Radiochromic film dosimetry for verification of dose distributions delivered with proton-beam radiosurgery

In this work we studied the feasibility of radiochromic film for dosimetry verification of proton Bragg peak stereotactic radiosurgery with multiple beams. High-sensitivity MD-55 radiochromic film was calibrated for proton beam irradiation and the RIT 113 system was employed for film evaluation. Simulated stereotactic radiosurery with a special phantom arrangement for film dosimetry was performed, following the same procedure as for a patient undergoing treatment. Five-beam irradiation was developed using a 3D treatment planning system. This plan was then delivered to the phantom in a one-day experiment. Planned and measured composite dose distributions were compared. Spatial accuracy of dose delivery to a region containing a simulated critical structure was evaluated for a single portal. Radiochromic film dosimetry validated the prescribed dose delivery within ±5%, one standard deviation, by comparing calculated doses with measured values. The alignment of apertures and boluses, as well as the alignment of the phantom with respect to the isocentre, was confirmed. Spatial accuracy of the method would have been able to detect possible misalignments greater than ±2 mm. We have demonstrated how radiochromic film dosimetry can be used to measure complex dose distributions in an irradiated phantom, thus enabling us to verify planned dose delivery of proton Bragg peak stereotactic radiosurgery with multiple beams. We assume that the dosimetric agreement between planned and measured dose distributions for the reported simulations will apply to patient treatments.