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At least 271 records · Page 15

Temporary Arterial Balloon Occlusion as an Adjunct to Yttrium-90 Radioembolization

Purpose. This study was designed to describe the technique of arterial occlusion using a temporary occlusion balloon system as an alternative to coil occlusion during Yttrium-90 radioembolization of hepatic tumors. Methods. Review of charts, angiography, and follow-up imaging studies of consecutive patients undergoing oncological embolization procedures in which a HyperForm system (ev3 Neurovascular, Irvine, CA) was used. Intraprocedural target vessel occlusion and patency of the target vessel on follow-up were recorded. Clinical data and Bremsstrahlung scans were reviewed for evidence of nontarget embolization. Results. Four radioembolization procedures were performed in three patients (all female, age 48-54 (mean 52) years). Five arteries were temporarily occluded (three gastroduodenal arteries, one right gastric artery, and one cystic artery). All radioembolization procedures were successfully completed. Follow-up imaging (either digital subtraction angiography (DSA) or computed tomography angiography (CTA)) was available for all patients between 28-454 (mean 183) days following the procedure, demonstrating all five vessels to be patent. No clinical or imaging evidence for nontarget embolization was found. Conclusions. Temporary balloon occlusion of small and medium-sized arteries during radioembolization allows safe therapy with preserved postprocedural vessel patency on early and midterm follow-up.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

The Residual Setup Errors of Different IGRT Alignment Procedures for Head and Neck IMRT and the Resulting Dosimetric Impact

Purpose: To assess residual setup errors during head and neck radiation therapy and the resulting consequences for the delivered dose for various patient alignment procedures. Methods and Materials: Megavoltage cone beam computed tomography (MVCBCT) scans from 11 head and neck patients who underwent intensity modulated radiation therapy were used to assess setup errors. Each MVCBCT scan was registered to its reference planning kVCT, with seven different alignment procedures: automatic alignment and manual registration to 6 separate bony landmarks (sphenoid, left/right maxillary sinuses, mandible, cervical 1 [C1]-C2, and C7-thoracic 1 [T1] vertebrae). Shifts in the different alignments were compared with each other to determine whether there were any statistically significant differences. Then, the dose distribution was recalculated on 3 MVCBCT images per patient for every alignment procedure. The resulting dose-volume histograms for targets and organs at risk (OARs) were compared to those from the planning kVCTs. Results: The registration procedures produced statistically significant global differences in patient alignment and actual dose distribution, calling for a need for standardization of patient positioning. Vertically, the automatic, sphenoid, and maxillary sinuses alignments mainly generated posterior shifts and resulted in mean increases in maximal dose to OARs of >3% of the planned dose. The suggested choice of C1-C2 as a reference landmark appears valid, combining both OAR sparing and target coverage. Assuming this choice, relevant margins to apply around volumes of interest at the time of planning to take into account for the relative mobility of other regions are discussed. Conclusions: Use of different alignment procedures for treating head and neck patients produced variations in patient setup and dose distribution. With concern for standardizing practice, C1-C2 reference alignment with relevant margins around planning volumes seems to be a valid option.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Fast Megavoltage Computed Tomography: A Rapid Imaging Method for Total Body or Marrow Irradiation in Helical Tomotherapy

Purpose: Megavoltage computed tomographic (MVCT) imaging has been widely used for the 3-dimensional (3-D) setup of patients treated with helical tomotherapy (HT). One drawback of MVCT is its very long imaging time, the result of slow couch speeds of approximately 1 mm/s, which can be difficult for the patient to tolerate. We sought to develop an MVCT imaging method allowing faster couch speeds and to assess its accuracy for image guidance for HT. Methods and Materials: Three cadavers were scanned 4 times with couch speeds of 1, 2, 3, and 4 mm/s. The resulting MVCT images were reconstructed using an iterative reconstruction (IR) algorithm with a penalty term of total variation and with a conventional filtered back projection (FBP) algorithm. The MVCT images were registered with kilovoltage CT images, and the registration errors from the 2 reconstruction algorithms were compared. This fast MVCT imaging was tested in 3 cases of total marrow irradiation as a clinical trial. Results: The 3-D registration errors of the MVCT images reconstructed with the IR algorithm were smaller than the errors of images reconstructed with the FBP algorithm at fast couch speeds (2, 3, 4 mm/s). The scan time and imaging dose at a speed of 4 mm/s were reduced to 30% of those from a conventional coarse mode scan. For the patient imaging, faster MVCT (3 mm/s couch speed) scanning reduced the imaging time and still generated images useful for anatomic registration. Conclusions: Fast MVCT with the IR algorithm is clinically feasible for large 3-D target localization, which may reduce the overall time for the treatment procedure. This technique may also be useful for calculating daily dose distributions or organ motion analyses in HT treatment over a wide area. Automated integration of this imaging is at least needed to further assess its clinical benefits.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Measurement of electron density with the phase-resolved cut-off probe method

The phase resolved cut-off probe method, a precise measurement method for the electron density, was recently proposed [J. H. Kwon et al., Appl. Phys. Lett. 96, 081502 (2010)]. This paper presents the measurements of electron density using the method under various experimental conditions (different pressures, powers, chamber volumes, and discharge sources). The result shows that the method is not only in good agreement with the previous method using wave transmittance under various experimental conditions but it is also able to find the cut-off point clearly even under difficult conditions such as high pressure ({approx} 1 Torr), high discharge power, and small plasma volume. The details of the experimental setup, the operating mechanism of the probe method, and the data processing procedure (algorithm) are also addressed. Furthermore, the reliability of the measurement method is investigated by using an electromagnetic field simulation with cold plasma model (CST-Drude model, Computer Simulation Technology).

70 PLASMA PHYSICS AND FUSION TECHNOLOGY↗

Percutaneous CT-Guided Biopsy of C3 Vertebral Body: Modified Approach for an Old Procedure

Percutaneous biopsy of upper cervical vertebrae is challenging due to the various critical structures in the location and often requires difficult trajectory such as transoral or paramaxillary approaches. The purpose of this manuscript is to illustrate the utility of head rotation in creating a potential space for direct percutaneous access to C3 vertebral body for safe biopsy.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Diaphragmatic Hernia After Radiofrequency Ablation for Hepatocellular Carcinoma

We describe a 71-year-old woman with a hepatocellular carcinoma who underwent percutaneous radiofrequency ablation (RF) with a single internally cooled electrode under computed tomography (CT) fluoroscopic guidance. Nine months after the procedure, CT images showed herniation of the large intestine into the right pleural cavity. To our knowledge this complication of RF performed with a single internally cooled electrode under CT guidance has not been previously reported.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Endovascular Management of Visceral Artery Pseudoaneurysms: Transcatheter Coil Embolization Using the Isolation Technique

PurposeTo describe our experiences with treatment of visceral artery pseudoaneurysms (VAPA) by transcatheter coil embolization using an isolation technique and to propose indications for treating VAPA with this method.Materials and MethodsWe treated 37 patients with VAPA endovascularly: There were 15 pancreaticoduodenal arcade, 10 hepatic, 5 renal, 3 splenic, and 1 each left gastric, gastroepiploic, adrenal, and superior mesenteric artery pseudoaneurysms. Preprocedure computed tomography (CT) and/or angiographic studies confirmed the presence of VAPA in all 37 patients. Using the isolation technique, we embolized vessels at sites distal and proximal to the pseudoaneurysm.ResultsTranscatheter coil embolization with the isolation technique was technically successful in 33 (89%) of 37 patients, and angiogram confirmed the complete disappearance of the VAPA in 32 patients. No major complications occurred during the procedures. In a patient with a pancreaticoduodenal arcade artery pseudoaneurysm, we were unable to control hemorrhage. In 30 of 32 patients who recovered after transcatheter coil embolization using the isolation technique, follow-up CT scan showed no flow in VAPA; they survived without rebleeding. Two of the 32 patients (6%) with confirmed complete disappearance of VAPA on angiogram and CT scan obtained the day after the procedure manifested rebleeding during follow-up.ConclusionTranscatheter coil embolization using the isolation technique is an effective alternative treatment in patients with VAPA. In combination with coil embolization, the isolation technique is particularly useful in patients whose pseudoaneurysms present surgical difficulties.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Patient-Specific Three-Dimensional Concomitant Dose From Cone Beam Computed Tomography Exposure in Image-Guided Radiotherapy

Purpose: The purpose of the present study was to quantify the concomitant dose received by patients undergoing cone beam computed tomography (CBCT) scanning in different clinical scenarios as a part of image-guided radiotherapy (IGRT) procedures. Methods and Materials: We calculated the three-dimensional concomitant dose received as a result of CBCT scans in 6 patients representing different clinical scenarios: two pelvis, two head and neck, and two chest. We assessed the effect that a daily on-line IGRT strategy would have on the patient dose distribution, assuming 40 CBCT scans throughout the treatment course. The additional dose to the planning target volume margin region was also estimated. Results: In the pelvis, a single CBCT scan delivered a mean dose to the femoral heads of 2-6 cGy and the rectum of 1-2 cGy. An additional dose to the planning target volume was within 1-3 cGy. In the chest, the mean dose to the planning target volume varied from 2.5 to 5 cGy. The lung and spinal cord planning organ at risk volume received {<=}4 cGy and {<=}5 cGy, respectively. In the head and neck, a single CBCT scan delivered a mean dose of 0.3 cGy, with bony structures receiving 0.5-0.8 cGy. The femoral heads received an additional dose of 1.5-2.5 Gy. A reduction of 20-30% in the mean dose to the organs at risk was achieved using bowtie filtration. In the head and neck, the dose to the eyes and brainstem was eliminated by decreasing the craniocaudal field size. Conclusions: The additional dose from on-line IGRT procedures can be clinically relevant. The organ dose can be significantly reduced with the use of appropriate patient-specific settings. The concomitant dose from CBCT should be accounted for and the acquisition settings optimized for optimal IGRT strategies on a patient basis.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Accurate spectroscopic characterization of oxirane: A valuable route to its identification in Titan's atmosphere and the assignment of unidentified infrared bands

In an effort to provide an accurate spectroscopic characterization of oxirane, state-of-the-art computational methods and approaches have been employed to determine highly accurate fundamental vibrational frequencies and rotational parameters. Available experimental data were used to assess the reliability of our computations, and an accuracy on average of 10 cm{sup –1} for fundamental transitions as well as overtones and combination bands has been pointed out. Moving to rotational spectroscopy, relative discrepancies of 0.1%, 2%-3%, and 3%-4% were observed for rotational, quartic, and sextic centrifugal-distortion constants, respectively. We are therefore confident that the highly accurate spectroscopic data provided herein can be useful for identification of oxirane in Titan's atmosphere and the assignment of unidentified infrared bands. Since oxirane was already observed in the interstellar medium and some astronomical objects are characterized by very high D/H ratios, we also considered the accurate determination of the spectroscopic parameters for the mono-deuterated species, oxirane-d1. For the latter, an empirical scaling procedure allowed us to improve our computed data and to provide predictions for rotational transitions with a relative accuracy of about 0.02% (i.e., an uncertainty of about 40 MHz for a transition lying at 200 GHz).

74 ATOMIC AND MOLECULAR PHYSICS↗

Chaos and turbulent nucleosynthesis prior to a supernova explosion

Three-dimensional (3D), time dependent numerical simulations of flow of matter in stars, now have sufficient resolution to be fully turbulent. The late stages of the evolution of massive stars, leading up to core collapse to a neutron star (or black hole), and often to supernova explosion and nucleosynthesis, are strongly convective because of vigorous neutrino cooling and nuclear heating. Unlike models based on current stellar evolutionary practice, these simulations show a chaotic dynamics characteristic of highly turbulent flow. Theoretical analysis of this flow, both in the Reynolds-averaged Navier-Stokes (RANS) framework and by simple dynamic models, show an encouraging consistency with the numerical results. It may now be possible to develop physically realistic and robust procedures for convection and mixing which (unlike 3D numerical simulation) may be applied throughout the long life times of stars. In addition, a new picture of the presupernova stages is emerging which is more dynamic and interesting (i.e., predictive of new and newly observed phenomena) than our previous one.

71 CLASSICAL AND QUANTUM MECHANICS, GENERAL PHYSIC↗

Virtual/Augmented Reality (VR/AR):Tools for Nuclear Training, Operations and Design

Introduction: Problems: Mistakes in the field due to a lack of information (Ex: Pump repair failure rate 50%); Avoidable exposure due to multiple employees for procedure adherence and monitoring; Debates over 2D drawings can be more easily resolved. Purpose: Training: Employees can be trained more effectively. Operating: Operations can be carried out more efficiently with fewer workers required with AR. Design Review: Pull the designers and designs into VR. Design: VR: Unreal Engine, Unity, Custom. AR: HoloLens: Unity, Custom - DirectX 12.

42 ENGINEERING↗

The coyote universe extended: Precision emulation of the matter power spectrum

Modern sky surveys are returning precision measurements of cosmological statistics such as weak lensing shear correlations, the distribution of galaxies, and cluster abundance. To fully exploit these observations, theorists must provide predictions that are at least as accurate as the measurements, as well as robust estimates of systematic errors that are inherent to the modeling process. In the nonlinear regime of structure formation, this challenge can only be overcome by developing a large-scale, multi-physics simulation capability covering a range of cosmological models and astrophysical processes. As a first step to achieving this goal, we have recently developed a prediction scheme for the matter power spectrum (a so-called emulator), accurate at the 1% level out to k ∼ 1 Mpc{sup –1} and z = 1 for wCDM cosmologies based on a set of high-accuracy N-body simulations. It is highly desirable to increase the range in both redshift and wavenumber and to extend the reach in cosmological parameter space. To make progress in this direction, while minimizing computational cost, we present a strategy that maximally reuses the original simulations. We demonstrate improvement over the original spatial dynamic range by an order of magnitude, reaching k ∼ 10 h Mpc{sup –1}, a four-fold increase in redshift coverage, to z = 4, and now include the Hubble parameter as a new independent variable. To further the range in k and z, a new set of nested simulations run at modest cost is added to the original set. The extension in h is performed by including perturbation theory results within a multi-scale procedure for building the emulator. This economical methodology still gives excellent error control, ∼5% near the edges of the domain of applicability of the emulator. A public domain code for the new emulator is released as part of the work presented in this paper.

79 ASTRONOMY AND ASTROPHYSICS↗

MO-F-16A-06: Implementation of a Radiation Exposure Monitoring System for Surveillance of Multi-Modality Radiation Dose Data

Purpose: We have implemented a commercially available Radiation Exposure Monitoring System (REMS) to enhance the processes of radiation dose data collection, analysis and alerting developed over the past decade at our sites of practice. REMS allows for consolidation of multiple radiation dose information sources and quicker alerting than previously developed processes. Methods: Thirty-nine x-ray producing imaging modalities were interfaced with the REMS: thirteen computed tomography scanners, sixteen angiography/interventional systems, nine digital radiography systems and one mammography system. A number of methodologies were used to provide dose data to the REMS: Modality Performed Procedure Step (MPPS) messages, DICOM Radiation Dose Structured Reports (RDSR), and DICOM header information. Once interfaced, the dosimetry information from each device underwent validation (first 15–20 exams) before release for viewing by end-users: physicians, medical physicists, technologists and administrators. Results: Before REMS, our diagnostic physics group pulled dosimetry data from seven disparate databases throughout the radiology, radiation oncology, cardiology, electrophysiology, anesthesiology/pain management and vascular surgery departments at two major medical centers and four associated outpatient clinics. With the REMS implementation, we now have one authoritative source of dose information for alerting, longitudinal analysis, dashboard/graphics generation and benchmarking. REMS provides immediate automatic dose alerts utilizing thresholds calculated through daily statistical analysis. This has streamlined our Closing the Loop process for estimated skin exposures in excess of our institutional specific substantial radiation dose level which relied on technologist notification of the diagnostic physics group and daily report from the radiology information system (RIS). REMS also automatically calculates the CT size-specific dose estimate (SSDE) as well as provides two-dimensional angulation dose maps for angiography/interventional procedures. Conclusion: REMS implementation has streamlined and consolidated the dosimetry data collection and analysis process at our institutions while eliminating manual entry error and providing immediate alerting and access to dosimetry data to both physicists and physicians. Brent Stewart has funded research through GE Healthcare.

60 APPLIED LIFE SCIENCES↗

SU-G-JeP3-07: Real-Time Image Guided Radiation Therapy for Heterotopic Ossification in Patients After Hip Replacement

Purpose: To demonstrate the feasibility of using CBCT in a real-time image guided radiation therapy (IGRT) for single fraction heterotopic ossification (HO) in patients after hip replacement. In this real-time procedure, all steps, from simulation, imaging, planning to treatment delivery, are performed at the treatment unit in one appointment time slot. This work promotes real-time treatment to create a paradigm shift in the single fraction radiation therapy. Methods: An integrated real-time IGRT for HO was developed and tested for radiation treatment of heterotopic ossification for patient after hip replacement. After CBCT images are acquired at the linac, and sent to the treatment planning system, the physician determines the field and/or draws a block. Subsequently, a simple 2D AP/PA plan with prescription of 700 cGy is created on-the-fly for physician to review. Once the physician approves the plan, the patient is treated on the same simulation position. This real-time treatment requires the team of attending physician, physicist, therapists, and dosimetrist to work in harmony to achieve all the steps in a timely manner. Results: Ten patients have been treated with this real-time treatment, having the same beams arrangement treatment plan and prescription as our clinically regular CT-based 2D plans. The average time for these procedures are 52.9 ±10.7 minutes from the time patient entered the treatment room until s/he exited, and 37.7 ±8.6 minutes from starting CBCT until last beam delivered. Conclusion: The real-time IGRT for HO treatment has been tested and implemented to be a clinically accepted procedure. This one-time appointment greatly enhances the waiting time, especially when patients in high level of pain, and provides a convenient approach for the whole clinical staff. Other disease sites will be also tested with this new technology.

60 APPLIED LIFE SCIENCES↗

JET MIXING ANALYSIS FOR SRS HIGH-LEVEL WASTE RECOVERY

The process of recovering the waste in storage tanks at the Savannah River Site (SRS) typically requires mixing the contents of the tank to ensure uniformity of the discharge stream. Mixing is accomplished with one to four slurry pumps located within the tank liquid. The slurry pump may be fixed in position or they may rotate depending on the specific mixing requirements. The high-level waste in Tank 48 contains insoluble solids in the form of potassium tetraphenyl borate compounds (KTPB), monosodium titanate (MST), and sludge. Tank 48 is equipped with 4 slurry pumps, which are intended to suspend the insoluble solids prior to transfer of the waste to the Fluidized Bed Steam Reformer (FBSR) process. The FBSR process is being designed for a normal feed of 3.05 wt% insoluble solids. A chemical characterization study has shown the insoluble solids concentration is approximately 3.05 wt% when well-mixed. The project is requesting a Computational Fluid Dynamics (CFD) mixing study from SRNL to determine the solids behavior with 2, 3, and 4 slurry pumps in operation and an estimate of the insoluble solids concentration at the suction of the transfer pump to the FBSR process. The impact of cooling coils is not considered in the current work. The work consists of two principal objectives by taking a CFD approach: (1) To estimate insoluble solids concentration transferred from Tank 48 to the Waste Feed Tank in the FBSR process and (2) To assess the impact of different combinations of four slurry pumps on insoluble solids suspension and mixing in Tank 48. For this work, several different combinations of a maximum of four pumps are considered to determine the resulting flow patterns and local flow velocities which are thought to be associated with sludge particle mixing. Two different elevations of pump nozzles are used for an assessment of the flow patterns on the tank mixing. Pump design and operating parameters used for the analysis are summarized in Table 1. The baseline pump orientations are chosen by the previous work [Lee et. al, 2008] and the initial engineering judgement for the conservative flow estimate since the modeling results for the other pump orientations are compared with the baseline results. As shown in Table 1, the present study assumes that each slurry pump has 900 gpm flowrate for the tank mixing analysis, although the Standard Operating Procedure for Tank 48 currently limits the actual pump speed and flowrate to a value less than 900 gpm for a 29 inch liquid level. Table 2 shows material properties and weight distributions for the solids to be modeled for the mixing analysis in Tank 48.

12 MANAGEMENT OF RADIOACTIVE AND NON-RADIOACTIVE W↗

Coagulation kinetics beyond mean field theory using an optimised Poisson representation

Binary particle coagulation can be modelled as the repeated random process of the combination of two particles to form a third. The kinetics may be represented by population rate equations based on a mean field assumption, according to which the rate of aggregation is taken to be proportional to the product of the mean populations of the two participants, but this can be a poor approximation when the mean populations are small. However, using the Poisson representation, it is possible to derive a set of rate equations that go beyond mean field theory, describing pseudo-populations that are continuous, noisy, and complex, but where averaging over the noise and initial conditions gives the mean of the physical population. Such an approach is explored for the simple case of a size-independent rate of coagulation between particles. Analytical results are compared with numerical computations and with results derived by other means. In the numerical work, we encounter instabilities that can be eliminated using a suitable “gauge” transformation of the problem [P. D. Drummond, Eur. Phys. J. B 38, 617 (2004)] which we show to be equivalent to the application of the Cameron-Martin-Girsanov formula describing a shift in a probability measure. The cost of such a procedure is to introduce additional statistical noise into the numerical results, but we identify an optimised gauge transformation where this difficulty is minimal for the main properties of interest. For more complicated systems, such an approach is likely to be computationally cheaper than Monte Carlo simulation.

71 CLASSICAL AND QUANTUM MECHANICS, GENERAL PHYSIC↗

Method for measuring the focal spot size of an x-ray tube using a coded aperture mask and a digital detector

Purpose: The goal of this study is to evaluate a new method based on a coded aperture mask combined with a digital x-ray imaging detector for measurements of the focal spot sizes of diagnostic x-ray tubes. Common techniques for focal spot size measurements employ a pinhole camera, a slit camera, or a star resolution pattern. The coded aperture mask is a radiation collimator consisting of a large number of apertures disposed on a predetermined grid in an array, through which the radiation source is imaged onto a digital x-ray detector. The method of the coded mask camera allows one to obtain a one-shot accurate and direct measurement of the two dimensions of the focal spot (like that for a pinhole camera) but at a low tube loading (like that for a slit camera). A large number of small apertures in the coded mask operate as a ''multipinhole'' with greater efficiency than a single pinhole, but keeping the resolution of a single pinhole. Methods: X-ray images result from the multiplexed output on the detector image plane of such a multiple aperture array, and the image of the source is digitally reconstructed with a deconvolution algorithm. Images of the focal spot of a laboratory x-ray tube (W anode: 35-80 kVp; focal spot size of 0.04 mm) were acquired at different geometrical magnifications with two different types of digital detector (a photon counting hybrid silicon pixel detector with 0.055 mm pitch and a flat panel CMOS digital detector with 0.05 mm pitch) using a high resolution coded mask (type no-two-holes-touching modified uniformly redundant array) with 480 0.07 mm apertures, designed for imaging at energies below 35 keV. Measurements with a slit camera were performed for comparison. A test with a pinhole camera and with the coded mask on a computed radiography mammography unit with 0.3 mm focal spot was also carried out. Results: The full width at half maximum focal spot sizes were obtained from the line profiles of the decoded images, showing a focal spot of 0.120 mmx0.105 mm at 35 kVp and M=6.1, with a detector entrance exposure as low as 1.82 mR (0.125 mA s tube load). The slit camera indicated a focal spot of 0.112 mmx0.104 mm at 35 kVp and M=3.15, with an exposure at the detector of 72 mR. Focal spot measurements with the coded mask could be performed up to 80 kVp. Tolerance to angular misalignment with the reference beam up to 7 deg. in in-plane rotations and 1 deg. deg in out-of-plane rotations was observed. The axial distance of the focal spot from the coded mask could also be determined. It is possible to determine the beam intensity via measurement of the intensity of the decoded image of the focal spot and via a calibration procedure. Conclusions: Coded aperture masks coupled to a digital area detector produce precise determinations of the focal spot of an x-ray tube with reduced tube loading and measurement time, coupled to a large tolerance in the alignment of the mask.

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗

Addendum to the AAPM's TG-51 protocol for clinical reference dosimetry of high-energy photon beams

An addendum to the AAPM's TG-51 protocol for the determination of absorbed dose to water in megavoltage photon beams is presented. This addendum continues the procedure laid out in TG-51 but new k{sub Q} data for photon beams, based on Monte Carlo simulations, are presented and recommendations are given to improve the accuracy and consistency of the protocol's implementation. The components of the uncertainty budget in determining absorbed dose to water at the reference point are introduced and the magnitude of each component discussed. Finally, the consistency of experimental determination of N{sub D,w} coefficients is discussed. It is expected that the implementation of this addendum will be straightforward, assuming that the user is already familiar with TG-51. The changes introduced by this report are generally minor, although new recommendations could result in procedural changes for individual users. It is expected that the effort on the medical physicist's part to implement this addendum will not be significant and could be done as part of the annual linac calibration.

62 RADIOLOGY AND NUCLEAR MEDICINE↗