Experimental investigation of TRS-483 reference dosimetry correction factors for Leksell Gamma Knife® Icon™ beams

Purpose: Radiosurgery using the Leksell Gamma Knife (R) (LGK) Icon (TM) is an established technique used for treating intracranial lesions. The largest beam field size the LGK Icon can produce is a 16 mm diameter sphere. Despite this, reference dosimetry on the LGK Icon is typically performed using ionization chambers calibrated in 10 x 10 cm(2) fields. Furthermore, plastic phantoms are widely used instead of liquid water phantoms. In an effort to resolve these issues, the International Atomic Energy Agency (IAEA) in collaboration with American Association of Physicists in medicine (AAPM) recently published Technical Report Series No. 483 (TRS-483) as a Code of Practice for small-field dosimetry. TRS-483 includes small-field correction factors, k(Qmsr,Q0)(fmsr,fref), intended to account for the differences between setups when using small-field modalities such as the LGK Icon, and conventional setups. Since the publication of TRS-483, at least three new sets of values of k(Qmsr,Q0)(fmsr,fref) for the LGK Icon have been published. The purpose of this study was to experimentally investigate the published values of k(Qmsr,Q0)(fmsr,fref) for commonly used phantom and ionization chamber (IC) models for the LGK Icon. Methods: Dose-rates from two LGK units were determined using acrylonitrile butadiene styrene (ABS) and Certified Medical Grade Solid Water (R) (SW) phantoms, and PTW 31010 and PTW 31016 ICs. Correction factors were applied, and the resulting dose-rates compared. Relative validity of the correction factors was investigated by taking the ratios of dose-rate correction factor products. Additionally, dose-rates from the individual sectors were determined in order to calculate the beam attenuation caused by the ABS phantom adapter. Results and Conclusions: It was seen that the dose-rate is underestimated by at least 1% when using the ABS phantom, which was attributed to fluence perturbation caused by the IC and phantom adapter. Published correction factors k(Qmsr,Q0)(fmsr,fref) account for these effects to varying degree and should be used. The SW phantom is unlikely to underestimate the dose-rate by more than 1%, and applying k(Qmsr,Q0)(fmsr,fref) could not be shown to be necessary. Out of the two phantom models, the ABS phantom is not recommended for use in LGK reference dosimetry. The use of newly published values of k(Qmsr,Q0)(fmsr,fref) should be considered. (c) 2020 The Authors. Medical Physics published by Wiley Periodicals LLC on behalf of American Association of Physicists in Medicine