Verification of an on line in vivo semiconductor dosimetry system for TBI with two TLD procedures

Camera selection for real-time in vivo radiation treatment verification systems using Cherenkov imaging

PURPOSE

To identify achievable camera performance and hardware needs in a clinical Cherenkov imaging system for real-time, in vivo monitoring of the surface beam profile on patients, as novel visual information, documentation, and possible treatment verification for clinicians.

METHODS

Complementary metal-oxide-semiconductor (CMOS), charge-coupled device (CCD), intensified charge-coupled device (ICCD), and electron multiplying-intensified charge coupled device (EM-ICCD) cameras were investigated to determine Cherenkov imaging performance in a clinical radiotherapy setting, with one emphasis on the maximum supportable frame rate. Where possible, the image intensifier was synchronized using a pulse signal from the Linac in order to image with room lighting conditions comparable to patient treatment scenarios. A solid water phantom irradiated with a 6 MV photon beam was imaged by the cameras to evaluate the maximum frame rate for adequate Cherenkov detection. Adequate detection was defined as an average electron count in the background-subtracted Cherenkov image region of interest in excess of 0.5% (327 counts) of the 16-bit maximum electron count value. Additionally, an ICCD and an EM-ICCD were each used clinically to image two patients undergoing whole-breast radiotherapy to compare clinical advantages and limitations of each system.

RESULTS

Intensifier-coupled cameras were required for imaging Cherenkov emission on the phantom surface with ambient room lighting; standalone CMOS and CCD cameras were not viable. The EM-ICCD was able to collect images from a single Linac pulse delivering less than 0.05 cGy of dose at 30 frames/s (fps) and pixel resolution of 512 × 512, compared to an ICCD which was limited to 4.7 fps at 1024 × 1024 resolution. An intensifier with higher quantum efficiency at the entrance photocathode in the red wavelengths [30% quantum efficiency (QE) vs previous 19%] promises at least 8.6 fps at a resolution of 1024 × 1024 and lower monetary cost than the EM-ICCD.

CONCLUSIONS

The ICCD with an intensifier better optimized for red wavelengths was found to provide the best potential for real-time display (at least 8.6 fps) of radiation dose on the skin during treatment at a resolution of 1024 × 1024.

In vivo dosimetry for total body irradiation: five-year results and technique comparison

The aim of this work is to establish if the new CT‐based total body irradiation (TBI) planning techniques used at University College London Hospital (UCLH) and Royal Free Hospital (RFH) are comparable to the previous technique at the Middlesex Hospital (MXH) by analyzing predicted and measured diode results. TBI aims to deliver a homogeneous dose to the entire body, typically using extended SSD fields with beam modulation to limit doses to organs at risk. In vivo dosimetry is used to verify the accuracy of delivered doses. In 2005, when the Middlesex Hospital was decommissioned and merged with UCLH, both UCLH and the RFH introduced updated CT‐planned TBI techniques, based on the old MXH technique. More CT slices and in vivo measurement points were used by both; UCLH introduced a beam modulation technique using MLC segments, while RFH updated to a combination of lead compensators and bolus. Semiconductor diodes were used to measure entrance and exit doses in several anatomical locations along the entire body. Diode results from both centers for over five years of treatments were analyzed and compared to the previous MXH technique for accuracy and precision of delivered doses. The most stable location was the field center with standard deviations of 4.1% (MXH), 3.7% (UCLH), and 1.7% (RFH). The least stable position was the ankles. Mean variation with fraction number was within 1.5% for all three techniques. In vivo dosimetry can be used to verify complex modulated CT‐planned TBI, and demonstrate improvements and limitations in techniques. The results show that the new UCLH technique is no worse than the previous MXH one and comparable to the current RFH technique.

PACS numbers: 87.55.Qr, 87.56.N‐

Characteristics of in vivo radiotherapy dosimetry

The recent discussion and debate about the use of in vivo dosimetry as a routine component of the radiotherapy treatment process has not included the limitations introduced by the physical characteristics of the detectors. Although a robust calibration procedure will ensure acceptable uncertainties in the measurements of tumour dose, further work is required to confirm the accuracy of critical organ measurements with a diode or a thermoluminescent dosemeter outside the main field owing to limitations caused by a non-uniform X-ray energy response of the detector, differences between the X-ray energy spectrum inside and outside the main field, and contaminating electrons.

Total Body Irradiation, Toward Optimal Individual Delivery: Dose Evaluation With Metal Oxide Field Effect Transistors, Thermoluminescence Detectors, and a Treatment Planning System

PURPOSE

To predict the three-dimensional dose distribution of our total body irradiation technique, using a commercial treatment planning system (TPS). In vivo dosimetry, using metal oxide field effect transistors (MOSFETs) and thermoluminescence detectors (TLDs), was used to verify the calculated dose distributions.

METHODS AND MATERIALS

A total body computed tomography scan was performed and loaded into our TPS, and a three-dimensional-dose distribution was generated. In vivo dosimetry was performed at five locations on the patient. Entrance and exit dose values were converted to midline doses using conversion factors, previously determined with phantom measurements. The TPS-predicted dose values were compared with the MOSFET and TLD in vivo dose values.

RESULTS

The MOSFET and TLD dose values agreed within 3.0% and the MOSFET and TPS data within 0.5%. The convolution algorithm of the TPS, which is routinely applied in the clinic, overestimated the dose in the lung region. Using a superposition algorithm reduced the calculated lung dose by approximately 3%. The dose inhomogeneity, as predicted by the TPS, can be reduced using a simple intensity-modulated radiotherapy technique.

CONCLUSIONS

The use of a TPS to calculate the dose distributions in individual patients during total body irradiation is strongly recommended. Using a TPS gives good insight of the over- and underdosage in a patient and the influence of patient positioning on dose homogeneity. MOSFETs are suitable for in vivo dosimetry purposes during total body irradiation, when using appropriate conversion factors. The MOSFET, TLD, and TPS results agreed within acceptable margins.

Investigation of radiosurgical beam profiles using Monte Carlo method

An accurate determination of the penumbra of radiosurgery profiles is critical to avoid complications in organs at risk adjacent to the tumor. Conventional detectors may not be accurate enough for small field sizes. The Monte Carlo (MC) method was used to study the behavior of radiosurgical beam profiles at the penumbral region; the BEAM code was also used in this work. Two collimators (2.2- and 0.3-cm diameter) were calculated and compared with empirical measurements obtained with the detectors normally used. The differences found between film dosimetry and MC revealed a systematic error in the reading procedure. In the process, a water phantom was simulated with a layer of the same composition as that of the film. MC calculations with film differed by a small amount from those obtained with the water phantom alone. In conclusion, MC may be used as a verification tool to support dosimetrical procedures with conventional detectors, especially in very small beams such as those used in radiosurgery. Furthermore, it has been proved that the film energy dependence is negligible for fields used in radiosurgery.

Feasibility of a semiconductor dosimeter to monitor skin dose in interventional radiology

The design and preliminary test results of a semiconductor silicon dosimeter are presented in this article. Use of this dosimeter is foreseen for real-time skin dose control in interventional radiology. The strong energy dependence of this kind of radiation detector is well overcome by filtering the silicon diode. Here, the optimal filter features have been calculated by numerical Monte Carlo simulations. A prototype has been built and tested in a radiological facility. The first experimental results show a good match between the filtered semiconductor diode response and an ionization chamber response, within 2% fluctuation in a 2.2 to 4.1 mm Al half-value layer (HVL) energy range. Moreover, the semiconductor sensor response is linear from 0.02 Gy/min to at least 6.5 Gy/min, covering the whole dose rate range found in interventional radiology. The results show that a semiconductor dosimeter could be used to monitor skin dose during the majority of procedures using x-rays below 150 keV. The use of this device may assist in avoiding radiation-induced skin injuries and lower radiation levels during interventional procedures.

A Monte Carlo approach for small electron beam dosimetry

BACKGROUND AND PURPOSE

In treatments where it is necessary to conform the field shape yielding a very small effective beam area, dosimetry and conventional treatment planning may be inaccurate. The Monte Carlo (MC) method can be an alternative to verify dose calculations. A conjunctival mucosa-associated lymphoid tissues lymphoma is presented, to show the importance of an independent assessment in critical situations.

MATERIALS AND METHODS

In this work, the MC technique has been employed using the program BEAM (based on EGS4 code). Electron beam simulation has been performed and the results have been compared with those obtained with films. The patient dose distribution has been obtained by two methods: the full Monte Carlo (FMC) simulation and a conventional planning system (PLATO).

RESULTS

Concerning dosimetry, some differences have been observed in the comparison of profiles obtained with film and those obtained with the MC method. Moreover, significant differences were found in the patient isodose distribution between both calculation methods.

CONCLUSIONS

The results highlight that, in treatments where small beams are needed, conventional dosimetry and planning systems have some limitations. Therefore, an independent and more accurate assessment, such as MC, would be desirable.

In vivo dosimetry during external photon beam radiotherapy

In this critical review of the current practice of patient dose verification, we first demonstrate that a high accuracy (about 1-2%, 1 SD) can be obtained. Accurate in vivo dosimetry is possible if diodes and thermoluminescence dosimeters (TLDs), the main detector types in use for in vivo dosimetry, are carefully calibrated and the factors influencing their sensitivity are taken into account. Various methods and philosophies for applying patient dose verification are then evaluated: the measurement of each field for each fraction of each patient, a limited number of checks for all patients, or measurements of specific patient groups, for example, during total body irradiation (TBI) or conformal radiotherapy. The experience of a number of centers is then presented, providing information on the various types of errors detected by in vivo dosimetry, including their frequency and magnitude. From the results of recent studies it can be concluded that in centers having modern equipment with verification systems as well as comprehensive quality assurance (QA) programs, a systematic error larger than 5% in dose delivery is still present for 0.5-1% of the patient treatments. In other studies, a frequency of 3-10% of errors was observed for specific patient groups or when no verification system was present at the accelerator. These results were balanced against the additional manpower and other resources required for such a QA program. It could be concluded that patient dose verification should be an essential part of a QA program in a radiotherapy department, and plays a complementary role to treatment-sheet double checking. As the radiotherapy community makes the transition from the conventional two-dimensional (2D) to three-dimensional (3D) conformal and intensity modulated dose delivery, it is recommended that new treatment techniques be checked systematically for a few patients, and to perform in vivo dosimetry a few times for each patient for situations where errors in dose delivery should be minimized.

Midplane dose determination during total body irradiation using in vivo dosimetry

BACKGROUND AND PURPOSE

During TBI techniques an accurate determination of the dose distribution is very difficult when using commercial treatment planning systems. In order to determine the midplane dose, an algorithm was developed based on the use of in vivo dosimetry.

MATERIALS AND METHODS

Scanditronix EDP-30 diodes were placed at the entrance and the exit surface for in vivo dosimetry. The proposed algorithm was validated firstly in a regular and homogeneous phantom of different thickness with an ionization chamber and TL dosimeters and secondly in an Alderson anthropomorphic phantom with TL dosimeters. In this study, in vivo measurements were evaluated in 60 patients and furthermore, in 20 of them, the midplane dose calculated with this algorithm was compared with the method described by Rizzotti A, Compri C, Garusi GF. Dose evaluation to patients irradiated by 60Co beams, by means of direct measurement on the incident and on the exit surfaces. Radiother. Oncol. 1985;3:279-283.

RESULTS

No differences were found between the two methods. The differences between dose values calculated with both methods and dose values measured with the ionization chamber and TL dosimeters were within +/-22% and +/-4%, respectively, in the regular and homogeneous phantom and within +/-2% in the Alderson phantom. The algorithm was useful in calculating the midplane dose when heterogeneities as lungs were present. Even when partial transmission blocks were used to reduce the dose to the lungs, the algorithm with modified correction factors gave a midplane lung dose in the Alderson phantom within 1.3% of the measurements with TL dosimeters. For 360 patients' measurements in each A-P and P-A field, the relative deviations were analyzed between the measured and calculated entrance, exit dose and midplane dose and the prescribed dose, always applying the temperature correction factor. These deviations at the entrance dose were within +/-4%. Greater deviations were found for the exit dose measurements. Deviations larger than +/-10% corresponded in general to obese patients, with a thickness over 25 cm. The relative deviations between the total received and prescribed midplane doses in 60 patients were within +/-3%.

CONCLUSIONS

The results indicate excellent correspondence between the total prescribed and calculated midplane doses using this algorithm while also no significant differences were found when the Rizzotti method was used. Comparison between doses measured with TL dosimeters in the core of Alderson phantom lungs and doses calculated from in vivo measurements showed that the proposed algorithm could be used in the presence of heterogeneities even when partial transmission blocks were used. The temperature correction factor must be applied in order to avoid a 2-3% dose overestimation.

Thermoluminescence dosimetry applied to in vivo dose measurements for total body irradiation techniques

BACKGROUND AND PURPOSE

In total body irradiation (TBI) treatments in vivo dosimetry is recommended because it makes it possible to ensure the accuracy and quality control of dose delivery. The aim of this work is to set up an in vivo thermoluminescence dosimetry (TLD) system to measure the dose distribution during the TBI technique used prior to bone marrow transplant. Some technical problems due to the presence of lung shielding blocks are discussed.

MATERIALS AND METHODS

Irradiations were performed in the Hospital de la Santa Creu i Sant Pau by means of a Varian Clinac-1800 linear accelerator with 18 MV X-ray beams. Different TLD calibration experiments were set up to optimize in vivo dose assessment and to analyze the influence on dose measurement of shielding blocks. An algorithm to estimate midplane doses from entrance and exit doses is proposed and the estimated dose in critical organs is compared to internal dose measurements performed in an Alderson anthropomorphic phantom.

RESULTS

The predictions of the dose algorithm, even in heterogeneous zones of the body such as the lungs, are in good agreement with the experimental results obtained with and without shielding blocks. The differences between measured and predicted values are in all cases lower than 2%.

CONCLUSIONS

The TLD system described in this work has been proven to be appropriate for in vivo dosimetry in TBI irradiations. The described calibration experiments point out the difficulty of calibrating an in vivo dosimetry system when lung shielding blocks are used.

A CT-aided PC-based physical treatment planning of TBI: a method for dose calculation

BACKGROUND AND PURPOSE

As for conventional radiotherapy, one of the basic requirements in Total Body Irradiation (TBI) is to know accurately the dose delivered to the entire body. Both the dosimetry and the treatment planning need to be improved. Physical, technical and dosimetrical aspects of TBI have been widely discussed in the literature. However, to our knowledge, no planning systems specifically designed for TBI are commercially available. This article describes a CT-aided PC-based planning system (TBI-Plansys) and its dose calculation algorithm, which applies scatter and inhomogeneity corrections, developed for the TBI technique currently in use at our centre (AP/PA irradiation with patient positioned on his side).

MATERIAL AND METHOD

A description of the material and method followed in the dosimetrical procedure is included as it constitutes the basis of the proposed dose calculation algorithm (more than 2D). A Windows programming environment has been used to develop the software.

RESULTS

TBI-Plansys uses patient CT data and indicates absolute and relative dose distributions along midline (at reference points), the transversal axis at the specification point and on transverse sections. The system also calculates the appropriate thicknesses of bolus and shielding to modify undesired dose distributions. TBI-Plansys has been checked against two other well-established systems (beam-zone method and our in vivo semiconductor probe-based system). The checks showed good accuracy with dose differences less than 1% and 3% for homogeneous and inhomogeneous tissues, respectively.

CONCLUSIONS

CT calculations by TBI-Plansys allow us to detect undesired distributions which may go unnoticed by calculations at only some specific points. The system has shown clear advantages for routine clinical use as it generates more detailed and accurate information than manual calculations and diminishes the time requirements.