The history and principles of chemical dosimetry for 3-D radiation fields: Gels, polymers and plastics

Validation of complex radiotherapy techniques using polymer gel dosimetry

Modern radiotherapy delivers highly conformal dose distributions to irregularly shaped target volumes while sparing the surrounding normal tissue. Due to the complex planning and delivery techniques, dose verification and validation of the whole treatment workflow by end-to-end tests became much more important and polymer gel dosimeters are one of the few possibilities to capture the delivered dose distribution in 3D. The basic principles and formulations of gel dosimetry and its evaluation methods are described and the available studies validating device-specific geometrical parameters as well as the dose delivery by advanced radiotherapy techniques, such as 3D-CRT/IMRT and stereotactic radiosurgery treatments, the treatment of moving targets, online-adaptive magnetic resonance-guided radiotherapy as well as proton and ion beam treatments, are reviewed. The present status and limitations as well as future challenges of polymer gel dosimetry for the validation of complex radiotherapy techniques are discussed.

Evaluation of Fused Deposition Modeling Materials for 3D-Printed Container of Dosimetric Polymer Gel

Accurate dosimetric verification is becoming increasingly important in radiotherapy. Although polymer gel dosimetry may be useful for verifying complex 3D dose distributions, it has limitations for clinical application due to its strong reactivity with oxygen and other contaminants. Therefore, it is important that the material of the gel storage container blocks reaction with external contaminants. In this study, we tested the effect of air and the chemical permeability of various polymer-based 3D printing materials that can be used as gel containers. A methacrylic acid, gelatin, and tetrakis (hydroxymethyl) phosphonium chloride gel was used. Five types of printing materials that can be applied to the fused deposition modeling (FDM)-type 3D printer were compared: acrylonitrile butadiene styrene (ABS), co-polyester (CPE), polycarbonate (PC), polylactic acid (PLA), and polypropylene (PP) (reference: glass vial). The map of R2 (1/T2) relaxation rates for each material, obtained from magnetic resonance imaging scans, was analyzed. Additionally, response histograms and dose calibration curves from the R2 map were evaluated. The R2 distribution showed that CPE had sharper boundaries than the other materials, and the profile gradient of CPE was also closest to the reference vial. Histograms and dose calibration showed that CPE provided the most homogeneous and the highest relative response of 83.5%, with 8.6% root mean square error, compared with the reference vial. These results indicate that CPE is a reasonable material for the FDM-type 3D printing gel container.

Optically stimulated luminescence in state-of-the-art LYSO:Ce scintillators enables high spatial resolution 3D dose imaging

In this contribution, we study the optically stimulated luminescence (OSL) exhibited by commercial \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\hbox {Lu}_{(2-x)}\hbox {Y}_x\hbox {SiO}_5$$\end{document}Lu(2-x)YxSiO5:Ce crystals. This photon emission mechanism, complementary to scintillation, can trap a fraction of radiation energy deposited in the material and provides sufficient signal to develop a novel post-irradiation 3D dose readout. We characterize the OSL emission through spectrally and temporally resolved measurements and monitor the dose linearity response over a broad range. The measurements show that the \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\hbox {Ce}^{3+}$$\end{document}Ce3+ centers responsible for scintillation also function as recombination centers for the OSL mechanism. The capture to OSL-active traps competes with scintillation originating from the direct non-radiative energy transfer to the luminescent centers. An OSL response on the order of 100 ph/MeV is estimated. We demonstrate the imaging capabilities provided by such an OSL photon yield using a proof-of-concept optical readout method. A 0.1 \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\hbox {mm}^3$$\end{document}mm3 spatial resolution for doses as low as 0.5 Gy is projected using a cubic crystal to image volumetric dose profiles. While OSL degrades the intrinsic scintillating performance by reducing the number of scintillation photons emitted following the passage of ionizing radiation, it can encode highly resolved spatial information of the interaction point of the particle. This feature combines ionizing radiation spectroscopy and 3D reusable dose imaging in a single material.

Study of Ag Nanoparticles in a Polyacrylamide Hydrogel Dosimeters by Optical Technique

The dosimetric characteristics of hydrogel dosimeters based on polyacrylamide (PAC) as a capping agent incorporating silver nitrate as a radiation-sensitive material are investigated using UV-Vis spectrophotometry within the dose range 0–100 Gy. Glycerol was used in the hydrogel matrix to promote the dosimetric response and increase the radiation sensitivity. Upon exposing the PAC hydrogel to γ-ray, it exhibits a Surface Plasmon Resonance (SPR) band at 453 nm, and its intensity increases linearly with absorbed doses up to 100 Gy. The results are compared with the silver nitrate gel dosimeter. Glycerol of 15% in the hydrogel matrix enhances the radiation sensitivity by about 30%. PAC hydrogel dosimeter can be considered a near water equivalent material in the 400 keV–20 MeV photon energy range. At doses less than 15 Gy, the PAC hydrogel dosimeter retains higher radiation sensitivity than the gel dosimeter. The total uncertainty (2σ) of the dose estimated using this hydrogel is about 4%. These results may support the validity of using this hydrogel as a dosimeter to verify radiotherapy techniques and dose monitoring during blood irradiation.

Development of a dosimeter prototype with machine learning based 3-D dose reconstruction capabilities

A 3-D dosimeter fills the need for treatment plan and delivery verification required by every modern radiation-therapy method used today. This report summarizes a proof-of-concept study to develop a water-equivalent solid 3-D dosimeter that is based on novel radiation-hard scintillating material. The active material of the prototype dosimeter is a blend of radiation-hard peroxide-cured polysiloxane plastic doped with scintillating agent P-Terphenyl and wavelength-shifter BisMSB. The prototype detector was tested with 6 MV and 10 MV x-ray beams at Ohio State University's Comprehensive Cancer Center. A 3-D dose distribution was successfully reconstructed by a neural network specifically trained for this prototype. This report summarizes the material production procedure, the material's water equivalency investigation, the design of the prototype dosimeter and its beam tests, as well as the details of the utilized machine learning approach and the reconstructed 3-D dose distributions.

Hydrogels for Three-Dimensional Ionizing-Radiation Dosimetry

Radiation-sensitive gels are among the most recent and promising developments for radiation therapy (RT) dosimetry. RT dosimetry has the twofold goal of ensuring the quality of the treatment and the radiation protection of the patient. Benchmark dosimetry for acceptance testing and commissioning of RT systems is still based on ionization chambers. However, even the smallest chambers cannot resolve the steep dose gradients of up to 30-50% per mm generated with the most advanced techniques. While a multitude of systems based, e.g., on luminescence, silicon diodes and radiochromic materials have been developed, they do not allow the truly continuous 3D dose measurements offered by radiation-sensitive gels. The gels are tissue equivalent, so they also serve as phantoms, and their response is largely independent of radiation quality and dose rate. Some of them are infused with ferrous sulfate and rely on the radiation-induced oxidation of ferrous ions to ferric ions (Fricke-gels). Other formulations consist of monomers dispersed in a gelatinous medium (Polyacrylamide gels) and rely on radiation-induced polymerization, which creates a stable polymer structure. In both gel types, irradiation causes changes in proton relaxation rates that are proportional to locally absorbed dose and can be imaged using magnetic resonance imaging (MRI). Changes in color and/or opacification of the gels also occur upon irradiation, allowing the use of optical tomography techniques. In this work, we review both Fricke and polyacrylamide gels with emphasis on their chemical and physical properties and on their applications for radiation dosimetry.

Polyphenolic extracts from the xerophyte Rhamnus lycioides as a radiation biodosimeter

The majority of dosimeters currently in use are synthetic and very expensive. Therefore, the study of the dosimetric characteristics of polyphenolic extracts of xerophytes is useful because drought stress causes an increase in the production of these cheap and natural compounds containing benzene rings. Here, the polyphenolic compounds were extracted from Rhamnus lycioides which was collected from Bou-Hedma National Park in Tunisia and identified using liquid chromatography-mass spectrometry (LC-MS). We investigated the impact of cobalt-60 (⁶⁰Co) irradiation (0-30 kilogray (kGy)) on the color parameters of polyphenolic extracts of R. lycioides using the Konica Minolta CR 300 portable colorimeter and UV-Visible spectroscopy. The structural and morphological characteristics of the irradiated extracts were assessed using Fourier transform infrared (FT-IR) spectroscopy, X-ray diffraction (XRD) technique and scanning electron microscopy (SEM). Overall, our results suggest that exposure to ionizing radiation (IR) of the polyphenolic components of the xerophyte R. lycioides has produced significant dose-dependent changes in their optical and morphological properties. Thus, these extracts can be valorized as biodosimeters in the dose range from 5 to 25 kGy.

Comprehensive evaluation of the high-resolution diode array for SRS dosimetry

A high-resolution diode array has been comprehensively evaluated. It consists of 1013 point diode detectors arranged on the two 7.7 × 7.7 cm² printed circuit boards (PCBs). The PCBs are aligned face to face in such a way that the active volumes of all diodes are in the same plane. All individual correction factors required for accurate dosimetry have been validated for conventional and flattening filter free (FFF) 6MV beams. That included diode response equalization, linearity, repetition rate dependence, field size dependence, angular dependence at the central axis and off-axis in the transverse, sagittal, and multiple arbitrary planes. In the end-to-end tests the array and radiochromic film dose distributions for SRS-type multiple-target plans were compared. In the equalization test (180° rotation), the average percent dose error between the normal and rotated positions for all diodes was 0.01% ± 0.1% (range -0.3 to 0.4%) and -0.01% ± 0.2% (range -0.9 to 0.9%) for 6 MV and 6MV FFF beams, respectively. For the axial angular response, corrected dose stayed within 2% from the ion chamber for all gantry angles, until the beam direction approached the detector plane. In azimuthal direction, the device agreed with the scintillator within 1% for both energies. For multiple combinations of couch and gantry angles, the average percent errors were -0.00% ± 0.6% (range: -2.1% to 1.6%) and -0.1% ± 0.5% (range -1.6% to 2.1%) for the 6MV and 6MV FFF beams, respectively. The measured output factors were largely within 2% of the scintillator, except for the 5 mm 6MV beam showing a 3.2% deviation. The 2%/1 mm gamma analysis of composite SRS measurements produced the 97.2 ± 1.3% (range 95.8-98.5%) average passing rate against film. Submillimeter (≤0.5 mm) dose profile alignment with film was demonstrated in all cases.

Raman spectroscopy as a tool to evaluate oxygen effects on the response of polymer gel dosimetry

Currently, advanced dosimeters like polymer gels are capable of obtaining reliable and accurate 3D dose distributions from correlations with the different polymerization degrees induced by incident radiation. Samples of polymer gel dosimeters are commonly read out using magnetic resonance imaging or optical methods like visible light transmission or laser computed tomography. Alternatively, this work proposes and evaluates the implementation of Raman spectroscopy to provide direct information on the effect of oxygen permeating through the walls of phantoms on the polymerization initiated by irradiation in three types of polymer gel dosimeters, namely NIPAM, ITABIS and PAGAT. The aim of the present study is to provide better and complete interpretations using three different containers, adequate for integral, 2D and 3D dose mapping. Moreover, Raman spectroscopy has been used to analyze the well-known effect of oxygen inhibition on the different polymer gel dosimeters remarking the importance of avoiding air exposition during sample storage and readout. Dose-response curves for different polymer gels were obtained in terms of measurements with a calibrated ionization chamber. Additionally, dedicated Monte Carlo simulations were performed aimed at characterizing dose for different X-ray irradiation setups, providing also suitable information to evaluate oxygen diffusion through the sample wall. The obtained results were contrasted with optical transmission readout as well as Monte Carlo simulations attaining very good agreements for all dosimeter types.

Evaluations of N-(Isobutoxymethyl) acrylamide gel dosimeter by NMR technique for radiotherapy and uncertainty in dose measurements

N-(Isobutoxymethyl) acrylamide (NIBMA) monomer in gelatin, named NIBMAGAT gel dosimeter, was prepared and investigated by nuclear magnetic imaging (NMR) for radiotherapy in the dose range of 0-30 Gy. NIBMA monomer polymerizes upon irradiation, increasing spin-spin relaxation rate R₂. The addition of glycerol as a co-solvent in the gel matrix improved its radiation sensitivity better than the co-solvents of acetone and methanol. The increase of glycerol content by 1% wt/wt enhanced the sensitivity by ˜ 3.1%. This gel has better radiation sensitivity as compared to the polyacrylamide gel (PAG) dosimeter; the sensitivities of NIBMAGAT gel and normoxic polyacrylamide gel (nPAG) are ≈0.13 and ≈0.1 s^-1.Gy^-1, respectively. By comparing NIBMAGAT gel dosimeter with PAG, nMAG and nPAG gel dosimeters, NIBMAGAT gel dosimeter is less influenced by scanning temperature than the last three dosimeters. The gel is water equivalent and has an energy-independent response from 80 keV to 20 MeV. The overall uncertainty of dose measurement using NIBMAGAT gel is 5.46% at 2σ. Our findings suggest the applicability of using NIBMAGAT gel dosimeter by NMR technique for dose verification/planning in the practice of clinical radiotherapy.

Quality assurance of volumetric-modulated arc therapy head and neck cancer treatment using PRESAGE® dosimeter

Background

Accurate three-dimensional dosimetry is essential in modern radiotherapy techniques such as volumetric-modulated arc therapy (VMAT) and intensity-modulated radiation therapy (IMRT). In this research work, the PRESAGE® dosimeter was used as quality assurance (QA) tool for VMAT planning for head and neck (H&N) cancer.

Material and method

Computer tomography (CT) scans of an Image Radiation Oncology Core (IROC) H&N anthropomorphic phantom with both IROC standard insert and PRESAGE® insert were acquired separately. Both CT scans were imported into the Pinnacle (9.4 version) TPS for treatment planning, where the structures [planning target volume (PTV), organs at risk) and thermoluminescent detectors (TLDs) were manually contoured and used to optimise a VMAT plan. Treatment planning was done using VMAT (dual arc: 182°–178°, 178°–182°). Beam profile comparisons and gamma analysis were used to quantify agreement with film, PRESAGE® measurement and treatment planning system (TPS) calculated dose distribution.

Results

The average ratio of TLD measured to calculated doses at the four PTV locations in the H&N phantom were between 0·95 to 0·99 for all three VMAT deliveries. Dose profiles were taken along the left–right, the anterior–posterior and superior–inferior axes, and good agreement was found between the PRESAGE® and Pinnacle profile. The mean value of gamma results for three VMAT deliveries in axial and sagittal planes were found to be 94·24 and 93·16% when compared with film and Pinnacle, respectively. The average values comparing the PRESAGE® results and dose values calculated on Pinnacle were observed to be 95·29 and 94·38% in the said planes, respectively, using a 5%/3 mm gamma criteria.

Conclusion

The PRESAGE® dose measurements and calculated dose of pinnacle show reasonable agreement in both axial and sagittal planes for complex dual arc VMAT treatment plans. In general, the PRESAGE® dosimeter is found to be a feasible QA tool of VMAT plan for H&N cancer treatment.

A hybrid volumetric dose verification method for single-isocenter multiple-target cranial SRS

A commercial semi‐empirical volumetric dose verification system (PerFraction [PF], Sun Nuclear Corp.) extracts multi‐leaf collimator positions from the electronic portal imaging device movies collected during a pre‐treatment run, while the rest of the delivered control point information is harvested from the accelerator log files. This combination is used to reconstruct dose on a patient CT dataset with a fast superposition/convolution algorithm. The method was validated for single‐isocenter multi‐target SRS VMAT treatments against absolute radiochromic film measurements in a cylindrical phantom. The targets ranged in size from 0.8 to 3.6 cm and in number from 3 to 10 per plan. A total of 17 films rotated at different angles around the cylinder axis were analyzed. Each of 27 total targets was intercepted by at least one film, and 2–4 different films were analyzed per plan. Film dose was always scaled to the ion chamber measurement in a high‐dose, low‐gradient area deliberately created at the isocenter. The planar dose agreement between PF and film using 3%(Global dose‐difference normalization)/1 mm gamma analysis was on average 99.2 ± 1.1%. The point dose difference in the low‐gradient area in the middle of every target was below 3%, while PF‐reconstructed and film dose centroids for individual targets showed submillimeter agreement when measured on a well aligned accelerator. Volumetrically, all voxels in all plans agreed between PF and the primary treatment planning system at the 3%/1 mm level. With proper understanding of its advantages and shortcomings, the tool can be applied to patient‐specific QA in routine radiosurgical clinical practice.

Radio-Fluorogenic Gel Dosimetry with Coumarin

Gel dosimeters are attractive detectors for radiation therapy, with properties similar to biological tissue and the potential to visualize volumetric dose distributions. Radio-fluorogenesis is the yield of fluorescent chemical products in response to energy deposition from ionizing radiation. This report shares the development of a novel radio-fluorogenic gel (RFG) dosimeter, gelatin infused with coumarin-3-carboxlyic acid (C3CA), for the quantification of imparted energy. Aqueous solutions exposed to ionizing radiation result in the production of hydroxyl free radicals through water radiolysis. Interactions between hydroxyl free radicals and coumarin-3-carboxylic acid produce a fluorescent product. 7-hydroxy-coumarin-3-carboxylic acid has a blue (445 nm) emission following ultra-violet (UV) to near UV (365–405 nm) excitation. Effects of C3CA concentration and pH buffers were investigated. The response of the RFG was explored with respect to strength, type, and exposure rate of high-energy radiation. Results show a linear dose response relationship independent of energy and type, with a dose-rate dependency. This report demonstrates increased photo-yield with high pH and the utility of gelatin-RFG for phantom studies of radiation dosimetry.

Real-time volumetric relative dosimetry for magnetic resonance-image-guided radiation therapy (MR-IGRT)

The integration of magnetic resonance imaging (MRI) with linear accelerators (linac) has enabled the use of 3D MR-visible gel dosimeters for real-time verification of volumetric dose distributions. Several iron-based radiochromic 3D gels were created in-house then imaged and irradiated in a pre-clinical 1.5 T-7 MV MR-Linac. MR images were acquired using a range of balanced-fast field echo (b-FFE) sequences during irradiation to assess the contrast and dose response in irradiated regions and to minimize the presence of MR artifacts. Out of four radiochromic 3D gel formulations, the FOX 3D gel was found to provide superior MR contrast in the irradiated regions. The FOX gels responded linearly with respect to real-time dose and the signal remained stable post-irradiation for at least 20 min. The response of the FOX gel also was found to be unaffected by the radiofrequency and gradient fields created by the b-FFE sequence during irradiation. A reusable version of the FOX gel was used for b-FFE sequence optimization to reduce artifacts by increasing the number of averages at the expense of temporal resolution. Regardless of the real-time MR sequence used, the FOX 3D gels responded linearly to dose with minimal magnetic field effects due to the strong 1.5 T field or gradient fields present during imaging. These gels can easily be made in-house using non-reusable and reusable formulations depending on the needs of the clinic, and the results of this study encourage further applications of 3D gels for MR-IGRT applications.

Dosimetric characterisation of anthropomorphic PRESAGE® dosimeter and EBT2 film for partial breast radiotherapy

Purpose

Whole-breast external beam radiotherapy results in significant reduction in the risk for breast cancer-related death, but this may be offset by an increase in deaths from other causes and toxicity to surrounding organs. Partial breast irradiation techniques are approaches that treat only the lumpectomy area rather than the whole breast. Quality assurance in the radiation therapy treatment planning process is essential to ensure accurate dose delivery to the patient. For this purpose, this article compares the results from an anthropomorphic PRESAGE® dosimeter, radiation treatment planning system and from the GAFCHROMIC® EBT2 film.

Materials and methods

A breast dosimeter was created and a three-field partial plan was generated in the Pinnacle3 treatment planning system. Dose distribution comparisons were made between Pinnacle3 treatment planning system, GAFCHROMIC® EBT2 film and PRESAGE® dosimeter. Dose–volume histograms (DVHs), gamma maps and line profiles were used to evaluate the comparison.

Results

DVHs of gross tumour volume, clinical tumour volume and planning tumour volume for the PRESAGE® dosimeter and Pinnacle3 treatment planning system shows that both measured and calculated statistics were in agreement, with a value of 97.8% of the prescribed dose. Gamma map comparisons showed that all three distributions passed 95% at the ±3%/±3 mm criteria. Comparisons of isodose line distribution between the PRESAGE® dosimeter, EBT2 film and planning system demonstrated agreement, with an average difference of 1.5%.

Conclusions

This work demonstrated the feasibility of PRESAGE® to function as an anthropomorphic phantom and laid the foundation for research studies in PRESAGE®/optical-computed tomography three-dimensional dosimetry with the most complex anthropomorphic phantoms.

Detection of therapeutic radiation in three-dimensions

For over the last twenty years there has been a multitude of sophisticated three-dimensional radiation delivery procedures developed which requires a corresponding verification of the impact on patients. This article reviews the state of the art in the development of chemical detectors used to characterize the three-dimensional shape of therapeutic radiation. These detectors are composed of polyurethane, radical initiator and a leuco dye, which is radiolytically oxidized to a dye absorbing at 630 nm.

Computational investigation of suitable polymer gel composition for the QA of the beam components of a BNCT irradiation field

This study investigated the optimum composition of the MAGAT polymer gel which is to be used in the quality assurance measurement of the thermal neutron, fast neutron and gamma ray components in the irradiation field used for boron neutron capture therapy at the Kyoto University Reactor. Simulations using the PHITS code showed that when combined with the gel, ⁶Li concentrations of 0, 10 and 100ppm were found to be potentially usable.

Fricke gel dosimeter as a tool in quality assurance of the radiotherapy treatment plans

Ferrous xylenol gel was evaluated as a dosimeter in verifications of treatment plans for treatments of female breast tumors in external-beam radiation therapy. The dosimeter was calibrated in a cubic wax phantom irradiated with 6 and 15MV beams of an Elekta clinical linear accelerator and then used for measurements of doses in an anthropomorphic phantom of a female torso, which mimicked female breasts after modified radical mastectomy and breast-conserving surgery. Doses measured with the gel in specific locations in the phantom were compared with values predicted by treatment plans created with the XiO treatment planning system (Elekta / IMPAQ) and with results of measurements with an IBA CC13 ionization chamber in the same locations. Differences between the values measured with the gel and predicted by the treatment planning system or measured with the ionization chamber were within 1.5% in most cases. In an area of as steep dose gradient, the difference reached 2.7%, which was explicable in terms of the finite size of the gel dosimeter. The dose response of the gel is dose rate and energy independent in the ranges used in most clinical linacs. The results have shown that ferrous xylenol gels can be used as dosimeters in quality assurance in radiation therapy.

Review of ultrasound image guidance in external beam radiotherapy part II: intra-fraction motion management and novel applications

Imaging has become an essential tool in modern radiotherapy (RT), being used to plan dose delivery prior to treatment and verify target position before and during treatment. Ultrasound (US) imaging is cost-effective in providing excellent contrast at high resolution for depicting soft tissue targets apart from those shielded by the lungs or cranium. As a result, it is increasingly used in RT setup verification for the measurement of inter-fraction motion, the subject of Part I of this review (Fontanarosa et al 2015 Phys. Med. Biol. 60 R77-114). The combination of rapid imaging and zero ionising radiation dose makes US highly suitable for estimating intra-fraction motion. The current paper (Part II of the review) covers this topic. The basic technology for US motion estimation, and its current clinical application to the prostate, is described here, along with recent developments in robust motion-estimation algorithms, and three dimensional (3D) imaging. Together, these are likely to drive an increase in the number of future clinical studies and the range of cancer sites in which US motion management is applied. Also reviewed are selections of existing and proposed novel applications of US imaging to RT. These are driven by exciting developments in structural, functional and molecular US imaging and analytical techniques such as backscatter tissue analysis, elastography, photoacoustography, contrast-specific imaging, dynamic contrast analysis, microvascular and super-resolution imaging, and targeted microbubbles. Such techniques show promise for predicting and measuring the outcome of RT, quantifying normal tissue toxicity, improving tumour definition and defining a biological target volume that describes radiation sensitive regions of the tumour. US offers easy, low cost and efficient integration of these techniques into the RT workflow. US contrast technology also has potential to be used actively to assist RT by manipulating the tumour cell environment and by improving the delivery of radiosensitising agents. Finally, US imaging offers various ways to measure dose in 3D. If technical problems can be overcome, these hold potential for wide-dissemination of cost-effective pre-treatment dose verification and in vivo dose monitoring methods. It is concluded that US imaging could eventually contribute to all aspects of the RT workflow.

Molecular structure effects on the post irradiation diffusion in polymer gel dosimeters

Polymer gel dosimeters have specific advantages for recording 3D radiation dose distribution in diagnostic and therapeutic medical applications. But, even in systems where the 3D structure is usually maintained for long periods of time after irradiation, it is still not possible to eliminate the diffusion of the different species in the regions of dose gradients within the gel. As a consequence, information of the dose loses quality over time. In the pursuit of a solution and to improve the understanding of this phenomenon a novel system based on itaconic acid and N-N'-methylene-bisacrylamide (BIS) is hereby proposed. Effects of changes in the chemical structure of the monomers over the dosimetric sensitivity and over the post-irradiation diffusion of species was studied. In this study, one of the carboxylic groups of the itaconic acid molecule was modified with aniline to obtain molecules with similar reactivity but different molecular sizes. Then, dosimeters based on these modified species and on the original ITA molecules were irradiated in an X-ray tomography apparatus at different doses up to 173Gy. Afterwards, the resulting dosimeters were characterized by Raman spectroscopy and optical absorbance in order to study their feasibility and capabilities as dosimetric systems, and by optical-CT to analyze the post irradiation diffusion.

Review on the characteristics of radiation detectors for dosimetry and imaging

The enormous advances in the understanding of human anatomy, physiology and pathology in recent decades have led to ever-improving methods of disease prevention, diagnosis and treatment. Many of these achievements have been enabled, at least in part, by advances in ionizing radiation detectors. Radiology has been transformed by the implementation of multi-slice CT and digital x-ray imaging systems, with silver halide films now largely obsolete for many applications. Nuclear medicine has benefited from more sensitive, faster and higher-resolution detectors delivering ever-higher SPECT and PET image quality. PET/MR systems have been enabled by the development of gamma ray detectors that can operate in high magnetic fields. These huge advances in imaging have enabled equally impressive steps forward in radiotherapy delivery accuracy, with 4DCT, PET and MRI routinely used in treatment planning and online image guidance provided by cone-beam CT. The challenge of ensuring safe, accurate and precise delivery of highly complex radiation fields has also both driven and benefited from advances in radiation detectors. Detector systems have been developed for the measurement of electron, intensity-modulated and modulated arc x-ray, proton and ion beams, and around brachytherapy sources based on a very wide range of technologies. The types of measurement performed are equally wide, encompassing commissioning and quality assurance, reference dosimetry, in vivo dosimetry and personal and environmental monitoring. In this article, we briefly introduce the general physical characteristics and properties that are commonly used to describe the behaviour and performance of both discrete and imaging detectors. The physical principles of operation of calorimeters; ionization and charge detectors; semiconductor, luminescent, scintillating and chemical detectors; and radiochromic and radiographic films are then reviewed and their principle applications discussed. Finally, a general discussion of the application of detectors for x-ray nuclear medicine and ion beam imaging and dosimetry is presented.

Comparison of an anthropomorphic PRESAGE® dosimeter and radiochromic film with a commercial radiation treatment planning system for breast IMRT: a feasibility study

This work presents a comparison of an anthropomorphic PRESAGE® dosimeter and radiochromic film measurements with a commercial treatment planning system to determine the feasibility of PRESAGE® for 3D dosimetry in breast IMRT. An anthropomorphic PRESAGE® phantom was created in the shape of a breast phantom. A five-field IMRT plan was generated with a commercially available treatment planning system and delivered to the PRESAGE® phantom. The anthropomorphic PRESAGE® was scanned with the Duke midsized optical CT scanner (DMOS-RPC) and the OD distribution was converted to dose. Comparisons were performed between the dose distribution calculated with the Pinnacle3 treatment planning system, PRESAGE®, and EBT2 film measurements. DVHs, gamma maps, and line profiles were used to evaluate the agreement. Gamma map comparisons showed that Pinnacle3 agreed with PRESAGE® as greater than 95% of comparison points for the PTV passed a ± 3%/± 3 mm criterion when the outer 8 mm of phantom data were discluded. Edge artifacts were observed in the optical CT reconstruction, from the surface to approximately 8 mm depth. These artifacts resulted in dose differences between Pinnacle3 and PRESAGE® of up to 5% between the surface and a depth of 8 mm and decreased with increasing depth in the phantom. Line profile comparisons between all three independent measurements yielded a maximum difference of 2% within the central 80% of the field width. For the breast IMRT plan studied, the Pinnacle3 calculations agreed with PRESAGE® measurements to within the ±3%/± 3 mm gamma criterion. This work demonstrates the feasibility of the PRESAGE® to be fashioned into anthropomorphic shape, and establishes the accuracy of Pinnacle3 for breast IMRT. Furthermore, these data have established the groundwork for future investigations into 3D dosimetry with more complex anthropomorphic phantoms.

Dosimetric verification of complex radiotherapy with a 3D optically based dosimetry system: dose painting and target tracking

BACKGROUND

The increasing complexity of radiotherapy (RT) has motivated research into three-dimensional (3D) dosimetry. In this study we investigate the use of 3D dosimetry with polymerizing gels and optical computed tomography (optical CT) as a verification tool for complex RT: dose painting and target tracking.

MATERIALS AND METHODS

For the dose painting studies, two dosimeters were irradiated with a seven-field intensity modulated radiotherapy (IMRT) plan with and without dose prescription based on a hypoxia image dataset of a head and neck patient. In the tracking experiments, two dosimeters were irradiated with a volumetric modulated arc therapy (VMAT) plan with and without clinically measured prostate motion and a third with both motion and target tracking. To assess the performance, 3D gamma analyses were performed between measured and calculated stationary dose distributions.

RESULTS

Gamma pass-rates of 95.3% and 97.3% were achieved for the standard and dose-painted IMRT plans. Gamma pass-rates of 91.4% and 54.4% were obtained for the stationary and moving dosimeter, respectively, while tracking increased the pass-rate for the moving dosimeter to 90.4%.

CONCLUSIONS

This study has shown that the 3D dosimetry system can reproduce and thus verify complex dose distributions, also when influenced by motion.

Comparison of methods for the measurement of radiation dose distributions in high dose rate (HDR) brachytherapy: Ge-doped optical fiber, EBT3 Gafchromic film, and PRESAGE® radiochromic plastic

PURPOSE

Dose distribution measurement in clinical high dose rate (HDR) brachytherapy is challenging, because of the high dose gradients, large dose variations, and small scale, but it is essential to verify accurate treatment planning and treatment equipment performance. The authors compare and evaluate three dosimetry systems for potential use in brachytherapy dose distribution measurement: Ge-doped optical fibers, EBT3 Gafchromic film with multichannel analysis, and the radiochromic material PRESAGE(®) with optical-CT readout.

METHODS

Ge-doped SiO2 fibers with 6 μm active core and 5.0 mm length were sensitivity-batched and their thermoluminescent properties used via conventional heating and annealing cycles. EBT3 Gafchromic film of 30 μm active thickness was calibrated in three color channels using a nominal 6 MV linear accelerator. A 48-bit transmission scanner and advanced multichannel analysis method were utilized to derive dose measurements. Samples of the solid radiochromic polymer PRESAGE(®), 60 mm diameter and 100 mm height, were analyzed with a parallel beam optical CT scanner. Each dosimetry system was used to measure the dose as a function of radial distance from a Co-60 HDR source, with results compared to Monte Carlo TG-43 model data. Each system was then used to measure the dose distribution along one or more lines through typical clinical dose distributions for cervix brachytherapy, with results compared to treatment planning system (TPS) calculations. Purpose-designed test objects constructed of Solid Water and held within a full-scatter water tank were utilized.

RESULTS

All three dosimetry systems reproduced the general shape of the isolated source radial dose function and the TPS dose distribution. However, the dynamic range of EBT3 exceeded those of doped optical fibers and PRESAGE(®), and the latter two suffered from unacceptable noise and artifact. For the experimental conditions used in this study, the useful range from an isolated HDR source was 5-40 mm for fibers, 3-50 mm for EBT3, and 4-21 mm for PRESAGE(®). Fibers demonstrated some over-response at very low dose levels, suffered from volume averaging effects in the dose distribution measurement, and exhibited up to 9% repeatability variation over three repeated measurements. EBT3 demonstrated excellent agreement with Monte Carlo and TPS dose distributions, with up to 3% repeatability over three measurements. PRESAGE(®) gave promising results, being the only true 3D dosimeter, but artifacts and noise were apparent.

CONCLUSIONS

The comparative response of three emerging dosimetry systems for clinical brachytherapy dose distribution measurement has been investigated. Ge-doped optical fibers have excellent spatial resolution for single-direction measurement but are currently too large for complex dose distribution assessment. The use of PRESAGE(®) with optical-CT readout gave promising results in the measurement of true 3D dose distributions but further development work is required to reduce noise and improve dynamic range for brachytherapy dose distribution measurements. EBT3 Gafchromic film with multichannel analysis demonstrated accurate and reproducible measurement of dose distributions in HDR brachytherapy. Calibrated dose measurements were possible with agreement within 1.5% of TPS dose calculations. The suitability of EBT3 as a dosimeter for 2D quality control or commissioning work has been demonstrated.