LABORATORY OPERATIONS MANUAL

“Clinical dosimetry”

for the students enrolled on the Master programme

“Nuclear Power Engineering”

Tomsk 2019
 In the process of mastering the discipline "Clinical dosimetry", students consistently
perform 5 laboratory works, which are organized on the basis of the radiological canyon of the
Tomsk Regional Oncology Center under the guidance of specialists. The results of laboratory
work are issued in the form of reports submitted for review by the teacher of the discipline.
Protection of reports on laboratory work is carried out orally.
The guidelines reflect the main sections of each laboratory work: the name, purpose of the
work, tasks for the work, tasks for the report and test questions. Reports on the implementation
of laboratory work with answers to test questions are submitted in writing, executed in
accordance with the TPU standard.
The number of pages in the report (with the exception of the title page and the list of
references) must be at least 15 and not more than 30.
The maximum score for successful laboratory work is 6-8-10, depending on the topic and
amount of work. The number of points received by the student for each laboratory work is
determined according to the knowledge assessment system.
Knowledge Assessment System

Score Assessment Criteria

8-10 Thorough knowledge of concepts and/or techniques together with a high

degree of skill and/or some elements of originality in satisfying the
requirements of an assignment.
6-8 Good level of knowledge of concepts and/or techniques together with
considerable skill in using them to satisfy the requirements of an
assignment.

4-6 Minimum knowledge of concepts and/or techniques needed to satisfy the

requirements of an assignment.

<4 Unacceptable level of knowledge of concepts and/or techniques together

with some skill in using them to satisfy the requirements of an assignment.

Instructions for the labs:

Laboratory work 1
“Clinical dosimetry of photon beams of high energies on the therapeutic beam of the gamma
equipment for external beam radiotherapy Theratron Equinox 100”

Objective:
Obtain absolute and relative clinical dosimetry skills of gamma beams for external
radiation therapy.

Tasks for work:

–Install water phantom (Blue Phantom);
–Measure the depth dose distribution using the ionization chamber CC13 for SSD = 100,
SSD = 90, S = 110 cm and field size (10 * 10, 20 * 20, 5 * 5 cm2);
–Measure the transverse profiles of the open beam using the ionization chamber CC13 for
field sizes (5 * 5, 10 * 10, 15 * 15, 20 * 20, 30 * 30, 40 * 40 cm2) at depths (5, 10 cm);
–Measure the transverse beam profiles with a motorized wedge using the CC13 ionization
chamber for field sizes (5 * 5, 10 * 10, 15 * 20 cm2);
 Perform absolute dose measurements at a depth of 5 cm and 10 cm for a field of 10 * 10
and SSD = 100 cm using the FC65-G ionization chamber.

Tasks for report design:

Briefly describe the process of installation and preparation of a water phantom for dose
measurements;
Describe the procedures for relative and absolute clinical dosimetry, including standard
measurement conditions and the rationale for the applicability of detectors;
Compare the depth distributions of the gamma beam depending on the RIP and field size,
explain the dependence;
Compare the transverse distributions of the gamma beam with the open field depending on
the size of the field and the depth of measurement, explain the dependence;
Compare the transverse gamma beam distributions for a field with a motorized wedge
depending on the size of the field and the depth of measurement, explain the dependence;
Assess the symmetry and flatness of the beam;
Determine the value of the absorbed dose in water according to the TRS-398 protocol;
Determine of the source activity.

Test questions:
- Definition of the following concepts: absorbed dose, stopping power, kerma, linear
energy transfer, fluence, energy fluence;
- What processes accompany the high-energy photon beam as it passes through matter?
- Equilibrium of charged particles (comparison of kerma and absorbed dose);
- What dosimeters are used in clinical dosimetry;
- Principles of operation of the cavity ionization chamber;
- Determination of the effective measurement point of the camera;
- Application of cavity theories for the ionization chamber and dosimetry protocols;
- Determination of radiation quality in gamma radiation 60Co dosimetry, if the camera was
calibrated on a 60Co reference beam.
- Standard conditions for the determination of Dw on a 60Co gamma-ray beam.
- Determination of the percentage dose in depth (for the primary component of the beam).
- Determination of Dw in standard conditions.
- Main correction factors for determining Dw?
- From what and how does the dose depend on the depth zmax (energy, field size, SSD)?

Laboratory work 2
“Clinical dosimetry of low and medium energy X-ray beams for orthovoltage radiotherapy
(Xstrahl 300)”

Objective:
Obtain absolute and relative clinical dosimetry skills of low and medium energy X-rays for
close-focus radiation therapy.

Tasks for work:

-Install solid-state phantom;
Measure the absolute dose on the surface of the phantom for low-energy X-rays for fields
(10 * 10, 8 * 8, 6 * 6, 4 * 4 cm2) with ionization chamber PTW 23342;
Install water phantom (Blue Phantom);
Measure the depth dose distribution for the medium-energy X-rays using the FC65-G
ionization chamber for the field size (10 * 10, 15 * 15, 20 * 20, 8 * 8, 6 * 6, 4 * 4 cm2);
 Perform measurements of the transverse profiles of the open beam for the medium-energy
X-rays using the FC65-G ionization chamber for field sizes (10 * 10, 15 * 15, 20 * 20, 8 * 8, 6 *
6, 4 * 4 cm2) at a depth of 2 cm;
Perform absolute dose measurements at a depth of 2 cm for medium-energy X-rays for
fields (10 * 10, 15 * 15, 20 * 20, 8 * 8, 6 * 6, 4 * 4 cm2) using the FC65-G ionization chamber;

Tasks for report design:

- Briefly describe the process of installation and preparation of a water phantom for
dosimetry measurements;
- Describe the procedures for relative and absolute clinical dosimetry, including standard
measurement conditions and the rationale for the applicability of detectors;
- Compare the depth dose distributions for low-energy and medium-energy X-rays
depending on the SSD and field size, explain the dependence;
- Compare the transverse distributions for low-energy and medium-energy X-rays with an
open field depending on the size of the field, explain the dependence;
- Assess the symmetry and flatness of the beam for low-energy and medium-energy X-
rays;
- Determine the magnitude of the absorbed dose in water for low-energy and medium-
energy X-rays according to the TRS-398 protocol.

Test questions:
- What are the main differences between the “airborne method” and the “water method” of
determining the absorbed dose in water for X-ray radiation?
- Values affecting the dosimeter?
- What does the backscatter factor show?
- How does the x-ray spectrum change depending on the filter used?
- Why does the fraction exposure time vary with different filters?
- How the backscatter factor will behave depending on increasing the size of the irradiation
field for the same beam quality
- How does PDD change depending on energy, field size, SSD?

Laboratory work 3
“Clinical dosimetry of the gamma radiation beam on the brachytherapy equipment (Multisource
HDR)”

Objective:
Obtain skills in conducting clinical gamma dosimetry for brachytherapy.

Tasks for work:

- Install a solid cylindrical phantom (PTW 9193);
- Carry out measurements of the reference air kerma rate in the air (RAKR) using the
FC65-G ionization chamber.

Tasks for report design:

- Determine the reference air kerma rate in the air (RAKR) of the source;
- Determine the current activity of the source.

Test questions:
- Basic requirements for installing a solid-state phantom?
- How is the influence of phantom material for determining RAKR taken into account?
- How is the transition to the standard conditions for determining RAKR in air (time,
distance) taken into account?
 - How is the source type taken into account for determining RAKR (60Co)?
- Describe the TG-43 formalism for calculating doses from point sources.
- What is the principle of superposition for brachytherapy dose calculation?
- How is the total dose calculated during irradiation?

Laboratory work 4
“Clinical dosimetry of photon beams of high energies on the therapeutic beam of the Elekta
Synergy linear accelerator”

Objective:
Obtain absolute and relative clinical dosimetry skills of high-energy photons for external
radiation therapy.

Tasks for work:

- Install water phantom (Blue Phantom);
- Measure the depth dose distribution using the ionization chamber CC13 for SSD = 100,
SSD = 90, SSD = 110 cm and field size (10 * 10, 20 * 20, 5 * 5 cm2) for photon beams;
- Measure the transverse profiles of the open beam using the ionization chamber CC13 for
field sizes (5 * 5, 10 * 10, 15 * 15, 20 * 20, 30 * 30, 40 * 40 cm 2) at depths (Dmax, 5, 10 cm ) for
6 and 10 MV photon beams;
- Measure the transverse beam profiles with a motorized wedge using the CC13 ionization
chamber for field sizes (5 * 5, 10 * 10, 15 * 15, 20 * 20, 30 * 20 cm 2) at depths (Dmax, 5, 10 cm)
for 6 and 10 MV photon beam;
- Perform absolute dose measurements for 6 and 10 MV photon beam energies at the depth
of 5 cm and 10 cm for a field of 10 * 10 cm 2 and SSD = 100, SAD = 100 cm using an FC65-G
ionization chamber.

Tasks for report design:

- Describe the procedures for relative and absolute clinical dosimetry, including standard
measurement conditions and the rationale for the applicability of detectors;
- Compare the depth dose distributions of the high-energy photon beam depending on the
SSD and the field size and photon radiation energies, explain the dependence;
- Compare the transverse distributions of the gamma beam with the open field depending
on the size of the field and the depth of measurement, the photon radiation energy, explain the
dependence;
- Assess the symmetry and flatness of the 6 and 10 MV beams;
- Compare the transverse distributions of the photon beams with a motorized wedge
depending on the size of the field and the depth of measurement, explain the dependence;
- Determine the value of the absorbed dose in water for photons beams according to the
TRS-398 and TG-51 protocols.

Test questions:
- Describe the areas of the transverse profile of a high-energy photon beams.
- Determination of the parameters of the transverse profile of a high-energy photon beam
(flatness, symmetry), requirements for them from the point of view of clinical use.
- The coefficient of radiation output for high energy photons.
- The reasons for the formation of "horns" in the transverse profile of high-energy photon
beams, their dependence on energy.
- Type of dose distribution with /without a flattening filter in the linac head for the photon
beam?
- Features of the beam profile measurement (transverse distributions).
- Determination of the profile of a large fields exceeding the phantom geometry?
 - What type of ionization chambers should be used for small sizes of radiation fields (less
than 5 * 5 cm2) and why?
- How the temperature and atmospheric pressure influence on the readings of the dosimeter
(ionization chamber).
- How the polarity effect influence on the dosimeter (ionization chamber) readings.
- How the ion recombination effect influence on dosimeter (ionization chamber) readings
- Determination of the quality of a beam of high-energy photons other than 60Co gamma
radiation. Beam quality value selection (measurements of beam quality under standard
conditions) according to TRS-398, advantages and disadvantages.
- Determination of the quality of a beam of high-energy photons other than 60Co gamma
radiation. Selection of beam quality value (measurements of beam quality in standard conditions
up to 10 MV and above 10 MV) according to TG-51, advantages and disadvantages
- Standard conditions for determining Dw in water for high energy photons (TRS-398).
- Standard conditions for determining Dw in water for high energy photons (TG-51).
- How does the position of zmax vary in depth depending on the energy, beam geometry?

Laboratory work 5
“Clinical dosimetry of electron beams of high energies on the therapeutic beam of the Elekta
Synergy linear accelerator”

Objective:
Obtain the absolute and relative clinical dosimetry skills of high-energy electrons for
external radiation therapy.

Tasks for work:

- Install water phantom (Blue Phantom);
- Measure the depth dose distribution using the PPC40 ionization chamber for SSD = 100,
SSD = 90, SSD = 110 cm and field size (6 * 6, 10 * 10, 14 * 14, 20 * 20 cm 2) for electron beam
energies 6 , 9, 12, 15 MeV;
- Measure the transverse profiles of the open beam using the PPC40 ionization chamber for
field sizes (6 * 6, 10 * 10, 14 * 14, 20 * 20 cm 2) at depths (Dmax, D90 cm) for electron beam
energies 6, 9, 12 , 15 MeV;
- Measure the absolute dose for electron energies of 6, 9, 12, 15 MeV at a depth of D max,
D90 cm for a field of 10 * 10 cm2and SSD = 100, SAD = 100 cm using the PPC40 ionization
chamber.

Tasks for report design:

- Briefly describe the process of installation and preparation of a water phantom for
dosimetry measurements;
- Describe the procedures for relative and absolute clinical dosimetry, including standard
measurement conditions and the rationale for the applicability of detectors;
-Compare the depth distributions of the high-energy electron beam as a function of the
SSD and the size of the field, explain the dependence;
- Compare the transverse distributions of the high-energy electron beam depending on the
size of the field and the depth of measurement, the radiation energy, explain the dependence;
- Assess the symmetry and flatness of the beams for the electron beam energies of 6, 9, 12,
15 MeV;
- Determine the value of the absorbed dose in water for electron radiation with an energy
of 6, 9, 12, 15 MeV according to the protocol TRS-398 and TG-51.

Compulsory Readings :
1. Absorbed dose determination in external beam radiotherapy: An international code of
practice for dosimetry based on standards of absorbed dose to water TRS-398 / P.
Andreo, D.T. Burns, K. Hohlfeld et al. // Absorbed Dose Determination in External Beam
Radiotherapy: An International Code of Practice for Dosimetry Based on Standards of
Absorbed Dose to Water. — 2000.
2. AAPM’s TG-51 protocol for clinical reference dosimetry of high-energy photon and
electron beams / P.R. Almond, P.J. Biggs, B.M. Coursey et al. // Medical Physics. —
1999. — Vol. 26, no. 9. — Pp. 1847–1870.
3. Addendum to the AAPM’s TG-51 protocol for clinical reference dosimetry of high-
energy photon beams / M. McEwen, L. Dewerd, G. Ibbott et al. // Medical Physics. —
2014. — Vol. 41, no. 4.
4. Schulz R.J., Almond P.R., Cunningham J.R. A protocol for the determination of absorbed
dose from high-energy photon and electron beams // Medical Physics. — 1983. — Vol.
10, no. 6. — Pp. 741–771.
5. Clinical electron-beam dosimetry: Report of AAPM radiation therapy committee task
group no. 25 / F.M. Khan, K.P. Doppke, K.R. Hogstrom et al. // Medical Physics. —
1991. — Vol. 18, no. 1. — Pp. 73–109.
6. AAPM protocol for 40-300 kV x-ray beam dosimetry in radiotherapy and radiobiology /
C.- M. Ma, C.W. Coffey, L.A. DeWerd et al. // Medical Physics. — 2001. — Vol. 28, no.
6. — Pp. 868–893.
7. Dosimetric verification of source strength for HDR afterloading units with Ir-192 and
Co-60 photon sources: Comparison if three different international protocols. Journal of
Medical Physics, Vol 37. No 4. 2012.
8. ESTRO booklet №8 – A Practical Guide to Quality Control of Brachytherapy Equipment.
Edited by Jack Venselaar José Pérez-Calatayud, ISBN 90-804532-8 © 2004 by ESTRO.
9. Update of AAPM Task Group No. 43 Report: A revised AAPM protocol for
brachytherapy dose calculations / Rivard MJ1, Coursey BM, DeWerd LA, Hanson WF,
Huq MS, Ibbott GS, Mitch MG, Nath R, Williamson JF. // Med Phys. 2004
Mar;31(3):633-74.
10. AAPM code of practice for radiotherapy accelerators: Report of AAPM radiation therapy task
group no. 45 / R. Nath, P.J. Biggs, F.J. Bova et al. // Medical Physics. — 1994. — Vol. 21, no. 7.
— Pp. 1093–1121
11. Report of AAPM Therapy Physics Committee Task Group 74: In-air output ratio, S-c, for
megavoltage photon beams / Zhu TC1, Ahnesjö A, Lam KL, Li XA, Ma CM, Palta JR,
Sharpe MB, Thomadsen B, Tailor RC. // Med Phys. 2009 Nov;36(11):5261-91.
12. Accelerator beam data commissioning equipment and procedures: Report of the TG-106
of the Therapy Physics Committee of the AAPM / I.J. Das, C.-W. Cheng, R.J. Watts et
al. // Medical Physics. — 2008. — Vol. 35, no. 9. — Pp. 4186–4215
13. Faiz M. Khan. The physics of radiation therapy. 5-th edition, 2014.
14. Van Dyk J (Editor) The Modern Technology of Radiation Oncology – A compendium for
Medical Physicists and Radiation Oncologists, Medical Physics Publishing (Madison,
Wisconsin), ISBN 0-944838-22-7.
15. Podgorsak EB (Technical Editor) Radiation Oncology Physics – A handbook for
Teachers and Students, IAEA Vienna, ISBN 92-0-107304-6.
16. Brady WL, Heilmann HP, Molls M (Eds) – New Technologies in Radiation Oncology,
Springer, ISBN 3-540-00321-5.