Purpose: The scope of this study was to determine a complete set of correction factors for several detectors in static small photon fields for two linear accelerators (linacs) and for several detectors. Methods: Measurements for Monte Carlo (MC) commissioning were performed for two linacs, Siemens Primus and Elekta Synergy. After having determined the source parameters that best fit the measurements of field specific output factors, profiles, and tissue‐phantom ratio, the generalized version of the classical beam quality correction factor for static small fields,kQclin,Qmsrfclin,fmsr, were determined for several types of detectors by using the egs_chamber Monte Carlo user code which can accurately reproduce the geometry and the material composition of the detector. The influence of many parameters (energy and radial FWHM of the electron beam source, field dimensions, type of accelerator) on the value of kQclin,Qmsrfclin,fmsr was evaluated. Moreover, a MC analysis of the parameters that influence the change of kQclin,Qmsrfclin,fmsr as a function of field dimension was performed. A detailed analysis of uncertainties related to the measurements of the field specific output factor and to the Monte Carlo calculation of kQclin,Qmsrfclin,fmsr was done. Results: The simulations demonstrated that the correction factor kQclin,Qmsrfclin,fmsr can be considered independent from the quality beam factor Q in the range 0.68 ± 0.01 for all the detectors analyzed. The kQclin,Qmsrfclin,fmsr of PTW 60012 and EDGE diodes can be assumed dependent only on the field size, for fields down to 0.5 × 0.5 cm2. The microLion, and the microchambers, instead, must be used with some caution because they exhibit a slight dependence on the radial FWHM of the electron source, and therefore, a correction factor only dependent on field size can be used for fields ≥0.75 × 0.75 and ≥1.0 × 1.0 cm2, respectively. The analysis of uncertainties gave an estimate of uncertainty for the 0.5 × 0.5 cm2 field of about 0.7% (1σ) for kQclin,Qmsrfclin,fmsr factor and of about 1.0% (1σ) for the field output factor, ΩQclin,Qmsrfclin,fmsr, of diodes, microchambers, and microLion. Conclusions: Stereotactic diodes with the appropriate kQclin,Qmsrfclin,fmsr are recommended for determining ΩQclin,Qmsrfclin,fmsr of small photon beams.

Monte Carlo (MC) simulation of dose to water and dose to detector has been used to calculate the correction factors needed for dose calibration and output factor measurements on the CyberKnife system. Reference field ionization chambers simulated were the PTW 30006, Exradin A12, and NE 2571 Farmer chambers, and small volume chambers PTW 31014 and 31010. Correction factors for Farmer chambers were found to be 0.7%-0.9% larger than those determined from TRS-398 due mainly to the dose gradient across the chamber cavity. For one microchamber where comparison was possible, the factor was 0.5% lower than TRS-398 which is consistent with previous MC simulations of flattening filter free Linacs. Output factor detectors simulated were diode models PTW 60008, 60012, 60017, 60018, Sun Nuclear edge detector, air-filled microchambers Exradin A16 and PTW 31014, and liquid-filled microchamber PTW 31018 microLion. Factors were generated for both fixed and iris collimators. The resulting correction factors differ from unity by up to +11% for air-filled microchambers and -6% for diodes at the smallest field size (5 mm), and tend towards unity with increasing field size (correction factor magnitude <1% for all detectors at field sizes >15 mm). Output factor measurements performed using these detectors with fixed and iris collimators on two different CyberKnife systems showed initial differences between detectors of >15% at 5 mm field size. After correction the measurements on each unit agreed within ∼1.5% at the smallest field size. This paper provides a complete set of correction factors needed to apply a new small field dosimetry formalism to both collimator types on the CyberKnife system using a range of commonly used detectors.

Compared with MC simulation, the Exradin W1 PSD can reproduce the PDDs, TMRs, and OARs in water with a high degree of accuracy; thus, the correction used for converting dose is very close to unity. The stereotactic diode is a viable alternative because it shows an acceptable systematic error in the measurement of PDDs and TMRs and a significant underestimation in only the tail region of the OAR measurements, where the dose is low and differences in dose may not be therapeutically meaningful.

Monte Carlo simulation was used to calculate correction factors for output factor (OF), percentage depth-dose (PDD), and off-axis ratio (OAR) measurements with the CyberKnife M6 System. These include the first such data for the InCise MLC. Simulated detectors include diodes, air-filled microchambers, a synthetic microdiamond detector, and point scintillator. Individual perturbation factors were also evaluated. OF corrections show similar trends to previous studies. With a 5 mm fixed collimator the diode correction to convert a measured OF to the corresponding point dose ratio varies between  -6.1% and  -3.5% for the diode models evaluated, while in a 7.6 mm  ×  7.7 mm MLC field these are  -4.5% to  -1.8%. The corresponding microchamber corrections are  +9.9% to  +10.7% and  +3.5% to  +4.0%. The microdiamond corrections have a maximum of  -1.4% for the 7.5 mm and 10 mm collimators. The scintillator corrections are <1% in all beams. Measured OF showed uncorrected inter-detector differences >15%, reducing to <3% after correction. PDD corrections at d > d were<2% for all detectors except IBA Razor where a maximum 4% correction was observed at 300 mm depth. OAR corrections were smaller inside the field than outside. At the beam edge microchamber OAR corrections were up to 15%, mainly caused by density perturbations, which blurs the measured penumbra. With larger beams and depths, PTW and IBA diode corrections outside the beam were up to 20% while the Edge detector needed smaller corrections although these did vary with orientation. These effects are most noticeable for large field size and depth, where they are dominated by fluence and stopping power perturbations. The microdiamond OAR corrections were <3% outside the beam. This paper provides OF corrections that can be used for commissioning new CyberKnife M6 Systems and retrospectively checking estimated corrections used previously. We recommend the PDD and OAR corrections are used to guide detector selection and inform the evaluation of results rather than to explicitly correct measurements.

A previous study of the corrections needed for output factor measurements with the CyberKnife system has been extended to include new diode detectors (IBA SFD and Exradin D1V), an air filled microchamber (Exradin CC01) and a scintillation detector (Exradin W1). The dependence of the corrections on detector orientation (detector long axis parallel versus perpendicular to the beam axis) and source to detector distance (SDD) was evaluated for these new detectors and for those in our previous study. The new diodes are found to over-respond at the smallest (5 mm) field size by 2.5% (D1V) and 3.3% (SFD) at 800 mm SDD, while the CC01 under-responds by 7.4% at the same distance when oriented parallel to the beam. Corrections for all detectors tend to unity as field size increases. The W1 corrections are <0.5% at all field sizes. Microchamber correction factors increase substantially if the detector is oriented perpendicular to the beam (by up to 23% for the PTW 31014). Corrections also vary with SDD, with the largest variations seen for microchambers in the perpendicular orientation (up to 13% change at 650 mm SDD versus 800 mm) and smallest for diodes (~1% change at 650 mm versus 800 mm). The smallest and most stable corrections are found for diodes, liquid filled microchambers and scintillation detectors, therefore these should be preferred for small field output factor measurements. If air filled microchambers are used, then the parallel orientation should be preferred to the perpendicular, and care should be taken to use corrections appropriate to the measurement SDD.