The use of small fields in radiotherapy techniques has increased substantially, in particular in stereotactic treatments and large uniform or nonuniform fields that are composed of small fields such as for intensity modulated radiation therapy (IMRT). This has been facilitated by the increased availability of standard and add-on multileaf collimators and a variety of new treatment units. For these fields, dosimetric errors have become considerably larger than in conventional beams mostly due to two reasons; (i) the reference conditions recommended by conventional Codes of Practice (CoPs) cannot be established in some machines and (ii) the measurement of absorbed dose to water in composite fields is not standardized. In order to develop standardized recommendations for dosimetry procedures and detectors, an international working group on reference dosimetry of small and nonstandard fields has been established by the International Atomic Energy Agency (IAEA) in cooperation with the American Association of Physicists in Medicine (AAPM) Therapy Physics Committee. This paper outlines a new formalism for the dosimetry of small and composite fields with the intention to extend recommendations given in conventional CoPs for clinical reference dosimetry based on absorbed dose to water. This formalism introduces the concept of two new intermediate calibration fields: (i) a static machine-specific reference field for those modalities that cannot establish conventional reference conditions and (ii) a plan-class specific reference field closer to the patient-specific clinical fields thereby facilitating standardization of composite field dosimetry. Prior to progressing with developing a CoP or other form of recommendation, the members of this IAEA working group welcome comments from the international medical physics community on the formalism presented here.

Accurate determination of collimator output factors is important for Leksell Gamma Knife radiosurgery. The new Leksell Gamma Knife Perfexion system has a completely redesigned collimator system and the collimator output factors are different from the other Leksell Gamma Knife models. In this study, a simple method was developed to validate the collimator output factors specifically for Leksell Gamma Knife Perfexion. The method uses double-shot exposures on a single film to eliminate repeated setups and the necessity to acquire dose calibration curves required for the traditional film exposure method. Using the method, the collimator output factors with respect to the 16 mm collimator were measured to be 0.929 +/- 0.009 and 0.817 +/- 0.012 for the 8 mm and the 4 mm collimator, respectively. These values are in agreement (within 2%) with the default values of 0.924 and 0.805 in the Leksell Gamma Plan treatment planning system. These values also agree with recently published results of 0.917 (8 mm collimator) and 0.818 (4 mm collimator) obtained from the traditional methods. Given the efficiency of the method, measurement and validation of the collimator output factors can be readily adopted in commissioning and quality assurance of a Leksell Gamma Knife Perfexion system.

Significant differences in shape, size, and location between the targets included in this study were identified and therefore the clinical implications of these differences should be further investigated.

This investigation involves quantifying the extent of intracranial peripheral dose arising from simulated targets situated in the skull-base or upper-spine region using the Leksell GammaKnife Perfexion treatment unit. For each of three spherical target volumes--denoted as Vs (4 cm3), VM (18 cm3), and VL (60 cm3)--three treatment plans were manually generated, one for each of the three collimator sizes--4, 8, and 16 mm. Each of the plans was delivered to a spherical dosimetry phantom with an insert containing EBT Gafchromic film. The total dose at 70 mm from the targets' edges, %D(70 mm), was measured as a function of elevation angle and expressed as a percentage of the prescription dose. The film insert was placed centered in the median sagittal plane (Leksell X = 100) and %D(70 mm) was measured for the angular range from 0 degree (superior/along Z axis) to 90 degrees (anterior/along Y axis). For a given collimator i, the irradiation time ti to treat a spherical target of volume V using the 50% isodose line was observed to follow a power-law relationship of the form ti = Ai(V/ Vi)n where Ai was the maximum dose divided by collimator dose rate and Vi was the volume encompassed by the 50% isodose line for a single shot. The mean value of n was 0.61 (range: 0.61-0.62). Along the superior (Z) direction (angle=0 degree) and up to angles of around 30 degrees, the %D(70 mm) was always highest for the 4 mm plans, followed by the 8 mm, followed by the 16 mm. In this angular range, the maximum measured %D(70 mm) was 1.7% of the prescription dose. The intracranial peripheral dose along the superior direction (combined scatter and leakage dose) resulting from irradiation of upper-spine or base-of-skull lesions is measured to be less than 2% of the prescription dose, even for very large (60 cm3) targets. The results of this study indicate that, for a given target volume, treatment plans consisting of only 4 mm shots yield larger peripheral dose in the superior direction than 8 mm shot only plans, which in turn yield larger peripheral dose than 16 mm shot only plans.

Background: Gamma knife surgery (GKS) is used at subnecrotic doses for temporal lobe epilepsy (TLE) treatment. Rat models of TLE have been used to probe the mechanisms underlying GKS. Previous GKS studies on rats have used the Leksell GammaPlan® (LGP) treatment planning system to determine the irradiation time to achieve the dose to deliver. Since LGP is not designed for such small structures, it is important to calibrate the system for the rat brain. Methods: We have used a Monte Carlo simulation (MCS) radiation transport scheme, with CT data as anatomical and tissue-specific information, to simulate the dose distribution in a rat brain when using a Leksell Gamma Knife®. Results: We show how dose distributions obtained by MCS quantitatively compare to those predicted by LGP, and discuss whether LGP should be used for studies involving rats. The energy deposited when using the 4-mm collimators was calculated for targets on both sides of the rat brain in the dorsal hippocampus, which allowed us to determine the exact time to irradiate rats with a given dose. Conclusion: The MCS method used in this study can easily be used for future GKS studies on small animals when accurate dose distributions are required.