In vivo dosimetry during external photon beam radiotherapy

Automation to facilitate optimisation of breast radiotherapy treatments using EPID-basedin vivodosimetry

Objective. To use automation to facilitate the monitoring of each treatment fraction using an electronic portal imaging device (EPID) basedin vivodosimetry (IVD) system, allowing optimisation of breast radiotherapy delivery for individual patients and cohorts.Approach. A suite of in-house software was developed to reduce the number of manual interactions with the commercial IVD system, dosimetry check. An EPID specific pixel sensitivity map facilitated use of the EPID panel away from the central axis. Point dose difference and the change in standard deviation in dose were identified as useful dose metrics, with standard deviation used in preference to gamma in the presence of a systematic dose offset. Automated IVD was completed for 3261 fractions across 704 patients receiving breast radiotherapy.Main results. Multiple opportunities for treatment optimisation were identified for individual patients and across patient cohorts as a result of successful implementation of automated IVD. 5.1% of analysed fractions were out of tolerance with 27.1% of these considered true positives. True positive results were obtained on any fraction of treatment and if IVD had only been completed on the first fraction, 84.4% of true positive results would have been missed. This was made possible due to the automation that saved over 800 h of manual intervention and stored data in an accessible database.Significance. An improved EPID calibration to allow off-axis measurement maximises the number of patients eligible for IVD (36.8% of patients in this study). We also demonstrate the importance in selecting context-specific assessment metrics and how these can lead to a managable false positive rate. We have shown that the use of fully automated IVD facilitates use on every fraction of treatment. This leads to identification of areas for treatment improvement for both individuals and across a patient cohort, expanding the uses of IVD from simply gross error detection towards treatment optimisation.

X-ray-Sensitive Doped CaF2-Based MRI Contrast Agents for Local Radiation Dose Measurement

Ionizing radiation has become widely used in medicine, with application in diagnostic techniques, such as computed tomography (CT) and radiation therapy (RT), where X-rays are used to diagnose and treat tumors. The X-rays used in CT and, in particular, in RT can have harmful side effects; hence, an accurate determination of the delivered radiation dose is of utmost importance to minimize any damage to healthy tissues. For this, medical specialists mostly rely on theoretical predictions of the delivered dose or external measurements of the dose. To extend the practical use of ionizing radiation-based medical techniques, such as magnetic resonance imaging (MRI)-guided RT, a more precise measurement of the internal radiation dose internally is required. In this work, a novel approach is presented to measure dose in liquids for potential future in vivo applications. The strategy relies on MRI contrast agents (CAs) that provide a dose-sensitive signal. The demonstrated materials are (citrate-capped) CaF2 nanoparticles (NPs) doped with Eu3+ or Fe2+/Fe3+ ions. Free electrons generated by ionizing radiation allow the reduction of Eu3+, which produces a very small contrast in MRI, to Eu2+, which induces a strong contrast. Oxidative species generated by high-energy X-rays can be measured indirectly using Fe2+ because it oxidizes to Fe3+, increasing the contrast in MRI. Notably, in the results, a strong increase in the proton relaxation rates is observed for the Eu3+-doped NPs at 40 kV. At 6 MV, a significant increase in proton relaxation rates is observed using CaF2 NPs doped with Fe2+/Fe3+ after irradiation. The presented concept shows great promise for use in the clinic to measure in vivo local ionizing radiation dose, as these CAs can be intravenously injected in a saline solution.

Monocrystalline diamond detector for online monitoring during synchrotron microbeam radiotherapy

Microbeam radiation therapy (MRT) is a radiotherapy technique combining spatial fractionation of the dose distribution on a micrometric scale, X-rays in the 50-500 keV range and dose rates up to 16 × 103 Gy s-1. Nowadays, in vivo dosimetry remains a challenge due to the ultra-high radiation fluxes involved and the need for high-spatial-resolution detectors. The aim here was to develop a striped diamond portal detector enabling online microbeam monitoring during synchrotron MRT treatments. The detector, a 550 µm bulk monocrystalline diamond, is an eight-strip device, of height 3 mm, width 178 µm and with 60 µm spaced strips, surrounded by a guard ring. An eight-channel ASIC circuit for charge integration and digitization has been designed and tested. Characterization tests were performed at the ID17 biomedical beamline of the European Synchrotron Radiation Facility (ESRF). The detector measured direct and attenuated microbeams as well as interbeam fluxes with a precision level of 1%. Tests on phantoms (RW3 and anthropomorphic head phantoms) were performed and compared with simulations. Synchrotron radiation measurements were performed on an RW3 phantom for strips facing a microbeam and for strips facing an interbeam area. A 2% difference between experiments and simulations was found. In more complex geometries, a preliminary study showed that the absolute differences between simulated and recorded transmitted beams were within 2%. Obtained results showed the feasibility of performing MRT portal monitoring using a microstriped diamond detector. Online dosimetric measurements are currently ongoing during clinical veterinary trials at ESRF, and the next 153-strip detector prototype, covering the entire irradiation field, is being finalized at our institution.

In vivodosimetry in cancer patients undergoing intraoperative radiation therapy

In vivodosimetry (IVD) is an important tool in external beam radiotherapy (EBRT) to detect major errors by assessing differences between expected and delivered dose and to record the received dose by individual patients. Also, in intraoperative radiation therapy (IORT), IVD is highly relevant to register the delivered dose. This is especially relevant in low-risk breast cancer patients since a high dose of IORT is delivered in a single fraction. In contrast to EBRT, online treatment planning based on intraoperative imaging is only under development for IORT. Up to date, two commercial treatment planning systems proposed intraoperative ultrasound or in-room cone-beam CT for real-time IORT planning. This makes IVD even more important because of the possibility for real-time treatment adaptation. Here, we summarize recent developments and applications of IVD methods for IORT in clinical practice, highlighting important contributions and identifying specific challenges such as a treatment planning system for IORT. HDR brachytherapy as a delivery technique was not considered. We add IVD for ultrahigh dose rate (FLASH) radiotherapy that promises to improve the treatment efficacy, when compared to conventional radiotherapy by limiting the rate of toxicity while maintaining similar tumour control probabilities. To date, FLASH IORT is not yet in clinical use.

Selective de-implementation of routine in vivo dosimetry

As cone-beam computed tomography (CBCT) has become the localization method for a majority of cases, the indications for diode-based confirmation of accurate patient set-up and treatment are now limited and must be balanced between proper resource allocation and optimizing efficiency without compromising safety. We undertook a de-implementation quality improvement project to discontinue routine diode use in non-intensity modulated radiotherapy (IMRT) cases in favor of tailored selection of scenarios where diodes may be useful. After analysis of safety reports from the last 5 years, literature review, and stakeholder discussions, our safety and quality (SAQ) committee introduced a recommendation to limit diode use to specific scenarios in which in vivo verification may add value to standard quality assurance (QA) processes. To assess changes in patterns of use, we reviewed diode use by clinical indication 4 months prior and after the implementation of the revised policy, which includes use of diodes for: 3D conformal photon fields set up without CBCT; total body irradiation (TBI); electron beams; cardiac devices within 10 cm of the treatment field; and unique scenarios on a case-by-case basis. We identified 4459 prescriptions and 1038 unique instances of diode use across five clinical sites from 5/2021 to 1/2022. After implementation of the revised policy, we observed an overall decrease in diode use from 32% to 13.2%, with a precipitous drop in 3D cases utilizing CBCT (from 23.2% to 4%), while maintaining diode utilization in the 5 selected scenarios including 100% of TBI and electron cases. By identifying specific indications for diode use and creating a user-friendly platform for case selection, we have successfully de-implemented routine diode use in favor of a selective process that identifies cases where the diode is important for patient safety. In doing so, we have streamlined patient care and decreased cost without compromising patient safety.

Novel framework for determining TPS-calculated doses corresponding to detector locations using 3D camera inin vivosurface dosimetry

Purpose. To address the shortcomings of current procedures for evaluating the measured-to-planned dose agreement inin vivodosimetry (IVD), this study aimed to develop an accurate and efficient novel framework to identify the detector location placed on a patient's skin surface using a 3D camera and determine the planned dose at the same anatomical position corresponding to the detector location.Methods. Breast cancer treatment was simulated using an anthropomorphic adult female phantom (ATOM 702D; CIRS, Norfolk, VA, USA). An optically stimulated luminescent dosimeter was used for surface dose measurements (MyOSLchip, RadPro International GmbH, Germany) at six IVD points. Three-dimensional surface imaging (3DSI) of the phantom with the detector was performed in the treatment position using a 3D camera. The developed framework, iSMART, was designed to import 3DSI and treatment planning data for determining the position of the IVD detectors in the 3D treatment planning DICOM image. The clinical usefulness of iSMART was evaluated in terms of accuracy and efficiency, for comparison with the results obtained using cone-beam computed tomography (CBCT) image guidance.Results. The relative dose difference between the planned doses determined using iSMART and CBCT images displayed similar accuracies (within approximately ±2.0%) at all detector locations. The relative dose differences between the planned and measured doses at the six detector locations ranged from -4.8% to 3.1% for the CBCT images and -3.5% to 2.1% for iSMART. The total time required to read the planned doses at six detector locations averaged at 8.1 and 0.8 min for the CBCT images and iSMART, respectively.Conclusions. The proposed framework can improve the robustness of IVD analyses and aid in accurate and efficient evaluations of the measured-to-planned dose agreement.

Assessment of a Therapeutic X-ray Radiation Dose Measurement System Based on a Flexible Copper Indium Gallium Selenide Solar Cell

Several detectors have been developed to measure radiation doses during radiotherapy. However, most detectors are not flexible. Consequently, the airgaps between the patient surface and detector could reduce the measurement accuracy. Thus, this study proposes a dose measurement system based on a flexible copper indium gallium selenide (CIGS) solar cell. Our system comprises a customized CIGS solar cell (with a size 10 × 10 cm2 and thickness 0.33 mm), voltage amplifier, data acquisition module, and laptop with in-house software. In the study, the dosimetric characteristics, such as dose linearity, dose rate independence, energy independence, and field size output, of the dose measurement system in therapeutic X-ray radiation were quantified. For dose linearity, the slope of the linear fitted curve and the R-square value were 1.00 and 0.9999, respectively. The differences in the measured signals according to changes in the dose rates and photon energies were <2% and <3%, respectively. The field size output measured using our system exhibited a substantial increase as the field size increased, contrary to that measured using the ion chamber/film. Our findings demonstrate that our system has good dosimetric characteristics as a flexible in vivo dosimeter. Furthermore, the size and shape of the solar cell can be easily customized, which is an advantage over other flexible dosimeters based on an a-Si solar cell.

Pre‐clinical and clinical evaluation of the HYPERSCINT plastic scintillation dosimetry research platform for in vivo dosimetry during radiotherapy

Purpose

The purpose of this work is to evaluate the Hyperscint‐RP100 scintillation dosimetry research platform (Hyperscint‐RP100, Medscint Inc., Quebec, QC, Canada) designed for clinical quality assurance (QA) for use in in vivo dosimetry measurements.

Methods

The pre‐clinical evaluation of the scintillator was performed using a Varian TrueBeam linear accelerator. Dependency on field size, depth, dose, dose rate, and temperature were evaluated in a water tank and compared to calibration data from commissioning and annual QA. Angularity was evaluated with a 3D printed phantom. The clinical evaluation was first performed in two cadaver dogs, and then in three companion animal dogs receiving radiation therapy for nasal tumors. A treatment planning CT scan was performed for cadavers and clinical patients. Prior to treatment, the probe was inserted into the radiation field. Radiation was then delivered and measured with the scintillator. For cadavers, the treatment was repeated after making an intentional shift in patient position to simulate a treatment error.

Results

In the preclinical measurements the dose differed from annual measurements as follows: field size −0.77 to 0.43%, depth dose −0.36 to 1.14%, dose −0.54 to 2.93%, dose rate 0.3 to 3.6%, and angularity −1.18 to 0.01%. Temperature dependency required a correction factor of 0.11%/°C. In the two cadavers, the dose differed by −1.17 to 0.91%. The device correctly detected the treatment error when the heads were intentionally laterally shifted. In three canine clinical patients treated in multiple fractions, the detected dose ranged from 98.33 to 103.15%.

Conclusion

Results of this new device are promising although more work is necessary to fully validate it for clinical dosimetry.

Evaluation of Given Dose Accuracy in Radiation Therapy of Patient with Breast Cancer Using Diode In Vivo Dosimetry

Background: The main goal of radiation therapy is to deliver the highest dose to the tumor and at the same time the lowest dose to the surrounding normal tissue. In vivo dosimetry is a quality control procedure that, instead of controlling the components separately, directly examines the dose reached to the tumor area. Objectives: In this study, the entrance, exit, and middle dose of the breast and supraclavicular area of patients with breast cancer under radiation therapy were measured and compared with calculations. Methods: In this experimental study, the entrance and exit doses of 33 patients with breast tumors treated with 6 MV and 18MV photons were measured simultaneously. The measurement was done, using p-type diodes after calibration and, then, the midpoint dose was calculated, using the transfer method and arithmetic mean method. Also, the entrance dose, exit dose, and midline dose measured with dosimeter were compared with the calculated values in the treatment planning system. Results: There was no significant difference between calculated and measured doses in the entrance, exit, and midline point in breast regions (P > 0.05), but in the supraclavicular region, a challenge was observed. The difference in entrance and midline point between calculation and measurement is not significant based on the transfer method, but there is a significant error based on the arithmetic mean method (P < 0.05). Conclusions: In vivo dosimetry by measured real given dose to the patient can perform a basic role in the quality control of the radiotherapy department. It seems in the entrance dose, the relative error is smaller but due to the smaller value of exit dose, the relative error in small values is more apparent.

Delta4 Discover transmission detector: A comprehensive characterization for in-vivo VMAT monitoring

OBJECTIVE

To investigate the dosimetric behaviour, influence on photon beam fluence and error detection capability of Delta⁴ Discover transmission detector.

METHODS

The transmission detector (TRD) was characterized on a TrueBeam linear accelerator with 6 MV beams. Linearity, reproducibility and dose rate dependence were investigated. The effect on photon beam fluence was evaluated in terms of beam profiles, percentage depth dose, transmission factor and surface dose for different open field sizes. The transmission factor of the 10x10 cm² field was entered in the TPS's configuration and its correct use in the dose calculation was verified recalculating 17 clinical IMRT/VMAT plans. Surface dose was measured for 20 IMRT fields. The capability to detect different delivery errors was investigated evaluating dose gamma index, MLC gamma index and leaf position of 15 manually modified VMAT plans.

RESULTS

TRD showed a linear dependence on MU. No dose rate dependence was observed. Short-term and long-term reproducibility were within 0.1% and 0.5%. The presence of the TRD did not significantly affect PDDs and profiles. The transmission factor of the 10x10 cm² field size was 0.985 and 0.983, for FF and FFF beams respectively. The 17 recalculated plans met our clinical gamma-index passing rate, confirming the correct use of the transmission factor by the TPS. The surface dose differences for the open fields increase for shorter SSDs and greater field size. Differences in surface dose for the IMRT beams were less than 2%. Output variation ≥2%, collimator angle variations within 0.3°, gantry angle errors of 1°, jaw tracking and leaf position errors were detected.

CONCLUSIONS

Delta⁴ Discover shows good linearity and reproducibility, is not dependent on dose rate and does not affect beam quality and dose profiles. It is also capable to detect dosimetric and geometric errors and therefore it is suitable for monitoring VMAT delivery.

In vivo dosimetry in low-voltage IORT breast treatments with XR-RV3 radiochromic film

PURPOSE

The objectives of the study were to establish a procedure for in vivo film-based dosimetry for intraoperative radiotherapy (IORT), evaluate the typical doses delivered to organs at risk, and verify the dose prescription.

MATERIALS AND METHODS

In vivo dose measurements were studied using XR-RV3 radiochromic films in 30 patients with breast cancer undergoing IORT using the Axxent® device (Xoft Inc.). The stability of the radiochromic films in the energy ranges used was verified by taking measurements at different depths. The stability of the scanner response was tested, and 5 different calibration curves were constructed for different beam qualities. Six pieces of film were placed in each of the 30 patients. All the pieces were correctly sterilized and checked to ensure that the process did not affect the outcome. All calibration and dose measurements were analyzed using the Radiochromic.com software application.

RESULTS

The doses were measured for 30 patients. The doses in contact with the applicator (prescription zone) were 19.8 ± 0.9 Gy. In the skin areas, the doses were as follows: 1-2 cm from the applicator, 1.86 ± 0.77 Gy; 2-5 cm, 0.73 ± 0.14 Gy; and greater than 5 cm, 0.28 ± 0.17 Gy. The dose delivered to the pectoral muscle (tungsten shielding disc) was 0.51 ± 0.27 Gy.

CONCLUSIONS

The study demonstrated the viability of XR-RV3 films for in vivo dose measurement in the dose and energy ranges applied in a complex procedure, such as breast IORT. The doses in organs at risk were far below the tolerances for cases such as those studied.

Characterisation and use of OSLD for in vivo dosimetry in head and neck intensity-modulated radiation therapy

Aim:

This study reveals the characteristic nature and the use of optically stimulated luminescence dosimeters (OSLD) as an in vivo dosimetry tool for head and neck intensity-modulated radiation therapy (IMRT).

Materials and methods:

Calibration and characterisation of OSLD such as sensitivity, reproducibility, dose-rate dependence, beam quality dependence, output factor measurement and comparison of two bleaching techniques using halogen and compact fluorescent lamp (CFL) were initially performed. Later, eye dose measurements were performed for head and neck IMRT patients using OSLD and were compared with the corresponding dose calculated by the treatment planning system (TPS).

Results:

While the sensitivity was found to be within ±5%, the dose-rate dependence and reproducibility were found to be within ±3%. The OSLD showed an under-response of 3% for 15 MV and an increase in response by 5% for Co60 (1·25 MeV) when compared with the 6 MV X-ray beam. Therefore, a separate calibration for different beam energies is required. The percentage deviation of OSLD to that of TPS was found to be within ±2·77%. The OSLD has been successfully used for the in vivo dosimetry of patients who received IMRT. Hence, it is concluded that OSLDs can serve as effective dosimeters for in vivo dosimetry.

Electron radiotherapy (IOERT) for applications outside of the breast: Dosimetry and influence of tissue inhomogeneities

PURPOSE

The purpose of study is to investigate the dosimetry of electron intraoperative radiotherapy (IOERT) of the Intraop Mobetron 2000 mobile LINAC in treatments outside of the breast. After commissioning and external validation of dosimetry, we report in vivo results of measurements for treatments outside the breast in a large patient cohort, and investigate if the presence of inhomogeneities can affect in vivo measurements.

METHODS AND MATERIALS

Applicator factors and profile curves were measured with a stereotactic diode. The applicators factors of the 6 cm flat and beveled applicators were also confirmed with radiochromic films, parallel-plate ion chamber and by an external audit performed with ThermoLuminescent Dosimeters (TLDs). The influence of bone on dose was investigated by using radiochromic films attached to an insert equivalent to cortical bone, immersed in the water phantom. In vivo dosimetry was performed on 126 patients treated with IOERT using metal oxide-silicon semiconductor field effect transistors (MOSFETs) placed on the tumor bed.

RESULTS

Relatively small differences were found among different detectors for measurements of applicator factors. In the external audit, the agreement with the TLD was mostly within ±0.2%. The largest increase of dose due to the presence of cortical bone insert was +6.0% with energy 12 MeV and 3 cm applicator. On average, in vivo dose was significantly (+3.1%) larger than prescribed dose.

CONCLUSION

IOERT in applications outside the breast results in low discrepancies between in vivo and prescribed doses, which can be also explained with the presence of tissue inhomogeneity.

An Empirical Transmitted EPID Dosimetry Method using a Back-Projection Algorithm

Background:

The present study aimed to introduce a rapid transmission dosimetry through an electronic portal-imaging device (EPID) to achieve two-dimensional (2D) dose distribution for homogenous environments.

Material and Methods:

In this Phantom study, first, the EPID calibration curve and correction coefficients for field size were obtained from EPID and ionization chamber. Second, the EPID off-axis pixel response was measured, and the grey-scale image of the EPID was converted into portal dose image using the calibration curve. Next, the scattering contribution was calculated to obtain the primary dose. Then, by means of a verified back-projection algorithm and the Scatter-to-Primary dose ratio, a 2D dose distribution at the mid-plane was obtained.

Results:

The results obtained from comparing the transmitted EPID dosimetry to the calculated dose, using commercial treatment planning system with gamma function while there is 3% dose difference and 3mm distance to agreement criteria, were in a good agreement. In addition, the pass rates of γ < 1 was 94.89% for the homogeneous volumes.

Conclusion:

Based on the results, the method proposed can be used in EPID dosimetry.

Dose Shadowing and Prosthesis Involvement for Megavoltage Photon In vivo Diode Dosimetry

AIM

The aim of the study is to investigate the photon beam perturbations induced by an in vivo diode in combination with prosthesis involvement in a human-like phantom.

MATERIALS AND METHODS

Beam perturbations for 6 MV and 10 MV photons caused by an EDP-203G in vivo diode in combination with prosthesis involvement were studied in a unique water-equivalent pelvic phantom, equipped with bony structures and Ti prosthesis using single fields between 2 × 2 and 15 cm × 15 cm as well as 10 MV lateral opposing fields and a four-field plan. Dose distributions were measured with Gafchromic EBT3 films with and without the diode included in the beams on the prosthesis (prosthetic fields) and non-prosthesis (non-prosthetic fields) sides of the phantom. Differences between prosthetic and non-prosthetic field dose data were determined to assess the effect of the prosthesis on the diode-induced beam perturbations inside the phantom.

RESULTS

Photon beam dose perturbations ranged from 2% to 7% and from 5% to 12% for prosthetic and non-prosthetic fields, respectively, with relative differences between 2% and 4%. In addition, d50 depths ranging from 8.7 to 11.5 cm and from 11.5 to 15 cm were acquired in the phantom for prosthetic and non-prosthetic fields, respectively, with relative differences between 2% and 5%.

CONCLUSION

On the basis of accuracy requirements in radiotherapy noting that a small underdose to tumors could yield a decrease in the probability of tumor control, the diode-induced beam perturbations in combination with prosthesis involvement in the photon fields may affect treatment outcome, as there would be a reduction in the prescribed target dose during treatment delivery.

Verification of lithium formate monohydrate in 3D-printed container for electron paramagnetic resonance dosimetry in radiotherapy

The nondestructive dosimetry achieved with electron paramagnetic resonance (EPR) dosimetry facilitates repetitive recording by the same dosimeter to increase the reliability of data. In precedent studies, solid paraffin was needed as a binder material to make the lithium formate monohydrate (LFM) EPR dosimeter stable and nonfragile; however, its use complicates dosimetry. This study proposes a newly designed pure LFM EPR dosimeter created by inserting LFM into a 3D-printed container. Dosimetric characteristics of the LFM EPR dosimeter and container, such as reproducibility, linearity, energy dependence, and angular dependence, were evaluated and verified through a radiation therapy planning system (RTPS). The LFM EPR dosimeters were irradiated using a clinical linear accelerator. The EPR spectra of the dosimeters were acquired using a Bruker EMX EPR spectrometer. Through this study, it was confirmed that there is no tendency in the EPR response of the container based on irradiation dose or radiation energy. The results show that the LFM EPR dosimeters have a highly sensitive dose response with good linearity. The energy dependence across each photon and electron energy range seems to be negligible. Based on these results, LFM powder in a 3D-printed container is a suitable option for dosimetry of radiotherapy. Furthermore, the LFM EPR dosimeter has considerable potential for in vivo dosimetry and small-field dosimetry via additional experiments, owing to its small effective volume and highly sensitive dose response compared with a conventional dosimeter.

Effect of low magnetic field on single-diode dosimetry for clinical use

PURPOSE

To evaluate the effect of a low magnetic field (B-field, 0.35 T) on QED™ for clinical use.

METHODS

Black and Blue QED were irradiated using tri-Co-60 magnetic resonance image-guided radiation therapy systems with and without the B-field. For both detectors, angular dependence of the beam orientation was evaluated by rotating the gantry and detector in parallel and perpendicular directions to the B-field. Angular dependence betweenthe directions of both QED and B-field was also measured. Response on the depth and output factor of both detectors was investigated for parallel and perpendicular setups, respectively.

RESULTS

When Black QED was placed on a surface, detector response decreased by 1.8% and 4.5% for parallel and perpendicular setups, respectively, owing to the B-field. The angular dependence of the beam orientation was not affected by B-field for both detectors. There was a significant angular dependence between Black QED and B-field direction and for the Black QED when the gantry was rotated. Owing to the B-field, the detector response at 90° decreased by 2.4%, response of Black QED on the depth was changed only on the surface, and output factor of Black QED was changed only on the surface. The response of Blue QED was not affected by the B-field for all examined situations.

CONCLUSIONS

Using Black QED on a surface in the same position as that in the calibration requires some correction to the B-field. Blue QED does not require correction as it is not affected by the B-field.

Prediction of skin dose in low-kV intraoperative radiotherapy using machine learning models trained on results of in vivo dosimetry

PURPOSE

The purpose of this study was to implement a machine learning model to predict skin dose from targeted intraoperative (TARGIT) treatment resulting in timely adoption of strategies to limit excessive skin dose.

METHODS

A total of 283 patients affected by invasive breast carcinoma underwent TARGIT with a prescribed dose of 6 Gy at 1 cm, after lumpectomy. Radiochromic films were used to measure the dose to the skin for each patient. Univariate statistical analysis was performed to identify correlation of physical and patient variables with measured dose. After feature selection of predictors of in vivo skin dose, machine learning models stepwise linear regression (SLR), support vector regression (SVR), ensemble with bagging or boosting, and feed forward neural networks were trained on results of in vivo dosimetry to derive models to predict skin dose. Models were evaluated by tenfold cross validation and ranked according to root mean square error (RMSE) and adjusted correlation coefficient of true vs predicted values (adj-R² ).

RESULTS

The predictors correlated with in vivo dosimetry were the distance of skin from source, depth-dose in water at depth of the applicator in the breast, use of a replacement source, and irradiation time. The best performing model was SVR, which scored RMSE and adj-R² , equal to 0.746 [95% confidence intervals (CI), 95% CI 0.737,0.756] and 0.481 (95% CI 0.468,0.494), respectively, on the tenfold cross validation.

CONCLUSION

The model trained on results of in vivo dosimetry can be used to predict skin dose during setup of patient for TARGIT and this allows for timely adoption of strategies to prevent of excessive skin dose.

Optimization of skin dose using in-vivo MOSFET dose measurements in bolus/non-bolus fraction ratio: A VMAT and a 3DCRT study

In‐phantom and in‐vivo three dimensional conformal radiation therapy (3DCRT) and volumetric modulated arc therapy (VMAT) skin doses, measured with and without bolus in a female anthropomorphic phantom RANDO and in patients, were compared against treatment planning system calculated values. A thorough characterization of the metal oxide semiconductor field effect transistor measurement system was performed prior to the measurements in phantoms and patients. Patients with clinical indication for postoperative external radiotherapy were selected. Skin dose showed higher values with 3DCRT technique compared with VMAT. The increase in skin dose due to the use of bolus was quantified. It was observed that, in the case of VMAT, the bolus effect on the skin dose was considerable when compared with 3DCRT. From the point of view of treatment time, bolus cost, and positioning reproducibility, the use of bolus in these situations can be optimized.

EPID-based in vivo dosimetry using Dosimetry Check™: Overview and clinical experience in a 5-yr study including breast, lung, prostate, and head and neck cancer patients

BACKGROUND

Independent verification of the dose delivered by complex radiotherapy can be performed by electronic portal imaging device (EPID) dosimetry. This paper presents 5-yr EPID in vivo dosimetry (IVD) data obtained using the Dosimetry Check (DC) software on a large cohort including breast, lung, prostate, and head and neck (H&N) cancer patients.

MATERIAL AND METHODS

The difference between in vivo dose measurements obtained by DC and point doses calculated by the Eclipse treatment planning system was obtained on 3795 radiotherapy patients treated with volumetric modulated arc therapy (VMAT) (n = 842) and three-dimensional conformal radiotherapy (3DCRT) (n = 2953) at 6, 10, and 15 MV. In cases where the dose difference exceeded ±10% further inspection and additional phantom measurements were performed.

RESULTS

The mean and standard deviation ( μ ± σ ) of the percentage difference in dose obtained by DC and calculated by Eclipse in VMAT was: 0.19 ± 3.89 % in brain, 1.54 ± 4.87 % in H&N, and 1.23 ± 4.61 % in prostate cancer. In 3DCRT, this was 1.79 ± 3.51 % in brain, - 2.95 ± 5.67 % in breast, - 1.43 ± 4.38 % in bladder, 1.66 ± 4.77 % in H&N, 2.60 ± 5.35% in lung and - 3.62 ± 4.00 % in prostate cancer. A total of 153 plans exceeded the ±10% alert criteria, which included: 88 breast plans accounting for 7.9% of all breast treatments; 28 H&N plans accounting for 4.4% of all H&N treatments; and 12 prostate plans accounting for 3.5% of all prostate treatments. All deviations were found to be as a result of patient-related anatomical deviations and not from procedural errors.

CONCLUSIONS

This preliminary data shows that EPID-based IVD with DC may not only be useful in detecting errors but has the potential to be used to establish site-specific dose action levels. The approach is straightforward and has been implemented as a radiographer-led service with no disruption to the patient and no impact on treatment time.

Verification of calculations carried out with the Eclipse treatment planning system

The goal of radiotherapy is to deliver prescribed dose to the target volume and simultaneously minimize the dose to the healthy organs. The purpose of this work was to verify the accuracy of calculations carried out with a treatment planning system (TPS). Measurements carried out with thermoluminescence detectors (TLDs) were compared with doses calculated with TPS. Doses were measured and calculated both in the open beam’s region and under individual blocks. Measurements were performed in the Randophantom. The work was carried out for photon beams generated in the Varian CLINAC 2100C accelerator. The maximum / minimum percentage differences between measured and calculated doses were 4.9/0.6%, 2.6/0%, and 3.5%/0.5% in open, shielded and partially shielded points, respectively. Differences between the measured and calculated doses were within acceptable limits.

In-vivo EPID dosimetry for IMRT and VMAT based on through-air predicted portal dose algorithm

We have adapted the methodology of Berry et al. (2012) for Intensity Modulated Radiotherapy (IMRT) and Volumetric Modulated Arc Therapy (VMAT) treatments at a fixed source to imager distance (SID) based on the manufacturer's through-air portal dose image prediction algorithm. In order to fix the SID a correction factor was introduced to account for the change in air gap between patient and imager. Commissioning data, collected with multiple field sizes, solid water thicknesses and air gaps, were acquired at 150 cm SID on the Varian aS1200 EPID. The method was verified using six IMRT and seven VMAT plans on up to three different phantoms. The method's sensitivity and accuracy were investigated by introducing errors. A global 3%/3 mm gamma was used to assess the differences between the predicted and measured portal dose images. The effect of a varying air gap on EPID signal was found to be significant - varying by up to 30% with field size, phantom thickness, and air gap. All IMRT plans passed the 3%/3 mm gamma criteria by more than 95% on the three phantoms. 23 of 24 arcs from the VMAT plans passed the 3%/3 mm gamma criteria by more than 95%. This method was found to be sensitive to a range of potential errors. The presented approach provides fast and accurate in-vivo EPID dosimetry for IMRT and VMAT treatments and can potentially replace many pre-treatment verifications.

Feasibility study of range-based registration using daily cone beam CT for intensity-modulated proton therapy

PURPOSE

Proton dose coverage is sensitive to proton beam range. The current practice of CT number-based registration for patient positioning focuses on matching the target and is not sufficient for proton therapy because the proton range depends on the medium traversed by the beam. Patient body deformations and anatomical changes result in range deviation in the target. We propose proton range-based registration to minimize the range deviation.

METHODS

The range was calculated from cone beam-computed tomography (CBCT) of the patient on couch, and the range deviation was the difference of the calculated range from that on the initial (day 1) CBCT. In the investigated prostate cases in which the main cause of range deviation was the rotation of femur bones, and in the investigated abdomen cases in which the main cause of range deviation was body growth and anatomic change, our range-based registration was used to obtain the optimal beam angle by minimizing the range deviation. The new angle was limited to be ±5° from that planned to prevent potentially increased dose to the organs at risk. To demonstrate the benefit of range-based registration, we investigated the range at the voxels on the surface of the target volume. The calculation error of range deviation due to CBCT scatter was investigated by using solid water phantoms with different thicknesses. Range-based registration using both CBCTs and CTs was performed in cases of two patients with pelvic rhabdomyosarcoma and one patient with upper abdominal tumor. The range was represented by the water-equivalent thickness to shorten the computation for online application purposes.

RESULTS

In the phantom study, the calculation error of range deviation due to CBCT scatter was within 2 mm for a 1-cm thickness change (the mean range deviation was 0.8 mm). In the CT study of the prostate cases, the range deviation (mean ± root-mean-square deviation) on the contour in each slice was efficiently reduced from 3.6 ± 2.8 mm to 2.1 ± 1.4 mm, with most slices being within 3 mm; in the CT study of the abdomen cases, the range deviation of the whole set was reduced from 4.4 ± 1.9 mm to 3.5 ± 2.1 mm. Both the mean and root-mean-square deviation of the range deviation on each treatment day were decreased. The dose coverage on the target was improved and the dose on the OARs was only slightly changed.

CONCLUSION

Range-based registration can efficiently mitigate range deviation due to patient positioning and anatomical changes. It can shorten patient positioning time and reduce the patient's dose from CBCT.

Response of Nanodot Optically Stimulated Luminescence Dosimeters to Therapeutic Electron Beams

Response of Al₂O₃:C-based nanoDot optically stimulated luminescence (OSL) dosimeter was studied for the dosimetry of 6, 9, 12, 16, and 20 MeV therapeutic electron beams. With reference to ionization chamber, no change in the response was observed with the change in the energy of electron beams for the field size from 6 cm × 6 cm to 25 cm × 25 cm, dose rates from 100 MU/min to 600 MU/min, and the linearity in the response up to 300 cGy. The fading of the transient signal was higher for 20 MeV electron beam than that of 6 MeV electron beam by about 5% as compared to value at 20 min after irradiation. The depletion of OSL signal per readout in 200 successive readouts was also found to change with dose and energy of electron beam from 6 MeV (9% and 12% per readout at 2 and 10 Gy, respectively) to 20 MeV (9% and 16% at 2 and 10 Gy, respectively). The OSL sensitivity changed in the range from 2% to 6% with accumulated doses from 2 to 8 Gy and with electron energy from 6 to 20 MeV, but the sensitivity could be reset using an optical annealing treatment. Although negligible fading for postirradiation storage from 20 min to several months, acceptable precision and linearity in the desired range, and high reproducibility makes nanoDot dosimeters very attractive for the dosimetry of therapeutic electron beams, a note should be made for changes in sensitivity at doses beyond 2 Gy and electron beams energy dependence in reuse, short-term fading, and signal depletion on repeated readout.

Initial characterization of a gel patch dosimeter for in vivo dosimetry

In vivo dosimetry is a greatly underutilized tool for patient safety in clinical external beam radiotherapy treatments, despite being recommended by several national and international organizations (AAPM, ICRU, IAEA, NACP). The reasons for this underutilization mostly relate to the feasibility and cost of in vivo dosimetry methods. Due to the increase in the number of beam angles and dose per fraction in modern treatments, there is a compelling need for a novel dosimeter that is robust and affordable while able to operate properly in these complex conditions. This work presents a gel patch dosimeter as a novel method of in vivo dosimetry. DEFGEL, a 6% T normoxic polyacrylamide gel, was injected into 1 cm thick acrylic molds to create 1 cm thick small cylindrical patch dosimeters. To evaluate the change in optical density due to radiation induced polymerization, dosimeters were scanned before and after irradiation using an in-house developed laser densitometer. The dose-responses of three separate batches of gel were evaluated and compared to check for linearity and repeatability. The response development time was evaluated to ensure that the patch dosimeter could be high throughput. Additionally, the potential of this system to be used as an in vivo dosimeter was tested with a clinically relevant end-to-end in vivo phantom test. All irradiations were performed with a Varian Clinac 21EX at the University of Wisconsin Medical Radiation Research Center (UWMRRC). The dose-response of all three batches of gel was found to be linear within the range of 2-20 Gy. At doses below 0.5 Gy the statistical uncertainties were prohibitively large to make quantitative assessments of the results. The three batches demonstrated good repeatability in the range of 2 Gy to up to 10 Gy, with only slight variations in response at higher doses. For low doses the dosimeter fully developed within an hour while at higher doses they fully developed within four hours. During the in vivo phantom test the predicted patch absorbed dose was 4.23 Gy while the readout dose was evaluated to be 4.37 Gy, which corresponds to a 3.2% discrepancy. The dosimeter and densitometer pairing shows promise as an in vivo dosimetry system, especially for hypofractionated or MRI-guided radiotherapy treatments where higher doses are prescribed.

A novel synthetic single crystal diamond device for in vivo dosimetry

PURPOSE

Aim of the present work is to evaluate the synthetic single crystal diamond Schottky photodiode developed at the laboratories of "Tor Vergata" University in Rome in a new dosimeter configuration specifically designed for offline wireless in vivo dosimetry (IVD) applications.

METHODS

The new diamond based dosimeter, single crystal diamond detector (SCDD-iv), consists of a small unwired detector and a small external reading unit that can be connected to commercial electrometers for getting the detector readout after irradiation. Two nominally identical SCDD-iv dosimeter prototypes were fabricated and tested. A basic dosimetric characterization of detector performances relevant for IVD application was performed under irradiation with (60)Co and 6 MV photon beams. Preirradiation procedure, response stability, short and long term reproducibility, leakage charge, fading effect, linearity with dose, dose rate dependence, temperature dependence, and angular response were investigated.

RESULTS

The SCDD-iv is simple, with no cables linked to the patient and the readout is immediate. The range of response with dose has been tested from 1 up to 12 Gy; the reading is independent of the accumulated dose and dose rate independent in the range between about 0.5 and 5 Gy/min; its temperature dependence is within 0.5% between 25 and 38 °C, and its directional dependence is within 2% from 0° to 90°. The combined relative standard uncertainty of absorbed dose to water measurements is estimated lower than the tolerance and action level of 5%.

CONCLUSIONS

The reported results indicate the proposed novel offline dosimeter based on a synthetic single crystal diamond Schottky photodiode as a promising candidate for in vivo dosimetry applications with photon beams.

Verification of Entrance Dose Measurements with Thermoluminescent Dosimeters in Conventional Radiotherapy Procedures Delivered with Co-60 Teletherapy Machine

Background:

The use of in vivo dosimetry with thermolumiscent dosimeters (TLDs) as a veritable means of quality control in conventional radiotherapy procedures was determined in this work.

Aim:

The objective of this study was to determine the role of in vivo dosimetry with thermoluminescent dosimeters (TLDs) as part of quality control and audit in conventional radiotherapy procedures delivered with Co-60 teletherapy machine.

Subjects and Methods:

Fifty-seven patients with cancers of the breast, pelvis, head and neck were admitted for this study. TLD system at the Radiation Monitoring and Protection Centre, Lagos State University, Ojo, Lagos-Nigeria was used for the in vivo entrance dose readings. All patients were treated with Co-60 (T780c) teletherapy machine at 80 cm source to surface distance located at Eko Hospitals, Lagos. Two TLDs were placed on the patient surface within 1 cm from the center of the field of treatment. Build-up material made of paraffin wax with a density of 0.939 g/cm³ and a thickness 0.5 cm was placed on top of the TLDs. A RADOS RE 200 TLD reader was used to read out the TLDs over 12 s and at a temperature of 300°C.

Results:

The results showed that there was no significant difference between the expected dose and measured dose of breast (P = 0.11), H and N (P = 0.52), and pelvis (P = 0.31) patients. Furthermore, percentage difference between expected dose and measured dose of the three treatment sites were not significantly different (P = 0.11). More so, 88.9% (16/18) treated breast, 91.3% (21/23) pelvis, and 86.7% (13/15) H and N patients had percentage deviation difference less than 5%. In general, 89.3% (50/56) patients admitted for this study had their percentage deviation difference below 5% recommended standard limit.

Conclusion:

The values obtained establish that there are no major differences from similar studies reported in literature. This study was also part of quality control and audit of the radiotherapy procedures in the center as expected by national and international regulatory bodies.

Beam perturbation characteristics of a 2D transmission silicon diode array, Magic Plate

The main objective of this study is to demonstrate the performance characteristics of the Magic Plate (MP) system when operated upstream of the patient in transmission mode (MPTM). The MPTM is an essential component of a real‐time QA system designed for operation during radiotherapy treatment. Of particular interest is a quantitative study into the influence of the MP on the radiation beam quality at several field sizes and linear accelerator potential differences. The impact is measured through beam perturbation effects such as changes in the skin dose and/or percentage depth dose (PDD) (both in and out of field). The MP was placed in the block tray of a Varian linac head operated at 6, 10 and 18 MV beam energy. To optimize the MPTM operational setup, two conditions were investigated and each setup was compared to the case where no MP is positioned in place (i.e., open field): (i) MPTM alone and (ii) MPTM with a thin passive contamination electron filter. The in‐field and out‐of‐field surface doses of a solid water phantom were investigated for both setups using a Markus plane parallel (Model N23343) and Attix parallel‐plate, MRI model 449 ionization chambers. In addition, the effect on the 2D dose distribution measured by the Delta⁴ QA system was also investigated. The transmission factor for both of these MPTM setups in the central axis was also investigated using a Farmer ionization chamber (Model 2571A) and an Attix ionization chamber. Measurements were performed for different irradiation field sizes of 5×5 cm2 and 10×10 cm2. The change in the surface dose relative to dmax was measured to be less than 0.5% for the 6 MV, 10 MV, and 18 MV energy beams. Transmission factors measured for both set ups (i & ii above) with 6 MV, 10 MV, and 18 MV at a depth of dmax and a depth of 10 cm were all within 1.6% of open field. The impact of both the bare MPTM and the MPTM with 1 mm buildup on 3D dose distribution in comparison to the open field investigated using the Delta⁴ system and both the MPTM versions passed standard clinical gamma analysis criteria. Two MPTM operational setups were studied and presented in this article. The results indicate that both versions may be suitable for the new real‐time megavoltage photon treatment delivery QA system under development. However, the bare MPTM appears to be slightly better suited of the two MP versions, as it minimally perturbs the radiation field and does not lead to any significant increase in skin dose to the patient.

PACS number(s): 87.50.up, 87.53.Bn, 87.55.N, 87.55.Qr, 87.56.Fc.

Feasibility of portal dosimetry for flattening filter-free radiotherapy

The feasibility of using portal dosimetry (PD) to verify 6 MV flattening filter‐free (FFF) IMRT treatments was investigated. An Elekta Synergy linear accelerator with an Agility collimator capable of delivering FFF beams and a standard iViewGT amorphous silicon (aSi) EPID panel (RID 1640 AL5P) at a fixed SSD of 160 cm were used. Dose rates for FFF beams are up to four times higher than for conventional flattened beams, meaning images taken at maximum FFF dose rate can saturate the EPID. A dose rate of 800 MU/min was found not to saturate the EPID for open fields. This dose rate was subsequently used to characterize the EPID for FFF portal dosimetry. A range of open and phantom fields were measured with both an ion chamber and the EPID, to allow comparison between the two. The measured data were then used to create a model within The Nederlands Kanker Instituut's (NKI's) portal dosimetry software. The model was verified using simple square fields with a range of field sizes and phantom thicknesses. These were compared to calculations performed with the Monaco treatment planning system (TPS) and isocentric ion chamber measurements. It was found that the results for the FFF verification were similar to those for flattened beams with testing on square fields, indicating a difference in dose between the TPS and portal dosimetry of approximately 1%. Two FFF IMRT plans (prostate and lung SABR) were delivered to a homogeneous phantom and showed an overall dose difference at isocenter of ∼0.5% and good agreement between the TPS and PD dose distributions. The feasibility of using the NKI software without any modifications for high‐dose‐rate FFF beams and using a standard EPID detector has been investigated and some initial limitations highlighted.

PACS number: 87.55.Qr

A Colorimetric Plasmonic Nanosensor for Dosimetry of Therapeutic Levels of Ionizing Radiation

Modern radiation therapy using highly automated linear accelerators is a complex process that maximizes doses to tumors and minimizes incident dose to normal tissues. Dosimeters can help determine the radiation dose delivered to target diseased tissue while minimizing damage to surrounding healthy tissue. However, existing dosimeters can be complex to fabricate, expensive, and cumbersome to operate. Here, we demonstrate studies of a liquid phase, visually evaluated plasmonic nanosensor that detects radiation doses commonly employed in fractionated radiotherapy (1-10 Gy) for tumor ablation. We accomplished this by employing ionizing radiation, in concert with templating lipid surfactant micelles, in order to convert colorless salt solutions of univalent gold ions (Au(1)) to maroon-colored dispersions of plasmonic gold nanoparticles. Differences in color intensities of nanoparticle dispersions were employed as quantitative indicators of the radiation dose. The nanoparticles thus formed were characterized using UV-vis absorbance spectroscopy, dynamic light scattering, and transmission electron microscopy. The role of lipid surfactants on nanoparticle formation was investigated by varying the chain lengths while maintaining the same headgroup and counterion; the effect of surfactant concentration on detection efficacy was also investigated. The plasmonic nanosensor was able to detect doses as low as 0.5 Gy and demonstrated a linear detection range of 0.5-2 Gy or 5-37 Gy depending on the concentration of the lipid surfactant employed. The plasmonic nanosensor was also able to detect radiation levels in anthropomorphic prostate phantoms when administered together with endorectal balloons, indicating its potential utility as a dosimeter in fractionated radiotherapy for prostate cancer. Taken together, our results indicate that this simple visible nanosensor has strong potential to be used as a dosimeter for validating delivered radiation doses in fractionated radiotherapies in a variety of clinical settings.

Anomaly Detection in Healthcare: Detecting Erroneous Treatment Plans in Time Series Radiotherapy Data

Adverse events in healthcare and medical errors result in thousands of accidental deaths and over one million excess injuries each year. Anomaly detection in medicine is an important task, especially in the area of radiation oncology where errors are very rare, but can be extremely dangerous, and even deadly. To avoid medical errors in radiation cancer treatment, careful attention needs to be made to ensure accurate implementation of the intended treatment plan. In this paper, we describe the work that resulted in a valuable predictive analytics tool for automatic detection of catastrophic errors in cancer radiotherapy, adding an important safeguard for patient safety. We designed a method for Dynamic Modeling and Prediction of Radiotherapy Treatment Deviations from Intended Plans (SmartTool) to automatically detect and highlight potential errors in a radiotherapy treatment plan, based on the data from several thousand prostate cancer treatments that were used to build the model. SmartTool determines if the treatment parameters are valid, against a previously built Predictive Model of a Medical Error (PMME). SmartTool communicates with a radiotherapy treatment management system, checking all the treatment parameters in the background prior to execution, and after the human expert QA is completed. Any anomalous treatment parameters are detected using an innovative intelligent algorithm in a completely automatic and unsupervised manner, and it flags the operator by highlighting the suspect parameter(s) for human intervention. Furthermore, the system is self-learning and constantly evolving, and the model is dynamically updated with the new treatment data.

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.

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.

Evaluation of six TPS algorithms in computing entrance and exit doses

Entrance and exit doses are commonly measured in in vivo dosimetry for comparison with expected values, usually generated by the treatment planning system (TPS), to verify accuracy of treatment delivery. This report aims to evaluate the accuracy of six TPS algorithms in computing entrance and exit doses for a 6 MV beam. The algorithms tested were: pencil beam convolution (Eclipse PBC), analytical anisotropic algorithm (Eclipse AAA), AcurosXB (Eclipse AXB), FFT convolution (XiO Convolution), multigrid superposition (XiO Superposition), and Monte Carlo photon (Monaco MC). Measurements with ionization chamber (IC) and diode detector in water phantoms were used as a reference. Comparisons were done in terms of central axis point dose, 1D relative profiles, and 2D absolute gamma analysis. Entrance doses computed by all TPS algorithms agreed to within 2% of the measured values. Exit doses computed by XiO Convolution, XiO Superposition, Eclipse AXB, and Monaco MC agreed with the IC measured doses to within 2%‐3%. Meanwhile, Eclipse PBC and Eclipse AAA computed exit doses were higher than the IC measured doses by up to 5.3% and 4.8%, respectively. Both algorithms assume that full backscatter exists even at the exit level, leading to an overestimation of exit doses. Despite good agreements at the central axis for Eclipse AXB and Monaco MC, 1D relative comparisons showed profiles mismatched at depths beyond 11.5 cm. Overall, the 2D absolute gamma (3%/3 mm) pass rates were better for Monaco MC, while Eclipse AXB failed mostly at the outer 20% of the field area. The findings of this study serve as a useful baseline for the implementation of entrance and exit in vivo dosimetry in clinical departments utilizing any of these six common TPS algorithms for reference comparison.

PACS numbers: 87.55.‐x, 87.55.D‐, 87.55.N‐, 87.53.Bn

A study of dosimetric characteristics for in vivo dosimetry with cylindrical n-type Isorad diode

Background and purpose

The objective was to determine diode characteristics before actual dose verification on human phantom and patients.

Materials and methods

The reliability and stability of equipment, signal stability, precision, dose response linearity, field flatness, perturbation of radiation dose, plastic to water conversion factor (Kpl), ionisation chambers (ICs) and diode calibration were determined. Correction factors for tray (CFtray), wedge (CFwedge), field size (CFFS), SSD (CFSSD), angle (CFangle) and block (CFblock) were found. Patient dose monitor, Isorad diode (n-type) and IC (PTW Frieburg), Co-60 unit (Theratron), ATOM Adult male human phantom (Model 701-D, CIRS) were used.

Results and conclusion

Good signal stability, precise data, and linear dose response, variation of 0·500% and 5·000% in field flatness and perturbation tests, respectively, were noted. Kpl was 1·006 for IC PTW Frieburg TW30013, 0114. The diode calibration factor was 0·989. CFtray, CFFS, CFSSD, CFangle, CFblock were 1·001, 1·001, 0·997, 1·006 and 0·990, respectively. CFwedge were 1·024, 1·030 and 1·038 for 30°, 45° and 60° wedges, respectively. The verification of above correction factors (CFs) on Nasopharynx and lung of human phantom was also done.

In vivo dosimetry of thyroid doses from different irradiated sites in children and adolescents: a cross-sectional study

Background

Scattered radiation can be assessed by in vivo dosimetry. Thyroid tissue is sensitive to radiation, even at doses <10 cGy. This study compared the scattered dose to the thyroid measured by thermoluminescent dosimeters (TLDs) and the estimated one by treatment planning system (TPS).

Methods

During radiotherapy to sites other than the thyroid of 16 children and adolescents, seventy-two TLD measurements at the thyroid were compared with TPS estimation.

Results

The overall TPS/TLD bias was 1.02 (95% LA 0.05 to 21.09). When bias was stratified by treatment field, the TPS overestimated TLD values at doses <1 cGy and underestimated them at doses >10 cGy. The greatest bias was found in pelvis and abdomen: 15.01 (95% LA 9.16 to 24.61) and 5.12 (95% LA 3.04 to 8.63) respectively. There was good agreement in orbit, head, and spine: bias 1.52 (95% LA 0.48 to 4.79), 0.44 (95% LA 0.11 to 1.82) and 0.83 (0.39 to 1.76) respectively. There was small agreement with broad limits for lung and mediastinum: 1.13 (95% LA 0.03 to 40.90) and 0.39 (95% LA 0.02 to 7.14) respectively.

Conclusions

The scattered dose can be measured with TLDs, and TPS algorithms for outside structures should be improved.

Application of spherical diodes for megavoltage photon beams dosimetry

PURPOSE

External beam radiation therapy (EBRT) usually uses heterogeneous dose distributions in a given volume. Designing detectors for quality control of these treatments is still a developing subject. The size of the detectors should be small to enhance spatial resolution and ensure low perturbation of the beam. A high uniformity in angular response is also a very important feature in a detector, because it has to measure radiation coming from all the directions of the space. It is also convenient that detectors are inexpensive and robust, especially to perform in vivo measurements. The purpose of this work is to introduce a new detector for measuring megavoltage photon beams and to assess its performance to measure relative dose in EBRT.

METHODS

The detector studied in this work was designed as a spherical photodiode (1.8 mm in diameter). The change in response of the spherical diodes is measured regarding the angle of incidence, cumulated irradiation, and instantaneous dose rate (or dose per pulse). Additionally, total scatter factors for large and small fields (between 1 × 1 cm(2) and 20 × 20 cm(2)) are evaluated and compared with the results obtained from some commercially available ionization chambers and planar diodes. Additionally, the over-response to low energy scattered photons in large fields is investigated using a shielding layer.

RESULTS

The spherical diode studied in this work produces a high signal (150 nC/Gy for photons of nominal energy of 15 MV and 160 for 6 MV, after 12 kGy) and its angular dependence is lower than that of planar diodes: less than 5% between maximum and minimum in all directions, and 2% around one of the axis. It also has a moderated variation with accumulated dose (about 1.5%/kGy for 15 MV photons and 0.7%/kGy for 6 MV, after 12 kGy) and a low variation with dose per pulse (± 0.4%), and its behavior is similar to commercial diodes in total scatter factor measurements.

CONCLUSIONS

The measurements of relative dose using the spherical diode described in this work show its feasibility for the dosimetry of megavoltage photon beams. A particularly important feature is its good angular response in the MV range. They would be good candidates for in vivo dosimetry, and quality assurance of VMAT and tomotherapy, and other modalities with beams irradiating from multiple orientations, such as Cyberknife and ViewRay, with minor modifications.

In vivo proton range verification: a review

Protons are an interesting modality for radiotherapy because of their well defined range and favourable depth dose characteristics. On the other hand, these same characteristics lead to added uncertainties in their delivery. This is particularly the case at the distal end of proton dose distributions, where the dose gradient can be extremely steep. In practice however, this gradient is rarely used to spare critical normal tissues due to such worries about its exact position in the patient. Reasons for this uncertainty are inaccuracies and non-uniqueness of the calibration from CT Hounsfield units to proton stopping powers, imaging artefacts (e.g. due to metal implants) and anatomical changes of the patient during treatment. In order to improve the precision of proton therapy therefore, it would be extremely desirable to verify proton range in vivo, either prior to, during, or after therapy. In this review, we describe and compare state-of-the art in vivo proton range verification methods currently being proposed, developed or clinically implemented.

Characterization of MOSFET detectors for in vivo dosimetry in interventional radiology and for dose reconstruction in case of overexposure

As MOSFET (Metal Oxide Semiconductor Field Effect Transistor) detectors allow dose measurements in real time, the interest in these dosimeters is growing. The aim of this study was to investigate the dosimetric properties of commercially available TN-502RD-H MOSFET silicon detectors (Best Medical Canada, Ottawa, Canada) in order to use them for in vivo dosimetry in interventional radiology and for dose reconstruction in case of overexposure. Reproducibility of the measurements, dose rate dependence, and dose response of the MOSFET detectors have been studied with a Co source. Influence of the dose rate, frequency, and pulse duration on MOSFET responses has also been studied in pulsed x-ray fields. Finally, in order to validate the integrated dose given by MOSFET detectors, MOSFETs and TLDs (LiF:Mg,Cu,P) were fixed on an Alderson-Rando phantom in the conditions of an interventional neuroradiology procedure, and their responses have been compared. The results of this study show the suitability of MOSFET detectors for in vivo dosimetry in interventional radiology and for dose reconstruction in case of accident, provided a well-corrected energy dependence, a pulse duration equal to or higher than 10 ms, and an optimized contact between the detector and the skin of the patient are achieved.