Monte Carlo simulated correction factors for output factor measurement with the CyberKnife system-results for new detectors and correction factor dependence on measurement distance and detector orientation

A previous study of the corrections needed for output factor measurements with the CyberKnife system has been extended to include new diode detectors (IBA SFD and Exradin D1V), an air filled microchamber (Exradin CC01) and a scintillation detector (Exradin W1). The dependence of the corrections on detector orientation (detector long axis parallel versus perpendicular to the beam axis) and source to detector distance (SDD) was evaluated for these new detectors and for those in our previous study. The new diodes are found to over-respond at the smallest (5 mm) field size by 2.5% (D1V) and 3.3% (SFD) at 800 mm SDD, while the CC01 under-responds by 7.4% at the same distance when oriented parallel to the beam. Corrections for all detectors tend to unity as field size increases. The W1 corrections are <0.5% at all field sizes. Microchamber correction factors increase substantially if the detector is oriented perpendicular to the beam (by up to 23% for the PTW 31014). Corrections also vary with SDD, with the largest variations seen for microchambers in the perpendicular orientation (up to 13% change at 650 mm SDD versus 800 mm) and smallest for diodes (similar to 1% change at 650 mm versus 800 mm). The smallest and most stable corrections are found for diodes, liquid filled microchambers and scintillation detectors, therefore these should be preferred for small field output factor measurements. If air filled microchambers are used, then the parallel orientation should be preferred to the perpendicular, and care should be taken to use corrections appropriate to the measurement SDD.