<p>The dose distribution around brachytherapy (BT) sources is characterized by steep dose gradients and an energy spectrum varying rapidly with depth in water around the source. These two properties make experimental verification of the dose distribution difficult, and put high demands on the dosimetry system in use regarding precision, size and energy dependence. The American Association of Physicists in Medicine (AAPM) recommends lithium fluoride (LiF) thermo-luminescence dosimetry (TLD) to be used for verification measurements, as it is the only dosimetry system meeting the requirements, but still the total combined uncertainty in dose-rate determination is as high as 7-9 % (1 σ). Lithium formate is a new dosimetry material that is less energy dependent than LiF, but more sensitive than the most common EPR (electron paramagnetic resonance) dosimetry material, alanine. In order to evaluate lithium formate EPR for BT dosimetry, dosimeters were produced for experimental dose determination around BT source 192Ir. The dosimeters were calibrated against an ionization chamber in a high energy photon beam. Dose to water was determined at 1, 3 and 5 cm radial distance from the source, which was stepped along a straight line in a PMMA phantom. The experiments were performed twice using 4 dosimeters per distance and experiment. Methods to correct for energy dependence were developed and evaluated. The uncertainty in measured dose was estimated. The experimental dose values agreed with the values from the treatment planning system with a maximum deviation of 3.3 %, and an average 1 σ uncertainty of 3 % at 3 and 5 cm and 5 % at 1cm. Uncertainty in radial distance from the source as well as source calibration were the dominating contributions to the total combined uncertainty. Lithium formate EPR has been shown to be a promising alternative to LiF TLD for BT dosimetry.</p>

<p>The technique of ESR-dosimetry and strategies for investigation of new materials as in regard to their applicability as ESR-dosimeters for radiotherapy has been reviewed. As an example six salts of formic and lactic acid has been evaluated. The applicability of the dosimeter has been judged by evaluating the tissue equivalence, radical yield, radical stability, spectral suitability, optimal readout parameters, dose response and sensitivity of the dosimetric system. Dependence of material characteristics and influence parameters has been analysed.</p><p>The reviewed methods have been successfully used for evaluation of the new materials. Lithium formate has been shown to be a good candidate relative to the state of the art dosimeter of alanine. Using optimal readout parameters lithium formate has been shown to be nine times as sensitive but even at moderate settings lithium formate is more sensitive. The results for lithium formate are in accordance to those of previous studies. The signal intensity of sodium formate has also proved to be high but unfortunately the signal fades rapidly.</p><p>Two new methods have been proposed as synthesis of the reviewed methods. The first allows flexible, effective and objective baseline correction of the ESR-spectrum. The second deals with dose response measurement by linear regression of the entire spectrum and was found to be successful in separating the spectral peaks of the induced radicals from the background signal.</p>

<p>The daily uncertainty concerning tumor localization is one of the major problems during the course of radiation therapy. Image guided-radiation therapy (IGRT) can be used to improve the localization and adjustment of the planning target volume. The aim of this work was to evaluate both the IGRT technique used for prostate cancer patients at the department of the Karolinska University Hospital and an alternative on-line adaptive radiation therapy (ART) method with an On-Board Imager (OBI).</p><p>In the first part of the thesis 2D and 3D image registration with an OBI were compared. Ten prostate cancer patients were involved in the analyses. Two different statistical tests were used to determine significant systematic deviations between the two methods. The second part concerns daily dose verifications and dose plan reoptimization of one intensity modulated radiation therapy (IMRT) prostate cancer patient treated with IGRT. The study was based on cone-beam computed tomography (CBCT) images acquired at 6 different treatment fractions. The risk of developing late rectal and bladder toxicity was quantified using normal tissue complication probability (NTCP) calculations. Additional measurements on an Alderson phantom were performed to verify the accuracy of using the CBCT images for dose calculations.</p><p>A statistically significant difference between the 2D-2D and the 3D-3D match applications could be observed in lateral and longitudinal direction. However, the effect differed among the patients. The phantom measurements showed small dose deviations between the CT and CBCT image, with a mean dose increase to the prostate and seminal vesicles (SV) of 2.5 %. The daily dose to the prostate and SV of the IMRT patient showed to be satisfactory. The daily dose to the rectum did not exceed the prescribed rectal dose except at one treatment fraction and the highest risk of developing late rectal toxicity was about 10.4 %. Large daily bladder dose variations were observed and at two treatment fractions the bladder dose restrictions were exceeded. With a reoptimization process of the dose plan, the dose to the bladder could be reduced while conserving the dose to the target.</p><p>This work shows that for these specific patient cases appropriate doses to the prostate and SV can be delivered with IGRT. However, introducing a suitable ART method could lead to a reduction of inter-fractional rectal and bladder dose variations.</p>

<p>Dosimetric characteristics of a CVD single crystal diamond detector have been evaluated. Detector stability, linearity, optimal bias, temperature dependence, directional dependence, priming and pre-irradiation behaviour, depth dose curves and dose profiles were investigated.</p><p>The optimal bias was determined to be 50 V. The detector stability measurement showed a too large variation for absolute dosimetry in a day to day measurement, but acceptable variation during one and the same day. The linearity constant, , in the relation between signal and dose rate, (Fowler 1966), was determined to 0.978 and 0.953 for two detectors. The sub-linearity was also observed in the depth dose curves and could be eliminated with a correction method. The diamond detector showed smaller temperature dependence than the EFD silicon diode. The directional dependency was, <1 %, up to at least ± 15˚ and therefore no angular correction is needed. A priming dose of 0.6 Gy was determined, which is considerably smaller than for existing detectors on the market. After pre-irradiation with electrons (8 and 18 MeV) a large and permanent desensitization of up to 31 % / 500 Gy was detected. This is in contradiction to what previous published articles claim. 15 MV photons also reduced the sensitivity of the detector, but no evidence that 5 MV photons do has been found. A 50 Gy dose of 180 MeV protons did not reduce the sensitivity either. The detector dose rate linearity was improved by electron pre-irradiation. The dose profile penumbras of the diamond detector were, for the most part, smaller than the RK ionization chamber, indicating a better spatial resolution.</p>

<p>In this thesis, a two-dimensional pixel-wise deconvolution method for partial volume correction (PVC) for combined Positron Emission Tomography and Computer Tomography (PET/CT) imaging has been developed. The method is based on Van Cittert's deconvolution algorithm and includes a noise reduction method based on adaptive smoothing and median filters. Furthermore, a technique to take into account the position dependent PET point spread function (PSF) and to reduce ringing artifacts is also described. The quantitative and qualitative performance of the proposed PVC algorithm was evaluated using phantom experiments with varying object size, background and noise level. PVC results in an increased activity recovery as well as image contrast enhancement. However, the quantitative performance of the algorithm is impaired by the presence of background activity and image noise. When applying the correction on clinical PET images, the result was an increase in standardized uptake values, up to 98% for small tumors in the lung. These results suggest that the PVC described in this work significantly improves activity recovery without producing excessive amount of ringing artifacts and noise amplification. The main limitations of the algorithm are the restriction to two dimensions and the lack of regularization constraints based on anatomical information from the co-registered CT images.</p>

External radiotherapy is a common treatment technique for cancer. It has been shown that radiation therapy is a both clinically and economically effective treatment for many types of cancer, even though the equipment is expensive. The technology is in constant evolution and more and more sophisticated and complex techniques are introduced. One of the main tasks for physicists at a radiotherapy department is quality control, i.e. making sure that the treatments are delivered in accordance with the dosimetric intentions. Over dosage of radiation can lead to severe side effects, while under dosage reduces the probability for patient cure. The present thesis is mainly focused on the verification of the calculated dose. Requirements for independent dose calculation software are identified and the procedures using such software are described. In the publications included in the thesis an algorithm specially developed for verification of dose calculations is described and tested. The calculation uncertainties connected with the described algorithm are investigated and modeled. A brief analysis of the quality assurance procedures available and used in external radiotherapy is also included in the thesis. The main conclusion of the thesis is that independent verification of the dose calculations is feasible in an efficient and cost effective quality control system. The independent calculations do not only serve as a protection against accidents, but can also be the basis for comparisons of the dose calculation performance at different clinics.

Radioiodine has been used in nuclear medicine for the treatment of thyroid diseases such as Thyroid Cancer and Thyrotoxicosis for many years. The treatment renders the patient radioactive. To minimize the dose to the patients’ relatives and the general public, restric-tions are imposed on the behaviour of the patient. This project presents the person dose equivalents actually received by family members of radioiodine patients following such restrictions. The family members wore hospital ID-bands on left and right wrists for up to four weeks. Each ID-band contained two LiF: Mg, Ti Thermo Luminescence Dosimeters (TLD) calibrated to measure air kerma. The TLDs were analysed and a total person dose equivalent received by the relative was calculated from the measured air kerma values. The results were compared to the dose constraints imposed by The Swedish Radiation Protection Authority (SSI FS 2000:3) in order to confirm that the new set of restrictions used at Karolinska University Hospital Huddinge maintains the dose to family members below the applicable limits. A total number of 22 relatives were recruited, 8 elderly, 7 adults and 7 children. Of the recruited relatives 4 (2 adults, 2 children) were excluded from the study as they had lost their dosimeter ID-bands or had other reasons not to participate in the study. This leaves the number of relatives used for data analysis at 18 individuals (8 elderly, 5 adults and 5 children) with a min age of 10 years and max age of 80 years. The observed average person dose equivalent of 0.43 mSv (max, 1.27; min, 0.12) indi-cates that the new method of individualised restriction used at Karolinska University Hospital Huddinge work as desired in keeping the dose to family members at an accept-able level. The accuracy of the clinical study has been shown to depend greatly on the method by which the dose is investigated but also on the properties of the TLD material used. There is a potential underestimation of air kerma due to fading of up to 30 %. In addition there are contributing uncertainties from both the calibration method and the conversion to person dose equivalent with the combined uncertainty estimated to be 14%.

The protection of the unborn child in pregnant women from ionizing radiation is very important because the foetus is particularly sensitive to the effects of radiation. In case of pregnant members of staff working with ionising radiation, the unborn child is treated as a member of the general public, and a dose limit of 1 mSv during pregnancy is applied in order to protect the foetus. The purpose of this work was to collect relevant information on exposure conditions and entrance doses of occupationally exposed workers in diagnostic radiology and nuclear medicine, and to give guidelines on how to estimate foetal doses for pregnant staff in such workplaces. With X-ray procedures, an accumulated dose of 2 mSv during pregnancy, measured on the trunk (breast or waist) and behind a lead apron, is sufficient to ensure a foetal dose below 1 mSv. For staff working with nuclear medicine, the corresponding limit is 1.5 mSv taking into account external exposure from 99mTc. When internal contamination cannot be neglected, additional precautions need to be considered.

The International Atomic Energy Agency (IAEA) and the World Health Organisation (WHO) operate the IAEA/WHO TLD postal dose audit programme. The purpose of the programme is to verify the beam calibration in radiotherapy centres in developing countries and to check the Secondary Standards Dosimetry Laboratories (SSDLs). Thermoluminescence dosimeters (TLDs) are used as transfer dosimeters and the evaluation of these are done at the IAEA Dosimetry Laboratory. In the present work the uncertainties in the process of dose determination from TLD readings have been evaluated. The analysis comprises the TLD reading reproducibility, uncertainties in the calibration coefficient, and uncertainties in factors correcting for fading of TL signal, influence of TLD holder, energy response and dose response non-linearity. The individual uncertainties were combined to estimate the total uncertainty in the evaluated dose from TLD readings. Experimental data from 2001-2005 were used in the analysis. The total uncertainty has been estimated to be 1.2 % for irradiations with 60Co -rays and 1.6 % for irradiations with high-energy X-rays. Results from irradiations by the Bureau International des Poids et Mesures (BIPM), Primary Standard Dosimetry Laboratories (PSDLs), Secondary Standard Dosimetry Laboratories (SSDLs) and reference centres compare favourably with the estimated uncertainties. The largest uncertainty components are in the energy correction factor (for high-energy X-rays) with a value of 1.1 % and in the dose response non-linearity correction factor with a value of 0.9 %. It has been shown that the acceptance limits of 5 % for TLD results of hospitals and 3.5 % for SSDLs are justified when related to the uncertainties in the dose calculations and the uncertainty in the determination of absorbed dose to water at the centre, as discussed in IAEA TRS-398 (IAEA, 2000), provided that it is followed.

Background: This is a retrospective study of patients treated with stereotactic body radiation therapy (SBRT) with the stereotactic body frame for centrally located lung tumours. The purpose was to investigate the doses to the different structures of the tracheobronchial tree and to relate these doses to the incidence of atelectasis. The goal was to estimate a tolerance dose for the bronchi. Materials: The patient material consisted of 71 patient treated at the Karolinska University Hospital for a total of 102 tumours between November 1993 and March 2004. The patient group consisted of 36 men and 35 women with a mean age at the treatment of 67 years (range 34-87). The group was a mixture of patients with primary lung cancer and pulmonary metastases. Methods: After rereading and reactivating the dose plans for the patients in the treatment planning system (TPS) the different tracheobronchial structures (trachea, right mainstem bronchus, right superior bronchus, right intermedius bronchus, right medius bronchus, right inferior bronchus, left mainstem bronchus, left superior bronchus, left intermedius bronchus, left inferior bronchus) were outlined. The dose distribution in each structure was calculated and a dose-volume histogram (DVH) was created. Patients were allocated to four groups, i.e. patients with right sided tumours (22), left sided tumours (14), mediastinal tumours (23) and bilateral tumours (10). After that the maximum and mean doses to all structures were analysed. An oncologist reviewed the medical records for the patients and especially looked for atelectasis. The doses were related to the incidence of atelectasis. Results and Conclusions: For the patient group with right sided tumours it seems like the maximum doses to the bronchi are higher for the patients with atelectasis in comparison with patients without atelectasis. A better correlation between atelectasis and maximum doses rather than mean doses was observed for these patients. At this moment the results are too preliminary, so it is not possible to suggest a tolerance dose for the bronchi. What can be said is that the maximum doses to the bronchi for patients with right sided tumours without atelectasis are below 250 Gy3 expressed in biologically equivalent dose (BED) with α/β=3Gy, while at least one bronchi structure in the atelectasis patients received a maximum dose above 250 Gy3.