In-situ calibration of clinical built-in KAP meters with traceability to a primary standard using a reference KAP meter

The air kerma-area product (KAP) is used for settings of diagnostic reference levels. The International Atomic Energy Agency (IAEA) recommends that doses in diagnostic radiology (including the KAP values) be estimated with an accuracy of at least ±7% (k = 2). Industry standards defined by the International Electrotechnical Commission (IEC) specify that the uncertainty of KAP meter measurements should be less than ±25 (k = 2). Medical physicists willing to comply with the IAEA's recommendation need to apply correction factors to KAP values reported by x-ray units. The aim of this work is to present and evaluate a calibration method for built-in KAP meters on clinical x-ray units. The method is based on (i) a tandem calibration method, which uses a reference KAP meter calibrated to measure the incident radiation, (ii) measurements using an energy-independent ionization chamber to correct for the energy dependence of the reference KAP meter, and (iii) Monte Carlo simulations of the beam quality correction factors that correct for differences between beam qualities at a standard laboratory and the clinic. The method was applied to the KAP meter in a Siemens Aristos FX plus unit. It was found that values reported by the built-in KAP meter differed from the more accurate values measured by the reference KAP meter by more than 25% for high tube voltages (more than 140 kV) and heavily filtered beams (0.3 mm Cu). Associated uncertainties were too high to claim that the IEC's limit of 25% was exceeded. Nevertheless the differences were high enough to justify the need for a more accurate calibration of built-in KAP meters. (paper)