Clinical use of Gafchromic EBT4 film for in vivo dosimetry for total body irradiation

Purpose: In vivo dosimetry is a common requirement to validate dose accuracy/uniformity in total body irradiation (TBI). Several detectors can be used for in vivo dosimetry, including thermoluminescent dosimeters (TLDs), diodes, ion chambers, optically stimulated luminescent dosimeters (OSLDs), and film. TLDs are well established for use in vivo but required expertise and clinical system availability may make them impractical for multifractionated TBI. OSLDs offer quick readout, but recalls have restricted their use. The purpose of this work was to validate the newly available Gafchromic EBT4 film for TBI in vivo dosimetry. Methods: Film calibration curves were created under standard conditions (6MV/15MV, 1.5/3.0 cm depth, 100 cm source-to-surface distance (SSD), 10 × 10 cm² field), and films were scanned at several time points (0.5–24 h) to determine the shortest development time that yielded accurate dose measurements. 4 × 4 cm² films were placed under 1.5 cm thick bolus on the anterior and posterior sides of a solid water phantom to measure entrance and exit dose under TBI conditions (∼600 cm SSD, 39.5 × 39.5 cm² field, 6 MV/15 MV). These measurements were compared to ion chamber and diode readings for validation. Film measurements were also compared to OSLD measurements for three TBI patients. Results: The shortest development time that resulted in accurate dosimetry and allowed for adequate physician review time was 4 h (± 4% dose accuracy). Film entrance and exit dose measurements were within ± 3.8% of ion chamber and diode readings for 6MV and 15MV beams. Patient film measurements were within ∼ ± 5% for the majority of anatomical measurement locations; however, film and OSLD readings for some anatomic locations deviated by > 10%. Conclusions: These results indicate that EBT4 film can be utilized for accurate in vivo dosimetry for TBI patients and shows good agreement with diode and ion chamber measurements. Further investigation into film and OSLD differences was not possible due to OSLD recalls.