Optical CT scanner for in-air readout of gels for external radiation beam 3D dosimetry

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.

Radiation Dosimetry by Use of Radiosensitive Hydrogels and Polymers: Mechanisms, State-of-the-Art and Perspective from 3D to 4D

Gel dosimetry was developed in the 1990s in response to a growing need for methods to validate the radiation dose distribution delivered to cancer patients receiving high-precision radiotherapy. Three different classes of gel dosimeters were developed and extensively studied. The first class of gel dosimeters is the Fricke gel dosimeters, which consist of a hydrogel with dissolved ferrous ions that oxidize upon exposure to ionizing radiation. The oxidation results in a change in the nuclear magnetic resonance (NMR) relaxation, which makes it possible to read out Fricke gel dosimeters by use of quantitative magnetic resonance imaging (MRI). The radiation-induced oxidation in Fricke gel dosimeters can also be visualized by adding an indicator such as xylenol orange. The second class of gel dosimeters is the radiochromic gel dosimeters, which also exhibit a color change upon irradiation but do not use a metal ion. These radiochromic gel dosimeters do not demonstrate a significant radiation-induced change in NMR properties. The third class is the polymer gel dosimeters, which contain vinyl monomers that polymerize upon irradiation. Polymer gel dosimeters are predominantly read out by quantitative MRI or X-ray CT. The accuracy of the dosimeters depends on both the physico-chemical properties of the gel dosimeters and on the readout technique. Many different gel formulations have been proposed and discussed in the scientific literature in the last three decades, and scanning methods have been optimized to achieve an acceptable accuracy for clinical dosimetry. More recently, with the introduction of the MR-Linac, which combines an MRI-scanner and a clinical linear accelerator in one, it was shown possible to acquire dose maps during radiation, but new challenges arise.

Hydrogels for Three-Dimensional Ionizing-Radiation Dosimetry

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

A fast dual wavelength laser beam fluid-less optical CT scanner for radiotherapy 3D gel dosimetry I: design and development

Three dimensional dosimetry by optical CT readout of radiosensitive gels or solids has previously been indicated as a solution for measurement of radiotherapy 3D dose distributions. The clinical uptake of these dosimetry methods has been limited, partly due to impracticalities of the optical readout such as the expertise and labour required for refractive index fluid matching. In this work a fast laser beam optical CT scanner is described, featuring fluid-less and dual wavelength operation. A second laser with a different wavelength is used to provide an alternative reference scan to the commonly used pre-irradiation scan. Transmission data for both wavelengths is effectively acquired simultaneously, giving a single scan process. Together with the elimination of refractive index fluid matching issues, scanning practicality is substantially improved. Image quality and quantitative accuracy were assessed for both dual and single wavelength methods. The dual wavelength scan technique gave improvements in uniformity of reconstructed optical attenuation coefficients in the sample 3D volume. This was due to a reduction of artefacts caused by scan to scan changes. Optical attenuation measurement accuracy was similar for both dual and single wavelength modes of operation. These results established the basis for further work on dosimetric performance.

Optical-CT 3D Dosimetry Using Fresnel Lenses with Minimal Refractive-Index Matching Fluid

Telecentric optical computed tomography (optical-CT) is a state-of-the-art method for visualizing and quantifying 3-dimensional dose distributions in radiochromic dosimeters. In this work a prototype telecentric system (DFOS-Duke Fresnel Optical-CT Scanner) is evaluated which incorporates two substantial design changes: the use of Fresnel lenses (reducing lens costs from $10-30K t0 $1-3K) and the use of a 'solid tank' (which reduces noise, and the volume of refractively matched fluid from 1 ltr to 10 cc). The efficacy of DFOS was evaluated by direct comparison against commissioned scanners in our lab. Measured dose distributions from all systems were compared against the predicted dose distributions from a commissioned treatment planning system (TPS). Three treatment plans were investigated including a simple four-field box treatment, a multiple small field delivery, and a complex IMRT treatment. Dosimeters were imaged within 2 h post irradiation, using consistent scanning techniques (360 projections acquired at 1 degree intervals, reconstruction at 2mm). DFOS efficacy was evaluated through inspection of dose line-profiles, and 2D and 3D dose and gamma maps. DFOS/TPS gamma pass rates with 3%/3mm dose difference/distance-to-agreement criteria ranged from 89.3% to 92.2%, compared to from 95.6% to 99.0% obtained with the commissioned system. The 3D gamma pass rate between the commissioned system and DFOS was 98.2%. The typical noise rates in DFOS reconstructions were up to 3%, compared to under 2% for the commissioned system. In conclusion, while the introduction of a solid tank proved advantageous with regards to cost and convenience, further work is required to improve the image quality and dose reconstruction accuracy of the new DFOS optical-CT system.

Investigations into the feasibility of optical-CT 3D dosimetry with minimal use of refractively matched fluids

PURPOSE

In optical-CT, the use of a refractively matched polyurethane solid-tank in place of a fluid bath has the potential to greatly increase practical convenience, reduce cost, and possibly improve the efficacy of flood corrections. This work investigates the feasibility of solid-tank optical-CT imaging for 3D dosimetry through computer simulation.

METHODS

A matlab ray-tracing simulation platform, ScanSim, was used to model a parallel-source telecentric optical-CT imaging system through a polyurethane solid-tank containing a central cylindrical hollow into which PRESAGE radiochromic dosimeters can be placed. A small amount of fluid fills the 1-5 mm gap between the dosimeter and the walls of the tank. The use of the solid-tank reduces the required amount of fluid by approximately 97%. To characterize the efficacy of solid-tank, optical-CT scanning simulations investigated sensitivity to refractive index (RI) mismatches between dosimeter, solid-tank, and fluid, for a variety of dosimeter (RI = 1.5-1.47) and fluid (RI = 1.55-1.0) combinations. Efficacy was evaluated through the usable radius (ru) metric, defined as the fraction of the radius of the dosimeter where measured dose is predicted to be within 2% of the ground truth entered into the simulation. Additional simulations examined the effect of increasing gap size (1-5 mm) between the dosimeter and solid-tank well. The effects of changing the lens tolerance (0.5°-5.0°) were also investigated.

RESULTS

As the RI mismatch between the dosimeter and solid-tank increased from 0 to 0.02, the usable radius decreased from 97.6% to 50.2%. The optimal fluid RI decreased nonlinearly from 1.5 to 1.34 as the mismatch increased and was up to 9% lower than the tank. Media mismatches between the dosimeter and solid-tank also exacerbate the effects of changing the gap size, with no easily quantifiable relationship with usable radius. Generally, the optimal fluid RI value increases as gap size increases and is closely matched to the dosimeter at large gap sizes (> 3 mm). Increasing the telecentric lens tolerance increases the usable radius for all refractive media combinations and improves the maximum usable radius of mismatched media to that of perfectly matched media for tolerances > 5.0°. The maximum usable radius can be improved up to a factor of 2 when lens tolerances are small (< 1.0°).

CONCLUSIONS

Dry solid-tank optical-CT imaging in a telecentric system is feasible if the dosimeter RI is a close match with the solid-tank (< 0.01 difference), providing accurate dose measurements within ± 2% of true dose to over 80% of the dosimeter volume. In order to achieve accurate measurements over 96% of the dosimeter volume (representing out to 2 mm from the dosimeter edge), the dosimeter-tank RI mismatch must be less than 0.005. Optimal results occur when the RI of the dosimeter and tank is the same, in which case the fluid will have the same RI. If mismatches between the tank and dosimeter RI occur, the RI of the matching fluid needs to be fine tuned to achieve the highest usable radius.

Radiation-induced refraction artifacts in the optical CT readout of polymer gel dosimeters

PURPOSE

The objective of this work is to demonstrate imaging artifacts that can occur during the optical computed tomography (CT) scanning of polymer gel dosimeters due to radiation-induced refractive index (RI) changes in polyacrylamide gels.

METHODS

A 1 L cylindrical polyacrylamide gel dosimeter was irradiated with 3 × 3 cm(2) square beams of 6 MV photons. A prototype fan-beam optical CT scanner was used to image the dosimeter. Investigative optical CT scans were performed to examine two types of rayline bending: (i) bending within the plane of the fan-beam and (ii) bending out the plane of the fan-beam. To address structured errors, an iterative Savitzky-Golay (ISG) filtering routine was designed to filter 2D projections in sinogram space. For comparison, 2D projections were alternatively filtered using an adaptive-mean (AM) filter.

RESULTS

In-plane rayline bending was most notably observed in optical CT projections where rays of the fan-beam confronted a sustained dose gradient that was perpendicular to their trajectory but within the fan-beam plane. These errors caused distinct streaking artifacts in image reconstructions due to the refraction of higher intensity rays toward more opaque regions of the dosimeter. Out-of-plane rayline bending was observed in slices of the dosimeter that featured dose gradients perpendicular to the plane of the fan-beam. These errors caused widespread, severe overestimations of dose in image reconstructions due to the higher-than-actual opacity that is perceived by the scanner when light is bent off of the detector array. The ISG filtering routine outperformed AM filtering for both in-plane and out-of-plane rayline errors caused by radiation-induced RI changes. For in-plane rayline errors, streaks in an irradiated region (>7 Gy) were as high as 49% for unfiltered data, 14% for AM, and 6% for ISG. For out-of-plane rayline errors, overestimations of dose in a low-dose region (∼50 cGy) were as high as 13 Gy for unfiltered data, 10 Gy for AM, and 3.1 Gy for ISG. The ISG routine also addressed unrelated artifacts that previously needed to be manually removed in sinogram space. However, the ISG routine blurred reconstructions, causing losses in spatial resolution of ∼5 mm in the plane of the fan-beam and ∼8 mm perpendicular to the fan-beam.

CONCLUSIONS

This paper reveals a new category of imaging artifacts that can affect the optical CT readout of polyacrylamide gel dosimeters. Investigative scans show that radiation-induced RI changes can cause significant rayline errors when rays confront a prolonged dose gradient that runs perpendicular to their trajectory. In fan-beam optical CT, these errors manifested in two ways: (1) distinct streaking artifacts caused by in-plane rayline bending and (2) severe overestimations of opacity caused by rays bending out of the fan-beam plane and missing the detector array. Although the ISG filtering routine mitigated these errors better than an adaptive-mean filtering routine, it caused unacceptable losses in spatial resolution.