INFN-LNS

DOSIMETRY COMMISSIONING OF THE LNS-INFN

PROTON THERAPY FACILITY

THE DOSIMETRIC CHARACTERISTICS OF NARROW PROTON BEAMS USED IN EYE

THERAPY HAVE BEEN DEFINED BY USING DIFFERENT RADIATION DETECTORS

IONIZATION CHAMBERS (parallel-plate,minithimble chambers)

SILICON DIODES
RADIOCHROMIC AND RADIOGHRAPHIC FILMS
THERMOLUMINESCENCE DETECTORS

1) CENTRAL AXIS DEPTH-DOSE DISTRIBUTIONS

2) LATERAL (TRANSVERSE) PROFILES
3) OUTPUT FACTORS (FSDF)

TO PROVIDE INPUT TO THE TPS AND FOR M.U. CALCULATIONS.

QUALITY CONTROL PROCEDURES

DOSIMETRIC COMMISSIONING OF 60 MeV PROTON BEAMS

PRODUCED AT LNS FOR EYE THERAPY
SHAPED WITH 5 - 30 mm CIRCULAR BRASS COLLIMATORS.

INFN-LNS

PROTON DEPTH-DOSE DISTRIBUTIONS

THE PTW MARKUS PLANE-PARALLEL ION CHAMBER WAS USED IN THE

COMMISSIONING AS THE REFERENCE DETECTOR FOR DEPTH-DOSE
MEASUREMENT IN PROTON BEAMS (ICRU 59, IAEA 398)

THE DESIGN OF THE MARKUS CHAMBER

1) Active volume=0.05 cm3, 2) Electrode separation=2 mm, 3) Collector diameter=5.4

mm
4) tentrance window=2.3 mg/cm2 5) Exact Location of peff.

PROVIDES DEPTH-DOSE DISTRIBUTIONS

WITH HIGH SPATIAL RESOLUTION AND HIGH PRECISION

) PMMA CUP IS PROVIDED TO SEAL THE CHAMBER FOR USE IN WATER

) A SPACER IS PROVIDED FOR USE IN A SOLID PHANTOM, WHICH ALSO
SERVES AS A HOLDER FOR A RADIOACTIVE SOURCE FOR STABILITY CHECKS.

INFN-LNS

PTW MARKUS PLANE-PARALLER ION CHAMBER

IN WATER PHANTOM

INFN-LNS

110

PTW- MARKUS ION CHAMBER

BRAGG PEAK

100

90

Relative dose (%)

80

70

60

50

40

30

PLATEAU REGION

20

10

INFN - LNS
0
0

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

31

32

33

34

35

Depth in water (mm)

CENTRE

MAXIMUM
RANGE

EQUIVALENT
ENERGY

(mm)

(MeV)

PEAK
PLATEAU
RATIO

F.W.H.M.
(mm)

Distal-dose
falloff
d90%-10%
(mm)

CATANA

30.60

60.2

4.68

3.29

0.81

CCO^

31.0

60.4

4.85

3.65

0.80

PSI^

30.0

60.0

4.47

^takenfromBJR Supplement 25(1996)

1.10

INFN-LNS

THE NEW SCANDITRONIX Si-DIODE IN PROTON BEAMS

(Proton Field waterproof Detector-narrow beam no.DZA192 1001)

INFN-LNS

THE NEW SCANDITRONIX Si-DIODE IN PROTON BEAMS

(Proton Field waterproof Detector-narrow beam no.DZA192 1001)

100

MarkusLNS

R elative D ose (% )

90

ScanditronixLNSDiode

80
70
60
50
40
30
20
10
0
0

10

15

20

25

30

35

Depth in water (mm)

CYLINDRICAL MINIDIODE SPECIFICATIONS

Detector Material: Hi-pSi, high doped p-type silicon (preirradiated for use in proton beams).
Detector diameter: 0.6 mm (t = 60 m)

DETECTOR

PEAKPLATEAU
RATIO

F.W.H.M
(mm)

Distal-dose
falloff(1)

d90%-10%
(mm)

Distal-dose
falloff(2)

d80%-20%
(mm

PRACTICAL
RANGE
(d10%,ICRU59)

PEAK
DEPTH
(mm)

MARKUSPTW

30.14

4.68

3.19

0.71

0.50

31.15

DIODE
SCANDITRON
IX

30.07

4.89

3.07

0.80

0.60

31.06

INFN-LNS

MODULATED PROTON DEPTH DOSES FOR EYE THERAPY

110
100

20 mm SOBP
RS 1.8 mm

90

Relative Dose (%)

80

14.5 mm SOBP
RS 14 mm

70
60
50

11 mm SOBP
RS 10 mm

40
30
20
10
0
0

10

15

20

25

30

35

Depth in water (mm)

MODULATOR
RANGE
SHIFTER

MODULATION
(SOBP)

(mm eye tissue)

DISTAL-DOSE
FALLOFF(1)

d90%-10%

(mm eye-tissue)

DISTAL-DOSE
FALLOFF(2)

d80%-20%

(mm eye tissue)

MAXIMUM
DOSE
INSOBP
%

BEAMRANGE
(90%DISTAL)

(mm eye-tissue)

MOD: 000/00
RS: 14 mm

14.5

0.91

0.65

101.6

14.38

MOD: 010/02
RS: 10 mm

10.5

0.90

0.60

104

18.27

MOD: 009/02
RS: 1.8 mm

20.30

0.80

0.55

103.9

27.04

CCO

17

0.90

0.75

<102

INFN-LNS

MODULATED PROTON DEPTH DOSES FOR EYE THERAPY

15 MM SOBP vs RANGE SHIFTER
110
100
90

RS = 10 mm

Relative Dose (%)

80

RS = 2 mm

RS = 14 mm

70
60
50
40
30
20
10
0
0

10

15

20

Depth in water (mm)

25

30

35

INFN-LNS

BEFORE EACH TREATMENT PERIOD

TREATMENT DEPTH DOSE PROFILES HAVE TO BE VERIFIED.

TO VERIFY RANGE MODULATION AND MAXIMUM RANGE OF THE BEAM

DEPTH-DOSE MEASUREMENT WHEEL (CCO DIODE SCANNER)

WHEEL IS COMPUTER CONTROLLED, AND RELATIVE DOSE MEASURED

AS RATIO BETWEEN WHEELS DETECTOR AND REFERENCE DETECTOR

TOLERANCES
1) [(MEASURED RANGE) / (REQUIRED RANGE)]: 0.2 mm
2) [(MEASURED MODULATION) / (REQUIRED MODULATION)]: [ -0.1 mm

// +0.9 mm ]

INFN-LNS

LATERAL OFF-AXIS BEAM PROFILES

1) LATERAL PENUMBRA:
H

2) Field ratio:

d80%-20%

90% fieldsize
50% fieldsize

3) L95%
4) SIMMETRY (AREA RATIO):

5) FLATNESS:

RT %

Sr

ABS (a .b) 200%

ab

Pmax Pmin
100%
Pmax Pmin

110
100
90
80

N .O .D .%

70
60
50
40
30
20
10
-20

1.3 -10
mm

0
0

10

20

X (mm)

MD-55-2 RADIOCHROMIC FILMS WERE USED IN COMMISSIONING

tissue equivalence dose rate indipendence
Linear dose response high spatial resolution

ONLY ONE CALIBRATION FILE IS NEEDED TO EVALUATE

FILMS EXPOSED AT DIFFERENT DEPTHS
Energy indipendence

Gafchromic film MD 55-2

INFN-LNS

Isocenter
Nozzle

PMMA Phantom

Beam axis

PMMA Fantom

Final collimator
Exposition point

1 cm

120

R
e
la
tiv
eIo
n
iza
tio
n%

100
80
60
40
20

2.5 cm
6 cm

0
0

10

15

20

25

30

35

Depth in w ater (m m )

2
1.8
y=-4E-05x 2+0,0207x-0,0095
R2=0,9989

1.6

N
.O
.D
.

1.4
1.2
1

1.2
1

0.8

y=0,0193x-0,0047
R2=0,998

0.8
N
.O
.D
.

0.6

0.6
0.4

0.4

0.2

0.2

0
0

10

20

30

40

50

60

Dose (Gy)

0
0

20

40

He-Ne Scanning Laser Densitomiter

60

Dose (Gy)

80

100

120

INFN - LNS

PROFILE MEASUREMENTS
MD - 55 RADIOCHROMIC FILM

120

100

=25mm

Relative dose

80

60

40

20

0
-20

-15

-10

-5

10

15

20

Distance from central axis (m m )

EXPERIMENTAL
SET-UP
(=25mm)

SOBP
(WIDTH)

MOD: 000/00
RS: 14 mm

14mm
zirr.=7mm

MOD: 010/02
RS: 10 mm

Lateral
penumbra (mm)

L95%
(mm)

Sr%

Rt%

(simmetry)

(flatness)

0.92

23

3%

3%

1.40

10mm
zirr.=12mm

0.92

23

2%

3%

1.30

MOD: 009/02
RS:1.8 mm

20mm
zirr.=14mm

0.93

23

3%

3%

1.15

18
zirr.=SOBP

3%

1.10

CCO

CAL

18
zirr.=SOBP

d80%-20%

1.50

INFN-LNS
KODAK XV FILMS AND SCANDITRONIX DIODE WERE USED IN COMMISSIONING

IF CALIBRATION FILES PRODUCED FOR KODAK XV FILMS

AT DEPTH OF SOBP ARE USED FOR TRANSVERSE BEAM MEASUREMENTS

GAF MD55-2 = KODAK XV FILM

MOD 010/02
RS:10 MM

Lateral penumbra
(mm)
H

L95%

Sr%

(mm)

(simmetry)

zirr.=12 mm

d80%-20%

KODAK XV

1.30

0.92

22.8

0.50

MD-55-2

1.27

0.92

22.7

0.90

120
Diodo
MD55

100

X-OMATV
N.O.D. %

80
60
40
20
0
-25

-20

-15

-10

-5

X Axis (Water m m )

10

15

20

25

INFN-LNS
BEFORE EACH TREATMENT

PROTON BEAM PROFILES AT ISOCENTRE ARE TO BE CHECKED

IN AIR X-Y DIODE SCANNING COMPUTER CONTROLLED DEVICE

PLANNED TOLERANCES

1)

LATERAL PENUMBRA (d80%-20%) 1.50 mm

2) BEAM SIMMETRY (Sr ) 3%

3)

BEAM FLATNESS: Rt%3%

4) FIELD RATIO: H 0.90

160

140

120

EXPERIMENTAL AND INTERPOLATED TRASVERSAL DOSE DISTRIBUTIONS (X Axis)

Collimator diameter [mm]:

25

Penombra sinistra [mm]:

1.2

Interpolation step [mm]:

0.1

Penombra destra [mm]:

1.3

R90/50:

0.89922

Omogeneit95% [mm]:

21.7

Simmetria [%]:

0.54297

Rt [%]:

2.7259

Path:

Z:\Misure\Trattamenti Marzo2002\20mar2002\preliminari\profilo11.prf

Dose [a.u.]

100

80

60

40

20
Experimental data
Interpolated data
0
-30

-20

-10

0
Distance from axes [mm]

10

20

30

INFN-LNS

DOSE MONITORING SYSTEM (IN-BEAM DOSE MONITORS)

THE PROTON DOSE
IS MONITORED BY TWO INDEPENDENT TRANSMISSION
UNSEALED ION CHAMBERS, PLACED IMMEDIATELY UPSTREAM OF THE PROTON
NOZZLE.
TRANSMISSION CHAMBERS HAVE SEPARATE CABLING, BIAS SUPPLIES (800 V) AND
CURRENT INTEGRATORS AND ARE ARRANGED AS A REDUNDANT COMBINATION TO
TERMINATE THE BEAM.
TRANSMISSION ION CHAMBERS ARE CALIBRATED DAILY AGAINST A REFERENCE
PARALLEL-PLATE MARKUS ION CHAMBER, LOCATED AT THE ISOCENTRE.

COMMISSIONING TESTS
1) PRECISION
1a) SHORT TERM PRECISION: (CV) OF THE RATIO R OF DOSE MONITOR UNITS TO
DOSIMETER SCALE READING FOR n=5 CONSECUTIVE IRRADIATIONS OF 15 Gy.

MEASURED CV = 0.1%
1b) LONG TERM PRECISION (WEEKLY STABILITY):

MEASURED [ (cGy/U.M.)WEEK] : 1.5%.

2) LINEARITY
THE RATIO V BETWEEN THE MEASURED PROTON DOSE AND DOSE MONITOR UNITS
SHALL BE WITHIN 1% AT ALL MONITOR SCALE READINGS, i.e. IN THE CLINICAL
RANGE UP TO 1520 Gy.

MEASURED RATIO

Vmax
1.005
Vmin

INFN - LNS

MEASURED DOSE, cGy

( Markus chamber)

MONITOR CHAMBER LINEARITY

DOSEMONITORINGSISTEM
TRANSMISSIONIONCHAMBER

2400
2200
2000
1800
1600
1400
1200
1000
800
600
400
200
0

R2=1

(Doserate=51.10Gy/min.)
0

50000

100000

150000
U.M. SENT

200000

250000

STABILITY OF CALIBRATION (long term )

103

cGy/U.M.

102

DOSE MONITORING SISTEM

TRANSMISSION ION CHAMBER

101
100
99
98
97
0

3
tim e (days)

INFN-LNS
DOSE RATE MONITORING (BEAM INTENSITY MONITOR)

THE PROTON BEAM RATE IS MONITORED BY THE VOLTAGE SIGNAL (VSF) PROVIDED BY THE
FIRST SCATTERING FOIL, LOCATED IN VACUUM IMMEDIATELY UPSTREAM OF THE EXIT
WINDOW.

IBEAM (nA) = 0.0412 + 6.0835 VSF

(R2=0.9999)

(VSF) IS USED BY THE C.S. TO STOP THE BEAM IF THE RATE XCEEDS A PRESET LIMIT.

NORMAL TREATMENT BEAM CURRENT 4 nA CLINICAL DOSE RATE =1220 Gy/min.

1.05

COLLECTED CHARGE (Markus, nC)

1.04

U.M. =K

1.03
1.02

Alarm current

1.01
1

Zmarkus = 1 mm
Full energy
beam

0.99

Normal
current

0.98
0.97
0

PROTON BEAM CURRENT (nA)

10

INFN-LNS

ABSOLUTE DOSIMETRY (BEAM CALIBRATION, cGy/U.M.)

FOR REFERENCE DOSIMETRY, AT LNS, A PLANE-PARALLEL MARKUS ION CHAMBER IS
USED IN A WATER PHANTOM, BY EXTENDING TO PROTON BEAMS THE FORMALISM OF THE
IAEA 381 CODE OF PRACTICE ON THE USE OF PLANE-PARALLEL ION CHAMBERS IN HIGH
ENERGY ELECTRON DOSIMETRY.

DwQ ( Peff ) M Q N Dpp,air ,Q0 Wair Q Wair Q 0 S w,air Q pQ

M Q M ( C ) kT ,P k pol ks
(sw,air)q

(nC)

( TAB. 7.1 ICRU 59)

pp
D , air ,Q0

ref

cGy

ref
N Dref,air Pcav
Pcelref

cGy/nC

pp

(Wair/e)cp = 1.031 (ICRU 59)

pQ = 1.00 (ICRU 59, IAEA TRS-398, MED.PHYS. 1995 :22)

FOR DOSE CALIBRATIONS OF INDIVIDUAL PATIENTS, THE CALIBRATION IS MADE IN A

UNIFORM DOSE REGION AT THE MIDDLE OF SOBP, AT ISOCENTRE, WITH THE 25 mm
DIAMETER REFERENCE COLLIMATOR ON BEAM DELIVERY NOZZLE.

FOR DAILY DOSE CHECKS, A PMMA PHANTOM BLOCK IS USED:

z PMMA z water 0.87

A RADIOACTIVE CHECK DEVICE (90Sr) IS USED FOR OPERATIONAL AND CONSTANCY CHECKS
OF DOSIMETRY SYSTEM (1%, NCRP).

INFN-LNS
AN EXRADIN T1 THIMBLE ION CHAMBER [A-150 TE, 0.05 cm3, NK(60Co)]
CAN BE USED AT LNS IN THE WATER PHANTOM, ACCORDING TO ICRU 59

Dw , p Gy M Q nC kT ,P k pol ks 0.6311 Gy 0.9534 1.031 S / water ,air

nC

BECAUSE OF THE Cavity length AND Outer diameter of the chamber,

USE IS LIMITED TO ( ) 15 mm AND (SOBP WIDTH) 12 mm.

WORK IN PROGRESS

NOW AVAILABLE BY PTW ND,w,60Co FOR T1 EXRADIN AND MARKUS LNS CHAMBERS

ADOPTION OF IAEA TRS-398 CODE OF PRACTICE

Dw,Q = MQ ND,w,Q0 kQ,Q0

ESTIMATED UNCERTAINTY OF Dw,Q UNDER REFERENCE CONDITIONS (1 S.D.)

ICRU 59

(Nk=1%)

IAEA TRS-398 (ND,w,Q0 =1%)

EXRADIN T1

2.6%

2.1%

PTW MARKUS

3.1%

2.5%

INFN-LNS

PROTON DOSIMETRY INTERCOMPARISON (ECHED, ICRU 59)

BEFORE STARTING LNS PROTON THERAPY FACILITY

) INTERCOMPARISON (1) AT CCO (PHYSICA MEDICA, VOL.XV, N.3)

LNS (PTW MARKUS, T1-EXRADIN) CCO (A-150 FW-IC18, REFERENCE DOSE)

(Dw) [(PTW MARKUS) / (FW-IC18)]: 1%

(Dw) [(T1-exradin) / (FW-IC18)]: 1.4%

) INTERCOMPARISON (2) AT PSI (PHYSICA MEDICA VOL.XVII, S.3, PTCOG XXX 1999)

1) CCO (FW-IC18, MARKUS) 2) LNS (MARKUS, EXRADIN-T1, PTW PMMA FARMER)

3) PSI (PTW GRAPHITE FARMER, MARKUS)

4) TERA ( MARKUS, EXRADIN-T1)

% = 1.2%

max (%) = 3.5%

INFN-LNS

DOSIMETRY INTERCOMPARISON AT PSI

(FULLY MODULATED BEAM)

Deviation from the mean (%)

-2
Standard deviation of the mean = 1.13%
Difference between maximum and minimum dose =
3.3%

-4

-6

-8
MARKUS EXRADIN FARMER MARKUS FWT 683
LNS
T1 LNS
LNS
CCO
CCO

FWT 725 MARKUS EXRADIN MARKUS FARMER

CCO
TERA
T1 TERA
PSI
PSI

INFN-LNS

OUTPUT FACTORS (FSDF)

) AT THE INITIAL CALIBRATION OF CYCLOTRON THE OUTPUT DOSE RATE HAS BEEN
MEASURED FOR ALL COLLIMATORS AREA ENCOUNTERD IN THE CLINICAL PRACTICE.

) TO EVALUATE IF THERE ARE SIGNIFICANT DROPS OF DOSE PER MONITOR UNIT

WHEN COLLIMATOR DIAMETER DECREASES TO A FEW MILLIMETERS.

) THE MOST RELIABLE RELATIVE OUTPUT VALUES

ARE PROVIDED FROM

RADIOCHROMIC DETECTORS, ESPECIALLY FOR NARROWEST BEAMS (VATNITSKY).

NO SIGNIFICANT DECREASE OF BEAM OUTPUT (cGy/U.M.)

FOR COLLIMATOR DIAMETER UP TO 5 mm

110
100
90

Relative output

80

GAF

Markus

Diode1

Diode2

TLD2

TLD1

70
60
50
40
30

MODULATED BEAM
Z = 21 mm WED
PMMA PHANTOM

20
10
0
0

10

12

14

16

Collimator diameter (mm)

18

20

22

24

26

28

INFN-LNS

OUTPUT FACTORS (FSDF)

) FROM EXPERIMENTAL RESULTS WE CAN STATE THE LOWER BOUND OF COLLIMATOR

DIAMETER FOR WHICH FRELATIVE OUTPUT IS MEASURED ACCURATELY WITH EACH
DETECTOR

110
100
90
80

GAF

Markus

Diode1

Diode2

TLD2

TLD1

Relative output

70
60
50
40
30

MODULATED BEAM
Z = 21 mm WED
PMMA PHANTOM

20
10
0
0

10

12

14

16

18

20

22

24

26

Collimator diameter (mm)

1) MARKUS CHAMBER CAN BE USED IN PROTON BEAMS WITH 12 mm

2) TLDs AND SCANDITRONIX DIODE CAN BE USED UP TO =8 mm
IN CLINICAL PRACTICE AT LNS

GAF-DETECTOR IS USED FOR EVALUATION OF OUTPUT FACTOR

FOR SHAPED NARROWEST BEAMS

28

INFN-LNS
PATIENT DOSES (STRAY RADIATION)
(PERSONAL MONITORING, TWO PATIENTS TESTED)

A) TWO PERSONAL BADGE-DOSIMETERS WERE PLACED ON THE

CHEST OF PATIENTS DURING THE WHOLE PROTON TREATMENT.
1) ENEA FILM BADGE PERSONAL DOSIMETER (, , x) 0.05 mSv
2) NRPB PADC NEUTRON PERSONAL DOSEMETER

PATIENTS COMPLETING TREATMENT

0.20 mSv

INDUCED DOSE RATE

15 Sv/h
(10)
1.5 Sv/h