Dosimetric characteristics of the small diameter BrainLab™ cones used for stereotactic radiosurgery

The purpose was to study the dosimetric characteristics of the small diameter (≤ 10.0 mm) BrainLAB cones used for stereotactic radiosurgery (SRS) treatments in conjunction with a Varian Trilogy accelerator. Required accuracy and precision in dose delivery during SRS can be achieved only when the geometric and dosimetric characteristics of the small radiation fields is completely understood. Although a number of investigators have published the dosimetric characteristics of SRS cones, to our knowledge, there is no generally accepted value for the relative output factor (ROF) for the 5.0 mm diameter cone. Therefore, we have investigated the dosimetric properties of the small (≤ 10.0 mm) diameter BrainLAB SRS cones used in conjunction with the iPlan TPS and a Trilogy linear accelerator with a SRS beam mode. Percentage depth dose (PDD), off-axis ratios (OAR), and ROF were measured using a SRS diode and verified with Monte Carlo (MC) simulations. The dependence of ROF on detector material response was studied. The dependence of PDD, OAR, and ROF on the alignment of the beam CAX with the detector motion line was also investigated using MC simulations. An agreement of 1% and 1 mm was observed between measurements and MC for PDD and OAR. The calculated ROF for the 5.0 mm diameter cone was 0.692 ± 0.008--in good agreement with the measured value of 0.683 ± 0.007 after the diode response was corrected. Simulations of the misalignment between the beam axis and detector motion axis for angles between 0.5°-1.0° have shown a deviation > 2% in PDD beyond a certain depth. We have also provided a full set of dosimetric data for BrainLAB SRS cones. Monte Carlo calculated ROF values for cones with diameters less than 10.0 mm agrees with measured values to within 1.8%. Care should be exercised when measuring PDD and OAR for small cones. We recommend the use of MC to confirm the measurement under these conditions.