Electronic dosimetry in radiation therapy

Neutron-gamma dosimetry for BNCT using field oxide transistors with gadolinium oxide as neutron converter layer

PURPOSE

A new type of electronic dosimeter is presented, capable of discerning between the doses of gamma photons and neutrons in a mixed beam as found in boron neutron capture therapy (BNCT). We introduce a real-time dosimeter based on a thick gate field oxide field effect transistor (FOXFET) covered with a neutron converter layer containing gadolinium.

METHODS

To sensitize the FOXFET dosimeter to neutron fluxes, a converter layer containing gadolinium oxide particles embedded in photoresines was deposited over the sensor surface. Mixed neutron-gamma field configurations with different neutron energy spectra were used to assess the FOXFET response, considering different thicknesses of the neutron converter layer.

RESULTS

The total gamma sensitivity of the devices resulted to be 43 mV/Gy. The responses of sensors with different converter layer thicknesses irradiated with different neutron spectra are simulated using GEANT4 code. The response to photons is not significantly modified with thin conversion layers when used in water medium.

CONCLUSIONS

A real-time dosimeter comprising a pair of FOXFET sensors-only one of them with a gadolinium neutron converter layer-allows the simultaneous measurement of gamma dose and neutron flux during BNCT irradiations.

Commercial photodiodes and phototransistors as dosimeters of photon beams for radiotherapy

PURPOSE

The response to radiation typically used in radiotherapy treatments has been experimentally evaluated for three samples of two phototransistors (BPW85B and OP505A) and two PIN photodiodes types (VTB8440BH and BPW34S).

METHODS

To that end, a staggered irradiation cycle has been applied which included dose rate values from 0.81 to 4.87 cGy/s, achieving a total absorbed dose of 21.4 Gy. The samples have been irradiated with a linear accelerator and the relations between the induced photocurrent and the average and instantaneous dose rates, and between the accumulated charge and the absorbed dose, have been determined. The radiation-induced output currents were measured by means of an external interface of the devices to a previously designed readout unit.

RESULTS

Experimental results of Si PIN photodiode BPW34S have shown a sensitivity of (13.9 ± 0.5) nC/cGy, slight sensitivity dependence on dose rate, and a high linearity of the current with the average and instantaneous dose rate, requiring only 10 V of reverse bias voltage. This device thermal drift has characterized and modeled for temperature effect compensation.

CONCLUSIONS

Silicon PIN photodiode BPW34S, previously tested for X-rays and Co-60 gamma ray source, can also be a reliable candidate for dose rate and absorbed skin dose determination in typical radiotherapy treatments irradiations. A low sensitivity loss below 2% up to 21.4 Gy has been measured, allowing its use as an affordable reusable skin dosimeter. Moreover, no significant difference has been observed between its response to dose-per-pulse and changing pulse repetition frequency in terms of sensitivity and dependence with dose-rate value.

FLASH Irradiation with Proton Beams: Beam Characteristics and Their Implications for Beam Diagnostics

FLASH irradiations use dose-rates orders of magnitude higher than commonly used in patient treatments. Such irradiations have shown interesting normal tissue sparing in cell and animal experiments, and, as such, their potential application to clinical practice is being investigated. Clinical accelerators used in proton therapy facilities can potentially provide FLASH beams; therefore, the topic is of high interest in this field. However, a clear FLASH effect has so far been observed in presence of high dose rates (>40 Gy/s), high delivered dose (tens of Gy), and very short irradiation times (<300 ms). Fulfilling these requirements poses a serious challenge to the beam diagnostics system of clinical facilities. We will review the status and proposed solutions, from the point of view of the beam definitions for FLASH and their implications for beam diagnostics. We will devote particular attention to the topics of beam monitoring and control, as well as absolute dose measurements, since finding viable solutions in these two aspects will be of utmost importance to guarantee that the technique can be adopted quickly and safely in clinical practice.

Physics and biology of ultrahigh dose-rate (FLASH) radiotherapy: a topical review

Ultrahigh dose-rate radiotherapy (RT), or 'FLASH' therapy, has gained significant momentum following various in vivo studies published since 2014 which have demonstrated a reduction in normal tissue toxicity and similar tumor control for FLASH-RT when compared with conventional dose-rate RT. Subsequent studies have sought to investigate the potential for FLASH normal tissue protection and the literature has been since been inundated with publications on FLASH therapies. Today, FLASH-RT is considered by some as having the potential to 'revolutionize radiotherapy'. FLASH-RT is considered by some as having the potential to 'revolutionize radiotherapy'. The goal of this review article is to present the current state of this intriguing RT technique and to review existing publications on FLASH-RT in terms of its physical and biological aspects. In the physics section, the current landscape of ultrahigh dose-rate radiation delivery and dosimetry is presented. Specifically, electron, photon and proton radiation sources capable of delivering ultrahigh dose-rates along with their beam delivery parameters are thoroughly discussed. Additionally, the benefits and drawbacks of radiation detectors suitable for dosimetry in FLASH-RT are presented. The biology section comprises a summary of pioneering in vitro ultrahigh dose-rate studies performed in the 1960s and early 1970s and continues with a summary of the recent literature investigating normal and tumor tissue responses in electron, photon and proton beams. The section is concluded with possible mechanistic explanations of the FLASH normal-tissue protection effect (FLASH effect). Finally, challenges associated with clinical translation of FLASH-RT and its future prospects are critically discussed; specifically, proposed treatment machines and publications on treatment planning for FLASH-RT are reviewed.

X-ray Visualization and Quantification Using Fibrous Color Dosimeter Based on Leuco Dye

A polystyrene (PS)-based fibrous color dosimeter, comprising a color former based on 2-(phenylamino)-6-(dipentylamino)-3-methylspiro[9H-xanthene-9,3′-phthalide] (Black305) fluoran leuco dye and a 2-(4-methoxystyryl)-4,6-bis(trichloromethyl)-1,3,5-triazine (MBTT) photoacid generator, was developed for visual detection of X-ray doses of 15 Gy and higher. The composite fiber was produced by using a centrifugal spinning method, and the obtained composite fiber exhibited a stable and uniform morphology with a fiber diameter of 10 μm or less and had sufficient mechanical strength. As an example of practical application, we successfully processed the composite fiber into an apron and clearly and visually confirmed that the color change from yellow to black occurs on the surface of the fabric under X-ray exposure.

Light-Dependent Resistors as Dosimetric Sensors in Radiotherapy

Safe quality control of radiotherapy treatments lies in reliable dosimetric sensors. Currently, ionization chambers and solid-state diodes along with electrometers as readout systems are accomplishing this task. In this work, we present a well-known and low-cost semiconductor sensor, the light-dependent resistor (LDR), as an alternative to the existing sensing devices for dosimetry. To demonstrate this, a complete characterization of the response to radiation of commercial LDRs has been conducted in terms of sensitivity, reproducibility and thermal correction under different bias voltages. Irradiation sessions have been applied under the common conditions in radiotherapy treatments using a hospital linear accelerator. Moreover, the same electrometer used for the ionization chamber has also been successfully used for LDRs. In comparison with the sensitivity achieved for the ionization chamber (0.2 nC/cGy at 400 V bias voltage), higher sensitivities have been measured for the proposed LDRs, ranging from 0.24 to 1.04 nC/cGy at bias voltages from 30 to 150 V, with a reproducibility uncertainty among samples of around 10%. In addition, LDR temperature dependence has been properly modeled using the simple thermistor model so that an easy thermal drift correction of dose measurements can be applied. Therefore, experimental results show that LDRs can be a reliable alternative to dosimetric sensors with the advantages of low size, affordable cost and the fact that it could be adopted with minimal changes in routine dosimetry quality control since the same readout system is fully compatible.

Evaluation of a pixelated large format CMOS sensor for x-ray microbeam radiotherapy

PURPOSE

Current techniques and procedures for dosimetry in microbeams typically rely on radiochromic film or small volume ionization chambers for validation and quality assurance in 2D and 1D, respectively. Whilst well characterized for clinical and preclinical radiotherapy, these methods are noninstantaneous and do not provide real time profile information. The objective of this work is to determine the suitability of the newly developed vM1212 detector, a pixelated CMOS (complementary metal-oxide-semiconductor) imaging sensor, for in situ and in vivo verification of x-ray microbeams.

METHODS

Experiments were carried out on the vM1212 detector using a 220 kVp small animal radiation research platform (SARRP) at the Helmholtz Centre Munich. A 3 x 3 cm² square piece of EBT3 film was placed on top of a marked nonfibrous card overlaying the sensitive silicon of the sensor. One centimeter of water equivalent bolus material was placed on top of the film for build-up. The response of the detector was compared to an Epson Expression 10000XL flatbed scanner using FilmQA Pro with triple channel dosimetry. This was also compared to a separate exposure using 450 µm of silicon as a surrogate for the detector and a Zeiss Axio Imager 2 microscope using an optical microscopy method of dosimetry. Microbeam collimator slits with range of nominal widths of 25, 50, 75, and 100 µm were used to compare beam profiles and determine sensitivity of the detector and both film measurements to different microbeams.

RESULTS

The detector was able to measure peak and valley profiles in real-time, a significant reduction from the 24 hr self-development required by the EBT3 film. Observed full width at half maximum (FWHM) values were larger than the nominal slit widths, ranging from 130 to 190 µm due to divergence. Agreement between the methods was found for peak-to-valley dose ratio (PVDR), peak to peak separation and FWHM, but a difference in relative intensity of the microbeams was observed between the detectors.

CONCLUSIONS

The investigation demonstrated that pixelated CMOS sensors could be applied to microbeam radiotherapy for real-time dosimetry in the future, however the relatively large pixel pitch of the vM1212 detector limit the immediate application of the results.

2D monolithic silicon-diode array detectors in megavoltage photon beams: does the fabrication technology matter? A medical physicist's perspective

A family of prototype 2D monolithic silicon-diode array detectors (MP512, Duo, Octa) has been proposed by the Centre for Medical Radiation Physics, University of Wollongong (Australia) for relative dosimetry in small megavoltage photon beams. These detectors, which differ in the topology of their 512 sensitive volumes, were originally fabricated on bulk p-type substrates. More recently, they have also been fabricated on epitaxial p-type substrates. In the literature, their performance has been individually characterized for quality assurance (QA) applications. The present study directly assessed and compared that of a MP512-bulk and that of a MP512-epitaxial in terms of radiation hardness, long-term stability, response linearity with dose, dose per pulse and angular dependence. Their measurements of output factors, off-axis ratios and percentage depth doses in square radiation fields collimated by the jaws and produced by 6 MV and 10 MV flattened photon beams were then benchmarked against those by commercially available detectors. The present investigation was aimed at establishing, from a medical physicist's perspective, how the bulk and epitaxial fabrication technologies would affect the implementation of the MP512s into a QA protocol. Based on results, the MP512-epitaxial would offer superior radiation hardness, long-term stability and achievable uniformity and reproducibility of the response across the 2D active area.

Quality assurance of Cyberknife robotic stereotactic radiosurgery using an angularly independent silicon detector

Purpose

The aim of this work was to evaluate the use of an angularly independent silicon detector (edgeless diodes) developed for dosimetry in megavoltage radiotherapy for Cyberknife in a phantom and for patient quality assurance (QA).

Method

The characterization of the edgeless diodes has been performed on Cyberknife with fixed and IRIS collimators. The edgeless diode probes were tested in terms of basic QA parameters such as measurements of tissue‐phantom ratio (TPR), output factor and off‐axis ratio. The measurements were performed in both water and water‐equivalent phantoms. In addition, three patient‐specific plans have been delivered to a lung phantom with and without motion and dose measurements have been performed to verify the ability of the diodes to work as patient‐specific QA devices. The data obtained by the edgeless diodes have been compared to PTW 60016, SN edge, PinPoint ionization chamber, Gafchromic EBT3 film, and treatment planning system (TPS).

Results

The TPR measurement performed by the edgeless diodes show agreement within 2.2% with data obtained with PTW 60016 diode for all the field sizes. Output factor agrees within 2.6% with that measured by SN EDGE diodes corrected for their field size dependence. The beam profiles’ measurements of edgeless diodes match SN EDGE diodes with a measured full width half maximum (FWHM) within 2.3% and penumbra widths within 0.148 mm. Patient‐specific QA measurements demonstrate an agreement within 4.72% in comparison with TPS.

Conclusion

The edgeless diodes have been proved to be an excellent candidate for machine and patient QA for Cyberknife reproducing commercial dosimetry device measurements without need of angular dependence corrections. However, further investigation is required to evaluate the effect of their dose rate dependence on complex brain cancer dose verification.

Radiation dose response of N channel MOSFET submitted to filtered X-ray photon beam

MOSFET can operate as a radiation detector mainly in high-energy photon beams, which are normally used in cancer treatments. In general, such an electronic device can work as a dosimeter from threshold voltage shift measurements. The purpose of this article is to show a new way for measuring the dose-response of MOSFETs when they are under X-ray beams generated from 100kV potential range, which is normally used in diagnostic radiology. Basically, the method consists of measuring the MOSFET drain current as a function of the radiation dose. For this the type of device, it has to be biased with a high value resistor aiming to see a substantial change in the drain current after it has been irradiated with an amount of radiation dose. Two types of N channel device were used in the experiment: a signal transistor and a power transistor. The delivered dose to the device was varied and the electrical curves were plotted. Also, a sensitivity analysis of the power MOSFET response was made, by varying the tube potential of about 20%. The results show that both types of devices have responses very similar, the shift in the electrical curve is proportional to the radiation dose. Unlike the power MOSFET, the signal transistor does not provide a linear function between the dose rate and its drain current. We also have observed that the variation in the tube potential of the X-ray equipment produces a very similar dose-response.

Investigation of RadFET response to X-ray and electron beams

The irradiation response of Radiation Sensing Field Effect Transistor (RadFET), also known as MOSFET/pMOS dosimeter, to high energy X-rays and electron beams was investigated. The threshold voltages before and after irradiation were measured and the trap densities in the gate oxide and oxide/silicon interface of the RadFETs are evaluated. The RadFETs were irradiated with 6MV X-rays, and 10 and 18MeV electron beams emitted from a Linear accelerator (LINAC). Linear and non-linear fits to experimental results showed that after an initial linear response up to several Gy, deviation from the linearity occurred due to electric field screening by the radiation induced oxide trapped charges. The radiation-induced fixed traps (FTs) and switching traps (STs) were analysed and the FT density was found to be higher than the ST density for all beam types and doses. The radiation response, fading characteristics, and variation of the trapped charges of the RadFETs showed similar behaviour in tests.

A carbon nanotube based x-ray detector

X-ray detectors based on metal-oxide semiconductor field effect transistors couple instantaneous measurement with high accuracy. However, they only have a limited measurement lifetime because they undergo permanent degradation due to x-ray beam exposure. A field effect transistor based on carbon nanotubes (CNTs), however, overcomes this drawback of permanent degradation, because it can be reset into its starting state after being exposed to the x-ray beam. In this work the CNTs were deposited using a dielectrophoresis method on SiO₂ coated p-type (boron-doped) Si substrates. For the prepared devices a best gate voltage shift of 244 V Gy^-1 and a source-drain current sensitivity of 382 nA Gy^-1 were achieved. These values are larger than those reached by the currently used MOSFET based devices.

Clinical examples of 3D dose distribution reconstruction, based on the actual MLC leaves movement, for dynamic treatment techniques

AIM

To present practical examples of our new algorithm for reconstruction of 3D dose distribution, based on the actual MLC leaf movement.

BACKGROUND

DynaLog and RTplan files were used by DDcon software to prepare a new RTplan file for dose distribution reconstruction.

MATERIALS AND METHODS

FOUR DIFFERENT CLINICALLY RELEVANT SCENARIOS WERE USED TO ASSESS THE FEASIBILITY OF THE PROPOSED NEW APPROACH: (1) Reconstruction of whole treatment sessions for prostate cancer; (2) Reconstruction of IMRT verification treatment plan; (3) Dose reconstruction in breast cancer; (4) Reconstruction of interrupted arc and complementary plan for an interrupted VMAT treatment session of prostate cancer. The applied reconstruction method was validated by comparing reconstructed and measured fluence maps. For all statistical analysis, the U Mann-Whitney test was used.

RESULTS

In the first two and the fourth cases, there were no statistically significant differences between the planned and reconstructed dose distribution (p = 0.910, p = 0.975, p = 0.893, respectively). In the third case the differences were statistically significant (p = 0.015). Treatment plan had to be reconstructed.

CONCLUSION

Developed dose distribution reconstruction algorithm presents a very useful QA tool. It provides means for 3D dose distribution verification in patient volume and allows to evaluate the influence of actual MLC leaf motion on the dose distribution.

Effect of correction/calibration factors on accuracy of in vivo dose delivery with cylindrical n-type Isorad diode in conventional radiotherapy

Purpose

The main aim was to use pre-calculated correction factors and calibration factors for measurement of accuracy of dose delivery before implementation of such in vivo dosimetry on real patients visiting for first radiation treatment. These factors were verified by generating the most common treatment plans on human phantom except for breast and colon using cobalt-60 unit.

Materials and methods

Six treatment plans were generated, i.e. nasopharynx, bladder, prostate, brain, larynx and lung of human phantom, total 18 fields were planned keeping in view the correction factors which are to be verified. MULTIDATA Decision Support System 2.5, Shimadzu simulator, Isorad diode-n type, electrometer patient dose monitor and ATOM Adult male human phantom were used.

Results and conclusion

For 18 fields, the dose delivery was accurate in the range 0·29–6·74%. The deviation between measured and expected doses to nasopharynx, lung, bladder, prostate, brain and larynx cases of human phantom ranged from 1·44–3·89%, 0·29–0·54%, 0·44–6·18%, 0·54–5·16%, 0·33–4·90%, 5·58–6·74%, respectively. In 30 palliative patient cases, the first radiation treatment was also monitored. The accuracy of dosimety ranged from 1·05% to 5·35%. This study is helpful to identify areas of improvement in treatment of patients like quality control/quality assurance (QA) of treatment planning system, beam data modifications, machine repair maintenance, QA audit in radiotherapy.

Radiation sensors based on the generation of mobile protons in organic dielectrics

A sensing scheme based on mobile protons generated by radiation, including ionizing radiation (IonR), in organic gate dielectrics is investigated for the development of metal-insulator-semiconductor (MIS)-type dosimeters. Application of an electric field to the gate dielectric moves the protons and thereby alters the flat band voltage (VFB) of the MIS device. The shift in the VFB is proportional to the IonR-generated protons and, therefore, to the IonR total dose. Triphenylsulfonium nonaflate (TPSNF) photoacid generator (PAG)-containing poly(methyl methacrylate) (PMMA) polymeric films was selected as radiation-sensitive gate dielectrics. The effects of UV (249 nm) and gamma (Co-60) irradiations on the high-frequency capacitance versus the gate voltage (C-VG) curves of the MIS devices were investigated for different total dose values. Systematic improvements in sensitivity can be accomplished by increasing the concentration of the TPSNF molecules embedded in the polymeric matrix.

An optimized calibration method for surface measurements with MOSFETs in shaped-beam radiosurgery

Nowadays MOSFET dosimeters are widely used for dose verification in radiotherapy procedures. Although their sensitive area satisfies size requirements for small field dosimetry, their use in radiosurgery has rarely been reported. The aim of this study is to propose and optimize a calibration method to perform surface measurements in 6 MV shaped-beam radiosurgery for field sizes down to 18 × 18 mm(2). The effect of different parameters such as recovery time between 2 readings, batch uniformity and build-up cap attenuation was studied. Batch uniformity was found to be within 2% and isocenter dose attenuation due to the build-up cap over the MOSFET was near 2% irrespective of field size. Two sets of sensitivity coefficients (SC) were determined for TN-502RD MOSFET dosimeters using experimental and calculated calibration; the latter being developed using an inverse square law model. Validation measurements were performed on a realistic head phantom in irregular fields. MOSFET dose values obtained by applying either measured or calculated SC were compared. For calibration, optimal results were obtained for an inter-measurement time lapse of 5 min. We also found that fitting the SC values with the inverse square law reduced the number of measurements required for calibration. The study demonstrated that combining inverse square law and Sterling-Worthley formula resulted in an underestimation of up to 4% of the dose measured by MOSFETs for complex beam geometries. With the inverse square law, it is possible to reduce the number of measurements required for calibration for multiple field-SSD combinations. Our results suggested that MOSFETs are suitable sensors for dosimetry when used at the surface in shaped-beam radiosurgery down to 18 × 18 mm(2).

A silicon strip detector dose magnifying glass for IMRT dosimetry

PURPOSE

Intensity modulated radiation therapy (IMRT) allows the delivery of escalated radiation dose to tumor while sparing adjacent critical organs. In doing so, IMRT plans tend to incorporate steep dose gradients at interfaces between the target and the organs at risk. Current quality assurance (QA) verification tools such as 2D diode arrays, are limited by their spatial resolution and conventional films are nonreal time. In this article, the authors describe a novel silicon strip detector (CMRP DMG) of high spatial resolution (200 microm) suitable for measuring the high dose gradients in an IMRT delivery.

METHODS

A full characterization of the detector was performed, including dose per pulse effect, percent depth dose comparison with Farmer ion chamber measurements, stem effect, dose linearity, uniformity, energy response, angular response, and penumbra measurements. They also present the application of the CMRP DMG in the dosimetric verification of a clinical IMRT plan.

RESULTS

The detector response changed by 23% for a 390-fold change in the dose per pulse. A correction function is derived to correct for this effect. The strip detector depth dose curve agrees with the Farmer ion chamber within 0.8%. The stem effect was negligible (0.2%). The dose linearity was excellent for the dose range of 3-300 cGy. A uniformity correction method is described to correct for variations in the individual detector pixel responses. The detector showed an over-response relative to tissue dose at lower photon energies with the maximum dose response at 75 kVp nominal photon energy. Penumbra studies using a Varian Clinac 21EX at 1.5 and 10.0 cm depths were measured to be 2.77 and 3.94 mm for the secondary collimators, 3.52 and 5.60 mm for the multileaf collimator rounded leaf ends, respectively. Point doses measured with the strip detector were compared to doses measured with EBT film and doses predicted by the Philips Pinnacle treatment planning system. The differences were 1.1% +/- 1.8% and 1.0% +/- 1.6%, respectively. They demonstrated the high temporal resolution capability of the detector readout system, which will allow one to investigate the temporal dose pattern of IMRT and volumetric modulated are therapy (VMAT) deliveries.

CONCLUSIONS

The CMRP silicon strip detector dose magnifying glass interfaced to a TERA ASIC DAQ system has high spatial and temporal resolution. It is a novel and valuable tool for QA in IMRT dose delivery and for VMAT dose delivery.