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.

A aferição da dose por técnica de dosimetria in vivo garante que a dose calculada pelo sistema de planejamento seja àquela entregue pelo acelerador linear (AL) durante a radioterapia, garantindo assim os processos de controle de qualidade. O objetivo deste trabalho foi validar a técnica de controle de qualidade em IMRT utilizando filme radiocrômico. Foram analisados 47 planejamentos de IMRT de três regiões: próstata, cabeça e pescoço e crânio. Para cada planejamento utilizouse um filme radiocrômico EBT2 acoplado ao cabeçote do acelerador linear através de uma bandeja preparada para o filme. A leitura e posterior análise da dose pontual e distribuição de dose após 24 horas, foi realizada em sofware desenvolvido em MatLab. O índice de aprovação foi de 92%. Quatro planos foram reprovados em pelo menos 1 critério, sendo 3 de cabeça e pescoço e 1 de crânio. Os resultados da dosimetria in vivo com filme radiocrômico foi validada, podendo ser considerada uma técnica confiável e prática na aferição da dose em radioterapia. / The measurement of dose, using the in vivo technique dosimetry, ensures that the dose calculated by the planning system is exactly the same as the dose delivered in linear accelerator, this ensures quality assurance in radiotherapy. The objective of this study was to evaluate the quality control techinique of IMRT treatments using radiochromic film. We analyzed 47 IMRT plans, which divided into three regions: Prostate, head and neck, and skull. For each plan, we used a radiochromic film coupled in linear accelerator head by a tray prepared to film placement. The film was stored for 24 hours after irradiation. Reading and analysis of point dose and 2D dose distribution were performed after this period. ll plans analyzed, the approval rating was 92%, and the others were flunked at least one criterion. Based on the results obtained in vivo dosimetry with radiochromic film was validated. This technique is reliable and practical to measure the dose delivered by linear accelerator.

A aferição da dose por técnica de dosimetria in vivo garante que a dose calculada pelo sistema de planejamento seja àquela entregue pelo acelerador linear (AL) durante a radioterapia, garantindo assim os processos de controle de qualidade. O objetivo deste trabalho foi validar a técnica de controle de qualidade em IMRT utilizando filme radiocrômico. Foram analisados 47 planejamentos de IMRT de três regiões: próstata, cabeça e pescoço e crânio. Para cada planejamento utilizouse um filme radiocrômico EBT2 acoplado ao cabeçote do acelerador linear através de uma bandeja preparada para o filme. A leitura e posterior análise da dose pontual e distribuição de dose após 24 horas, foi realizada em sofware desenvolvido em MatLab. O índice de aprovação foi de 92%. Quatro planos foram reprovados em pelo menos 1 critério, sendo 3 de cabeça e pescoço e 1 de crânio. Os resultados da dosimetria in vivo com filme radiocrômico foi validada, podendo ser considerada uma técnica confiável e prática na aferição da dose em radioterapia. / The measurement of dose, using the in vivo technique dosimetry, ensures that the dose calculated by the planning system is exactly the same as the dose delivered in linear accelerator, this ensures quality assurance in radiotherapy. The objective of this study was to evaluate the quality control techinique of IMRT treatments using radiochromic film. We analyzed 47 IMRT plans, which divided into three regions: Prostate, head and neck, and skull. For each plan, we used a radiochromic film coupled in linear accelerator head by a tray prepared to film placement. The film was stored for 24 hours after irradiation. Reading and analysis of point dose and 2D dose distribution were performed after this period. ll plans analyzed, the approval rating was 92%, and the others were flunked at least one criterion. Based on the results obtained in vivo dosimetry with radiochromic film was validated. This technique is reliable and practical to measure the dose delivered by linear accelerator.

Tissue heterogeneity effects present a major challenge to electron beam dosimetry in radiotherapy and radiation protection. The perturbation of the absorbed dose distribution in tissue due to the presence of heterogeneous material boundaries was investigated in this work. Experiments were conducted in a tissue-equivalent phantom in order to quantify electron backscatter from various materials. For these experiments, irradiations were performed using a 6MeV (nominal) electron beam under conditions of one dimensional geometry. Depth-energy degradation of the electron beam provided mean electron energies of 2.3MeV, 1.9MeV, and 1.4MeV at interface locations. Backscatter phenomena were investigated for the following interface geometries: polystyrene/air, polystyrene/cortical-bone-equivalent plastic, polystyrene/copper, and polystyrene/bismuth. Novel radiochromic film dosimetry techniques were developed for these experiments, and the dose and energy response characteristics of GAFChromic Type 37-041 film were investigated. Monte Carlo simulations of the experiments were performed in parallel, using tile ITS TIGER code, and methodologies were developed to determine appropriate input parameters to these simulations. From experimental and Monte Carlo results, the backscatter factor at the interface, its spatial variation with depth, and its dependence on electron energy and scatterer atomic number were investigated. / Thesis / Master of Science (MS)

O sucesso do tratamento de neoplasias depende da precisão na localização tumoral e de áreas críticas limítrofes, e da distribuição da dose entregue a esses volumes. O objetivo deste trabalho foi verificar a utilização do filme radiocrômico Gafchromic R EBT2 na avaliação da distribuição de dose em planejamentos radioterápicos, desenvolvendo um protocolo dosimétrico capaz de verificar a conformidade entre distribuições de doses planejada e entregue em teleterapia. Avaliou-se também, a contribuição da separação dos canais RGB das imagens para o controle da qualidade dos planejamentos utilizando esses filmes. Com esse intuito, realizou-se testes para verificação das características do filme EBT2 e do digitalizador a fim de obter-se um protocolo dosimétrico adequado. Realizou-se a simulação de tratamentos de sistema nervoso central com a irradiação de um objeto simulador homogêneo, com 5 campos em um acelerador linear de 6 MV e comparou-se com os dados do sistema de planejamento através de mapas de índice gama. Observou-se que o canal verde, apresenta maior conformidade aos valores de referência. Os mapas de índice gama, resultaram em uma conformação de 98% para critérios de aceitação de DD = 3 % e DTA = 3 mm, de acordo com os limites estabelecidos no Report 62 do ICRU. Ao final deste trabalho, concluiu-se que o protocolo estabelecido com a análise do canal verde no filme EBT2 é adequado para a realização do controle da qualidade em tratamentos conformacionais, sendo uma ferramenta de fácil implementação para avaliação da distribuição de dose nesses tratamentos. / The successful treatment of neoplasms depends on the accurate localization of the tumor and adjacent critical areas, and the distribution of the dose delivered to these volumes. The objective of this work was to verify the use of radiochromic film Gafchromic R EBT2 to evaluate the dose distribution in radiotherapy planning, developing a dosimetric protocol able to check the conformity between the planned and delivered dose distributions in teletherapy. The contribution of the RGB channel separation in the images to quality control of the planning was also evaluated. With this purpose, EBT2 film was calibrated and studied to verify its characteristics when read with a scanner in order to obtain a suitable dosimetric protocol. Simulation in a homogeneous phantom with 5 radiation fields on a 6 MV linear accelerator was compared with the planning system data through gamma index maps. It was observed that the green channel has a higher conformity with the reference values. The gamma index maps resulted in a conformation of 98% when the acceptance criteria was DD = 3% and DTA = 3 mm, according to the limits established by the ICRU Report 62. This study concluded that the protocol established for the analysis EBT2 films with green channel is suitable for performing quality control in conformational treatments.

Purpose: To examine the dosimetric characteristics of Gafchromic EBT3 film when measuring small fields of radiation, and compare it against other common radiation detectors. Methods and Materials: EBT3 film was placed in a solid water phantom and irradiated with 6MV photons, field sizes from 10x10cm2 down to 6x6mm2. The films were scanned with a Vidar DosimetryPRO Advantage Red scanner, and analyzed with RIT113 software. The films were also scanned at different orientations and times to quantify the discrepancies associated with scanning orientation and post-exposure darkening. The same fields were measured with a PTW TN30013 farmer chamber, an Exradin T1 cylindrical ion chamber, a PTW parallel plate ion chamber, and a Sun Nuclear Edge Detector (diode). Output factors were calculated for each detector and compared for accuracy. The output factors were measured from a Varian Clinac iX, Clinac 21EX, Trilogy, and TrueBeam; as well as a Novalis Tx. The outputs from different machines at different clinics were compared. Results: The EBT3 film and Edge Detector were the only detectors that succeeded in accurately measuring the output from all field sizes; the ion chambers were too large and failed for field sizes below 4x4cm2 due to volume averaging. The dose measured with the film increased by an average of 8.8% after one week post-irradiation. The dose measured was also reduced by an average of 4.4% by scanning the film in landscape orientation, as opposed to portrait orientation. It was shown that the output factors for the smallest field of 6x6mm2--successfully measured with film and diode--varied between 0.54-0.74 for five different machines at three different clinics. Conclusions: The feasibility of using Gafchromic EBT3 film to measure very small fields of radiation is confirmed. Of the other 4 detectors used, only the diode was shown to be capable of accurately measuring small fields of radiation. The need to optimize the film dosimetry process--including the time films are scanned post-irradiation, the consistency of the scanning orientation of the calibration and subsequent films, and the measurement procedure on the computer software--is highlighted.

O sucesso do tratamento de neoplasias depende da precisão na localização tumoral e de áreas críticas limítrofes, e da distribuição da dose entregue a esses volumes. O objetivo deste trabalho foi verificar a utilização do filme radiocrômico Gafchromic R EBT2 na avaliação da distribuição de dose em planejamentos radioterápicos, desenvolvendo um protocolo dosimétrico capaz de verificar a conformidade entre distribuições de doses planejada e entregue em teleterapia. Avaliou-se também, a contribuição da separação dos canais RGB das imagens para o controle da qualidade dos planejamentos utilizando esses filmes. Com esse intuito, realizou-se testes para verificação das características do filme EBT2 e do digitalizador a fim de obter-se um protocolo dosimétrico adequado. Realizou-se a simulação de tratamentos de sistema nervoso central com a irradiação de um objeto simulador homogêneo, com 5 campos em um acelerador linear de 6 MV e comparou-se com os dados do sistema de planejamento através de mapas de índice gama. Observou-se que o canal verde, apresenta maior conformidade aos valores de referência. Os mapas de índice gama, resultaram em uma conformação de 98% para critérios de aceitação de DD = 3 % e DTA = 3 mm, de acordo com os limites estabelecidos no Report 62 do ICRU. Ao final deste trabalho, concluiu-se que o protocolo estabelecido com a análise do canal verde no filme EBT2 é adequado para a realização do controle da qualidade em tratamentos conformacionais, sendo uma ferramenta de fácil implementação para avaliação da distribuição de dose nesses tratamentos. / The successful treatment of neoplasms depends on the accurate localization of the tumor and adjacent critical areas, and the distribution of the dose delivered to these volumes. The objective of this work was to verify the use of radiochromic film Gafchromic R EBT2 to evaluate the dose distribution in radiotherapy planning, developing a dosimetric protocol able to check the conformity between the planned and delivered dose distributions in teletherapy. The contribution of the RGB channel separation in the images to quality control of the planning was also evaluated. With this purpose, EBT2 film was calibrated and studied to verify its characteristics when read with a scanner in order to obtain a suitable dosimetric protocol. Simulation in a homogeneous phantom with 5 radiation fields on a 6 MV linear accelerator was compared with the planning system data through gamma index maps. It was observed that the green channel has a higher conformity with the reference values. The gamma index maps resulted in a conformation of 98% when the acceptance criteria was DD = 3% and DTA = 3 mm, according to the limits established by the ICRU Report 62. This study concluded that the protocol established for the analysis EBT2 films with green channel is suitable for performing quality control in conformational treatments.

Ces dernières années, les techniques de traitement des cancers par radiothérapie externe se sont complexifiéesafin de cibler la tumeur tout en protégeant les organes à risque. Les systèmes de planification de traitement (TPS)réalisent un calcul prévisionnel de la distribution de la dose absorbée dans le patient (via des images CT).Afin d’obtenir un résultat de dose précis dans un temps raisonnable, le calcul est effectué par des algorithmessimplifiés. En présence de dispositifs médicaux métalliques de masses volumiques élevées (prothèses de hancheou prothèses dentaires), les algorithmes atteignent leurs limites. De plus, ces dispositifs perturbent lareconstruction tomodensitométrique en créant des artéfacts sur les images rendant difficile la délinéation desorganes. L’objectif de ce travail a été d’évaluer les algorithmes implémentés dans les TPS en présenced’hétérogénéités de forte densité avec des mesures expérimentales et le code de calcul Monte-Carlo BEAMnrcdans un fantôme anthropomorphique tout d’abord avec des échantillons naturels, puis avec des échantillonscalibrés. Ensuite, une évaluation rétrospective des algorithmes cliniques par rapport à Monte-Carlo a été réaliséeavec des patients traités en RC3D et en RCMI.Les mesures ont mis en évidence une atténuation pouvant aller jusqu’à 17 % pour l’amalgame dentaire parrapport à l’algorithme clinique sur les images CT avec artéfacts, créant une zone de sous-dosage dans le volumecible. L’ensemble des résultats a donné lieu à des recommandations pour la clinique (corriger les images CT si levolume cible est à moins de 3 cm d’une prothèse, privilégier l’algorithme AAA plutôt que Pencil Beam…). / The last few years, cancer treatment techniques in radiation therapy have become more complex to better targetthe tumor while protecting the organs at risk. The treatment planning systems (TPS) achieve a predictivecalculation of the distribution of the dose absorbed by the patient (via CT images).In order to obtain an accurate dose result within a reasonable time, the calculation is performed with simplifiedalgorithms. In the presence of medical devices made of high density metal (hip prosthesis or dental prosthesis),the algorithms reach their limits. Moreover, these devices disrupt computed tomography reconstruction, creatingartifacts on the images and thus making difficult the delineation of organs. The aim of this work is to evaluatethe algorithms of the TPS in the presence of high density heterogeneity using experimental measurements andthe Monte Carlo BEAMnrc code in an anthropomorphic phantom: on one hand with natural samples, and on theother hand, with calibrated samples. Then, a retrospective evaluation of clinical algorithms compared to MonteCarlo is achieved using treated patients in Conformal Radiotherapy and in Intensity Modulated RadiationTherapy (IMRT). The measurements show an attenuation of up to 17 % for dental amalgam compared with theclinical algorithm on CT images with artifacts, creating an under-dosage area in the target volume. All theseresults lead to recommendations for the clinical treatments (corrected CT images if the target volume is closerthan 3 cm to prosthesis, favor the AAA algorithm rather than Pencil Beam …).

A Radioterapia de lesões cerebrais próximas a estruturas críticas necessitam de uma alta precisão na localização e na dose. O rigor na liberação da dose deve ser acompanhado por um preciso controle da qualidade nos aparelhos que envolvam a prática. O comissionamento do sistema de planejamento consiste em averiguar e confirmar os cálculos realizados pelo sistema. Porém, mesmo com todo controle da qualidade no comissionamento, existem vários aspectos que podem influenciar na administração da dose no volume alvo, o que exige a necessidade de se fazer uma avaliação final, no ato do tratamento, in vivo. O objetivo deste trabalho é desenvolver uma técnica de dosimetria in vivo como parte de um programa de controle da qualidade em radioterapia estereotáxica. Na técnica de dosimetria in vivo, utilizaram-se segmentos de filme radiocrômico, com dimensões de 1x1 cm2, acoplados na área externa ao colimador formado por micro-lâminas, Moduleaf. Estes filmes foram inseridos na região central do feixe. Os filmes foram irradiados e calibrados para obtenção dos fatores campos, na configuração da técnica. Com estes dados foi elaborado um programa computacional, o qual calcula a densidade relativa que um filme deve adquirir quando submetido a uma exposição nesta configuração. Como a técnica de dosimetria in vivo usa os dados do TPS, validaram-se alguns parâmetros do comissionamento do TPS. Complementando o estudo da dosimetria in vivo foram avaliados cinco planos não co-planares, sendo o primeiro com 15 campos e os outros com 25 campos. Antes de iniciar o procedimento o segmento de filme era acoplado ao aparelho e após a execução do tratamento a densidade ótica era avaliada e comparada com a calculada pelo programa desenvolvido. No comissionamento, todas as dosimetrias relativas apresentaram diferenças percentuais menores que 2%, quando comparados os resultados medidos com os calculados pelo sistema de planejamento. No desenvolvimento da técnica de dosimetria in vivo, a diferença percentual média da verificação dosimétrica, no momento da irradiação, comparado com a calculada pela planilha foi de 1,5%, enquanto que a dosimetria absoluta aplicada ao controle da qualidade convencional foi aprovada com diferença percentual média de 2,5% e a função gama média encontrada foi de 97,9% dos pontos aprovados com critério de aceitação %=2% e D=2 mm. Logo, todos os dados estão em concordância com os limites estabelecidos pelo TRS-430. Desta forma, conclui-se que foi desenvolvida uma técnica de dosimetria in vivo como parte de um programa de controle da qualidade em radioterapia estereotáxica com filme radiocrômico, já que foram confirmados os parâmetros básicos do comissionamento do sistema de planejamento e a técnica foi validada com o controle de qualidade convencional nos cinco planos analisados. / Radiation therapy of brain lesions near critical structures requires a highly accurate location and dose. The accuracy in dose delivery should be accompanied by an accurate quality control in devices involving the practice. The commissioning of the planning system is to ascertain and confirm the calculations performed by the system, but even with all quality control in the commissioning, there are several aspects that may influence the dosing the target volume, which necessitates the need to make a final assessment at the time of treatment, in vivo. The objective of this work is to develop a technique for in vivo dosimetry as part of quality assurance in stereotactic radiotherapy. In vivo dosimetry technique, we used segments of film radiocrômico, with dimensions of 1x1 cm2, coupled to the external area formed by the micro-collimator blades, Moduleaf. These films were inserted in the central region of the beam. The films were irradiated and calibrated to obtain factors of fields in the configuration of the technique. With these data we designed a computer program which calculates the relative density of a film must acquire when subjected to an exposure in this setting. As the technique of in vivo dosimetry using data from the TPS, validated parameters are the commissioning of the TPS. Complementing the study of in vivo dosimetry were evaluated five non-coplanar plans, the first with 15 fields and the other with 25 fields. Before starting the procedure, the film segment was attached to the unit and after the treatment is the optical density was measured and compared with those calculated by the program developed. At commissioning, all presented on dosimetry percentage differences less than 2%, when comparing the measured results with those calculated by the planning system. In developing the technique of in vivo dosimetry, the mean percent difference dosimetry verification at the time of irradiation compared with the calculated by the sheet was 1.5%, while the absolute dosimetry applied to the conventional quality control has been approved as mean percent difference 2.5% and the gamma function mean was 97.9% of the points agreed with the acceptance criterion % = 2% and D = 2 mm. Therefore, all data are in agreement with the limits set by TRS-430. Thus, we conclude that we have developed a technique for in vivo dosimetry as part of a quality assurance in stereotactic radiotherapy radiocrômico film, since some parameters were confirmed to commissioning the planning system and the technique was validated with control quality standard in five plans analyzed.