On the validity of 3D polymer gel dosimetry: II. Physico-chemical effects

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.

Pilot scale validation campaign of gel dosimetry for pre-treatment quality assurance in stereotactic radiotherapy

PURPOSE

Complex stereotactic radiotherapy treatment plans require prior verification. A gel dosimetry system was developed and tested to serve as a high-resolution 3D dosimeter for Quality Assurance (QA) purposes.

MATERIALS AND METHODS

A modified version of a polyacrylamide polymer gel dosimeter based on chemical response inhibition was employed. Different sample geometries (cuvettes and phantoms) were manufactured for calibration and QA acquisitions. Irradiations were performed with a Varian Trilogy linac, and analyses of irradiated gel dosimeters were performed via MRI with a 1.5 T Philips Achieva at 1 mm3 or 2 mm3 isotropic spatial resolution. To assess reliability of polymer gel data, 54 stereotactic clinical treatment plans were delivered both on dosimetric gel phantoms and on the Delta4 dosimeter. Results from the two devices were evaluated through a global gamma index over a range of acceptance criteria and compared with each other.

RESULTS

A quantitative and tunable control of dosimetric gel response sensitivity was achieved through chemical inhibition. An optimized MRI analysis protocol allowed to acquire high resolution phantom dose data in timeframes of ≈ 1 h. Conversion of gel dosimeter data into absorbed dose was achieved through internal calibration. Polymer gel dosimeters (2 mm3 resolution) and Delta4 presented an agreement within 4.8 % and 2.7 % at the 3 %/1 mm and 2 %/2 mm gamma criteria, respectively.

CONCLUSIONS

Gel dosimeters appear as promising tools for high resolution 3D QA. Added complexity of the gel dosimetry protocol may be justifiable in case of small target volumes and steep dose gradients.

Verification of dose distribution in high dose-rate brachytherapy for cervical cancer using a normoxic N-vinylpyrrolidone polymer gel dosimeter

The polymer gel dosimeter has been proposed for use as a 3D dosimeter for complex dose distribution measurement of high dose-rate (HDR) brachytherapy. However, various shapes of catheter/applicator for sealed radioactive source transport used in clinical cases must be placed in the gel sample. The absorbed dose readout for the magnetic resonance (MR)-based polymer gel dosimeters requires calibration data for the dose-transverse relaxation rate (R2) response. In this study, we evaluated in detail the dose uncertainty and dose resolution of three calibration methods, the multi-sample and distance methods using the Ir-192 source and the linear accelerator (linac) method using 6MV X-rays. The use of Ir-192 sources increases dose uncertainty with steep dose gradients. We clarified that the uniformly irradiated gel sample improved the signal-to-noise ratio (SNR) due to the large slice thickness of MR images and could acquire an accurate calibration curve using the linac method. The curved tandem and ovoid applicator used for intracavitary irradiation of HDR brachytherapy for cervical cancer were reproduced with a glass tube to verify the dose distribution. The results of comparison with the treatment planning system (TPS) calculation by gamma analysis on the 3%/2 mm criterion were in good agreement with a gamma pass rate of 90%. In addition, the prescription dose could be evaluated accurately. We conclude that it is easy to place catheter/applicator in the polymer gel dosimeters, making them a useful tool for verifying the 3D dose distribution of HDR brachytherapy with accurate calibration methods.

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.

PAGAT gel dosimetry for everyone: gel production, measurement and evaluation

Polymer gel (PG) dosimetry is a valuable tool to measure complex dose distributions in 3D with a high spatial resolution. However, due to complex protocols that need to be followed for in-house produced PGs and the high costs of commercially available gels, PG gels are only rarely applied in quality assurance procedures worldwide. In this work, we provide an introduction to perform highly standardized dosimetric PG experiments using PAGAT (PolyAcrylamide Gelatine gel fabricated at ATmospheric conditions) dosimetry gel. PAGAT gel can be produced at atmospheric conditions, at low costs and is evaluated using magnetic resonance imaging (MRI). The conduction of PG experiments is described in great detail including the gel production, treatment planning, irradiation, MRI evaluation and post-processing procedure. Furthermore, a plugin in an open source image processing tool for post-processing is provided free of charge that allows a standardized and reproducible analysis of PG experiments.

Towards real-time 4D radiation dosimetry on an MRI-Linac

4D radiation dosimetry using a highly radiation-sensitive polymer gel dosimeter with real-time quantitative magnetic resonance imaging (MRI) readout is presented as a technique to acquire the accumulated radiation dose distribution during image-guided radiotherapy on an MRI-Linac. Optimized T ₂-weighted Turbo-Spin-Echo (TSE) scans are converted into quantitative ΔR ₂ maps and subsequently to radiation dose maps. The concept of temporal uncertainty is introduced as a metric of effective temporal resolution. A mathematical framework is presented to optimize the echo time of the TSE sequence in terms of dose resolution, and the trade-off between temporal resolution and dose resolution is discussed. The current temporal uncertainty achieved with the MAGAT gel dosimeter on a 1 T MRI-Linac is 3.8 s which is an order of magnitude better than what has been achieved until now. The potential of real-time 4D radiation dosimetry in a theragnostic MRI-Linac is demonstrated for two scenarios: an irradiation with three coplanar beams on a head phantom and a dynamic arc treatment on a cylindrical gel phantom using a rotating couch. The dose maps acquired on the MRI-Linac are compared with a treatment plan and with dose maps acquired on a clinical 3 T MRI scanner. 3D gamma map evaluations for the different modalities are provided. While the presented method demonstrates the potential of gel dosimetry for tracking the dose delivery during radiotherapy in 4D, a shortcoming of the MAGAT gel dosimeter is a retarded dose response. The effect of non-ideal radiofrequency pulses resulting from limitations in the specific absorption rate or B₁-field inhomogeneity on the TSE acquired ΔR ₂ values is analysed experimentally and by use of computational modelling with a Bloch simulator.

Absolute dosimetry with polymer gels-a TLD reference system

BACKGROUND AND PURPOSE

Absolute dosimetry in 3D with polymer gels (PG) is generally complicated and usually requires a second independent measurement with conventional detectors. This is why, PG are often used only for relative dosimetry. To overcome this drawback, we combine PG with a 1D thermoluminescence (TL) detector within the same measurement. The TL detector information is then used as additional information for calibration of the gel.

MATERIALS AND METHODS

The PAGAT dosimetry gel was used in combination with TLD600 (LiF:Mg,Ti). TL detectors were attached on the surface of the PG container placed inside a cylindrical phantom. To test the usability of this setup, two irradiation geometries were carried out: (a) homogeneous target coverage and (b) small-field irradiation. PG was evaluated with magnetic resonance imaging (MRI) and the TL detectors with a Harshaw 5500 hot gas reader.

RESULTS

PG dosimetry alone showed deviations of up to 4% as compared to calculations. Including additionally the dose information of the TL detectors for PG calibration, this deviation was decreased to less than 1% for both irradiation geometries. This is also reflected by the very high [Formula: see text]-passing rates of  >  96% (3%/3 mm) and  >93% (2%/2 mm), respectively.

CONCLUSION

This study presents a novel method combining 3D PG and TL dose measurements for the purpose of absolute 3D dose measurements that can also be applied in complex anthropomorphic phantoms using only a single measurement. The method was validated for two different irradiation geometries including a homogeneous large field as well as a small field irradiation with sharp dose gradients.

Dose distribution verification in high-dose-rate brachytherapy using a highly sensitive normoxic N-vinylpyrrolidone polymer gel dosimeter

Rapid technological advances in high-dose-rate brachytherapy have led to a requirement for greater accuracy in treatment planning system calculations and in the verification of dose distributions. In high-dose-rate brachytherapy, it is important to measure the dose distribution in the low-dose region at a position away from the source in addition to the high-dose range in the proximity of the source. The aim of this study was to investigate the accuracy of a treatment plan designed for prostate cancer in the low-dose range using a normoxic N-vinylpyrrolidone-based polymer gel (VIPET gel) dosimeter containing inorganic salt as a sensitizer (iVIPET). The dose response was evaluated on the basis of the transverse relaxation rate (R₂) measured by magnetic resonance scanning. In the verification of the treatment plan, gamma analysis showed that the dose distributions obtained from the polymer gel dosimeter were in good agreement with those calculated by the treatment planning system. The gamma passing rate according to the 2%/2 mm criterion was 97.9%. The iVIPET gel dosimeter provided better accuracy for low doses than the normal VIPET gel dosimeter, demonstrating the potential to be a useful tool for quality assurance of the dose distribution delivered by high-dose-rate brachytherapy.

Introduction of a deformable x-ray CT polymer gel dosimetry system

This study introduces the first 3D deformable dosimetry system based on x-ray computed tomography (CT) polymer gel dosimetry and establishes the setup reproducibility, deformation characteristics and dose response of the system. A N-isopropylacrylamide (NIPAM)-based gel formulation optimized for x-ray CT gel dosimetry was used, with a latex balloon serving as the deformable container and low-density polyethylene and polyvinyl alcohol providing additional oxygen barrier. Deformable gels were irradiated with a 6 MV calibration pattern to determine dosimetric response and a dosimetrically uniform plan to determine the spatial uniformity of the response. Wax beads were added to each gel as fiducial markers to track the deformation and setup of the gel dosimeters. From positions of the beads on CT images the setup reproducibility and the limits and reproducibility of gel deformation were determined. Comparison of gel measurements with Monte Carlo dose calculations found excellent dosimetric accuracy, comparable to that of an established non-deformable dosimetry system, with a mean dose discrepancy of 1.5% in the low-dose gradient region and a gamma pass rate of 97.9% using a 3%/3 mm criterion. The deformable dosimeter also showed good overall spatial dose uniformity throughout the dosimeter with some discrepancies within 20 mm of the edge of the container. Tracking of the beads within the dosimeter found that sub-millimetre setup accuracy is achievable with this system. The dosimeter was able to deform and relax when externally compressed by up to 30 mm without sustaining any permanent damage. Internal deformations in 3D produced average marker movements of up to 12 mm along the direction of compression. These deformations were also shown to be reproducible over 100 consecutive deformations. This work has established several important characteristics of a new deformable dosimetry system which shows promise for future clinical applications, including the validation of deformable dose accumulation algorithms.

Computational investigation of suitable polymer gel composition for the QA of the beam components of a BNCT irradiation field

This study investigated the optimum composition of the MAGAT polymer gel which is to be used in the quality assurance measurement of the thermal neutron, fast neutron and gamma ray components in the irradiation field used for boron neutron capture therapy at the Kyoto University Reactor. Simulations using the PHITS code showed that when combined with the gel, ⁶Li concentrations of 0, 10 and 100ppm were found to be potentially usable.

Evaluation of accuracy and precision in polymer gel dosimetry

PURPOSE

To assess the overall reproducibility and accuracy of an X-ray computed tomography (CT) polymer gel dosimetry (PGD) system and investigate what effects the use of generic, interbatch, and intrabatch gel calibration have on dosimetric and spatial accuracy.

METHODS

A N-isopropylacrylamide (NIPAM)-based gel formulation optimized for X-ray CT gel dosimetry was used, and the results over four different batches of gels were analyzed. All gels were irradiated with three 6 MV beams in a calibration pattern at both the bottom and top of the dosimeter. Postirradiation CT images of the gels were processed using background subtraction, image averaging, adaptive mean filtering, and remnant artifact removal. The gel dose distributions were calibrated using a Monte Carlo (Vancouver Island Monte Carlo system) calculated dose distribution of the calibration pattern. Using the calibration results from all gels, an average or "generic" calibration curve was calculated and this generic calibration curve was used to calibrate each of the gels within the sample. For each of the gels, the irradiation pattern at the bottom of the dosimeter was also calibrated using the irradiation pattern at the top of the dosimeter to evaluate intragel calibration.

RESULTS

Comparison of gel measurements with Monte Carlo dose calculations found excellent dosimetric accuracy when using an average (or generic) calibration with a mean dose discrepancy of 1.8% in the low-dose gradient region which compared to a "best-case scenario" self-calibration method with a mean dose discrepancy of 1.6%. The intragel calibration method investigated produced large dose discrepancies due to differences in dose response at the top and bottom of the dosimeter, but the use of a dose-dependent correction reduced these dose errors. Spatial accuracy was found to be excellent for the average calibration method with a mean distance-to-agreement (DTA) of 0.63 mm and 99.6% of points with a DTA < 2 mm in high-dose gradient regions. This compares favorably to the self-calibration method which produced a mean DTA of 0.61 mm and 99.8% of points with a DTA < 2 mm. Gamma analysis using a 3%/3 mm criterion also found good agreement between the gel measurement and Monte Carlo dose calculation when using either the average calibration or self-calibration methods (96.8% and 98.2%, respectively).

CONCLUSIONS

An X-ray CT PGD system was evaluated and found to have excellent dosimeteric and spatial accuracy when compared to Monte Carlo dose calculations and the use of generic and interbatch calibration methods were found to be effective. The establishment of the accuracy and reproducibility of this system provides important information for clinical implementation.

Evaluation of hybrid SART + OS + TV iterative reconstruction algorithm for optical-CT gel dosimeter imaging

Optical computed tomography (optical-CT) is a high-resolution, fast, and easily accessible readout modality for gel dosimeters. This paper evaluates a hybrid iterative image reconstruction algorithm for optical-CT gel dosimeter imaging, namely, the simultaneous algebraic reconstruction technique (SART) integrated with ordered subsets (OS) iteration and total variation (TV) minimization regularization. The mathematical theory and implementation workflow of the algorithm are detailed. Experiments on two different optical-CT scanners were performed for cross-platform validation. For algorithm evaluation, the iterative convergence is first shown, and peak-to-noise-ratio (PNR) and contrast-to-noise ratio (CNR) results are given with the cone-beam filtered backprojection (FDK) algorithm and the FDK results followed by median filtering (mFDK) as reference. The effect on spatial gradients and reconstruction artefacts is also investigated. The PNR curve illustrates that the results of SART  +  OS  +  TV finally converges to that of FDK but with less noise, which implies that the dose-OD calibration method for FDK is also applicable to the proposed algorithm. The CNR in selected regions-of-interest (ROIs) of SART  +  OS  +  TV results is almost double that of FDK and 50% higher than that of mFDK. The artefacts in SART  +  OS  +  TV results are still visible, but have been much suppressed with little spatial gradient loss. Based on the assessment, we can conclude that this hybrid SART  +  OS  +  TV algorithm outperforms both FDK and mFDK in denoising, preserving spatial dose gradients and reducing artefacts, and its effectiveness and efficiency are platform independent.

Radiological properties of nanocomposite Fricke gel dosimeters for heavy ion beams

The radiological properties of nanocomposite Fricke gel (NC-FG) dosimeters prepared with different concentrations of nano-clay, perchloric acid and ferrous ions in deaerated conditions were investigated under carbon and argon ion beam irradiation covering a linear-energy-transfer (LET) range of 10 to 3000 eV/nm. We found that NC-FG exhibits radiological properties distinct from those of conventional Fricke gel. The radiation sensitivity of NC-FG is independent of the LET and is nearly constant even at very high LET (3000 eV/nm) values in the Bragg peak region of the argon ion beam. In addition, whereas conventional Fricke gel dosimeters only operate under acidic conditions, NC-FG dosimeters function under both acidic and neutral conditions. The radiation sensitivity decreases with decreasing nano-clay concentration in NC-FG, which indicates that the nano-clay plays a vital role in the radiation-induced oxidation of Fe(2.)

Simultaneous mapping of water shift and B1 (WASABI)-Application to field-Inhomogeneity correction of CEST MRI data

PURPOSE

Together with the development of MRI contrasts that are inherently small in their magnitude, increased magnetic field accuracy is also required. Hence, mapping of the static magnetic field (B₀ ) and the excitation field (B₁ ) is not only important to feedback shim algorithms, but also for postprocess contrast-correction procedures.

METHODS

A novel field-inhomogeneity mapping method is presented that allows simultaneous mapping of the water shift and B₁ (WASABI) using an off-resonant rectangular preparation pulse. The induced Rabi oscillations lead to a sinc-like spectrum in the frequency-offset dimension and allow for determination of B₀ by its symmetry axis and of B₁ by its oscillation frequency.

RESULTS

Stability of the WASABI method with regard to the influences of T₁ , T₂ , magnetization transfer, and repetition time was investigated and its convergence interval was verified. B₀ and B₁ maps obtained simultaneously by means of WASABI in the human brain at 3 T and 7 T can compete well with maps obtained by standard methods. Finally, the method was applied successfully for B₀ and B₁ correction of chemical exchange saturation transfer MRI (CEST-MRI) data of the human brain.

CONCLUSION

The proposed WASABI method yields a novel simultaneous B₀ and B₁ mapping within 1 min that is robust and easy to implement. Magn Reson Med 77:571-580, 2017. © 2016 International Society for Magnetic Resonance in Medicine.

Incorporating multislice imaging into x-ray CT polymer gel dosimetry

PURPOSE

To evaluate multislice computed tomography (CT) scanning for fast and reliable readout of radiation therapy (RT) dose distributions using CT polymer gel dosimetry (PGD) and to establish a baseline assessment of image noise and uniformity in an unirradiated gel dosimeter.

METHODS

A 16-slice CT scanner was used to acquire images through a 1 L cylinder filled with water. Additional images were collected using a single slice machine. The variability in CT number (NCT) associated with the anode heel effect was evaluated and used to define a new slice-by-slice background subtraction artifact removal technique for CT PGD. Image quality was assessed for the multislice system by evaluating image noise and uniformity. The agreement in NCT for slices acquired simultaneously using the multislice detector array was also examined. Further study was performed to assess the effects of increasing x-ray tube load on the constancy of measured NCT and overall scan time. In all cases, results were compared to the single slice machine. Finally, images were collected throughout the volume of an unirradiated gel dosimeter to quantify image noise and uniformity before radiation is delivered.

RESULTS

Slice-by-slice background subtraction effectively removes the variability in NCT observed across images acquired simultaneously using the multislice scanner and is the recommended background subtraction method when using a multislice CT system. Image noise was higher for the multislice system compared to the single slice scanner, but overall image quality was comparable between the two systems. Further study showed NCT was consistent across image slices acquired simultaneously using the multislice detector array for each detector configuration of the slice thicknesses examined. In addition, the multislice system was found to eliminate variations in NCT due to increasing x-ray tube load and reduce scanning time by a factor of 4 when compared to imaging a large volume using a single slice scanner. Images acquired through an unirradiated, active gel revealed NCT varies between the top and bottom of the 1 L cylinder as well as across the diameter of the cylinder by up to 7 HU.

CONCLUSIONS

Multislice CT imaging has been evaluated for CT PGD and found to be the superior technique compared to single slice imaging in terms of the time required to complete a scan and the tube load characteristics associated with each scanning method. The implementation of multislice scanning is straightforward and expected to facilitate routine gel dosimetry measurements for complex dose distributions in modern RT centers.

FlexyDos3D: a deformable anthropomorphic 3D radiation dosimeter: radiation properties

Three dimensional radiation dosimetry has received growing interest with the implementation of highly conformal radiotherapy treatments. The radiotherapy community faces new challenges with the commissioning of image guided and image gated radiotherapy treatments (IGRT) and deformable image registration software.A new three dimensional anthropomorphically shaped flexible dosimeter, further called 'FlexyDos3D', has been constructed and a new fast optical scanning method has been implemented that enables scanning of irregular shaped dosimeters. The FlexyDos3D phantom can be actuated and deformed during the actual treatment. FlexyDos3D offers the additional advantage that it is easy to fabricate, is non-toxic and can be molded in an arbitrary shape with high geometrical precision.The dosimeter formulation has been optimized in terms of dose sensitivity. The influence of the casting material and oxygen concentration has also been investigated. The radiophysical properties of this new dosimeter are discussed including stability, spatial integrity, temperature dependence of the dosimeter during radiation, readout and storage, dose rate dependence and tissue equivalence.

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.

3D evaluation of 3DVH program using BANG3 polymer gel dosimeter

PURPOSE

With the recent introduction of intensity modulated arc therapy techniques, there is an increasing need for validation of treatment delivery in three-dimensional (3D) space. A commercial dosimetry device ArcCHECK™ (Sun Nuclear Corporation, Melbourne, FL, USA) can be used in conjunction with 3DVH program. With this system, one can reconstruct the 3D dose distribution produced in the actual patient. In this work the authors evaluate the relative accuracy of the ArcCHECK™-3DVH system using BANG3 (MGS Research, Guilford, CT, USA) polymer gel dosimeter.

METHODS

About 15-cm diameter and 20-cm long cylindrical phantoms filled with BANG3 was used to simulate a patient, to which a volumetrically modulated arc therapy plan was created with Pinnacle3 treatment planning software (Philips Healthcare, Andover, MA, USA). The plan (76 Gy total in 38 fractions) was designed for prostate radiotherapy using a 6 MV photon beam from an Elekta Synergy linear accelerator (Elekta AB, Stockholm, Sweden). The treatment was delivered to the simulated patient. The same plan was used to irradiate an ArcCHECK™ device with an insert plug. The point dose at the isocenter was measured using a Farmer-type ionization chamber. The measured dose data were imported into the 3DVH program, which generated the 3D dose distributions projected onto the simulated patient. The dose data recorded in the polymer gel were read out using a MRI scanner and the 3D dose distribution delivered to the simulated patient was analyzed and compared with those from the 3DVH program and the Pinnacle3 software. The comparison was accomplished by using the gamma index, overlaying the isodose lines for a set of data on selected planes, and computing dose-volume histogram of structures.

RESULTS

The dose at the center of the ArcCHECK™ device measured with an ionization chamber was 1.82% lower than the dose predicted by Pinnacle3. The 3D dose distribution generated by Pinnacle3 was compared with those obtained by the ArcCHECK™-3DVH system and BANG3. The gamma passing rates for criteria of 3% dose difference, 3 mm distance-to-agreement, and 25% lower dose threshold were 99.1% for the former and 95.7% for the latter. The mean and maximum PTV doses estimated by the 3DVH were 74.0 and 79.3 Gy in comparison to 74.4 and 76.5 Gy with Pinnacle3. Those values for BANG3 measurements were 74.7 and 79.5 Gy. The mean doses to rectum were 40.2, 39.8, and 38.8 Gy for Pinnacle3, 3DVH, and BANG3, whereas the mean doses to the bladder were 26.7, 25.7, and 21.7 Gy, respectively.

CONCLUSIONS

The ArcCHECK™-3DVH system provides an accurate estimation of 3D dose distribution in an actual patient within a clinically meaningful tolerance level. However, both 3DVH and BANG3 showed two noticeable differences from Pinnacle3. First, the measured dose throughout the PTV region was less uniform than Pinnacle3. Second, the dose gradient at the interface between PTV and rectum was steeper than Pinnacle3 prediction. Further investigation may be able to identify the cause for these findings.

Preparation of polymer gel dosimeters based on less toxic monomers and gellan gum

New polymer gel dosimeters consisting of 2-hydroxyethyl methacrylate (HEMA), triethylene glycol monoethyl ether monomethacrylate (TGMEMA), polyethylene glycol 400 dimethacrylate (9G), tetrakis (hydroxymethyl) phosphonium chloride as an antioxidant, and gellan gum as a gel matrix were prepared. They were optically analyzed by measuring absorbance to evaluate a dose response. The absorbance of the polymer gel dosimeters that were exposed to (60)Co γ-rays increased with increasing dose. The dosimeters comprising HEMA and 9G showed a linear increase in absorbance in the dose range from 0 to 10 Gy. The dose response depended on the 9G concentration. For others comprising HEMA, 9G and TGMEMA, the absorbance of the polymer gel dosimeters drastically increased above a certain dose, and then leveled off up to 10 Gy. The optical variations in these polymer gel dosimeters were also induced by x-irradiation from Cyberknife radiotherapy equipment. Furthermore, the exposed region of the latter polymer gel dosimeter exhibited a thermo-responsive behavior.

Evaluation of radiochromic gel dosimetry and polymer gel dosimetry in a clinical dose verification

A quantitative comparison of two full three-dimensional (3D) gel dosimetry techniques was assessed in a clinical setting: radiochromic gel dosimetry with an in-house developed optical laser CT scanner and polymer gel dosimetry with magnetic resonance imaging (MRI). To benchmark both gel dosimeters, they were exposed to a 6 MV photon beam and the depth dose was compared against a diamond detector measurement that served as golden standard. Both gel dosimeters were found accurate within 4% accuracy. In the 3D dose matrix of the radiochromic gel, hotspot dose deviations up to 8% were observed which are attributed to the fabrication procedure. The polymer gel readout was shown to be sensitive to B0 field and B1 field non-uniformities as well as temperature variations during scanning. The performance of the two gel dosimeters was also evaluated for a brain tumour IMRT treatment. Both gel measured dose distributions were compared against treatment planning system predicted dose maps which were validated independently with ion chamber measurements and portal dosimetry. In the radiochromic gel measurement, two sources of deviations could be identified. Firstly, the dose in a cluster of voxels near the edge of the phantom deviated from the planned dose. Secondly, the presence of dose hotspots in the order of 10% related to inhomogeneities in the gel limit the clinical acceptance of this dosimetry technique. Based on the results of the micelle gel dosimeter prototype presented here, chemical optimization will be subject of future work. Polymer gel dosimetry is capable of measuring the absolute dose in the whole 3D volume within 5% accuracy. A temperature stabilization technique is incorporated to increase the accuracy during short measurements, however keeping the temperature stable during long measurement times in both calibration phantoms and the volumetric phantom is more challenging. The sensitivity of MRI readout to minimal temperature fluctuations is demonstrated which proves the need for adequate compensation strategies.