High resolution MR based polymer dosimetry versus film densitometry: a systematic study based on the modulation transfer function approach

Validation of complex radiotherapy techniques using polymer gel dosimetry

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

Basic Properties of a New Polymer Gel for 3D-Dosimetry at High Dose-Rates Typical for FFF Irradiation Based on Dithiothreitol and Methacrylic Acid (MAGADIT): Sensitivity, Range, Reproducibility, Accuracy, Dose Rate Effect and Impact of Oxygen Scavenger

The photon induced radical-initiated polymerization in polymer gels can be used for high-resolution tissue equivalent dosimeters in quality control of radiation therapy. The dose (D) distribution in radiation therapy can be measured as a change of the physical measurement parameter T2 using T2-weighted magnetic resonance imaging. The detection by T2 is relying on the local change of the molecular mobility due to local polymerization initiated by radicals generated by the ionizing radiation. The dosimetric signals R2 = 1/T2 of many of the current polymer gels are dose-rate dependent, which reduces the reliability of the gel for clinical use. A novel gel dosimeter, based on methacrylic acid, gelatin and the newly added dithiothreitol (MAGADIT) as an oxygen-scavenger was analyzed for basic properties, such as sensitivity, reproducibility, accuracy and dose-rate dependence. Dithiothreitol features no toxic classification with a difference to THPC and offers a stronger negative redox-potential than ascorbic acid. Polymer gels with three different concentration levels of dithiothreitol were irradiated with a preclinical research X-ray unit and MR-scanned (T2) for quantitative dosimetry after calibration. The polymer gel with the lowest concentration of the oxygen scavenger was about factor 3 more sensitive to dose as compared to the gel with the highest concentration. The dose sensitivity (α = ∆R2/∆D) of MAGADIT gels was significantly dependent on the applied dose rate D˙ (≈48% reduction between D˙ = 0.6 Gy/min and D˙ = 4 Gy/min). However, this undesirable dose-rate effect reduced between 4–8 Gy/min (≈23%) and almost disappeared in the high dose-rate range (8 ≤ D˙≤ 12 Gy/min) used in flattening-filter-free (FFF) irradiations. The dose response varied for different samples within one manufacturing batch within 3%–6% (reproducibility). The accuracy ranged between 3.5% and 7.9%. The impact of the dose rate on the spatial integrity is demonstrated in the example of a linear accelerator (LINAC) small sized 5 × 10 mm² 10 MV photon field. For MAGADIT the maximum shift in the flanks in this field is limited to about 0.8 mm at a FFF dose rate of 15 Gy/min. Dose rate sensitive polymer gels likely perform better at high dose rates; MAGADIT exhibits a slightly improved performance compared to the reference normoxic polymer gel methacrylic and ascorbic acid in gelatin initiated by copper (MAGIC) using ascorbic acid.

Assessment of optical CT as a future QA tool for synchrotron x-ray microbeam therapy

Synchrotron microbeam radiation therapy (MRT) is an advanced form of radiotherapy for which it is extremely difficult to provide adequate quality assurance. This may delay or limit its clinical uptake, particularly in the paediatric patient populations for whom it could be especially suitable. This study investigates the extent to which new developments in 3D dosimetry using optical computed tomography (CT) can visualise MRT dose distributions, and assesses what further developments are necessary before fully quantitative 3D measurements can be achieved. Two experiments are reported. In the first cylindrical samples of the radiochromic polymer PRESAGE(®) were irradiated with different complex MRT geometries including multiport treatments of collimated 'pencil' beams, interlaced microplanar arrays and a multiport treatment using an anthropomorphic head phantom. Samples were scanned using transmission optical CT. In the second experiment, optical CT measurements of the biologically important peak-to-valley dose ratio (PVDR) were compared with expected values from Monte Carlo simulations. The depth-of-field (DOF) of the optical CT system was characterised using a knife-edge method and the possibility of spatial resolution improvement through deconvolution of a measured point spread function (PSF) was investigated. 3D datasets from the first experiment revealed excellent visualisation of the 50 μm beams and various discrepancies from the planned delivery dose were found. The optical CT PVDR measurements were found to be consistently 30% of the expected Monte Carlo values and deconvolution of the microbeam profiles was found to lead to increased noise. The reason for the underestimation of the PVDR by optical CT was attributed to lack of spatial resolution, supported by the results of the DOF characterisation. Solutions are suggested for the outstanding challenges and the data are shown already to be useful in identifying potential treatment anomalies.

Medical physics aspects of the synchrotron radiation therapies: Microbeam radiation therapy (MRT) and synchrotron stereotactic radiotherapy (SSRT)

Stereotactic Synchrotron Radiotherapy (SSRT) and Microbeam Radiation Therapy (MRT) are both novel approaches to treat brain tumor and potentially other tumors using synchrotron radiation. Although the techniques differ by their principles, SSRT and MRT share certain common aspects with the possibility of combining their advantages in the future. For MRT, the technique uses highly collimated, quasi-parallel arrays of X-ray microbeams between 50 and 600 keV. Important features of highly brilliant Synchrotron sources are a very small beam divergence and an extremely high dose rate. The minimal beam divergence allows the insertion of so called Multi Slit Collimators (MSC) to produce spatially fractionated beams of typically ∼25-75 micron-wide microplanar beams separated by wider (100-400 microns center-to-center(ctc)) spaces with a very sharp penumbra. Peak entrance doses of several hundreds of Gy are extremely well tolerated by normal tissues and at the same time provide a higher therapeutic index for various tumor models in rodents. The hypothesis of a selective radio-vulnerability of the tumor vasculature versus normal blood vessels by MRT was recently more solidified. SSRT (Synchrotron Stereotactic Radiotherapy) is based on a local drug uptake of high-Z elements in tumors followed by stereotactic irradiation with 80 keV photons to enhance the dose deposition only within the tumor. With SSRT already in its clinical trial stage at the ESRF, most medical physics problems are already solved and the implemented solutions are briefly described, while the medical physics aspects in MRT will be discussed in more detail in this paper.

Establishing the suitability of quantitative optical CT microscopy of PRESAGE® radiochromic dosimeters for the verification of synchrotron microbeam therapy

Previous research on optical computed tomography (CT) microscopy in the context of the synchrotron microbeam has shown the potential of the technique and demonstrated high quality images, but has left two questions unanswered: (i) are the images suitably quantitative for 3D dosimetry? and (ii) what is the impact on the spatial resolution of the system of the limited depth-of-field of the microscope optics? Cuvette and imaging studies are reported here that address these issues. Two sets of cuvettes containing the radiochromic plastic PRESAGE® were irradiated at the ID17 biomedical beamline of the European Synchrotron Radiation facility over the ranges 0-20 and 0-35 Gy and a third set of cuvettes was irradiated over the range 0-20 Gy using a standard medical linac. In parallel, three cylindrical PRESAGE® samples of diameter 9.7 mm were irradiated with test patterns that allowed the quantitative capabilities of the optical CT microscope to be verified, and independent measurements of the imaging modulation transfer function (MTF) to be made via two different methods. Both spectrophotometric analysis and imaging gave a linear dose response, with gradients ranging from 0.036-0.041 cm(-1) Gy(-1) in the three sets of cuvettes and 0.037 (optical CT units) Gy(-1) for the imaging. High-quality, quantitative imaging results were obtained throughout the 3D volume, as illustrated by depth-dose profiles. These profiles are shown to be monoexponential, and the linear attention coefficient of PRESAGE® for the synchrotron-generated x-ray beam is measured to be (0.185 ± 0.02) cm(-1) in excellent agreement with expectations. Low-level (<5%) residual image artefacts are discussed in detail. It was possible to resolve easily slit patterns of width 37 µm (which are smaller than many of the microbeams used on ID-17), but some uncertainty remains as to whether the low values of MTF for the higher spatial frequencies are scanner related or a result of genuine (but non-ideal) dose distributions. We conclude that microscopy images from our scanner do indeed have intensities that are proportional to spectrophotometric optical density and can thus be used as the basis for accurate dosimetry. However, further investigations are necessary before the microscopy images can be used to make the quantitative measures of peak-to-valley ratios for small-diameter microbeams. We suggest various strategies for moving forward and are optimistic about the future potential of this system.

Magnetic resonance imaging for adaptive cobalt tomotherapy: A proposal

Magnetic resonance imaging (MRI) provides excellent soft tissue contrast for oncology applications. We propose to combine a MRI scanner with a helical tomotherapy (HT) system to enable daily target imaging for improved conformal radiation dose delivery to a patient. HT uses an intensity-modulated fan-beam that revolves around a patient, while the patient slowly advances through the plane of rotation, yielding a helical beam trajectory. Since the use of a linear accelerator to produce radiation may be incompatible with the pulsed radiofrequency and the high and pulsed magnetic fields required for MRI, it is proposed that a radioactive Cobalt-60 ((60)Co) source be used instead to provide the radiation. An open low field (0.25 T) MRI system is proposed where the tomotherapy ring gantry is located between two sets of Helmholtz coils that can generate a sufficiently homogenous main magnetic field.It is shown that the two major challenges with the design, namely acceptable radiation dose rate (and therefore treatment duration) and moving parts in strong magnetic field, can be addressed. The high dose rate desired for helical tomotherapy delivery can be achieved using two radiation sources of 220TBq (6000Ci) each on a ring gantry with a source to axis-of-rotation distance of 75 cm. In addition to this, a dual row multi-leaf collimator (MLC) system with 15 mm leaf width at isocentre and relatively large fan beam widths between 15 and 30 mm per row shall be employed. In this configuration, the unit would be well-suited for most pelvic radiotherapy applications where the soft tissue contrast of MRI will be particularly beneficial. Non-magnetic MRI compatible materials must be used for the rotating gantry. Tungsten, which is non-magnetic, can be used for primary collimation of the fan-beam as well as for the MLC, which allows intensity modulated radiation delivery. We propose to employ a low magnetic Cobalt compound, sycoporite (CoS) for the Cobalt source material itself.Rotational delivery is less susceptible to problems related to the use of a low energy megavoltage photon source while the helical delivery reduces the negative impact of the relatively large penumbra inherent in the use of Cobalt sources for radiotherapy. On the other hand, the use of a (60)Co source ensures constant dose rate with gantry rotation and makes dose calculation in a magnetic field as easy as the range of secondary electrons is limited.The MR-integrated Cobalt tomotherapy unit, dubbed 'MiCoTo,' uses two independent physical principles for image acquisition and treatment delivery. It would offer excellent target definition and will allow following target motion during treatment using fast imaging techniques thus providing the best possible input for adaptive radiotherapy. As an additional bonus, quality assurance of the radiation delivery can be performed in situ using radiation sensitive gels imaged by MRI.

An investigation of the potential of optical computed tomography for imaging of synchrotron-generated x-rays at high spatial resolution

X-ray microbeam radiation therapy (MRT) is a novel form of treatment, currently in its preclinical stage, which uses microplanar x-ray beams from a synchrotron radiation source. It is important to perform accurate dosimetry on these microbeams, but, to date, there has been no accurate enough method available for making 3D dose measurements with isotropic, high spatial resolution to verify the results of Monte Carlo dose simulations. Here, we investigate the potential of optical computed tomography for satisfying these requirements. The construction of a simple optical CT microscopy (optical projection tomography) system from standard commercially available hardware is described. The measurement of optical densities in projection data is shown to be highly linear (r2=0.999). The depth-of-field (DOF) of the imaging system is calculated based on the previous literature and measured experimentally using a commercial DOF target. It is shown that high quality images can be acquired despite the evident lack of telecentricity and despite DOF of the system being much lower than the sample diameter. Possible reasons for this are discussed. Results are presented for a complex irradiation of a 22 mm diameter cylinder of the radiochromic polymer PRESAGE, demonstrating the exquisite 'dose-painting' abilities available in the MRT hutch of beamline ID-17 at the European Synchrotron Radiation Facility. Dose distributions in this initial experiment are equally well resolved on both an optical CT scan and a corresponding transmission image of radiochromic film, down to a line width of 83 microm (6 lp mm(-1)) with an MTF value of 0.40. A group of 33 microm wide lines was poorly resolved on both the optical CT and film images, and this is attributed to an incorrect exposure time calculation, leading to under-delivery of dose. Image artefacts in the optical CT scan are discussed. PRESAGE irradiated using the microbeam facility is proposed as a suitable material for producing phantom samples for quantitative characterization of optical CT microscopy systems.

Dosimetric characterization of CyberKnife radiosurgical photon beams using polymer gels

Dose distributions registered in water equivalent, polymer gel dosimeters were used to measure the output factors and off-axis profiles of the radiosurgical photon beams employed for CyberKnife radiosurgery. Corresponding measurements were also performed using a shielded silicon diode commonly employed for CyberKnife commissioning, the PinPoint ion chamber, and Gafchromic EBT films, for reasons of comparison. Polymer gel results of this work for the output factors of the 5, 7.5, and 10 mm diameter beams are (0.702 +/- 0.029), (0.872 +/- 0.039), and (0.929 +/- 0.041), respectively. Comparison of polymer gel and diode measurements shows that the latter overestimate output factors of the two small beams (5% for the 5 mm beam and 3% for the 7.5 mm beams). This is attributed to the nonwater equivalence of the high atomic number silicon material of the diode detector. On the other hand, the PinPoint chamber is found to underestimate output factors up to 10% for the 5 mm beam due to volume averaging effects. Polymer gel and EBT film output factor results are found in close agreement for all beam sizes, emphasizing the importance of water equivalence and fine detector sensitive volume for small field dosimetry. Relative off-axis profile results are in good agreement for all dosimeters used in this work, with noticeable differences observed only in the PinPoint estimate of the 80%-20% penumbra width, which is relatively overestimated.

Characterization of a parallel-beam CCD optical-CT apparatus for 3D radiation dosimetry

3D measurement of optical attenuation is of interest in a variety of fields of biomedical importance, including spectrophotometry, optical projection tomography (OPT) and analysis of 3D radiation dosimeters. Accurate, precise and economical 3D measurements of optical density (OD) are a crucial step in enabling 3D radiation dosimeters to enter wider use in clinics. Polymer gels and Fricke gels, as well as dosimeters not based around gels, have been characterized for 3D dosimetry over the last two decades. A separate problem is the verification of the best readout method. A number of different imaging modalities (magnetic resonance imaging (MRI), optical CT, x-ray CT and ultrasound) have been suggested for the readout of information from 3D dosimeters. To date only MRI and laser-based optical CT have been characterized in detail. This paper describes some initial steps we have taken in establishing charge coupled device (CCD)-based optical CT as a viable alternative to MRI for readout of 3D radiation dosimeters. The main advantage of CCD-based optical CT over traditional laser-based optical CT is a speed increase of at least an order of magnitude, while the simplicity of its architecture would lend itself to cheaper implementation than both MRI and laser-based optical CT if the camera itself were inexpensive enough. Specifically, we study the following aspects of optical metrology, using high quality test targets: (i) calibration and quality of absorbance measurements and the camera requirements for 3D dosimetry; (ii) the modulation transfer function (MTF) of individual projections; (iii) signal-to-noise ratio (SNR) in the projection and reconstruction domains; (iv) distortion in the projection domain, depth-of-field (DOF) and telecentricity. The principal results for our current apparatus are as follows: (i) SNR of optical absorbance in projections is better than 120:1 for uniform phantoms in absorbance range 0.3 to 1.6 (and better than 200:1 for absorbances 1.0 to 3.5 with the test target and a novel absorbance range extension method), (ii) the spatial resolution is shown to be at worst 0.5 mm (and often better than this) with an associated DOF of 8 cm, (iii) the SNR of uniform phantoms in reconstruction domain is above 80:1 (one standard deviation) over an absorbance dynamic range of 0.3 to 1.6, (iv) the apparatus is telecentric and without distortion. Finally, a sample scan and reconstruction of a scan of a PRESAGE dosimeter are shown, demonstrating the capabilities of the apparatus.

Basic investigations on the performance of a normoxic polymer gel with tetrakis-hydroxy-methyl-phosphonium chloride as an oxygen scavenger: reproducibility, accuracy, stability, and dose rate dependence

Magnetic resonance (MR)-based polymer gel dosimetry using normoxic polymer gels, represents a new dosimetric method specially suited for high-resolution three-dimensional dosimetric problems. The aim of this study was to investigate the dose response with regard to stability, accuracy, reproducibility, and the dose rate dependence. Tetrakis-hydroxy-methyl-phosphonium chloride (THPC) is used as an oxygen scavenger, and methacrylic acid as a monomer. Accuracy, reproducibility, and dose resolution were determined for MR protocols at low spatial resolution (typical for clinical scanners), medium, and microimaging-resolution protocols at three different dose levels. The dose-response stability and preirradiation-induced variations in R2, related to the time interval between preparation and irradiation of the polymer gel, were investigated. Also postirradiation stability of the polymer gel was considered. These experiments were performed using a 60Co beam (E = 1.2 MV) in a water phantom. Moreover, we investigated the dose rate dependence in the low, medium, and saturation dose region of the normoxic polymer gel using a linear accelerator at photon energy of 25 MV. MR scanning was performed on a 3 T whole body scanner (MEDSPEC 30/80, BRUKER BIOSPIN, Ettlingen, Germany) using several coils and different gradient systems adapted to the acquired spatial resolution investigated. For T2-parameter selective imaging and determination of the relaxation rate R2 = 1/T2, a multiple spin echo sequence with 20 equidistant echoes was used. With regard to preirradiation induced variations R2 increases significantly with the increasing time interval between the polymer gel preparation and irradiation. Only a slight increase in R2 can be observed for varying the postirradiation-time solely. The dose reproducibility at voxel volumes of about 1.4 x 1.4 x 2 mm3 is better than 2%. The accuracy strongly depends on the calibration curve. THPC represents a very effective oxygen scavenger in methacrylic acid and gelatin. Polymer gels containing THPC offer high sensitivity to dose but their dose response also strongly depends on dose rate in the medium and high dose region.

Experimental determination of the effect of detector size on profile measurements in narrow photon beams

The aim of this work is to investigate experimentally the detector size effect on narrow beam profile measurements. Polymer gel and magnetic resonance imaging dosimetry was used for this purpose. Profile measurements (Pm(s)) of a 5 mm diameter 6 MV stereotactic beam were performed using polymer gels. Eight measurements of the profile of this narrow beam were performed using correspondingly eight different detector sizes. This was achieved using high spatial resolution (0.25 mm) two-dimensional measurements and eight different signal integration volumes A X A X slice thickness, simulating detectors of different size. "A" ranged from 0.25 to 7.5 mm, representing the detector size. The gel-derived profiles exhibited increased penumbra width with increasing detector size, for sizes >0.5 mm. By extrapolating the gel-derived profiles to zero detector size, the true profile (Pt) of the studied beam was derived. The same polymer gel data were also used to simulate a small-volume ion chamber profile measurement of the same beam, in terms of volume averaging. The comparison between these results and actual corresponding small-volume chamber profile measurements performed in this study, reveal that the penumbra broadening caused by both volume averaging and electron transport alterations (present in actual ion chamber profile measurements) is a lot more intense than that resulted by volume averaging effects alone (present in gel-derived profiles simulating ion chamber profile measurements). Therefore, not only the detector size, but also its composition and tissue equivalency is proved to be an important factor for correct narrow beam profile measurements. Additionally, the convolution kernels related to each detector size and to the air ion chamber were calculated using the corresponding profile measurements (Pm(s)), the gel-derived true profile (Pt), and convolution theory. The response kernels of any desired detector can be derived, allowing the elimination of the errors associated with narrow beam profile measurements.

Einsatz normoxischer Polymergele in der 3D-Dosimetrie für die Radiochirurgie

The aim of this study was to describe the manufacture of normoxic polymer gels, to characterize their dose response relationship, to optimize MR imaging parameters in order to minimize the standard deviation in the measured dose and to use the gel in a dose verification experiment in radiosurgery. The normoxic polymer gel used is simple to manufacture under normal atmospheric conditions and is characterized by a linear dose relationship up to 40 Gy. MR imaging was performed using 2-dimensional (20) single spin echo pulse sequences with two different echo times. The imaging parameters were optimized in order to minimize the standard deviation of the measured transversal relaxation rate R2 and to achieve a geometrical resolution of 1.5 mm. Comparisons of calculated and measured relative 3D dose distributions using a multi isocentric irradiation with Gamma Knife B showed a good overall agreement of both the isodose levels and the differential and cumulative dose volume histograms. The standard deviation in the measured dose was approximately 9% at 30 Gy. The evaluation according to the gamma criterion showed that 96% of the dose voxels remained within a spatial uncertainty of 1.5 mm and a dose uncertainty of 8%.