Application of Dose Area Product and DAP Ratio to Dosimetry in IMRT and Small Field External Beam Radiotherapy

S Duane, F Graber, RAS Thomas

Background
The aim of this work is to improve photon dosimetry in composite fields such as are used in delivering 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 possible lack of electron equilibrium. Effective electronic equilibrium may only be achieved in the combined treatment. There are two aspects: absolute measurement of the dose itself is addressed in the related poster[1], and a proposed beam quality parameter to support the transfer of absorbed dose calibration from one composite field to another is considered here.

Definition of DAPR20/10
The proposed beam quality parameter is the ratio of DAP at depths 20 cm and 10 cm, for fixed source to detector distance and using the same surface S, shown in Figure 2.

Quality-dependence of DAPR20/10
As a beam quality parameter, DAPR20/10 has a similar variation with energy to TPR20/10, Figure 5. The quality-dependent correction kQ, measured at NPL for an ion chamber of type NE2611, is replotted in Figure 6 as a function of the proposed beam quality parameter DAPR.

DAPR20/10 = DAP20 cm /DAP10 cm

In Monte Carlo simulations one can take S to be infinite, but the measurements reported here were made with a PTW 786 transmission monitor chamber, whose sensitive volume has a diameter of 155 mm, in beams from an Elekta Synergy linac.

Beam Quality
The quality of a photon beam normally refers to its penetrating power, but the beam quality parameter is also used to express the variation of an ion chambers absorbed dose calibration coefficient. The penetrating power of the radiation, which is a function of photon attenuation and scatter cross-sections and so depends on the photon energy spectrum, determines the distribution of dose with depth within the phantom. Accurate modelling of percentage depth dose distributions is essential to good treatment planning. The response of an ion chamber is a function of the effective stopping power ratio, water to air, which is determined by the secondary electron fluence spectrum at the position of (and as perturbed by) the chamber. To express the quality-dependence of calibration coefficients, one needs a beam quality parameter which is related to this stopping power ratio, which could in principle be quite different from the penetrating power. The transfer of absorbed dose calibration from reference conditions to actual measurement conditions depends on this beam quality parameter. Conventional beam quality specifiers such as TPR20/10 and %dd(10)X, are directly related to penetrating power but only indirectly related to stopping power ratio.

Figure 5: Beam quality parameters TPR20/10 and DAPR20/10 as a function of nominal beam energy for an Elekta Synergy linac. DAPR20/10 has not yet been measured in the 15 MV beam.

Figure 2: The definition of Dose Area Product Ratio, DAPR20/10.

Field size dependence

Primary and scattered photon fluence vary with depth in quite different ways. A larger field produces more phantom scatter and the beam has a greater effective penetrating power. This causes a significant field-size dependence in depth dose data, which is reflected directly in those beam quality specifiers. In contrast, the effective water to air stopping power ratio at depth in a phantom, at a point on the central axis, varies only weakly with field size and hardly at all with depth. This is why in ion chamber measurements of central axis depth dose data for photon beams (unlike electron beams), we dont worry about the conversion from ionisation to dose: the absorbed dose calibration coefficient of an ion chamber is essentially constant. DAPR20/10, defined below, is a potential beam quality parameter. It measures penetrating power in a very similar way to TPR20/10, and has the advantage that it is essentially independent of field size (and shape, and focal distance). However, it involves an integral over (and beyond) the area of the primary beam and so the quality it measures must be some sort of average over the whole beam. When quality varies across the beam, as is the case with a conventional flattening filter, then DAPR20/10 cannot be expected to represent that variation. This prompts a key question: if Q = DAPR20/10 is to be the beam quality parameter in an expression for the quality dependence of ion chambers calibration coefficient, ND,w(Q), what would be the conditions under which that absorbed dose is measured? This question is addressed in the related poster[1], where it is suggested that the absorbed dose should be an average, taken over a volume in which the dose is essentially constant. Probably, that volume should be the same size as the sensitive volume of the detector being calibrated, and it could be almost as large as the PTV itself.

Field-independence of DAPR20/10
Provided the surface S contains the whole beam at both depths, the ratio DAPR20/10 turns out to be essentially independent of the field size, Figure 3. For comparison, the field size dependence of TPR20/10 is shown in Figure 4, taken from Sauer [3].

Figure 6: Experimentally determined quality-dependent correction factor, kQ, plotted as a function of DAPR20/10.

Application of DAPR20/10 to IMRT dosimetry

Provided that an IMRT treatment uses fields delivered with a single energy, the field size- and shape-independence of DAPR20/10 means that the measured beam quality parameter would take the same value for all fields. It may therefore be regarded as a beam quality parameter for the IMRT treatment itself, and this parameter used to obtain a value for kQ from Figure 6. This would provide one route by which absorbed dose in an IMRT treatment may be made traceable to standard reference dosimetry.

Figure 3: DAPR20/10 measured in an Elekta Synergy 6MV beam for a range of square fields using a PTW 786 ion chamber in a solid water equivalent phantom.

Dose Area Product, DAP

For a beam normally incident on a phantom, Dose Area Product, DAP, is the integral of dose over an specified surface S, usually normal to the beam axis and larger than the beam area. The use of DAP for photon dosimetry in small fields has been proposed by Djouguela et al. [2]. The variation of DAP with depth in phantom is shown in Figure 1.

DAPR20/10 for dynamic and rotational therapy

DAPR20/10 requires the combination of sequential measurements of DAP in two different setups. This approach becomes more problematic when the number of fields is large, or the beam varies continuously, as in rotational therapy. It would be preferable to make the two measurements simultaneously and combine them in real time. The PTW transmission chamber used in the measurements reported here presents a minimal perturbation to the beam, and so it would be possible to set up two such chambers in one phantom, take the ratio of ionisation currents from the chambers and measure essentially the same beam quality parameter in real time.

References
[1] DUANE, S., et al., Development of an Absorbed Dose Calorimeter for use in IMRT and Small Field External Beam Radiotherapy, poster CN182-221, IDOS Symposium, Vienna, 9-12 November 2010. [2] DJOUGUELA, A., et al., The dose-area product, a new parameter for the dosimetry of narrow photon beams, Z. Med. Phys 16 (2006) 217-227. [3] SAUER, O.A., Determination of the quality index (Q) for photon beams at arbitrary field sizes, Med. Phys 36 (2009) 4168-4172.
Figure 1: Percentage depth DAP, measured at 6MV for a fixed source detector distance (analogous to a TMR curve).

Figure 4: Field size dependence of TPR20/10, reproduced from Sauer [3], with permission. The values of 6MV DAPR20/10 from Figure 3 are contained in the solid rectangle.

Like TPR20/10, the proposed parameter DAPR20/10 is also essentially independent of the actual source to detector distance.

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