Cobalt-60 (Co-60) units played an integral role in radiation therapy from the mid-1950s to the 1970s. Although they continue to be used to treat cancer in some parts of the world, their role has been significantly reduced due to the invention of medical linear accelerators. A number of groups have indicated a strong potential for Co-60 units in modern radiation therapy. The Medical Physics group at the Cancer Center of the Southeastern Ontario and Queen’s University has shown the feasibility of Intensity Modulated Radiation Therapy (IMRT) via simple conformal treatment planning and dose delivery using a Co-60 unit. In this thesis, initial Co-60 tomotherapy planning investigations on simple uniform phantoms are extended to actual clinical cases based on patient CT data. The planning is based on radiation dose data from a clinical Co-60 unit fitted with a multileaf collimator (MLC) and modeled in the EGSnrc Monte Carlo system. An in house treatment planning program is used to calculate IMRT dose distributions. Conformal delivery in a single slice on a uniform phantom based on sequentially delivered pencil beams is verified by Gafchromic film. Volumetric dose distributions for Co-60 serial tomotherapy are then generated for typical clinical sites that had been treated at our clinic by conventional 6MV IMRT using Varian Eclipse treatment plans. The Co-60 treatment plans are compared with the clinical IMRT plans using conventional matrices such as dose volume histograms (DVH). Dose delivery based on simultaneously opened MLC leaves is also explored and a novel MLC segmentation method is proposed. In order to increase efficiency of dose calculations, a novel convolution based fluence model for treatment planning is also proposed. The ion chamber measurements showed that the Monte Carlo modeling of the beam data under the MIMiC MLC is accurate. The film measurements from the uniform phantom irradiations confirm that IMRT plans from our in-house treatment planning system are deliverable. Comparing the Co-60 dose distributions and DVHs to the IMRT plans from the clinic indicates that Co-60 is able to provide similar dose conformality to targets and dose sparing to critical organs. The results of the novel MLC segmentation algorithm and the photon fluence model proposed in this work compared well with the Monte Carlo calculations. In summary, the investigations presented in this thesis confirm that Co-60 tomotherapy is indeed capable of providing state-of-the-art conformal dose delivery. We have shown that the perceived beam limitations often identified with Co 60 (e.g., lower penetration, source size artifacts under small field collimation, and larger penumbra) are negligible when using intensity modulated techniques. / Thesis (Ph.D, Physics, Engineering Physics and Astronomy) -- Queen's University, 2013-08-22 11:34:14.861

Cobalt-60 (Co-60) units played an integral role in radiation therapy from the mid-1950s to the 1970s. Although they continue to be used to treat cancer in some parts of the world, their role has been significantly reduced due to the invention of medical linear accelerators. A number of groups have indicated a strong potential for Co-60 units in modern radiation therapy. The Medical Physics group at the Cancer Center of the Southeastern Ontario and Queen’s University has shown the feasibility of Intensity Modulated Radiation Therapy (IMRT) via simple conformal treatment planning and dose delivery using a Co-60 unit. In this thesis, initial Co-60 tomotherapy planning investigations on simple uniform phantoms are extended to actual clinical cases based on patient CT data. The planning is based on radiation dose data from a clinical Co-60 unit fitted with a multileaf collimator (MLC) and modeled in the EGSnrc Monte Carlo system. An in house treatment planning program is used to calculate IMRT dose distributions. Conformal delivery in a single slice on a uniform phantom based on sequentially delivered pencil beams is verified by Gafchromic film. Volumetric dose distributions for Co-60 serial tomotherapy are then generated for typical clinical sites that had been treated at our clinic by conventional 6MV IMRT using Varian Eclipse treatment plans. The Co-60 treatment plans are compared with the clinical IMRT plans using conventional matrices such as dose volume histograms (DVH). Dose delivery based on simultaneously opened MLC leaves is also explored and a novel MLC segmentation method is proposed. In order to increase efficiency of dose calculations, a novel convolution based fluence model for treatment planning is also proposed. The ion chamber measurements showed that the Monte Carlo modeling of the beam data under the MIMiC MLC is accurate. The film measurements from the uniform phantom irradiations confirm that IMRT plans from our in-house treatment planning system are deliverable. Comparing the Co-60 dose distributions and DVHs to the IMRT plans from the clinic indicates that Co-60 is able to provide similar dose conformality to targets and dose sparing to critical organs. The results of the novel MLC segmentation algorithm and the photon fluence model proposed in this work compared well with the Monte Carlo calculations. In summary, the investigations presented in this thesis confirm that Co-60 tomotherapy is indeed capable of providing state-of-the-art conformal dose delivery. We have shown that the perceived beam limitations often identified with Co 60 (e.g., lower penetration, source size artifacts under small field collimation, and larger penumbra) are negligible when using intensity modulated techniques. / Thesis (Ph.D, Physics, Engineering Physics and Astronomy) -- Queen's University, 2013-08-22 11:34:14.861

Radiotherapy is used in clinics to treat cancer with highly energetic ionizing particles. The radiation dose can be measured indirectly by means of radiation detectors or dosimeters. The dose deposited in a detector can be related to dose deposited in a point within the patient. In theory, however, this is only possible under charged particle equilibrium (CPE). The motivation behind the dissertation was driven by the difficult, yet crucial, dosimetry in non-CPE regions. Inaccurate dose assessment performed with standard dosimetry using ionization chambers may significantly impact the outcomes of radiotherapy treatments. Therefore, advanced dosimetry methods tailored specifically to suit non-CPE conditions must be used. This work aims to improve dosimetry in two types of non-CPE conditions that pose dosimetric challenges: regions near interfaces of tissues with low- and high- density media and in small photon fields. To achieve the main dissertation objectives, an enhanced film dosimetry protocol with a novel film calibration approach was implemented. This calibration method is based on the percent depth dose (PDD) tables and was shown to be efficient and accurate. As a result, the PDD calibration method was used for the film dosimetry process throughout the dissertation work. Monte Carlo (MC) calculations for the small field dosimetry were performed using phase-space files (PSFs) provided by Varian for TrueBeam linac. The MC statistical uncertainty in these types of calculations is limited by the number of particles (due to latent variance) in the used PSFs. This study investigated the behaviour of the latent variances (LV) with beam energy, depth in phantom, and calculation resolution (voxel size). LV was evaluated for standard 10x10 cm2 fields as well as small fields (down to 1.3 mm diameter). The results showed that in order to achieve sub-percent LV in open 10x10 cm2 field MC simulations a single PSF can be used, whereas for small SRS fields (1.3—10 mm) more PSFs (66—8 PSFs) would have to be summed. The first study in this dissertation compared the performance of several dosimetric methods in three multi-layer heterogeneous phantoms with water/air, water/lung, and water/steel interfaces irradiated with 6 and 18 MV photon beams. MC calculations were used, along with Acuros XB, anisotropic analytical algorithm (AAA), GafChromic EBT2 film, and MOSkin dosimeters. PDDs were calculated and measured in these heterogeneous phantoms. The result of this study showed that Acuros XB, AAA, and MC calculations were within 1% in the regions with CPE. At media interfaces and buildup regions, differences between Acuros XB and MC were in the range of +4.4% to -12.8%. MOSkin and EBT2 measurements agreed to MC calculations within ~ 2.5%-4.5%. AAA did not predict the backscatter dose from the high-density heterogeneity. For the third, multilayer lung phantom, 6 MV beam PDDs calculated by all treatment planning system (TPS) algorithms were within 2% of MC. 18 MV PDDs calculated by Acuros XB and AAA differed from MC by up to 3.2 and 6.8%, respectively. MOSkin and EBT2 each differed from MC by up to 3%. All dosimetric techniques, except AAA, agreed within 3% in the regions with particle equilibrium. Differences between the dosimetric techniques were larger for the 18 MV than the 6 MV beam. This study provided a comparative performance evaluation of several advanced dosimeters in heterogeneous phantoms. This combination of experimental and calculation dosimetry techniques was used for the first time to evaluate the dose near these interfaces. The second study in the dissertation aims to improve dose measurement accuracy in small radiotherapy fields. Field output factors of 6 MV beams from TrueBeam linear accelerator (linac) collimated with 1.27-40 mm diameter cones were calculated and measured using MC and EBT3 films. A set of detector specific correction factors for two widely used dosimeters (EFD-3G diode and PTW-60019 microDiamond detectors) were determined based on GafChromic EBT3 film measurements and calculated using MC methods. MC calculations were performed for microDiamond detector in parallel and perpendicular orientations relative to the beam axis. The result of this study showed that the measured OFs agreed within 2.4% for fields ≥10 mm. For the cones of 1.27, 2.46, and 3.77 mm diameter maximum differences were 17.9%, 1.8% and 9.0%, respectively. MC calculated OF in water agreed with those obtained using EBT3 film within 2.2% for all fields. MC calculated output correction factors for microDiamond detector in fields ≥10 mm ranged within 0.975-1.020 for perpendicular and parallel orientations. MicroDiamond detector correction factors calculated for the 1.27, 2.46 and 3.77 mm fields were 1.974, 1.139 and 0.982 with detector in parallel orientation, and these factors were 1.150, 0.925 and 0.914 in perpendicular orientation. EBT3 and MC obtained correction factors agreed within 3.7% for fields of ≥3.77 mm and within 5.9% for smaller cones. This work provided output correction factors for microDiamond and EFD-3G detectors in very small fields of 1.27 – 3.77 mm diameter and demonstrated over and under-response of these detectors in such fields. These correction factors allow improve the accuracy of dose measurements in small photon fields using these detectors. / Graduate / 2019-08-30