IAEA Training Material on Radiation Protection in Radiotherapy

Radiation Protection in
Radiotherapy

Part 2

Radiation Physics
Lecture 2: Dosimetry and Equipment

Rationale

Radiation dose delivered to the target

and surrounding tissues is one of the
major predictors of radiotherapy
treatment outcome (compare part 3 of
the course). It is generally assumed that
the dose must be accurately delivered
within +/-5% of the prescribed dose to
ensure the treatment aims are met.

Radiation Protection in Radiotherapy

Part 2, lecture 2: Dosimetry and equipment

Objectives

To understand the relevance of radiation dose

and dosimetry for radiotherapy
To be able to explain the difference between
absolute and relative dosimetry
To be able to discuss the features of the most
common dosimeters in radiotherapy:
ionization chambers, semiconductors,
thermoluminescence dosimeters (TLD) and
film

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Part 2, lecture 2: Dosimetry and equipment

Contents of lecture 2
1. Absolute and relative dosimetry
2. The dosimetric environment: phantoms
3. Dosimetric techniques
physical background
practical realization

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Part 2, lecture 2: Dosimetry and equipment

1. Absolute and relative dosimetry

Absolute dosimetry is a technique that yields

information directly on absorbed dose in Gy. This
absolute dosimetric measurement is also referred to
as calibration. All further measurements are then
compared to this known dose under reference
conditions. This means
relative dosimetry is performed. In general no
conversion coefficients or correction factors are
required in relative dosimetry since it is only the
comparison of two dosimeter readings, one of them
being in reference conditions.

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Part 2, lecture 2: Dosimetry and equipment

Absolute dosimetry
Required for every radiation quality once
Determination of absorbed dose (in Gy)
at one reference point in a phantom
Well defined geometry (example for a
linear accelerator: measurements in
water, at 100cm FSD, 10x10cm2 field
size, depth 10cm
Follows protocols (compare part 10)

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Part 2, lecture 2: Dosimetry and equipment

Absolute dosimetry
Required for every radiation quality
once
ce:
n
a
t
r
o
p
m
i
s
u
ndoabsolute dose (in Gy)
Determination
Of tremeof
metry
i
s
o
d
e
t
u
l
o
s
b
If t he a
G
INphantom
Ha
T
Y
at one reference
point
in
R
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V
E
t
c
is incorre
ong
r
w
e
b
l
l
i
w
Well defined geometry: Eg. water
phantom, 100cm FSD, 10x10cm 2 field
size, depth 10cm
Follows protocols (compare part 10)

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Part 2, lecture 2: Dosimetry and equipment

Quick Question

A dose of 1Gy delivers a huge quantity of

energy to the patient - is it true or false?

Answer
FALSE 1Gy = 1J/kg. Delivering this amount
of energy would raise the temperature of
tissue by less than 0.001oC. Even for a 100kg
person it is much less than the energy
consumed with a bowl of muesli please note
the amount of energy in food is often listed on
the package.
Radiation Protection in Radiotherapy

Part 2, lecture 2: Dosimetry and equipment

Relative dosimetry
Relates dose under non-reference
conditions to the dose under reference
conditions
Typically at least two measurements
are required:

one in conditions where the dose shall be

determined
one in conditions where the dose is known

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Examples for relative dosimetry

Characterization of a radiation beam

percentage depth dose, tissue maximum
ratios or similar
profiles

Determination of factors affecting output

field size factors, applicator factors
filter factors, wedge factors
patient specific factors (e.g. electron cutout)

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Percentage depth dose

measurement

Variation of dose
in a medium
(typically water)
with depth
Includes
attenuation and
inverse square
law components

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Percentage depth dose

Relates dose
at different
depths in water
(or the patient)
to the dose at the
depth of dose
maximum - note
that the y axis is
relative!!!

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TAR, TMR, TPR

Relative dosimetry for isocentric treatment

set-up (compare part 5)
All can be converted into percentage depth
dose

TAR = ratio of dose in phantom with x cm

overlaying tissue to dose at the same point in air
TMR = ratio of dose with x cm overlaying tissue to
dose at dose maximum (detector position fixed)
TPR as TMR but as a ratio to dose at a reference
point (e.g. 10cm overlaying tissue)

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TMR, TPR

Mimics isocentric
conditions
TMR is a special
case of TPR
where the
reference
phantom depth is
depth of
maximum dose

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PDD and TMR

Percentage depth dose

(PDD) changes with
distance of the patient
to the source due to
variations in the inverse
square law (ISL), TAR,
TMR and TPR do not.

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Part 2, lecture 2: Dosimetry and equipment

Strong ISL
dependence

Weak ISL
dependence

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Output factors

Compare dose with dose under

reference conditions
different field sizes
wedge factor
tray factor
applicator factor
electron cutout factor

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Example: wedge factor

Dose under
reference
conditions

Could also involve different field sizes and/or

different depths of the detector in the phantom
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Quick Question

Is a Half Value Layer measurement for

the determination of X Ray quality
absolute or relative dosimetry?

Answer
Relative

dosimetry:

we relate the dose with different aluminium

or copper filters in the beam to the dose
without the filters to determine which filter
thickness attenuates the beam to half its
original intensity
the result is independent of the actual dose
given - we could measure for 10s or 20s or
60s each time, as long as we ensure the
irradiation is identical for all measurements

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2. The dosimetric environment

Phantoms

A phantom represents the radiation properties of

the patient and allows the introduction of a
radiation detector into this environment, a task that
would be difficult in a real patient.
A very important example is the scanning water
phantom.
Alternatively, the phantom can be made of slabs of
tissue mimicking material or even shaped as a
human body (anthropomorphic).

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Scanning water
phantom

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Slab phantoms

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Tissue equivalent materials

Many specifically manufactured materials

such as solid water (previous slide), white
water, plastic water,
Polystyrene (good for megavoltage beams,
not ideal for low energy photons)
Perspex (other names: PMMA, Plexiglas) tissue equivalent composition, but with higher
physical density - correction is necessary.

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Anthropomorphic phantom

Whole body
phantom: ART

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Allows placement of radiation detectors in

the phantom (shown here are TLDs)

Includes
inhomogeneities
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RANDO
phantom

torso

CT slice
through lung
Head with
TLD holes
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Pediatric phantom

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Some remarks on phantoms

It is essential that they are tested prior to use

Cheaper alternatives can also be used

physical measurements - weight, dimensions

radiation measurements - CT scan, attenuation
checks
wax for shaping of humanoid phantoms
cork as lung equivalent

As long as their properties and limitations are

known - they are useful

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3. Radiation effects and dosimetry

Radiation effect

Dosimetric method

Ionization in gases

Ionization chamber

Ionization in liquids

Liquid filled ionization chamber

Ionization in solids

Semiconductors
Diamond detectors

Luminescence

Thermoluminescence dosimetry

Fluorescence

Scintillators

Chemical transitions

Radiographic film
Chemical dosimetry
NMR dosimetry

Heat

Calorimetry

Biological effects

Erythema
Chromosome damage

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Principles of radiation detection

Ionization chamber
Geiger Mueller Counter
Thermoluminescence dosimetry
Film
Semiconductors

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Detection of Ionization in Air

Ion chamber

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Adapted
from Collins
2001

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Detection of Ionization in Air

Adapted
from
Metcalfe
1998

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Ionometric measurements
Ionization Chamber
200-400V
Measures exposure
which can be
converted to dose
not very sensitive

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Geiger Counter
>700V
Every ionization
event is counted
Counter of events
not a dosimeter
very sensitive

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Ionization Chambers
600cc chamber

Thimble chambers
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Cross section through a Farmer type

chamber (from Metcalfe 1996)

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Ionization Chambers

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Farmer 0.6 cc
chamber and
electrometer
Most important
chamber in
radiotherapy
dosimetry

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Electrometer

From the chamber

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Ionization chambers
Relatively large volume for small signal
(1Gy produces approximately 36nC in
1cc of air)
To improve spatial resolution at least in
one dimension parallel plate type
chambers are used.

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Parallel plate chambers

From Metcalfe et al 1996

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Parallel Plate Ionization Chambers

Used for
low energy X Rays (< 60 KV)
Electrons of any energy but rated as the
preferred method for energies < 10 MeV
and essential for energies < 5 MeV

Many types available in different

materials and sizes
Often sold in combination with a suitable
slab phantom

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Parallel Plate Ionization

Chambers - examples

Markus chamber
small
designed for
electrons

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Holt chamber
robust
embedded in
polystyrene slab

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Well type ionization chamber

For calibration of
brachytherapy
sources

Brachytherapy
source

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Ionization chamber type survey

meters

not as sensitive as G-M devices but not affected by

pulsed beams such as occur with accelerators
because of the above,
this is the preferred
device around high
energy radiotherapy
accelerators

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Geiger-Mueller Counter
Not a dosimeter - just a
counter of radiation events
Very sensitive
Light weight and
convenient to use
Suitable for miniaturization

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Geiger-Mueller (G-M) Devices

Useful for
area monitoring
room monitoring
personnel
monitoring

Care required in regions of high dose rate

or pulsed beams as reading may be
inaccurate

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Thermoluminescence
dosimetry (TLD)
Small crystals
Many different materials
Passive dosimeter - no cables required
Wide dosimetric range (Gy to 100s of
Gy)
Many different applications

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Various TLD types

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Simplified scheme of the TLD

process

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TLD glow curves

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Glow curves
Allow research
Are powerful QA tools - does the glow
curve look OK?
Can be used for further evaluation
May improve the accuracy through glow
curve deconvolution

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The role of different dopants

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Importance of thermal
treatment

Determines the arrangement of

impurities
sensitivity
fading
response to different radiation qualities

Maintain thermal treatment constant...

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Dose
response of
LiF:Mg,Ti:
wide dosimetric
range
watch
supralinearity
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Variation of TLD response with

radiation quality

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Materials: oh what a choice...

LiF:Mg,Ti (the gold standard)

CaF2 (all natural, or with Mn, Dy or Tm)
CaSO4
BeO
Al2O3 :C (record sensitivity 1uGy)
LiF:Mg,Cu,P (the new star?)

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TLD reader
photomultiplier based
planchet and hot N2 gas heating
available

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What can one expect...

Reproducibility: single chip 2% (0.1Gy,

1SD)
Accuracy (4 chips standard, 2 chips
measurement) 3% (0.1Gy, 95%
confidence)
about 30 minutes per measurement...

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Radiographic film
Reduction of silver halide to silver
Requires processing ---> problems with
reproducibility
Two dimensional dosimeter
High spatial resolution
High atomic number ---> variations of
response with radiation quality

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Radiographic film
Often prepacked
for ease of use

Cross section

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Film: dose response

Evaluation of film via

optical density
OD = log (I0 / I)
Densitometers are
commercially
available

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Radiographic film dosimetry in

practice

Depends on excellent
processor QA
Commonly used for
demonstration of dose
distributions
Problems with
accuracy and
variations in response
with X Ray energy

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Radiochromic film
New development
No developing
Not (very) light
sensitive
Better tissue
equivalence
Expensive

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Semiconductor Devices
Diodes
MOSFET detectors

Diodes for water phantom

measurements
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Diodes
Mostly used like
a photocell generating
a voltage proportional
to the dose received.

From Metcalfe et al. 1996

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Metal Oxide Semiconductor

Field Effect Transistor
MOSFETs = extremely
small sensitive volume

From Metcalfe et al. 1996

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1. irradiation

2. Charge
carriers trapped
in Si substrate

3. Current
between source
and drain altered
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Gate bias during

irradiation:
determines sensitivity

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Readout
after irradiation:
gate bias required
to maintain
constant current

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Diodes and other Solid State

Devices

Advantages

direct reading
sensitive
small size
waterproofing
possible

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Disadvantages

temperature
sensitive
sensitivity may
change --> recalibration necessary
regular QA
procedures need to
be followed

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Summary of lecture 2
Ion chambers
Well understood,
accurate, variety of
forms available
Large, high voltage
required

Semiconductors
Small, robust

TLDs
Small, no cables
required

Film
Two dimensional,
ease of use

Temperature
dependence

Delayed readout,
complex handling

Common use

Reference
dosimetry, beam
scanning

Beam scanning, in
vivo dosimetry

Dose verification,
in vivo dosimetry

Not tissue
equivalent, not
very reproducible
QA, assessment of
dose distributions

Comment

Most common and

important
dosimetric
technique

New developments
(MOSFETs) may
increase utility

Also used for

dosimetric
intercomparisons
(audits)

New developments
(radiochromic
film) may increase
utility

Advantages

Disadvantages

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General Summary: Physics

In radiotherapy, photons (X Rays and gamma rays)

and electrons are the most important radiation types
Accuracy of dose delivery is essential for good
practice in radiotherapy
Absolute dosimetry determines the absorbed dose in
Gray at a well-defined reference point. Relative
dosimetry relates then the dose in all other points or
the dose under different irradiation conditions to this
absolute measurement.
There are many different techniques available for
dosimetry - none is perfect and it requires training and
experience to choose the most appropriate technique
for a particular purpose and interpret the results

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Where to Get More

Information
Medical physicists
Textbooks:

Khan F. The physics of radiation therapy. 1994.

Metcalfe P.; Kron T.; Hoban P. The physics of
radiotherapy X-rays from linear accelerators. 1997.
Cember H. Introduction to health physics. 1983
Williams J; Thwaites D. Radiotherapy Physics. 1993.

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Any questions?

Question:

Which radiation detectors could be useful

for in vivo dosimetry and why?

In radiotherapy the dose delivered to the patient is typically

too large for radiographic film which in addition to this is
light sensitive. Ionisation chambers are often fragile and
require high voltage, both not ideal when working with
patients. Therefore, TLDs are often used as detectors for in
vivo dosimetry. They are small, do not require cables for the
measurement and there are materials which are virtually
tissue equivalent. TLDs can be complemented by diodes if
an immediate reading (= active dosimetry) is required.
As TLDs, diodes are solid state dosimeters and therefore
sensitive and small. Other detectors of interest in this group
would be MOSFETs.
A different class of in vivo dosimeters are exit dose
detectors in the form of electronic portal imaging (compare
part 5). They may prove very useful for on-line verification.
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