrating the Linacs –
Defined and discussed
◦ The Linac itself using ion chamber field instruments – Illustrated
briefly
 IVD dosemeters as Monitor Instruments – calibrated by field
instruments; not used for Definitive calibration of the linac
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Further Reading…
Sibtain section 7.9
2019 Walter and Miller – pp31-39
2012 Walter and Miller (Symonds et al.) –
section 1, chapter 3

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Any questions?
Thanks for your attention!

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