Measurement of radiotherapy CBCT dose in a phantom using different methods.

Cone beam computed tomography (CBCT) is used widely for the precise and accurate patient set up needed during radiation therapy, notably for hypo fractionated treatments, such as intensity modulated radiation therapy and stereotactic radiation therapy. Reported doses associated with CBCT indicate the potential to approach radiation tolerance levels for some critical organs. However while some manufacturers state the CBCT dose for each standard protocol, currently there are no standard or recognised protocols for CBCT dosimetry. This study has applied wide beam computed tomography dosimetry approaches as reported by the International Atomic Energy Agency and the American Association of Physicists in Medicine to investigate dosimetry for the Varian Trilogy linear accelerator with on-board imager v1.5. Three detection methods were used including (i) the use of both 100 mm and 300 mm pencil ionisation chambers, (ii) a 0.6 cm(3) ionisation chamber and (iii) gafchromic film. Measurements were performed using custom built 45 cm long PMMA phantoms as well as standard 15 cm long phantoms for both head and body simulation. The results showed good agreement between each other detector system (within 3 %). The measured CBCT dose for the above methods showed a large difference to the dose stated by Varian, with the measured dose being 40 % over the stated dose for the standard head protocol. This shows the importance of independently verifying the stated dose given by the vendor for standard procedures.