A basic dosimetric study of PRESAGE: the effect of different amounts of fabricating components on the sensitivity and stability of the dosimeter

A Review of PRESAGE Radiochromic Polymer and the Compositions for Application in Radiotherapy Dosimetry

Recent advances in radiotherapy technology and techniques have allowed a highly conformal radiation to be delivered to the tumour target inside the body for cancer treatment. A three-dimensional (3D) dosimetry system is required to verify the accuracy of the complex treatment delivery. A 3D dosimeter based on the radiochromic response of a polymer towards ionising radiation has been introduced as the PRESAGE dosimeter. The polyurethane dosimeter matrix is combined with a leuco-dye and a free radical initiator, whose colour changes in proportion to the radiation dose. In the previous decade, PRESAGE gained improvement and enhancement as a 3D dosimeter. Notably, PRESAGE overcomes the limitations of its predecessors, the Fricke gel and the polymer gel dosimeters, which are challenging to fabricate and read out, sensitive to oxygen, and sensitive to diffusion. This article aims to review the characteristics of the radiochromic dosimeter and its clinical applications. The formulation of PRESAGE shows a delicate balance between the number of radical initiators, metal compounds, and catalysts to achieve stability, optimal sensitivity, and water equivalency. The applications of PRESAGE in advanced radiotherapy treatment verifications are also discussed.

Bismuth oxide nanoparticles as agents of radiation dose enhancement in intraoperative radiotherapy

PURPOSE

Intraoperative radiotherapy (IORT) technique is an advanced radio therapeutic method used for delivery of a single high-dose radiation during surgery while removing healthy tissues from the radiation field. Nowadays, growing attention is being paid to IORT for its low-energy (kilovoltage) delivery as it requires less radiation protection, but suffers several disadvantages, including high-dose delivery and prolonged treatment time. The application of nanoparticles with high atomic number and high attenuation coefficients in kilovoltage energy may help overcome the mentioned shortcomings. This study was designed to investigate and quantify the mean dose enhancement factor (DEF) in the presence of nanoparticles using IORT method.

METHODS

Bismuth oxide nanoparticles (Bi₂ O₃ NPs), both in sheet and spherical formats, were synthesized using a novel hydrothermal method and characterized with x-ray diffraction (XRD), transmission electron microscopy (TEM), and Brunauer-Emmett-Teller (BET) analysis. Genipin-gelatin gel dosimeter (GENIPIN) was produced in three batches of pure with sheet and with spherical nanoparticles in concentration of 46.596 µg/ml, and irradiated with 50 kV x-rays.

RESULTS

Samples were scanned by a spectrophotometer, which indicated a DEF of 3.28  ±  0.37 and 2.50  ±  0.23 for sheet and spherical NPs, respectively. According to the results of this study, GENIPIN is a suitable dosimeter for the evaluation of three-dimensional dose distribution in the presence Bi₂ O₃ NPs.

CONCLUSION

As a result, IORT along with Bi₂ O₃ NPs has the potential to reduce treatment time and/or normal tissue dose; moreover, it could provide localized dose enhancement.

Temperature dependence and temporal stability of stacked radiochromic sheets for three-dimensional dose verification

PURPOSE

Recently a novel radiochromic sheet dosimeter, termed as PRESAGE sheets, consisting of leuco crystal violet dye and radical initiator had been developed and characterized. This study examines the dosimeter's temporal stability and storage temperature dependence postirradiation, and its applicability for dose verification in three dimensions (3D) as a stack dosimeter.

METHODS

PRESAGE sheets were irradiated using 6 MV photons at a dose range of 0-20 Gy with the change in optical density measured using a flatbed scanner. Following their irradiation, PRESAGE sheets were stored in different temperature environments (-18 °C, 4 °C, and 22 °C) and scanned at different time points, ranging from 1 to 168 h postirradiation, to track changes in measured signal and linearity of dose response. Multiple PRESAGE sheets were bound together to create a 12 × 13 × 8.7 cm³ film stack, with EBT3 film inserted between the sheets in the central region of the stack, that was treated using a clinical VMAT plan. Based on the results from the time and storage temperature study, two-dimensional (2D) relative dose distribution measurements in PRESAGE were acquired promptly following irradiation at selected planes in the coronal, sagittal, and axial orientation of the film stack and compared to the treatment planning system calculations in their respective axes. Dose distribution measurements on the coronal axis of the stack dosimeter were also independently verified using EBT3 film.

RESULTS

The dose response was observed to be linear (R² > 0.995) with sheets stored in colder temperatures retaining their signal and dose response sensitivity for extended periods postirradiation. Sheets stored in 22 °C environment should be measured within an hour postirradiation. Sheets stored in a 4 °C and -18 °C environment can be scanned up to 20- and 72 h postirradiation, respectively, while preserving the integrity of their dose response sensitivity and linearity of dose response within a mean absolute percent error of 2.0%. For instance, at 20 h postirradiation the dose response sensitivity for sheets stored in a -18 °C, 4 °C, and 22 °C temperature environment was measured to be 97%, 91%, and 77% of their original values measured within an hour postirradiation, respectively. The 2D gamma pass rate for central slices exceed 95% for PRESAGE film stack compared with treatment planning system on selected planes in the axial, coronal, and sagittal orientation and EBT3 film in the coronal orientation using a 2D gamma index of 2%/2mm. The gamma pass rate in comparing the calculated dose distribution with the measured dose distribution from PRESAGE-LCV was observed to decrease in sheets scanned at later elapsed times postirradiation. In one example, the gamma pass rate for 2%/2mm criteria in the coronal plane was observed to decrease from 97.7% pass rate when scanned within an hour postirradiation to 92.1% pass rate when scanned at 20 h postirradiation under room temperature conditions.

CONCLUSIONS

This is the first study to demonstrate that the temporal stability of PRESAGE sheets can be enhanced through its storage in colder temperature environments postirradiation and that sheets as a film stack dosimeter hold promise for precise relative dose distribution measurements in 3D where advanced optical CT is unavailable.

Improvement in sensitivity of radiochromic 3D dosimeter based on rigid polyurethane resin by incorporating tartrazine

We investigated the influence of incorporating tartrazine on the dose response characteristics of radiochromic 3D dosimeters based on polyurethane resin. We use three types of polyurethane resins with different Shore hardness values: 30 A, 50 A, and 80 D. PRESAGE dosimeters are fabricated with different chemical components and concentrations. Tartrazine (Yellow No. 5) helps incorporate a yellow dye to fabricate the dosimeter. Elemental composition is analyzed with the Z_eff. Three sets of six different PRESAGE dosimeters were fabricated to investigate the effects of incorporating yellow dye on the dose response characteristics of the dosimeter. The dose response curve was obtained by measuring the optical absorbance using a spectrometer and optical density using optical CT, respectively. The energy and dose rate dependences are evaluated for the dosimeter with the highest sensitivity. For the optical density measurement, significant sensitivity enhancements of 36.6% and 32.7% were achieved in polyurethane having a high Shore hardness of 80 D and 50 A by incorporating tartrazine, respectively. The same results were obtained in the optical absorbance measurements. The ratio of the Z_eff of the dosimeter with 80 D Shore hardness to water was 1.49. The polyurethane radiochromic dosimeter with a Shore hardness of 80 D showed the highest sensitivity and energy and dose rate independence upon the incorporation of tartrazine.

Three-dimensional radiation dosimetry using polymer gel and solid radiochromic polymer: From basics to clinical applications

Accurate dose measurement tools are needed to evaluate the radiation dose delivered to patients by using modern and sophisticated radiation therapy techniques. However, the adequate tools which enable us to directly measure the dose distributions in three-dimensional (3D) space are not commonly available. One such 3D dose measurement device is the polymer-based dosimeter, which changes the material property in response to radiation. These are available in the gel form as polymer gel dosimeter (PGD) and ferrous gel dosimeter (FGD) and in the solid form as solid plastic dosimeter (SPD). Those are made of a continuous uniform medium which polymerizes upon irradiation. Hence, the intrinsic spatial resolution of those dosimeters is very high, and it is only limited by the method by which one converts the dose information recorded by the medium to the absorbed dose. The current standard methods of the dose quantification are magnetic resonance imaging, optical computed tomography, and X-ray computed tomography. In particular, magnetic resonance imaging is well established as a method for obtaining clinically relevant dosimetric data by PGD and FGD. Despite the likely possibility of doing 3D dosimetry by PGD, FGD or SPD, the tools are still lacking wider usages for clinical applications. In this review article, we summarize the current status of PGD, FGD, and SPD and discuss the issue faced by these for wider acceptance in radiation oncology clinic and propose some directions for future development.

An investigation of PRESAGE® 3D dosimetry for IMRT and VMAT radiation therapy treatment verification

The purpose of this work was to characterize three formulations of PRESAGE(®) dosimeters (DEA-1, DEA-2, and DX) and to identify optimal readout timing and procedures for accurate in-house 3D dosimetry. The optimal formulation and procedure was then applied for the verification of an intensity modulated radiation therapy (IMRT) and a volumetric modulated arc therapy (VMAT) treatment technique. PRESAGE(®) formulations were studied for their temporal stability post-irradiation, sensitivity, and linearity of dose response. Dosimeters were read out using a high-resolution optical-CT scanner. Small volumes of PRESAGE(®) were irradiated to investigate possible differences in sensitivity for large and small volumes ('volume effect'). The optimal formulation and read-out technique was applied to the verification of two patient treatments: an IMRT plan and a VMAT plan. A gradual decrease in post-irradiation optical-density was observed in all formulations with DEA-1 exhibiting the best temporal stability with less than 4% variation between 2-22 h post-irradiation. A linear dose response at the 4 h time point was observed for all formulations with an R(2) value >0.99. A large volume effect was observed for DEA-1 with sensitivity of the large dosimeter being ~63% less than the sensitivity of the cuvettes. For the IMRT and VMAT treatments, the 3D gamma passing rates for 3%/3 mm criteria using absolute measured dose were 99.6 and 94.5% for the IMRT and VMAT treatments, respectively. In summary, this work shows that accurate 3D dosimetry is possible with all three PRESAGE(®) formulations. The optimal imaging windows post-irradiation were 3-24 h, 2-6 h, and immediately for the DEA-1, DEA-2, and DX formulations, respectively. Because of the large volume effect, small volume cuvettes are not yet a reliable method for calibration of larger dosimeters to absolute dose. Finally, PRESAGE(®) is observed to be a useful method of 3D verification when careful consideration is given to the temporal stability and imaging protocols for the specific formulation used.

Water equivalence evaluation of PRESAGE(®) formulations for megavoltage electron beams: a Monte Carlo study

To investigate the radiological water equivalency of three different formulations of the radiochromic, polyurethane based dosimeter PRESAGE(®) for three dimensional (3D) dosimetry of electron beams. The EGSnrc/BEAMnrc Monte Carlo package was used to model 6-20 MeV electron beams and calculate the corresponding doses delivered in the three different PRESAGE(®) formulations and water. The depth of 50 % dose and practical range of electron beams were determined from the depth dose calculations and scaling factors were calculated for these electron beams. In the buildup region, a 1.0 % difference in dose was found for all PRESAGE(®) formulations relative to water for 6 and 9 MeV electron beams while the difference was negligible for the higher energy electron beams. Beyond the buildup region (at a depth range of 22-26 mm for the 6 MeV beam and 38 mm for the 9 MeV beam), the discrepancy from water was found to be 5.0 % for the PRESAGE(®) formulations with lower halogen content than the original formulation, which was found to have a discrepancy of up to 14 % relative to water. For a 16 MeV electron beam, the dose discrepancy from water increases and reaches about 7.0 % at 70 mm depth for the lower halogen content PRESAGE(®) formulations and 20 % at 66 mm depth for the original formulation. For the 20 MeV electron beam, the discrepancy drops to 6.0 % at 90 mm depth for the lower halogen content formulations and 18 % at 85 mm depth for the original formulation. For the lower halogen content PRESAGE(®), the depth of 50 % dose and practical range of electrons differ from water by up to 3.0 %, while the range of differences from water is between 6.5 and 8.0 % for the original PRESAGE(®) formulation. The water equivalent depth scaling factor required for the original formulation of PRESAGE(®) was determined to be 1.07-1.08, which is larger than that determined for the lower halogen content formulations (1.03) over the entire beam energy range of electrons. All three of the PRESAGE(®) formulations studied require a depth scaling factor to convert depth in PRESAGE(®) to water equivalent depth for megavoltage electron beam dosimetry. Compared to the original PRESAGE(®) formulation, the lower halogen content formulations require a significantly smaller scaling factor and are thus recommended over the original PRESAGE(®) formulation for electron beam dosimetry.

Physics-aspects of dose accuracy in high dose rate (HDR) brachytherapy: source dosimetry, treatment planning, equipment performance and in vivo verification techniques

This study provides a review of recent publications on the physics-aspects of dosimetric accuracy in high dose rate (HDR) brachytherapy. The discussion of accuracy is primarily concerned with uncertainties, but methods to improve dose conformation to the prescribed intended dose distribution are also noted. The main aim of the paper is to review current practical techniques and methods employed for HDR brachytherapy dosimetry. This includes work on the determination of dose rate fields around brachytherapy sources, the capability of treatment planning systems, the performance of treatment units and methods to verify dose delivery. This work highlights the determinants of accuracy in HDR dosimetry and treatment delivery and presents a selection of papers, focusing on articles from the last five years, to reflect active areas of research and development. Apart from Monte Carlo modelling of source dosimetry, there is no clear consensus on the optimum techniques to be used to assure dosimetric accuracy through all the processes involved in HDR brachytherapy treatment. With the exception of the ESTRO mailed dosimetry service, there is little dosimetric audit activity reported in the literature, when compared with external beam radiotherapy verification.

Temperature dependence of the dose response for a solid-state radiochromic dosimeter during irradiation and storage

PURPOSE

The dose response of radiochromic dosimeters is based on radiation-induced chemical reactions and is thus likely to be thermally influenced. In this study we have therefore investigated the temperature dependence of the dose response for such dosimeters, regarding both irradiation and storage conditions.

METHODS

Dosimeter samples in cuvettes were irradiated to 5 Gy. The temperature for the different cuvettes during irradiation and post-irradiation storage was varied in the range of 3-30 degrees C in order to quantify the temperature dependence of the dosimeter response. The optical properties of the dosimeter samples were measured using a spectrophotometer before irradiation as well as at several times after irradiation to quantify the temporal variation of dose response (expressed as the optical density change induced by irradiation) as a function of storage temperature.

RESULTS

The measurements show considerable temperature dependencies of dose response both during irradiation and storage. Fit to an Arrhenius equation revealed an activation energy of 1.4 +/- 0.2 eV for the variation in irradiation temperature, indicating a contribution from a thermally activated process. Variation in dose response at different storage temperatures showed an exponential increase with time followed by a decrease in optical density. Exponential Arrhenius fits to rate constants gave activation energies of 1.7 +/- 0.2 eV for the increase in dose response and 2.3 +/- 0.5 eV for the subsequent decrease, in this case dominated by thermally activated processes.

CONCLUSIONS

Due to the exponential dependencies, stabilization of the dosimeter during irradiation at low temperatures (e.g., 5 degrees C) is preferable in clinical use to optimize the accuracy of the dose response. In addition, a low storage temperature is recommended in order to minimize the post-irradiation temporal change in dose response and thereby increase the post-irradiation stability of the dosimeter. The measurements in this study show that if the observed temperature and temporal dependencies are not considered, this could potentially deteriorate the accuracy of the dosimeter.

Characterization of the optical properties and stability of Presage™ following irradiation with photons and carbon ions

BACKGROUND

The on-going development of both intensity-modulated radiotherapy (IMRT), including the more recent intensity-modulated arc therapy, as well as particle beam therapy, has created a clear need for accurate verification of dose distributions in three dimensions (3D). Presage™ is a new 3D dosimetry material that exhibits a radiochromic response when exposed to ionizing radiation. In this study we have 1) developed an improved optical set-up for measurements of changes in OD of Presage™ point dosimeters, 2) investigated the dose response of Presage™ for photons and carbon ions in the therapy range, 3) investigated the dose response of Presage™ for photons in the kGy range and 4) investigated the fading (i.e. bleaching) of Presage™ postirradiation.

MATERIALS AND METHODS

Presage™ was examined in 1 × 1 × 4.5 cm(3) optical cuvettes; a cuvette holder assured accurate repositioning, and the optical setup included a reference detector to take into account laser intensity fluctuations. The cuvettes were measured pre- and postirradiation for a two week period.

RESULTS

A linear response was observed between dose and optical response between 0 Gy and 100 Gy for γ-radiation from Co-60 and for carbon ions (both plateau and SOBP) from 0 to 20 Gy. The dosimeter was found to have a saturation dose of approximately 100 Gy for photons. A linear energy transfer (LET) effect was not observed in the dose response of different LET radiation. The postirradiation change in optical fading was found to be 0.5% ΔOD/day.

CONCLUSIONS

Our study shows that Presage™ remains a dosimeter of interest for radiation therapy with other particles as well as photons in the therapy dose range.

Development and characterization of a novel PRESAGE formulation for radiotherapy applications

A novel water equivalent formulation of PRESAGE dosimeter more suitable for radiotherapy applications has been introduced and its radiological water equivalency has been investigated. Furthermore, its radiological properties have been compared with an existing PRESAGE formulation over an energy range from 10 to 20 MeV. Monte Carlo simulation method has been implemented to determine and compare depth dose profiles in both of the PRESAGE formulations at two different photon energies (140 KV(P) and 6 MV). The results show that our proposed PRESAGE formulation is more water equivalent than its known formulation especially for low photon energy beams.