Objective To investigate muli-leaf collimator (MLC)-defined small field output factors calculated by the treatment planning system (TPS), and to study the measuring method of small field output factors verified by 0.015 cc PinPoint ionization chamber.Methods Eight medical accelerators for intensity-modulated radiation therapy (IMRT) were investigated in Henan province, and TPS-calculated output factors for various small fields (6 cm ×6 cm,4 cm ×4 cm,3 cm ×3 cm and 2 cm ×2 cm) were compared with published values recommended by IAEA.If the relative deviation was more than ± 3％ for the 2 cm ×2 cm field size and ±2％ for the fields of 6 cm ×6 cm, 4 cm ×4 cm and 3 cm ×3 cm, which was beyond the scope of IAEA allowed, the output factors will be measured and verified using 0.015 cc PinPoint ionization chamber and Unidos electrometer.Results TPS-calculated small field output factors for eight medical accelerators were compared with published values.The relative deviation of small field output factors for five pieces of equipment, which accounted for 62.5％ of the total, met the IAEA's requirement, while the other three, which accounted for 37.5％ of the total, did not.After measuring with PinPoint ionization chamber, the results from only three pieces of equipment met minimum IAEA's requirement.Conclusions MLC-defined small field output factors calculated by TPS for some medical accelerators in Henan need to be measured and corrected using micro-ionization chamber, and the measured values could be taken as the basis of radiation treatment planning.

Objective To validate the absorbed dose and two-dimensional dose distribution from photon beam by using Thermoluminescent dosimeter (TLD) and film for intensity modulated radiation therapy (IMRT).Methods A total of 8 medical accelerators were selected among 5 third-grade first-class hospitals using non-probabilistic sampling method in Henan province.TLDs were put into polytetrafluoroethylene solid phantom with size of 5 cm × 15 cm × 15 cm provided by IAEA.After CT scanning,the radiotherapeutic plans were formulated through image transmission to the treatment planning system (TPS).The IMRT plan was implemented for measurement of TLD-absorbed doses under the conditions of 5 cm × 5 cm field,90 cm SSD,10 cm depth,6 MV photon beam and 6 Gy absorbed dose and corresponding measurement unit (MU).The 25 cm × 25 cm film-absorbed dose measurement was made in the same manner as TLD under the conditions of 30 cm × 30 cm size,20 cm thickness,95 cm SSD and 5 cm depth.Results Of eight accelerators,the requirements can be met for 7 accelerators with respect to the relative deviation of TLD absorbed dose except 1.For film,relative deviations were all consistent with the requirements.The passing rate of two-dimensional dose distribution was in line with the requirements for 7 accelerators except 1.Conclusions TLD and film can be used to check the MLC field absorbed dose and two-dimensional dose distribution.This methodis simple,easy to operate and suitable for the implementation of IMRT quality control in hospitals in Henan province.

Objective To measure the positioning accuracy of multi-leaf collimators (MLC) leaves by using radiochromic films,with aim to providing data in support of IAEA's methodology validation.Methods The present study focused on 8 accelerators (Varian,Elekta and Siemens machines) at 6 hospitals in Henan province with highly skilled physicists.The 25 cm × 25 cm radiochromic films were put on 30 cm × 30 cm homogeneous solid phantoms and covered with a 2.0-cm-thick homogeneous solid phantom slabs.The CT-scanned images were transmitted to TPS for plan formulation.With 6 MV X-ray,MLC created 5 strip 3 cm × 0.6 cm picket fence field,each with 3.0 cm strip separation.The SSD was 100 cm at the maximum dose point,with a 250 MU to each strip.The irradiated radiochromic films were returned to IAEA for analysis within one week and compared with the values given by IAEA.Results The difference of film-measured and TPS-planned positions of MLC leaves for each strip picket fence should be within ± 0.5 mm as required by IAEA.For 7 of 8 accelerators selected,the differences of accurately measured MLC leaf positions were all within ±0.5 mm,which were in line with the IAEA requirements,with only other one being beyond-0.5 mm,not consistent with the IAEA requirements.The differences of film-measured actual widths between each pair and all pairs of leaves were within ±0.75 mm as required by IAEA for 7 accelerators,whereas the other one was outside ± 0.75 mm,not consistent with the IAEA requirements.The standard deviation of film-measured actual width of MCL leaf between each pair and all pairs for 7 accelerators were ≤ 0.3 mm as required by IAEA,whereas the other one was 0.5 mm,not consistent with IAEA requirements.Conclusions The MLC positioning accuracy of a few of medical accelerators in Henan is not qualified.It is of great significance to carry out regular quality examination as well as third-party verification to ensure precise delivery of radiotherapy.

Objective: To investigate the implementation of GBZ/T 201.3-2014 Radiation Shielding Specification for Radiotherapy Room--Part 3: Radiotherapy Room of γ-ray Sources (hereinafter referred to GBZ/T 201.3-2014). Methods: A total of 129 personnels, who were involved in the approval and supervision of radiation diagnosis and treatment construction projects in 19 provincial administrative agencies, engaged in radiation protection testing and evaluation of γ-ray radiotherapy rooms in radiation health technology service institutions, and used GBZ/T 201.3-2014 in other institutions (environmental impact assessment, education and scientific research), were selected as the participants using a stratified random sampling method. A questionnaire survey was conducted to assess their awareness and application of the standard. Results: The participants' awareness of GBZ/T 201.3-2014 was ≥63.6%, but the training rate was only 9.1% to 50.0%. The familiarity with the various chapters of the standard was over 86.4%. And 42.6% of the participants reported using the standard at least once a year. Regarding the applicability of the standard, all of the participants believed that the standard meets the needs of approval, supervision, testing, or evaluation, and adapts to the updated development of radiotherapy equipment and technology. And 94.6% of the participants believed that the use of the standard could improve the level of protection design and management, and 92.2% believed that the standard was widely applied. Regarding the adequacy of the standard, 97.7% of the participants believed that the standard's reference for ambient dose equivalent rate was reasonable, while 34.1% believed that the standard needs revision. Conclusion: The participants are satisfied with the standard and believe its applicability. They have a good level of awareness of the standard, but there is a room for improvement in their familiarity with the shielding calculation related content of the standard. The promotion, training, and practicality of the standard need to be strengthened.

Objective: To use TLDs and radiochromic films to verify the prescribed doses to both planned target volume (PTV) and organ at risk (OAR) and the 2D dose distribution in IMRT. Methods: Eight accelerators of different models were selected in Henan province. The polystyrene phantom provided by IAEA was scanned using CT scanners and then the scanned images were transmitted to treatment planning system (TPS) for prescribing respectively the doses to PTV and OAR. IMRT was performed with phantom exposed to a 6 MV X-rays. The irradiated TLDs and films were delivered for measurement and estimation at Secondary Standard Dosimetry Laboratory at National Institute for Radiological Protection, Chinese Center for Disease Control and Prevention. Results: According to IAEA requirements, the relative deviations of the TLD-measured and TPS-planned values were within ±7.0% for the prescribed doses to PTV and OAR. The measured results for PTV have shown that the relative deviation of TLD-measured and TPS-planned values were within -0.3% to 6.9% for 8 accelerators, all consistent with the IAEA requirements. For OAR, the relative deviations of TLD-measured and TPS-planned were within -7.0% to 0.3% for 6 accelerators, consistent with the requirements, whereas those for other 2 accelerators were within -10.8% to -8.4%, not up to the requirements. IAEA required that, for 2D dose distribution, the pass rate of 3 mm/3% be ≥90%. The measured values for 7 accelerators were from 90.2% to 99.9%, consistent with the requirements, whereas that for another one was 70.0%, not meeting the requirement. Conclusions The method to verify, using radiochromic film and TLD, the prescribed doses to PTV and OAR and the pass rate of 2D dose distribution is simple and reliable. It is an important step to implement quality control for IMRT and can provide effective support for medical or third-party service institution to verify clinically prescribed dose.