The use of radiochromic film (RCF) dosimetry in radiation therapy is extensive due to its high level of achievable accuracy for a wide range of dose values and its suitability under a variety of measurement conditions. However, since the publication of the 1998 AAPM Task Group 55, Report No. 63 on RCF dosimetry, the chemistry, composition, and readout systems for RCFs have evolved steadily. There are several challenges in using the new RCFs, readout systems and validation of the results depending on their applications. Accurate RCF dosimetry requires understanding of RCF selection, handling and calibration methods, calibration curves, dose conversion methods, correction methodologies as well as selection, operation and quality assurance (QA) programs of the readout systems. Acquiring this level of knowledge is not straight forward, even for some experienced users. This Task Group report addresses these issues and provides a basic understanding of available RCF models, dosimetric characteristics and properties, advantages and limitations, configurations, and overall elemental compositions of the RCFs that have changed over the past 20 yr. In addition, this report provides specific guidelines for data processing and analysis schemes and correction methodologies for clinical applications in radiation therapy.

Thermoluminescent dosimeters (TLD) and optically stimulated luminescent dosimeters (OSLD) are practical, accurate, and precise tools for point dosimetry in medical physics applications. The charges of Task Group 191 were to detail the methodologies for practical and optimal luminescence dosimetry in a clinical setting. This includes: (a) to review the variety of TLD/OSLD materials available, including features and limitations of each; (b) to outline the optimal steps to achieve accurate and precise dosimetry with luminescent detectors and to evaluate the uncertainty induced when less rigorous procedures are used; (c) to develop consensus guidelines on the optimal use of luminescent dosimeters for clinical practice; and (d) to develop guidelines for special medically relevant uses of TLDs/OSLDs such as mixed photon/neutron field dosimetry, particle beam dosimetry, and skin dosimetry. While this report provides general guidelines for TLD and OSLD processes, the report provides specific details for TLD‐100 and nanoDotTM dosimeters because of their prevalence in clinical practice.

Purpose To determine whether in-house patient-specific IMRT QA results predict the Imaging and Radiation Oncology Core (IROC)-Houston phantom results. Methods and Materials IROC Houston’s IMRT head and neck phantoms have been irradiated by numerous institutions as part of clinical trial credentialing. We retrospectively compared these phantom results with those of in-house IMRT QA (following the institution’s clinical process) for 855 irradiations performed between 2003 and 2013. The sensitivity and specificity of IMRT QA to detect unacceptable or acceptable plans was determined relative to the IROC Houston phantom results. Additional analyses evaluated specific IMRT QA dosimeters and analysis methods. Results IMRT QA universally showed poor sensitivity relative to the head and neck phantom i.e., poor ability to predict a failing IROC Houston phantom result. Depending on how the IMRT QA results were interpreted, overall sensitivity ranged from 2% to 18%. For different IMRT QA methods, sensitivity ranged from 3% to 54%. Although the observed sensitivity was particularly poor at clinical thresholds (e.g., 3% dose difference or 90% of pixels passing gamma), receiver operator characteristic analysis indicated that no threshold showed good sensitivity and specificity for the devices evaluated. Conclusions IMRT QA is not a reasonable replacement for a credentialing phantom. Moreover, the particularly poor agreement between IMRT QA and the IROC Houston phantoms highlights surprising inconsistency in the QA process.

The Radiological Physics Center (RPC) has functioned continuously for 38 years to assure NCI and the cooperative groups that institutions participating in multi-institutional trials can be expected to deliver radiation treatments that are clinically comparable to those delivered by other institutions in the cooperative groups. To accomplish this, the RPC monitors the machine output, the dosimetry data utilized by the institutions, the calculation algorithms used for treatment planning, and the institutions' quality control procedures. The methods of monitoring include on-site dosimetry review by an RPC physicist, and a variety of remote audit tools. The introduction of advanced technology clinical trials has prompted several study groups to require participating institutions and personnel to become credentialed, to assure their familiarity and capability with techniques such as 3DCRT, IMRT, SBRT and brachytherapy. The RPC conducts a variety of credentialing activities, beginning with questionnaires to evaluate an institution's understanding of the protocol and their capabilities. Treatment planning benchmarks are used to allow the institution to demonstrate their planning ability, and to facilitate a review of the accuracy of treatment planning systems under relevant conditions. The RPC also provides mailable anthropomorphic phantoms to verify tumor dose delivery for special treatment techniques. While conducting these reviews, the RPC has amassed a large amount of data describing the dosimetry at participating institutions. Representative data from the monitoring programs will be discussed and examples will be presented of specific instances in which the RPC contributed to the discovery and resolution of dosimetry errors.

Purpose To determine the impact of treatment planning algorithm on the accuracy of heterogeneous dose calculations in the Radiological Physics Center (RPC) thorax phantom. Methods and Materials We retrospectively analyzed the results of 304 irradiations of the RPC thorax phantom at 221 different institutions as part of credentialing for RTOG clinical trials; the irradiations were all done using 6-MV beams. Treatment plans included those for intensity-modulated radiation therapy (IMRT) as well as 3D conformal therapy (3D CRT). Heterogeneous plans were developed using Monte Carlo (MC), convolution/superposition (CS) and the anisotropic analytic algorithm (AAA), as well as pencil beam (PB) algorithms. For each plan and delivery, the absolute dose measured in the center of a lung target was compared to the calculated dose, as was the planar dose in 3 orthogonal planes. The difference between measured and calculated dose was examined as a function of planning algorithm as well as use of IMRT. Results PB algorithms overestimated the dose delivered to the center of the target by 4.9% on average. Surprisingly, CS algorithms and AAA also showed a systematic overestimation of the dose to the center of the target, by 3.7% on average. In contrast, the MC algorithm dose calculations agreed with measurement within 0.6% on average. There was no difference observed between IMRT and 3D CRT calculation accuracy. Conclusion Unexpectedly, advanced treatment planning systems (those using CS and AAA algorithms) overestimated the dose that was delivered to the lung target. This issue requires attention in terms of heterogeneity calculations and potentially in terms of clinical practice.