Radioactive sources used in brachytherapy must be dosimetrically characterized prior to clinical use as defined the TG-43 protocol. In our previous project, Gafchromic film dosimetry was used to experimentally obtain the anisotropy function for an M-19 iridium-192 brachytherapy seed being developed by Source Production Equipment Corp (St. Rose, LA). In this project, the Monte Carlo N-Particle Transport code (MCNP) was used to computationally obtain the full set of TG-43 parameters including the Dose Rate Constant, the Reference Dose Rate, the Radial Dose Function, and the Anisotropy Constant for the M-19 seed.

This thesis details the measurement and simulation of patient skin doses arising from X-ray exposure during interventional cardiology procedures. Interventional cardiology procedures can be long and complex resulting in high skin doses, to the extent that radiation burns may be produced. Twenty patients were used in the study consisting of 10 coronary angiogram and 10 coronary angioplasty procedures. Radiochromic films were used to measure skin dose directly. The Gafchromic® XR-RV2 film was chosen for its suitability for this project. The key characteristics of this film were experimentally determined including: dose response, energy dependence, polarisation and post-exposure growth. The dose range was found to be ideally suited for the doses encountered in this study. Energy dependence was found to be ~14% between 60 and 125 kVp at 1 Gy and introduced an unavoidable uncertainty into dose calculations from unknown beam energies. Document scanner characteristics were also been investigated and a scanning protocol is determined. A mathematical model was created to use the geometry and exposure information encoded into acquisition files to reconstruct dose and dose distributions. The model requires a set of study files encoded according to the DICOM format, as well as user input for fluoroscopic estimations. The output is a dose map and dose summary. Simulation parameters were varied and results compared with film measurements to provide the most accurate model. From the data collected the relation between dose area product, maximum skin dose and fluoroscopic time were also investigated. The results demonstrated that a model based on acquisition information can accurately predict maximum skin dose and provide useful geometrical information. The model is currently being developed into a standalone program for use by the Medical Physics and Bioengineering department.

This thesis details the measurement and simulation of patient skin doses arising from X-ray exposure during interventional cardiology procedures. Interventional cardiology procedures can be long and complex resulting in high skin doses, to the extent that radiation burns may be produced. Twenty patients were used in the study consisting of 10 coronary angiogram and 10 coronary angioplasty procedures. Radiochromic films were used to measure skin dose directly. The Gafchromic® XR-RV2 film was chosen for its suitability for this project. The key characteristics of this film were experimentally determined including: dose response, energy dependence, polarisation and post-exposure growth. The dose range was found to be ideally suited for the doses encountered in this study. Energy dependence was found to be ~14% between 60 and 125 kVp at 1 Gy and introduced an unavoidable uncertainty into dose calculations from unknown beam energies. Document scanner characteristics were also been investigated and a scanning protocol is determined. A mathematical model was created to use the geometry and exposure information encoded into acquisition files to reconstruct dose and dose distributions. The model requires a set of study files encoded according to the DICOM format, as well as user input for fluoroscopic estimations. The output is a dose map and dose summary. Simulation parameters were varied and results compared with film measurements to provide the most accurate model. From the data collected the relation between dose area product, maximum skin dose and fluoroscopic time were also investigated. The results demonstrated that a model based on acquisition information can accurately predict maximum skin dose and provide useful geometrical information. The model is currently being developed into a standalone program for use by the Medical Physics and Bioengineering department.

La braquiterapia es una técnica por la cual se introducen en el cuerpo fuentes radiactivas encapsuladas, situándolas cerca de los tumores por medio de aplicadores. Esta técnica permite impartir la dosis requerida al tumor evitando todo lo posible dañar los tejidos sanos. Con el fin de poder realizar lo mejor posible la planificación del tratamiento, es muy importante conocer tan precisamente como sea posible la distribución de dosis no sólo alrededor de la fuente sino también del aplicador. En la tesis, se ha utilizado una fuente de Ir-192 tipo Microselectron de la empresa Nucletron con un aplicador ginecológico constituido por un tubo intrauterino de acero inoxidable y dos cilindros vaginales de polímeros. Se ha realizado, mediante cálculos y medidas, un estudio de la distribución de dosis alrededor del aplicador. Las medidas se han realizado utilizando una cámara de ionización tipo Wellhöfer CC04 así como películas radiocrómicas tipo Gafchromic © EBT. Las películas permiten obtener isodosis y la cámara de ionización se ha utilizado para obtener dosis en profundidad. Para asegurar un buen posicionamiento de los sistemas de medida y de la fuente, se ha fabricado un maniquí de plexiglás. Los cálculos de distribución de dosis se han realizado utilizando el software de planificación de tratamiento (TPS) PLATO v14.3 así como el programa MCNP5 basado en el método Monte Carlo, para lo cual se ha desarrollado un modelo del conjunto fuente, aplicador y maniquí. Los TPS no tienen en cuenta la atenuación en los materiales que constituyen el aplicador; por lo que es importante conocer la influencia de este efecto sobre el cálculo de la dosis. La comparación de cálculos y medidas, pone de manifiesto que el efecto de blindaje a causa del tubo intrauterino no es significativo, excepto en el campo próximo al tubo, a menos de un centímetro de éste. Las películas Gafchromic © EBT y la cámara de ionización Wellhöfer CC04, utilizados durante la tesis, han permitido realizar medidas dede distribución de dosis y también de dosis absoluta, que han llevado a la validación de la simulación realizada con MCNP5 en ciertas situaciones geométricas simples. El programa MCNP5 es una herramienta muy potente para el estudio de las distribuciones de dosis en braquiterapia, particularmente para situaciones donde una dosimetría experimental resulta imposible, por ejemplo en contacto con el tubo intrauterino o en zonas muy próximas a éste. Para distancias superiores a 1 cm de la fuente, los resultados de la estimación de dosis realizada por el sistema PLATOv14.3 muestran un buen acuerdo con las medidas y los cálculos realizados. Finalmente, se ha realizado un análisis completo de las incertidumbres relativas a la utilización del programa de cálculo MCNP5. Se ha estudiado para ello el efecto de los diferentes elementos relacionados con el modelo desarrollado, pero también con el propio programa. Es necesario indicar que una evaluación de la incertidumbre global es esencial en el caso de comparación con otros sistemas de cálculo o con las medidas efectivas. / Gerardy, IYJ. (2011). Evaluation d'un système de planification pour un traitement de brachythérapie gynécologique en utilisant des techniques Monte Carlo et des mesures expérimentales [Tesis doctoral no publicada]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/14272 / Palancia

La précision du calcul de dose est cruciale pour la qualité de la planification et de la réalisation des traitements en radiothérapie. L’objectif de ce travail était d’évaluer la qualité des algorithmes de calcul de dose des faisceaux d’électrons pour des conditions particulières proches des situations cliniques rencontrées. Une méthodologie spécifique de dosimétrie par films radiochromiques des faisceaux d’électrons a été développée et validée, y compris pour des situations difficiles avec une précision de 3.1% en dose absolue et 2.6% en dose relative. Cette technique a permis de développer des tests de Contrôle Qualité généralistes rapides et efficaces qui servent de base de données mesurées en cas de changement de version du système de planification de traitement et/ou d’algorithme de calcul de dose. Les mesures par films ont été comparées avec les calculs de deux algorithmes de calcul de dose Pencil Beam et Monte Carlo. Les deuxcodes ont donné des résultats similaires dans les tests d’obliquité, d’irrégularité et de DSP étendue. En revanche, les calculs Monte Carlo sont plus précis en présence d’hétérogénéités. D’autre part, cette méthode de dosimétrie par films radiochromiques a permis de développer un nouveau mode d’évaluation des plans de traitement avec des films découpés et insérés dans des fantômes anthropomorphiques (de type thorax et tête) de manière à obtenir la distribution de dose en 2D dans un plan transversal donné ; ces tests cliniques pouvant aussi être utilisés dans le cadre d’un Contrôle de Qualité interne adapté à l’activité clinique du service. La comparaison des mesures avec les calculs a montré une meilleure précision dans les calculs Monte Carlo par rapport aux calculs Pencil Beam au niveau des hétérogénéités, notamment dans les poumons, les cavités et les os. / In radiotherapy, the dose calculation accuracy is crucial for the quality and the outcome of the treatments. The purpose of our study was to evaluate the accuracy of dose calculation algorithms for electron beams in situations close to clinical conditions. A new practical approach of radiochromic film dosimetry was developed and validated especially for difficult situations. An accuracy of 3.1% and 2.6% was achieved for absolute and relative dosimetry respectively. Using this technique a measured database of dose distributions was developed to form the basis of several fast and efficient QualityAssurance tests. Such tests are intended to be used also when the dose calculation algorithm is changed or the Treatment Planning System replaced. Pencil Beam and Monte Carlo dose calculations were compared to the measured data for simple geometrical phantom setups. They both gave similar results for obliquity, surface irregularity and extended SSD tests but the Monte Carlo calculation was more accurate in presence of heterogeneities. The same radiochromic film dosimetry method was applied to film cuts inserted into anthropomorphic phantoms providing a 2D dose distribution for any transverse plan. This allowed us to develop clinical test that can be also used for internal Quality Assurance purposes. As for simpler geometries, the Monte Carlo calculations showed better agreement with the measured data than the Pencil Beam calculation, especially in presence of heterogeneities such as lungs, cavities and bones.

The Eu-XFEL, a 3.4 km long free electron laser situated in Hamburg, Germany was commissioned in 2017, and has since been at the forefront of cutting edge technologies. The short laser-like X-ray pulses produced within the facility can be used to film ultrafast phenomena such as the formation or breakup of chemical bonds, research the composition and structure of complex biomolecules on the atomic scale, and can even be used to study matter under extreme conditions. Since its commissioning, a concern has been raised regarding the demagnetization of the permanent magnets present in the undulator system as a result of stray radiation. To monitor this, Gafchromic EBT-3 films along with other dosimetric tools have been installed at various points along the beamline to monitor radiation induced damages and predict the lifetime of the undulator system. This work focuses on optimizing the calibration of Gafchromic EBT-3 films for accurate estimations of the unwanted dose absorbed in the magnetic material, and was achieved by increasing the amount of calibration measurements and segmenting the measurements, in turn performing the calibration in parts. The results show that calibrating the EBT-3 films according to the proposed method can accurately estimate unknown doses up to 52 Gy.

For patients receiving radiation therapy, there is a risk of developing radiation induced carcinomas, especially if they have a long life expectancy. However, radiotherapy is not the only contributor of radiation exposure to healthy tissue. With the introduction of highly conformal treatment techniques comes the increase in pretreatment imaging necessary to accurately target tumour volumes and consequently, radiation exposure to healthy tissue. In this work the radiation dose delivered to radiosensitive organs from a number of treatment planning techniques was evaluated and the risk of radiation induced cancer was assessed. MOSFET detectors and Gafchromic film were used to measure the accumulative concomitant dose to the thyroid and contralateral breast from early stage breast carcinoma radiotherapy and to the contralateral testis from seminoma radiotherapy, with dose contributions from CT imaging for treatment planning, pretreatment imaging (CBCT) and treatment delivery peripheral dose. To the author's knowledge this is the first work investigating the total concomitant treatment related dose and associated risk to these treatment sites. Peripheral dose contributed the largest concomitant dose to the healthy tissue, measuring up to 0.7, 1.0 and 5.0 Gy to the testis, thyroid and contralateral breast, respectively. The highest testicular, thyroid and contralateral breast carcinoma risk was found to be 0.4, 0.2 and 1.4%, respectively. In conclusion, the risk of radiation induced carcinoma to the assessed radiosensitive tissues was found to be minimal, however, when considering treatment techniques and/or introducing pretreatment imaging protocols, the dose to the normal tissue should be kept as low as reasonably achievable.

Purpose: The aim of this study was to develop a method of measuring changes in the skin microcirculation and skin dose for mastectomy patients in connection with the radiation treatment. The distribution of the skin dose, its dependence on the energy of the beam, field geometry and bolus material and the accuracy of the given skin dose in the treatment planning system were studied. Finally, the correlation between the given dose and the changes in skin microcirculation was evaluated. Methods: Skin dose was measured using GafChromic EBT3 films. To evaluate the impact of different energies and field geometry measurements on a PMMA phantom were done. Dose measurements were done using an anthropomorphic phantom and in patients. The measured skin doses were compered to the doses calculated using the treatment planning system. Before and after treatment, skin blood perfusion was measured using laser speckle contrast imaging. In connection with the last measurement also methyl nicotinate was used to increase the perfusion for the measurement. Results: The measurements on the PMMA-phantom indicate that a larger photon energy results in a lower dose to the skin, but a higher exit dose. Furthermore a more oblique angle results in a higher skin dose and a larger field size also results in an increased skin dose. The patient measurements showed that the skin dose was significantly different in different areas of the irradiated field. The highest dose was measured in the area in which a bolus was applied. All patients showed a significant increase in skin blood of the perfusion within the irradiated area. The comparison between the measured doses and the doses calculated using the treatment planning system shows an underestimation of the skin dose by the treatment planning system depending on the incident angle and the presence of bolus material. Conclusion: The distribution of the skin dose during breast cancer radiotherapy in mastectomy patients is heterogeneous with the highest dose in the area of the mastectomy scar, due to the presence of bolus material. A correlation can be noticed between the changed in microcirculation and the radiation dose to the skin. Estimation of the skin dose using the treatment planning system is inaccurate, but film doseimetry offers an easy-to use method to accurately measure the dose to different areas of the irradiated skin.

Spatially fractionated radiation therapy (or grid) using megavoltage x-rays is a relatively new method of treating bulky (>8 cm) malignant tumors. Unlike the conventional approach in which the entire tumor is targeted with a nearly uniform radiation field, in grid the incident radiation is collimated with a special grid collimator. As such, only the volume under the open areas of the grid receives direct irradiation from the incident beam; the rest only sees scattered radiation and hence receives significantly less dose. Those regions seeing less dose serve as regrowth areas for normal tissues, thus reducing the normal tissue complication probability after the treatment. Although the grid dose distribution in a tumor is non-uniform, the regression of tumor mass has exhibited uniform regression clinically. Protons have two advantages over megavoltage x-rays which are typically used for grid: (1) protons scatter less in tissue, and (2) they have a fixed range in tissue (the Bragg peak) that can be used to target a tumor. The goal of this thesis is to computationally and experimentally assess the feasibility of grid using clinical proton beams. The proton pencil beams at the Provision Cancer Center in Knoxville, Tennessee, are used to create an array of beams mimicking the arrangement of beams in grid therapy. The dose distributions at various depths in a solid-water phantom are obtained computationally by the Monte Carlo code MCNP and validated by RayStation experimental Gafchromic film EBT3. The results are compared with those of the grid using megavoltage x-rays.

En tant que laboratoire national pour la métrologie des rayonnements ionisants, le Laboratoire National Henri Becquerel met au point les méthodes de mesures absolues pour établir les références dosimétriques. Il dispose, entre autres, de références dans des faisceaux de rayons X utilisés en radiothérapie et ayant une taille de champ comprise entre 10 et 2 cm de côté. Afin de s’approcher des plus petits champs utilisés en clinique, la miniaturisation des détecteurs absolus n’étant pas possible, il est proposé dans cette thèse de remplacer la dose absorbée en un point par le produit dose surface (PDS). L’applicabilité du PDS mesuré à l’aide de dosimètres dont la surface sensible est plus grande que celle du champ de rayonnement a été vérifiée. Ainsi, un calorimètre graphite avec une surface sensible de 3 cm de diamètre a été conçu, construit et testé. En vue du transfert des références dosimétriques à l’utilisateur, une chambre d’ionisation de même diamètre a elle aussi été réalisée et testée. Son coefficient d’étalonnage en termes de PDS a été déterminé dans des faisceaux circulaires de 2, 1 et 0.75 cm de diamètre avec une incertitude type inférieure à 0.7 %. La distribution relative de la dose absorbée dans l’eau en deux dimensions a été mesurée au moyen d’un dosimètre diamant, d’une chambre d’ionisation PinPoint et de films gafchromiques, pour lesquels un protocole de lecture spécifique a été mis au point. Les résultats dans le faisceau de 2 cm de diamètre ont montré un bon accord entre les approches en termes de PDS et de dose absorbée dans l’eau en un point, après application des facteurs de correction obtenus au moyen de simulations Monte Carlo et des mesures de distribution de dose. Les coefficients d’étalonnage de la chambre d’ionisation de grandes dimensions établis dans les champs de 1 et 0.75 cm de diamètre sont compatibles aux incertitudes près mais s’écartent de -2.6 % de celui établi dans le champ de 2 cm de diamètre. L’utilisation du PDS nécessite donc une surface de détection notablement plus grande que la section du mini-Faisceau. / The French primary standard dosimetry laboratory “Laboratoire National Henri Becquerel” is in charge of the establishment of dosimetric standards for ionizing radiation beams. Absolute dose measurements are thus available for X-Ray beams used in radiotherapy for field sizes between 10 and 2 cm. Since the miniaturization of absolute dosimeters is not possible for smaller field sizes, a dose area product (DAP) has been suggested as a substitute to the absorbed dose at a point.In order to measure a DAP with dosimeters which sensitive surface is larger than the beam, a graphite calorimeter with a sensitive surface of 3 cm diameter was designed, built and tested. An ionization chamber with the same diameter was realized and tested to transfer the dosimetric references to the end users. Its calibration factor in terms of DAP was determined in circular beams of 2, 1 and 0.75 cm diameter with an uncertainty smaller than 0.7 %. The two-Dimension relative dose distribution was measured thanks to a diamond dosimeter, a PinPoint ionization chamber and gafchromic films, using a specific protocol.Both approaches, respectively based on a PDS and an absorbed dose to water at a point, were in good agreement in the 2 cm beam. Correction factors determined from Monte Carlo simulations and measured dose distributions were needed for this comparison. The calibration factor of the large ionization chamber in the 1 and 0.75 cm diameter beams were in good agreement within the uncertainties but a gap of -2.6 % was found with the one established in the 2 cm diameter beam. As a result, the DAP can be used if the sensitive surface is much larger than the beam section.