title: Comparison and uncertainty evaluation of different calibration protocols and ionization chambers for low-energy surface brachytherapy dosimetry.
abstract: OBJECTIVE
  A surface electronic brachytherapy (EBT) device is in fact an x-ray source collimated with specific applicators. Low-energy (<100 kVp) x-ray beam dosimetry faces several challenges that need to be addressed. A number of calibration protocols have been published for x-ray beam dosimetry. The media in which measurements are performed are the fundamental difference between them. The aim of this study was to evaluate the surface dose rate of a low-energy x-ray source with small field applicators using different calibration standards and different small-volume ionization chambers, comparing the values and uncertainties of each methodology.
  
  
  METHODS
  The surface dose rate of the EBT unit Esteya (Elekta Brachytherapy, The Netherlands), a 69.5 kVp x-ray source with applicators of 10, 15, 20, 25, and 30 mm diameter, was evaluated using the AAPM TG-61 (based on air kerma) and International Atomic Energy Agency (IAEA) TRS-398 (based on absorbed dose to water) dosimetry protocols for low-energy photon beams. A plane parallel T34013 ionization chamber (PTW Freiburg, Germany) calibrated in terms of both absorbed dose to water and air kerma was used to compare the two dosimetry protocols. Another PTW chamber of the same model was used to evaluate the reproducibility between these chambers. Measurements were also performed with two different Exradin A20 (Standard Imaging, Inc., Middleton, WI) chambers calibrated in terms of air kerma.
  
  
  RESULTS
  Differences between surface dose rates measured in air and in water using the T34013 chamber range from 1.6% to 3.3%. No field size dependence has been observed. Differences are below 3.7% when measurements with the A20 and the T34013 chambers calibrated in air are compared. Estimated uncertainty (with coverage factor k = 1) for the T34013 chamber calibrated in water is 2.2%-2.4%, whereas it increases to 2.5% and 2.7% for the A20 and T34013 chambers calibrated in air, respectively. The output factors, measured with the PTW chambers, differ by less than 1.1% for any applicator size when compared to the output factors that were measured with the A20 chamber.
  
  
  CONCLUSIONS
  Measurements using both dosimetric protocols are consistent, once the overall uncertainties are considered. There is also consistency between measurements performed with both chambers calibrated in air. Both the T34013 and A20 chambers have negligible stem effect. Any x-ray surface brachytherapy system, including Esteya, can be characterized using either one of these calibration protocols and ionization chambers. Having less correction factors, lower uncertainty, and based on measurements, performed in closer to clinical conditions, the TRS-398 protocol seems to be the preferred option.
authors.affiliation: Radiation Oncology Department, La Fe University and Polytechnic Hospital, Valencia 46026, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Candela-Juan
authors.affiliation: Department of Atomic, Molecular, and Nuclear Physics, University of Valencia, Burjassot 46100, Spain and Instituto de Física Corpuscular (UV-CSIC), Paterna 46980, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Vijande
authors.affiliation: Radiation Oncology Department, Hospital La Ribera, Alzira 46600, Spain.
authors.forename: T
authors.initials: T
authors.lastname: García-Martínez
authors.affiliation: Elekta Brachytherapy, Veenendaal 3905 TH, The Netherlands.
authors.forename: Y
authors.initials: Y
authors.lastname: Niatsetski
authors.affiliation: Elekta Brachytherapy, Veenendaal 3905 TH, The Netherlands.
authors.forename: G
authors.initials: G
authors.lastname: Nauta
authors.affiliation: Elekta Brachytherapy, Veenendaal 3905 TH, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Schuurman
authors.affiliation: Radiation Oncology Department, Lynn Regional Cancer Center, Boca Raton Community Hospital, Boca Raton, Florida 33486.
authors.forename: Z
authors.initials: Z
authors.lastname: Ouhib
authors.affiliation: Department of Atomic, Molecular, and Nuclear Physics, University of Valencia, Burjassot 46100, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Ballester
authors.affiliation: Radiation Oncology Department, La Fe University and Polytechnic Hospital, Valencia 46026, Spain and Department of Radiotherapy, Clínica Benidorm, Benidorm 03501, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Perez-Calatayud
mesh_terms: D001918:Brachytherapy / Q000295:instrumentation* / Q000379:methods*; D002138:Calibration; D019047:Phantoms, Imaging; D017785:Photons; D011874:Radiometry / Q000295:instrumentation* / Q000379:methods*; D035501:Uncertainty; D014867:Water; D014965:X-Rays
chemical_list: D014867:Water