title: Sum signal dosimetry: A new approach for high dose quality assurance with Gafchromic EBT3.
abstract: Gafchromic EBT3 film dosimetry in radiosurgery (RS) and hypofractionated radiotherapy (HRT) is complicated by the limited film accuracy at high fractional doses. The aim of this study is to develop and evaluate sum signal (SS) film dosimetry to increase dose resolution at high fractional doses, thus allowing for use of EBT3 for dose distribution verification of RS/HRT treatments. To characterize EBT3 dose-response, a calibration was performed in the dose range 0.44-26.43 Gy. Red (RC) and green (GC) channel net optical densities were linearly added to produce the SS. Dose resolution and overall accuracy of the dosimetric protocol were estimated and compared for SS,RC, and GC. A homemade Matlab software was developed to compare, in terms of gamma analysis, dose distributions delivered by a Cyberknife on EBT3 films to dose distributions calculated by the treatment planning system. The new SS and conventional single channel (SC) methods were compared, using 3%/1 and 4%/1 mm acceptance criteria, for 20 patient plans. Our analysis shows that the SS dose-response curve is characterized by a steeper trend in comparison with SC, with SS providing a higher dose resolution in the whole dose range investigated. Gamma analysis confirms that the percentage of points satisfying the agreement criteria is significantly higher for SS compared to SC: 95.03% vs. 88.41% (P = 0.014) for 3%/1 mm acceptance criteria and 97.24% vs. 93.58% (P = 0.048) for 4%/1 mm acceptance criteria. This study demonstrates that the SS approach is a new and effective method to improve dosimetric accuracy in the framework of the RS-HRT patient-specific quality assurance protocol.
authors.affiliation: School of Medical Physics, University of Milan, 20133, Milan, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Cusumano
authors.affiliation: Health Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133, Milan, Italy.
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Fumagalli
authors.affiliation: Health Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Ghielmetti
authors.affiliation: School of Medical Physics, University of Milan, 20133, Milan, Italy.
authors.forename: Linda
authors.initials: L
authors.lastname: Rossi
authors.affiliation: Department of Computer Science, University of Milan, 20135, Milan, Italy.
authors.forename: Giuliano
authors.initials: G
authors.lastname: Grossi
authors.affiliation: Department of Computer Science, University of Milan, 20135, Milan, Italy.
authors.forename: Raffaella
authors.initials: R
authors.lastname: Lanzarotti
authors.affiliation: Department of Neurosurgery, Radiotherapy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133, Milan, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Fariselli
authors.affiliation: Health Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133, Milan, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: De Martin
mesh_terms: D005373:Film Dosimetry; D006801:Humans; D009369:Neoplasms / Q000601:surgery*; D019047:Phantoms, Imaging; D011785:Quality Assurance, Health Care / Q000592:standards*; D011786:Quality Control; D016634:Radiosurgery / Q000592:standards*; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods; D012984:Software
keywords: Gafchromic EBT3; dosimetric verification; radiosurgery/hypofractioned radiotherapy