Energy response of optically stimulated luminescent dosimeters for non-reference measurement locations in a 6 MV photon beam

Feasibility of Customized Thermoplastic Patient-Specific Helmet Bolus for Scalp Irradiation Using Volumetric-Modulated Arc Therapy Planning

Introduction: In this study, we sought to develop a thermoplastic patient-specific helmet bolus that could deliver a uniform therapeutic dose to the target and minimize the dose to the normal brain during whole-scalp treatment with a humanoid head phantom. Methods: The bolus material was a commercial thermoplastic used for patient immobilization, and the holes in the netting were filled with melted paraffin. We compared volumetric-modulated arc therapy treatment plans with and without the bolus for quantitative dose distribution analysis. We analyzed the dose distribution in the region of interest to compare dose differences between target and normal organs. For quantitative analysis of treatment dose, OSLD chips were attached at the vertex (VX), posterior occipital (PO), right (RT), and left temporal (LT) locations. Results: The average dose in the clinical target volume was 6553.8 cGy (99.3%) with bolus and 5874 cGy (89%) without bolus, differing by more than 10% from the prescribed dose (6600 cGy) to the scalp target. For the normal brain, it was 3747.8 cGy (56.8%) with bolus and 5484.6 cGy (83.1%) without bolus. These results show that while the dose to the treatment target decreased, the average dose to the normal brain, which is mostly inside the treatment target, increased by more than 25%. With the bolus, the OSLD measured dose was 102.5 ± 1.2% for VX and 101.5 ± 1.9%, 95.9 ± 1.9%, and 81.8 ± 2.1% for PO, RT, and LT, respectively. In addition, the average dose in the treatment plan was 102%, 101%, 93.6%, and 80.7% for VX, PO, RT, and LT. When no bolus was administered, 59.6 ± 2.4%, 112.6 ± 1.8%, 47.1 ± 1.6%, and 53.1 ± 2.3% were assessed as OSLD doses for VX, PO, RT, and LT, respectively. Conclusion: This study proposed a method to fabricate patient-specific boluses that are highly reproducible, accessible, and easy to fabricate for radiotherapy to the entire scalp and can effectively spare normal tissue while delivering sufficient surface dose.

Fetal dose estimation for Virtual Tangential-fields Arc Therapy whole breast irradiation by optically stimulated luminescence dosimeters

Breast cancer is the most frequently diagnosed tumor in pregnant women and radiation therapy should carefully be weighted up because of the dose to the fetus. The aim of this study was to investigate fetal dose in a patient treated with Virtual Tangential-fields Arc Therapy (ViTAT), an innovative technique for whole breast irradiation. Optically stimulated luminescence detectors (OSLDs) were calibrated on a Varian TrueBeam linac, with both a 6X and 6XFFF beam quality, and used for out-of-field measurements. Fetal dose related with ViTAT technique was compared to the standard 3D conformal radiation therapy technique (3DCRT). The fetal dose delivered with a ViTAT technique planned with 6XFFF beam was also investigated. Measurements were taken on a phantom composed of Rando Alderson Phantom slices and solid water slabs. OSLDs were placed in a region identified by the height of the fundus from conception to the twentieth week using a custom made PMMA grid. Due to the higher number of monitor units, the peripheral dose of ViTAT delivered with 6X beams is higher than that of 3DCRT. However, nanoDots measurements prove that ViTAT can be used in place of 3DCRT while maintaining similar fetal dose levels if 6XFFF beams are used.

A novel technique for peripheral dose measurements in external beam radiation therapy

Introduction:

In radiotherapy, the dose delivered outside the field is known as peripheral dose (PD). In this study, we have attempted to develop a dataset using the PD values measured with a two-dimensional array, IMatrixx.

Methods:

The IMatrixx was used to measure the PD up to a distance of 45 cm from the field edge, in a Varian Clinac 2100-C machine. Solid water slabs and water phantom were used to get the required geometry for the PD measurements. The measurements were done for different field sizes, collimator angles, source to surface distance (SSD) and depths. The influence of gantry angles and photon energies on the PD was studied. The surface dose measurements were carried out using thermoluminescent detectors (TLD).

Results:

The dataset shows that the PD increased significantly with field size and depth and its increase was insignificant for collimator rotation and SSD. The influence of gantry angle was less pronounced at dmax than at the surface. The TLD measurements at the surface of patients were in agreement with the IMatrixx measurements.

Conclusions:

The IMatrixx can be used for the generation of PD values and it is less time-consuming, accurate, and commonly available in all radiotherapy departments.

APPLICATIONS OF OPTICALLY STIMULATED LUMINESCENCE IN MEDICAL DOSIMETRY

If the first decade of the new millennium saw the establishment of a more solid foundation for the use of the Optically Stimulated Luminescence (OSL) in medical dosimetry, the second decade saw the technique take root and become more widely used in clinical studies. Recent publications report not only characterization and feasibility studies of the OSL technique for various applications in radiotherapy and radiology, but also the practical use of OSL for postal audits, estimation of staff dose, in vivo dosimetry, dose verification and dose mapping studies. This review complements previous review papers and reports on the topic, providing a panorama of the new advances and applications in the last decade. Attention is also dedicated to potential future applications, such as LET dosimetry, 2D/3D dosimetry using OSL, dosimetry in magnetic resonance imaging-guided radiotherapy (MRIgRT) and dosimetry of extremely high dose rates (FLASH therapy).

Management of radiotherapy patients with implanted cardiac pacemakers and defibrillators: A Report of the AAPM TG-203†

Managing radiotherapy patients with implanted cardiac devices (implantable cardiac pacemakers and implantable cardioverter-defibrillators) has been a great practical and procedural challenge in radiation oncology practice. Since the publication of the AAPM TG-34 in 1994, large bodies of literature and case reports have been published about different kinds of radiation effects on modern technology implantable cardiac devices and patient management before, during, and after radiotherapy. This task group report provides the framework that analyzes the potential failure modes of these devices and lays out the methodology for patient management in a comprehensive and concise way, in every step of the entire radiotherapy process.

Calibration strategies for use of the nanoDot OSLD in CT applications

Aluminum oxide based optically stimulated luminescent dosimeters (OSLD) have been recognized as a useful dosimeter for measuring CT dose, particularly for patient dose measurements. Despite the increasing use of this dosimeter, appropriate dosimeter calibration techniques have not been established in the literature; while the manufacturer offers a calibration procedure, it is known to have relatively large uncertainties. The purpose of this work was to evaluate two clinical approaches for calibrating these dosimeters for CT applications, and to determine the uncertainty associated with measurements using these techniques. Three unique calibration procedures were used to calculate dose for a range of CT conditions using a commercially available OSLD and reader. The three calibration procedures included calibration (a) using the vendor-provided method, (b) relative to a 120 kVp CT spectrum in air, and (c) relative to a megavoltage beam (implemented with 60 Co). The dose measured using each of these approaches was compared to dose measured using a calibrated farmer-type ion chamber. Finally, the uncertainty in the dose measured using each approach was determined. For the CT and megavoltage calibration methods, the dose measured using the OSLD nanoDot was within 5% of the dose measured using an ion chamber for a wide range of different CT scan parameters (80-140 kVp, and with measurements at a range of positions). When calibrated using the vendor-recommended protocol, the OSLD measured doses were on average 15.5% lower than ion chamber doses. Two clinical calibration techniques have been evaluated and are presented in this work as alternatives to the vendor-provided calibration approach. These techniques provide high precision for OSLD-based measurements in a CT environment.

Field-size correction factors of a radiophotoluminescent glass dosimeter for small-field and intensity-modulated radiation therapy beams

PURPOSE

We evaluated the energy responses of a radiophotoluminescent glass dosimeter (RPLD) to variations in small-field and intensity-modulated radiation therapy (IMRT) conditions using experimental measurements and Monte Carlo simulation.

METHODS

Several sizes of the jaw and multileaf collimator fields and various plan-class IMRT-beam measurements were performed using the RPLD and an ionization chamber. The field-size correction factor for the RPLD was determined for 6- and 10-MV x rays. This correction factor, together with the perturbation factor, was also calculated using Monte Carlo simulation with the EGSnrc/egs_chamber user code. In addition, to evaluate the response of the RPLD to clinical-class-specific reference fields, the field-size correction factor for the clinical IMRT plan was measured.

RESULTS

The calculated field-size correction factor ranged from 1.007 to 0.981 (for 6-MV x rays) and from 1.012 to 0.990 (for 10-MV x rays) as the jaw-field size ranged from 1 × 1 cm² to 20 × 20 cm² . The atomic composition perturbation factor for these jaw fields decreased by 3.2% and 1.9% for the 6- and 10-MV fields, respectively. The density perturbation factor was unity for field sizes ranging from 3 × 3 cm² to 20 × 20 cm² , whereas that for field sizes ranging from 3 × 3 cm² to 1 × 1 cm² decreased by 3.2% (for 6-MV x rays) and 4.3% (for 10-MV x rays). The volume-averaging factor rapidly increased for field sizes below 1.6 × 1.6 cm² . The results for the MLC fields were similar to those for the jaw fields. For plan-class IMRT beams, the field-size correction and perturbation factors were almost unity. The difference between the doses measured using the RPLD and ionization chamber was within 1.2% for the clinical IMRT plan at the planning-target volume (PTV) region.

CONCLUSIONS

For small fields of size 1.6 × 1.6 cm² or less, it was clarified that the volume averaging and density perturbation were the dominant effects responsible for the variation in the RPLD response. Moreover, perturbation correction is required when measuring a field size 1.0 × 1.0 cm² or less. Under the IMRT conditions, the difference in the responses of the RPLD between the reference conditions and the PTV region calculated by Monte Carlo simulation did not exceed 0.8%. These results indicate that it is feasible to measure IMRT dosage using an RPLD at the PTV region.

Study of dosimetric characteristics of a commercial optically stimulated luminescence system

Background

Optically stimulated luminescence dosimeters (OSLDs) have a number of advantages in radiation dosimetry making them an excellent dosimeter for in vivo dosimetry. The study aimed to study the dosimetric characteristics of a commercial optically stimulated luminescence (OSL) system by Landauer Inc., before using it for routine clinical practice for in vivo dosimetry in radiotherapy. Further, this study also aimed to investigate the cause of variability found in the literature in a few dosimetric parameters of carbon-doped aluminium oxide (Al2O3:C).

Materials and methods

The commercial OSLD system uses Al2O3:C nanoDotTM as an active radiation detector and InLightTM microStar® as a readout assembly. Inter-detector response, energy, dose rate, field size and depth dependency of the detector response were evaluated for all available clinical range of photon beam energies in radiotherapy.

Results

Inter-detector variation in OSLD response was found within 3·44%. After single light exposure for the OSL readout, detector reading decreased by 0·29% per reading. The dose linearity was investigated between dose range 50–400 cGy. The dose response curve was found to be linear until 250 cGy, after this dose, the dose response curve was found to be supra-linear in nature. OSLD response was found to be energy independent for Co60 to 10 MV photon energies.

Conclusions

The cause of variability found in the literature for some dosimetric characteristics of Al2O3:C is due to the difference in general geometry, construction of dosimeter, geometric condition of irradiation, phantom material and geometry, beam energy. In addition, the irradiation history of detector used and difference in readout methodologies had varying degree of uncertainties in measurements. However, the large surface area of the detector placed in the phantom with sufficient build-up and backscatter irradiated perpendicularly to incident radiation in Co60 beam is a good method of choice for the calibration of a dosimeter. Understanding the OSLD response with all dosimetric parameters may help us in estimation of accurate dose delivered to patient during radiotherapy treatment.

Characterization of the nanoDot OSLD dosimeter in CT

PURPOSE

The extensive use of computed tomography (CT) in diagnostic procedures is accompanied by a growing need for more accurate and patient-specific dosimetry techniques. Optically stimulated luminescent dosimeters (OSLDs) offer a potential solution for patient-specific CT point-based surface dosimetry by measuring air kerma. The purpose of this work was to characterize the OSLD nanoDot for CT dosimetry, quantifying necessary correction factors, and evaluating the uncertainty of these factors.

METHODS

A characterization of the Landauer OSL nanoDot (Landauer, Inc., Greenwood, IL) was conducted using both measurements and theoretical approaches in a CT environment. The effects of signal depletion, signal fading, dose linearity, and angular dependence were characterized through direct measurement for CT energies (80-140 kV) and delivered doses ranging from ∼5 to >1000 mGy. Energy dependence as a function of scan parameters was evaluated using two independent approaches: direct measurement and a theoretical approach based on Burlin cavity theory and Monte Carlo simulated spectra. This beam-quality dependence was evaluated for a range of CT scanning parameters.

RESULTS

Correction factors for the dosimeter response in terms of signal fading, dose linearity, and angular dependence were found to be small for most measurement conditions (<3%). The relative uncertainty was determined for each factor and reported at the two-sigma level. Differences in irradiation geometry (rotational versus static) resulted in a difference in dosimeter signal of 3% on average. Beam quality varied with scan parameters and necessitated the largest correction factor, ranging from 0.80 to 1.15 relative to a calibration performed in air using a 120 kV beam. Good agreement was found between the theoretical and measurement approaches.

CONCLUSIONS

Correction factors for the measurement of air kerma were generally small for CT dosimetry, although angular effects, and particularly effects due to changes in beam quality, could be more substantial. In particular, it would likely be necessary to account for variations in CT scan parameters and measurement location when performing CT dosimetry using OSLD.

The mean photon energy ĒF at the point of measurement determines the detector-specific radiation quality correction factor kQ,M in (192)Ir brachytherapy dosimetry

The application of various radiation detectors for brachytherapy dosimetry has motivated this study of the energy dependence of radiation quality correction factor kQ,M, the quotient of the detector responses under calibration conditions at a (60)Co unit and under the given non-reference conditions at the point of measurement, M, occurring in photon brachytherapy. The investigated detectors comprise TLD, radiochromic film, ESR, Si diode, plastic scintillator and diamond crystal detectors as well as ionization chambers of various sizes, whose measured response-energy relationships, taken from the literature, served as input data. Brachytherapy photon fields were Monte-Carlo simulated for an ideal isotropic (192)Ir point source, a model spherical (192)Ir source with steel encapsulation and a commercial HDR GammaMed Plus source. The radial source distance was varied within cylindrical water phantoms with outer radii ranging from 10 to 30cm and heights from 20 to 60cm. By application of this semiempirical method - originally developed for teletherapy dosimetry - it has been shown that factor kQ,M is closely correlated with a single variable, the fluence-weighted mean photon energy ĒF at the point of measurement. The radial profiles of ĒF obtained with either the commercial (192)Ir source or the two simplified source variants show little variation. The observed correlations between parameters kQ,M and ĒF are represented by fitting formulae for all investigated detectors, and further variation of the detector type is foreseen. The herewith established close correlation of radiation quality correction factor kQ,M with local mean photon energy ĒF can be regarded as a simple regularity, facilitating the practical application of correction factor kQ,M for in-phantom dosimetry around (192)Ir brachytherapy sources. ĒF values can be assessed by Monte Carlo simulation or measurement. A technique describing the local measurement of ĒF will be published separately.

Long term OSLD reader stability in the ACDS level one audit

The Australian Clinical Dosimetry Service (ACDS) has demonstrated the capacity to perform a basic dosimetry audit on all radiotherapy clinics across Australia. During the ACDS’s three and a half year trial the majority of the audits were performed using optically stimulated luminescence dosimeters (OSLD) mailed to facilities for exposure to a reference dose, and then returned to the ACDS for analysis. This technical note investigates the stability of the readout process under the large workload of the national dosimetry audit. The OSLD readout uncertainty contributes to the uncertainty of several terms of the dose calculation equation and is a major source of uncertainty in the audit. The standard deviation of four OSLD readouts was initially established at 0.6 %. Measurements over 13 audit batches—each batch containing 200−400 OSLDs—showed variability (0.5−0.9 %) in the readout standard deviation. These shifts have not yet necessitated a change to the audit scoring levels. However, a standard deviation in OSLD readouts greater than 0.9 % will change the audit scoring levels. We identified mechanical wear on the OSLD readout adapter as a cause of variability in readout uncertainty, however, we cannot rule out other causes. Additionally we observed large fluctuations in the distribution of element correction factors (ECF) for OSLD batches. We conclude that the variability in the width of the ECF distribution from one batch to another is not caused by variability in readout uncertainty, but rather by variations in the OSLD stock.

A 2D DNA lattice as an ultrasensitive detector for beta radiations

There is growing demand for the development of efficient ultrasensitive radiation detectors to monitor the doses administered to individuals during therapeutic nuclear medicine which is often based on radiopharmaceuticals, especially those involving beta emitters. Recently biological materials are used in sensors in the nanobio disciplines due to their abilities to detect specific target materials or sites. Artificially designed two-dimensional (2D) DNA lattices grown on a substrate were analyzed after exposure to pure beta emitters, (90)Sr-(90)Y. We studied the Raman spectra and reflected intensities of DNA lattices at various distances from the source with different exposure times. Although beta particles have very low linear energy transfer values, the significant physical and chemical changes observed throughout the extremely thin, ∼0.6 nm, DNA lattices suggested the feasibility of using them to develop ultrasensitive detectors of beta radiations.