Ultrasound tomography imaging of radiation dose distributions in polymer gel dosimeters: preliminary study

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.

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.

Technical Note: Radiotherapy dose characterization of gel dosimetry using shear wave elasticity imaging

PURPOSE

Radiotherapy is an effective treatment for many types of cancer in clinical settings. Gel dosimetry has the potential to record three-dimensional (3D) dose distribution compared to a conventional ion chamber. As the elasticity of the gel is altered after irradiation due to gel polymerization, we aim to measure the dose recorded in gel dosimetry with ultrasonic shear wave elasticity imaging (SWEI), a nondestructive and quantitative elasticity imaging tool.

METHODS

In this study, a cylindrical N-isopropylacrylamide (NIPAM) polymer gel with a diameter of 10 cm and a height of 10 cm and with cellulose as an ultrasonic scatterer was irradiated by a linear accelerator with the irradiation parameters of 6 MV x-ray, dose rate of 100 cGy/min and field size of 10  ×  20 mm² . The six gel phantoms were irradiated with the dose of 0, 1, 3, 5, 8, or 10 Gy. The gel phantoms were measured with SWEI at 24, 36, and 48 h after x-ray irradiation. The two-dimensional (2D) shear wave velocity and Young's modulus maps corresponding to x-ray dose distribution were reconstructed following a time-of-flight reconstruction from a set of time-series displacement maps. The spatial resolution of the reconstructed SWEI image is ~1 mm.

RESULTS

Our results show that the elastic modulus increases linearly as irradiation dose increases (R²  = 0.94 at 24 h, R²  = 0.98 at 36 h, R²  = 0.98 at 48 h), suggesting that the gel elasticity is highly associated with x-ray irradiation dose at 36 h post irradiation, and the dose resolution was 0.66 kPa/Gy. From the 3D elastic modulus maps, the dose distribution along the depth and lateral direction can be reflected in the NIPAM gel dosimetry using SWEI as well.

CONCLUSIONS

In this study, the irradiated NIPAM gel phantom was quantitatively measured with SWEI for the first time to read the dose distribution recorded in the gel dosimetry. The results suggest that the gel elasticity is highly associated with x-ray irradiation dose. In the future, 2D/or 3D dose distribution from intensity modulated radiotherapy (IMRT) or other potential particle radiotherapy will be measured and reconstructed with SWEI and compared with the dose map from a treatment planning system (TPS) in the clinic.

Improving the quality of reconstructed X-ray CT images of polymer gel dosimeters: zero-scan coupled with adaptive mean filtering

This study evaluated the feasibility of combining the 'zero-scan' (ZS) X-ray computed tomography (CT) based polymer gel dosimeter (PGD) readout with adaptive mean (AM) filtering for improving the signal to noise ratio (SNR), and to compare these results with available average scan (AS) X-ray CT readout techniques. NIPAM PGD were manufactured, irradiated with 6 MV photons, CT imaged and processed in Matlab. AM filter for two iterations, with 3 × 3 and 5 × 5 pixels (kernel size), was used in two scenarios (a) the CT images were subjected to AM filtering (pre-processing) and these were further employed to generate AS and ZS gel images, and (b) the AS and ZS images were first reconstructed from the CT images and then AM filtering was carried out (post-processing). SNR was computed in an ROI of 30 × 30 for different pre and post processing cases. Results showed that the ZS technique combined with AM filtering resulted in improved SNR. Using the previously-recommended 25 images for reconstruction the ZS pre-processed protocol can give an increase of 44% and 80% in SNR for 3 × 3 and 5 × 5 kernel sizes respectively. However, post processing using both techniques and filter sizes introduced blur and a reduction in the spatial resolution. Based on this work, it is possible to recommend that the ZS method may be combined with pre-processed AM filtering using appropriate kernel size, to produce a large increase in the SNR of the reconstructed PGD images.

Review of ultrasound image guidance in external beam radiotherapy part II: intra-fraction motion management and novel applications

Imaging has become an essential tool in modern radiotherapy (RT), being used to plan dose delivery prior to treatment and verify target position before and during treatment. Ultrasound (US) imaging is cost-effective in providing excellent contrast at high resolution for depicting soft tissue targets apart from those shielded by the lungs or cranium. As a result, it is increasingly used in RT setup verification for the measurement of inter-fraction motion, the subject of Part I of this review (Fontanarosa et al 2015 Phys. Med. Biol. 60 R77-114). The combination of rapid imaging and zero ionising radiation dose makes US highly suitable for estimating intra-fraction motion. The current paper (Part II of the review) covers this topic. The basic technology for US motion estimation, and its current clinical application to the prostate, is described here, along with recent developments in robust motion-estimation algorithms, and three dimensional (3D) imaging. Together, these are likely to drive an increase in the number of future clinical studies and the range of cancer sites in which US motion management is applied. Also reviewed are selections of existing and proposed novel applications of US imaging to RT. These are driven by exciting developments in structural, functional and molecular US imaging and analytical techniques such as backscatter tissue analysis, elastography, photoacoustography, contrast-specific imaging, dynamic contrast analysis, microvascular and super-resolution imaging, and targeted microbubbles. Such techniques show promise for predicting and measuring the outcome of RT, quantifying normal tissue toxicity, improving tumour definition and defining a biological target volume that describes radiation sensitive regions of the tumour. US offers easy, low cost and efficient integration of these techniques into the RT workflow. US contrast technology also has potential to be used actively to assist RT by manipulating the tumour cell environment and by improving the delivery of radiosensitising agents. Finally, US imaging offers various ways to measure dose in 3D. If technical problems can be overcome, these hold potential for wide-dissemination of cost-effective pre-treatment dose verification and in vivo dose monitoring methods. It is concluded that US imaging could eventually contribute to all aspects of the RT workflow.

Role of gel dosimeters in boron neutron capture therapy

Gel dosimeters have acquired a unique status in radiotherapy, especially with the advent of the new techniques in which there is a need for three-dimensional dose measurement with high spatial resolution. One of the techniques in which the use of gel dosimeters has drawn the attention of the researchers is the boron neutron capture therapy. Exploring the history of gel dosimeters, this paper sets out to study their role in the boron neutron capture therapy dosimetric process.

Ultrasound attenuation computed tomography assessment of PAGAT gel dose

Ultrasound has been previously investigated as an alternative readout method for irradiated polymer gel dosimeters, with authors reporting varying dose responses. We extend previous work utilizing a new computed tomography ultrasound scanner comprising of two identical 5 MHz, 128-element linear-array ultrasound transducers, co-axially aligned and submerged in water as a coupling agent, with rotational of the gel dosimeter between the transducers facilitated by a robotic arm. We have investigated the dose-dependence of both ultrasound bulk attenuation and broadband ultrasound attenuation (BUA) for the PAGAT gel dosimeter. The ultrasound bulk attenuation dose sensitivity was found to be 1.46  ±  0.04 dB m( -1) Gy( -1), being in agreement with previously published results for PAG and MAGIC gels. BUA was also found to be dose dependent and was measured to be 0.024  ±  0.003 dB MHz( -1) Gy( -1); the advantage of BUA being its insensitivity to frequency-independent attenuation mechanisms including reflection and refraction, thereby minimizing image reconstruction artefacts.

A novel method of estimating dose responses for polymer gels using texture analysis of scanning electron microscopy images

Polymer gels are regarded as a potential dosimeter for independent validation of absorbed doses in clinical radiotherapy. Several imaging modalities have been used to convert radiation-induced polymerization to absorbed doses from a macro-scale viewpoint. This study developed a novel dose conversion mechanism by texture analysis of scanning electron microscopy (SEM) images. The modified N-isopropyl-acrylamide (NIPAM) gels were prepared under normoxic conditions, and were administered radiation doses from 5 to 20 Gy. After freeze drying, the gel samples were sliced for SEM scanning with 50×, 500×, and 3500× magnifications. Four texture indices were calculated based on the gray level co-occurrence matrix (GLCM). The results showed that entropy and homogeneity were more suitable than contrast and energy as dose indices for higher linearity and sensitivity of the dose response curves. After parameter optimization, an R² value of 0.993 can be achieved for homogeneity using 500× magnified SEM images with 27 pixel offsets and no outlier exclusion. For dose verification, the percentage errors between the prescribed dose and the measured dose for 5, 10, 15, and 20 Gy were −7.60%, 5.80%, 2.53%, and −0.95%, respectively. We conclude that texture analysis can be applied to the SEM images of gel dosimeters to accurately convert micro-scale structural features to absorbed doses. The proposed method may extend the feasibility of applying gel dosimeters in the fields of diagnostic radiology and radiation protection.

Evaluation of three-dimensional polymer gel dosimetry using X-ray CT and R2 MRI

It is difficult to obtain images of thin slices from measurement of spin-spin relaxation (R2) with magnetic resonance imaging (MRI) using the traditional dose reading method of polymer gel dosimetry. In this study, the dose reading method was performed using X-ray computed tomography (CT) for proton beam measurements in order to enable collection of thin slices. In addition, three-dimensional (3D) images of polymer gels were constructed using volume rendering. As a result of acquisition of thin slices, more detailed 3D data consisting of smaller voxel sizes compared to R2 were acquired. However, it was found that with thin slice thicknesses and small voxels, the signal-to-noise ratio around the voxels deteriorated. In addition, the coefficient of variation of non-irradiated gels with CT was smaller than that with R2 MRI.

Polymer gel dosimeters with enhanced sensitivity for use in x-ray CT polymer gel dosimetry

A primary limitation of current x-ray CT polymer gel dosimetry is the low contrast, and hence poor dose resolution, of dose images produced by the system. The low contrast is largely due to the low-dose sensitivity of current formulations of polymer gel for x-ray CT imaging. This study reports on the investigation of new dosimeter formulations with improved dose sensitivity for x-ray CT polymer gel dosimetry. We incorporate an isopropanol co-solvent into an N-isopropylacrylamide-based gel formulation in order to increase the total monomer/crosslinker concentration (%T) within the formulation. It is shown that gels of high %T exhibit enhanced dose sensitivity and dose resolutions over traditional formulations. The gels are shown to be temporally stable and reproducible. A single formulation (16%T) is used to demonstrate the capabilities of the x-ray CT polymer gel dosimetry system in measuring known dose distributions. A 1 L gel volume is exposed to three separate irradiations: a single-field percent depth dose, a two-field 'cross' and a three-field 'test case'. The first two irradiations are used to generate a dose calibration curve by which images are calibrated. The calibrated images are compared with treatment planning predictions and it is shown that the x-ray CT polymer gel dosimetry system is capable of capturing spatial and dose information accurately. The proposed new gel formulation is shown to be sensitive, stable and to improve the dose resolution over current formulations so as to provide a feasible gel for clinical applications of x-ray CT polymer gel dosimetry.

Polymer gel dosimetry

Polymer gel dosimeters are fabricated from radiation sensitive chemicals which, upon irradiation, polymerize as a function of the absorbed radiation dose. These gel dosimeters, with the capacity to uniquely record the radiation dose distribution in three-dimensions (3D), have specific advantages when compared to one-dimensional dosimeters, such as ion chambers, and two-dimensional dosimeters, such as film. These advantages are particularly significant in dosimetry situations where steep dose gradients exist such as in intensity-modulated radiation therapy (IMRT) and stereotactic radiosurgery. Polymer gel dosimeters also have specific advantages for brachytherapy dosimetry. Potential dosimetry applications include those for low-energy x-rays, high-linear energy transfer (LET) and proton therapy, radionuclide and boron capture neutron therapy dosimetries. These 3D dosimeters are radiologically soft-tissue equivalent with properties that may be modified depending on the application. The 3D radiation dose distribution in polymer gel dosimeters may be imaged using magnetic resonance imaging (MRI), optical-computerized tomography (optical-CT), x-ray CT or ultrasound. The fundamental science underpinning polymer gel dosimetry is reviewed along with the various evaluation techniques. Clinical dosimetry applications of polymer gel dosimetry are also presented.

High frequency poroelastic waves in hydrogels

In this work a continuum model for high frequency poroelastic longitudinal waves in hydrogels is presented. A viscoelastic force describing the interaction between the polymer network and the bounded water present in such materials is introduced. The model is tested by means of ultrasound wave speed and attenuation measurements in polyvinylalcohol hydrogel samples. The theory and experiments show that ultrasound attenuation decreases linearly with the increase in the water volume fraction beta of the hydrogel. The introduction of the viscoelastic force between the bounded water and the polymer network leads to a bi-phasic theory, showing an ultrasonic fast wave attenuation that can vary as a function of the frequency with a non-integer exponent in agreement with the experimental data in literature. When beta tends to 1 (100% of interstitial water) due to the presence of bounded water in the hydrogel, the ultrasound phase velocity acquires higher value than that of pure water. The ultrasound speed gap at beta=1 is confirmed by the experimental results, showing that it increases in less cross-linked gel samples which own a higher concentration of bounded water.

Polymer gel dosimetry

Polymer gel dosimeters are fabricated from radiation sensitive chemicals which, upon irradiation, polymerize as a function of the absorbed radiation dose. These gel dosimeters, with the capacity to uniquely record the radiation dose distribution in three-dimensions (3D), have specific advantages when compared to one-dimensional dosimeters, such as ion chambers, and two-dimensional dosimeters, such as film. These advantages are particularly significant in dosimetry situations where steep dose gradients exist such as in intensity-modulated radiation therapy (IMRT) and stereotactic radiosurgery. Polymer gel dosimeters also have specific advantages for brachytherapy dosimetry. Potential dosimetry applications include those for low-energy x-rays, high-linear energy transfer (LET) and proton therapy, radionuclide and boron capture neutron therapy dosimetries. These 3D dosimeters are radiologically soft-tissue equivalent with properties that may be modified depending on the application. The 3D radiation dose distribution in polymer gel dosimeters may be imaged using magnetic resonance imaging (MRI), optical-computerized tomography (optical-CT), x-ray CT or ultrasound. The fundamental science underpinning polymer gel dosimetry is reviewed along with the various evaluation techniques. Clinical dosimetry applications of polymer gel dosimetry are also presented.

Sensitivity calibration procedures in optical-CT scanning of BANG 3 polymer gel dosimeters

The dose response of the BANG 3 polymer gel dosimeter (MGS Research Inc., Madison, CT) was studied using the OCTOPUS laser CT scanner (MGS Research Inc., Madison, CT). Six 17 cm diameter and 12 cm high Barex cylinders, and 18 small glass vials were used to house the gel. The gel phantoms were irradiated with 6 and 10 MV photons, as well as 12 and 16 MeV electrons using a Varian Clinac 2100EX. Three calibration methods were used to obtain the dose response curves: (a) Optical density measurements on the 18 glass vials irradiated with graded doses from 0 to 4 Gy using 6 or 10 MV large field irradiations; (b) optical-CT scanning of Barex cylinders irradiated with graded doses (0.5, 1, 1.5, and 2 Gy) from four adjacent 4 x 4 cm2 photon fields or 6 x 6 cm2 electron fields; and (c) percent depth dose (PDD) comparison of optical-CT scans with ion chamber measurements for 6 x 6 cm2, 12 and 16 MeV electron fields. The dose response of the BANG3 gel was found to be linear and energy independent within the uncertainties of the experimental methods (about 3%). The slopes of the linearly fitted dose response curves (dose sensitivities) from the four field irradiations (0.0752 +/- 3%, 0.0756 +/- 3%, 0.0767 +/- 3%, and 0.0759 +/- 3% cm(-1) Gy(-1)) and the PDD matching methods (0.0768 +/- 3% and 0.0761 +/- 3% cm(-1) Gy(-1)) agree within 2.2%, indicating a good reproducibility of the gel dose response within phantoms of the same geometry. The dose sensitivities from the glass vial approach are different from those of the cylindrical Barex phantoms by more than 30%, owing probably to the difference in temperature inside the two types of phantoms during gel formation and irradiation, and possible oxygen contamination of the glass vial walls. The dose response curve obtained from the PDD matching approach with 16 MeV electron field was used to calibrate the gel phantom irradiated with the 12 MeV, 6 x 6 cm2 electron field. Three-dimensional dose distributions from the gel measurement and the Eclipse planning system (Varian Corporation, Palo Alto, CA) were compared and evaluated using 3% dose difference and 2 mm distance-to-agreement criteria.

Quantitative ultrasonic elastography for gel dosimetry

Advanced radiation techniques such as intensity-modulated radiotherapy (IMRT) for complex geometries in which targets are close to organs at risk have been introduced in radiation therapy, creating a need for procedures that allow easy three-dimensional (3-D) measurement of dose for verification purposes. Polymer gels that change their material properties when irradiated have been suggested for such use. For example, the change in their magnetic properties has been thoroughly investigated with magnetic resonance imaging (MRI). Also, we have previously shown that the mechanical stiffness, i.e., Young's modulus, of these gels changes with dose. This finding prompted us to assess whether we can image a radiation-induced stiffness distribution with quantitative ultrasound elastography and whether the stiffness distribution is correlated with the dose distribution. A methacrylic-acid-based gel was loaded with scatterers to create an ultrasound echoic signal. It was irradiated to create a rod-like region of increased stiffness with a 10 x 10 mm(2) cross-section. The gel block was compressed in a frame that restricted the movement of the gel to planes orthogonal to the long axis of the irradiated region and ultrasonic echo data were acquired in the central plane during compression. This simplified irradiation pattern and experimental set-up were designed to approximate plane-strain conditions and was chosen for proof of concept. The movement of the gel was tracked from ultrasound images of a different compressional state using cross-correlation, enabling a displacement map to be created. The shear modulus was reconstructed using an inverse algorithm. The role of the magnitude of the regularization parameter in the inverse problem and the boundary conditions in influencing the spatial distribution of stiffness and, thus, final dose contrast was investigated through parametric studies. These parameters were adjusted using prior knowledge about the stiffness in parts of the material, e.g., the background was not irradiated and therefore its stiffness was homogeneous. It was observed that a suitable choice for these reconstruction parameters was essential for a quantitative application of stiffness measurement such as dosimetry. The dose contrast and distribution found with the optimal parameters were close to those obtained with MRI. Initial results reported in this article are encouraging and indicate that with ongoing refinement of ultrasound elastography techniques and accompanying inverse algorithms, this approach could play an important role in gel dosimetry.

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

Over the past few years there has been much interest in the development of three-dimensional dosimeters to determine the complex absorbed dose distribution in modern radiotherapy techniques such as IMRT and IGRT. In routine methods used for three-dimensional dosimetry, polymer gels are commonly used. Recently, a novel transparent polymer dosimeter, known as PRESAGE, has been introduced in which a radiochromic color change is observed upon radiation. PRESAGE has some advantages over usual polymer gel dosimeters. It has been noted that the sensitivity of PRESAGE can be changed when different amounts of the components are used for its fabrication. This study has focused on the assessment of dosimetric characteristics of PRESAGE for various amounts of components in its formulation. To achieve this, PRESAGE dosimeters were fabricated using various amounts of their constituting components. Then the dosimeters were irradiated to (60)Co gamma photons for a range of radiation doses from 0 to 50 Gy. Consequently, the light absorption changes of the dosimeters were measured by a spectrophotometer at different post-irradiation time periods. It was generally observed that as the concentration of the radical initiator is increased, the PRESAGE dosimeter sensitivity is increased while its stability is decreased. Furthermore, it was noted that with the high concentration of the radical initiator and leuco dye, the sensitivity of PRESAGE is decreased.

Light-scattering-induced artifacts in a complex polymer gel dosimetry phantom

Certain polymer gels become turbid on exposure to ionizing radiation, a property exploited in medical dosimetry to produce three-dimensional dose maps for radiotherapy. These maps can be read using optical computed tomography (CT). A test phantom of complex shape ("layered tube") was developed to investigate the optical properties of polymer gel dosimeters when read using optical CT. Extinction coefficient profiles from tomographically reconstructed slices of the phantom exhibited several artifacts. A simple model invoking scattered light in the gel was able to account for all artifacts, which in a real dosimeter may have been mistaken for other phenomena, resulting in incorrect readings of dose.

A preliminary analysis of LET effects in the dosimetry of proton beams using PRESAGE and optical CT

PRESAGE is a solid dosimeter based on a clear polyurethane matrix doped with radiochromic components (leuco dyes). On exposure to ionizing radiation a colour change is generated in the dosimeter, and hence an optical absorption or optical density change that can be read out by optical CT. The main focus of present investigations has been to investigate the possible LET dependence of PRESAGE to the dose deposited at the Bragg maxima using proton beam absorbed dose measurements, and the linearity of response of the dosimeter. Proton irradiations were performed using the proton beam facility at the Douglas Cyclotron, Clatterbridge Centre for Oncology (CCO) using a configuration that approximates the one routinely used in treatment of patients with ocular tumours. The samples were irradiated with both monoenergetic and modulated proton beams. Optical tomography measurements were carried out with our in-house CCD-based optical-CT system. Initial results for monoenergetic beams show that in PRESAGE the measured ratio of the Bragg peak dose to entrance dose is approximately 2:1 whereas the true value measured at CCO is approximately 5:1. For range-modulated proton beams, the absorbed dose close to the end of the proton range, i.e. at the Bragg peak, is underestimated by approximately 20% compared to the corresponding diode measurement. Further investigations are necessary to understand and quantify the effect of LET on PRESAGE, and to measure the uncertainties related to our optical CT.

Polymer gel dosimetry on a multislice computed tomography scanner: effect of changing parameters on CTDI

Polymer gel dosimetry undertaken on a multislice CT scanner provides an alternative method to conventional dosimetry measurements. Polymer gel dosimeters were used to measure CT radiation doses and compared to TLD and ionization chamber measurements in different diameter phantoms. CTDI was investigated for each of these phantoms for a range of mAs (100-400 mAs), tube voltage (100-135 kV) and nominal slice width (2-32 mm). Linear fits of the CTDI values for mAs show for the smallest phantom diameter an increase in CTDI of 60% for both TLD and polymer gel dosimeters. A similar increase in CTDI of 50% at 100 kVp and 100% for 135 kVp was also noted. It was also shown that slice width variation measured with either polymer gel or TLD was greatest with the smallest slice widths. In summary, it was found that polymer gels can be used as an alternative dosimeter to TLD for the determination of SWDP and subsequent CTDI calculations.

Characterization of the ultrasonic attenuation coefficient and its frequency dependence in a polymer gel dosimeter

Research on polymer-gel dosimetry has been driven by the need for three-dimensional dosimetry, and because alternative dosimeters are unsatisfactory or too slow for that task. Magnetic resonance tomography is currently the most well-developed technique for determining radiation-induced changes in polymer structure, but quick low-cost alternatives remain of significant interest. In previous work, ultrasound attenuation and speed of sound were found to change as a function of absorbed radiation dose in polymer-gel dosimeters, although the investigations were restricted to one ultrasound frequency. Here, the ultrasound attenuation coefficient mu in one polymer gel (MAGIC) was investigated as a function of radiation dose D and as a function of ultrasonic frequency f in a frequency range relevant for imaging dose distributions. The nonlinearity of the frequency dependence was characterized, fitting a power-law model mu = af(b); the fitting parameters were examined for potential use as additional dose readout parameters. In the observed relationship between the attenuation coefficient and dose, the slopes in a quasi-linear dose range from 0 to 30 Gy were found to vary with the gel batch but lie between 0.0222 and 0.0348 dB cm(-1) Gy(-1) at 2.3 MHz, between 0.0447 and 0.0608 dB cm(-1) Gy(-1) at 4.1 MHz and between 0.0663 and 0.0880 dB cm(-1) Gy(-1) at 6.0 MHz. The mean standard deviation of the slope for all samples and frequencies was 15.8%. The slope was greater at higher frequencies, but so were the intra-batch fluctuations and intra-sample standard deviations. Further investigations are required to overcome the observed variability, which was largely associated with the sample preparation technique, before it can be determined whether any frequency is superior to others in terms of accuracy and precision in dose determination. Nevertheless, lower frequencies will allow measurements through larger samples. The fit parameter a of the frequency dependence, describing the attenuation coefficient at 1 MHz, was found to be dose dependent, which is consistent with our expectations, as polymerization is known to be associated with increased absorption of ultrasound. No significant dose dependence was found for the fit parameter b, which describes the nonlinearity with frequency. This is consistent with the increased absorption being due to the introduction of new relaxation processes with characteristic frequencies similar to those of existing processes. The data presented here will help with optimizing the design of future 3D dose-imaging systems using ultrasound methods.

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

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

A practical three-dimensional dosimetry system for radiation therapy

There is a pressing need for a practical three-dimensional (3D) dosimetry system, convenient for clinical use, and with the accuracy and resolution to enable comprehensive verification of the complex dose distributions typical of modern radiation therapy. Here we introduce a dosimetry system that can achieve this challenge, consisting of a radiochromic dosimeter (PRESAGE) and a commercial optical computed tomography (CT) scanning system (OCTOPUS). PRESAGE is a transparent material with compelling properties for dosimetry, including insensitivity of the dose response to atmospheric exposure, a solid texture negating the need for an external container (reducing edge effects), and amenability to accurate optical CT scanning due to radiochromic optical contrast as opposed to light-scattering contrast. An evaluation of the performance and viability of the PRESAGE/OCTOPUS, combination for routine clinical 3D dosimetry is presented. The performance of the two components (scanner and dosimeter) was investigated separately prior to full system test. The optical CT scanner has a spatial resolution of < or = 1 mm, geometric accuracy within 1 mm, and high reconstruction linearity (with a R2 value of 0.9979 and a standard error of estimation of approximately 1%) relative to independent measurement. The overall performance of the PRESAGE/OCTOPUS system was evaluated with respect to a simple known 3D dose distribution, by comparison with GAFCHROMIC EBT film and the calculated dose from a commissioned planning system. The "measured" dose distribution in a cylindrical PRESAGE dosimeter (16 cm diameter and 11 cm height) was determined by optical-CT, using a filtered backprojection reconstruction algorithm. A three-way Gamma map comparison (4% dose difference and 4 mm distance to agreement), between the PRESAGE, EBT and calculated dose distributions, showed full agreement in measurable region of PRESAGE dosimeter (approximately 90% of radius). The EBT and PRESAGE distributions agreed more closely with each other than with the calculated plan, consistent with penumbral blurring in the planning data which was acquired with an ion chamber. In summary, our results support the conclusion that the PRESAGE optical-CT combination represents a significant step forward in 3D dosimetry, and provides a robust, clinically effective and viable high-resolution relative 3D dosimetry system for radiation therapy.

An investigation of the use of transmission ultrasound to measure acoustic attenuation changes in thermal therapy

The potential of using a commercial ultrasound transmission imaging system to quantitatively monitor tissue attenuation changes after thermal therapy was investigated. The ultrasound transmission imaging system used, the AcoustoCam (Imperium Inc., MD) allows ultrasonic images to be captured using principles similar to that of a CCD-type camera that collects light. Ultrasound energy is focused onto a piezoelectric array by an acoustic lens system, creating a gray scale acoustic image. In this work, the pixel values from the acoustic images were assigned acoustic attenuation values by imaging polyacrylamide phantoms of varying known attenuation. After the calibration procedure, data from heated polyacrylamide/bovine serum albumin (BSA) based tissue-mimicking (TM) phantoms and porcine livers were acquired. Samples were heated in water at temperatures of 35, 45, 55, 65, and 75 degrees C for 1 h. Regions of interest were chosen in the images and acoustic attenuation values before and after heating were compared. An increase in ultrasound attenuation was found in phantoms containing BSA and in porcine liver. In the presence of BSA, attenuation in the TM phantom increased by a factor of 1.5, while without BSA no significant changes were observed. The attenuation of the porcine liver increased by up to a factor of 2.4, consistent with previously reported studies. The study demonstrates the feasibility of using a quantitative ultrasound transmission imaging system for monitoring thermal therapy.

Investigation of a 2D two-point maximum entropy regularization method for signal-to-noise ratio enhancement: application to CT polymer gel dosimetry

This study presents a new method of image signal-to-noise ratio (SNR) enhancement by utilizing a newly developed 2D two-point maximum entropy regularization method (TPMEM). When utilized as an image filter, it is shown that 2D TPMEM offers unsurpassed flexibility in its ability to balance the complementary requirements of image smoothness and fidelity. The technique is evaluated for use in the enhancement of x-ray computed tomography (CT) images of irradiated polymer gels used in radiation dosimetry. We utilize a range of statistical parameters (e.g. root-mean square error, correlation coefficient, error histograms, Fourier data) to characterize the performance of TPMEM applied to a series of synthetic images of varying initial SNR. These images are designed to mimic a range of dose intensity patterns that would occur in x-ray CT polymer gel radiation dosimetry. Analysis is extended to a CT image of a polymer gel dosimeter irradiated with a stereotactic radiation therapy dose distribution. Results indicate that TPMEM performs strikingly well on radiation dosimetry data, significantly enhancing the SNR of noise-corrupted images (SNR enhancement factors >15 are possible) while minimally distorting the original image detail (as shown by the error histograms and Fourier data). It is also noted that application of this new TPMEM filter is not restricted exclusively to x-ray CT polymer gel dosimetry image data but can in future be extended to a wide range of radiation dosimetry data.

Three-dimensional dose verification for intensity modulated radiation therapy using optical CT based polymer gel dosimetry

Dose distributions generated from intensity-modulated-radiation-therapy (IMRT) treatment planning present high dose gradient regions in the boundaries between the target and the surrounding critical organs. Dose accuracy in these areas can be critical, and may affect the treatment. With the increasing use of IMRT in radiotherapy, there is an increased need for a dosimeter that allows for accurate determination of three-dimensional (3D) dose distributions with high spatial resolution. In this study, polymer gel dosimetry and an optical CT scanner have been employed to implement 3D dose verification for IMRT. A plastic cylinder of 17 cm diameter and 12 cm height, filled with BANG3 polymer gels (MGS Research, Inc., Madison, CT) and modified to optimal dose-response characteristics, was used for IMRT dose verification. The cylindrical gel phantom was immersed in a 24 x 24 x 20 cm water tank for an IMRT irradiation. The irradiated gel sample was then scanned with an optical CT scanner (MGS Research Inc., Madison, CT) utilizing a single He-Ne laser beam and a single photodiode detector. Similar to the x-ray CT process, filtered back-projection was used to reconstruct the 3D dose distribution. The dose distributions measured from the gel were compared with those from the IMRT treatment planning system. For comparative dosimetry, a solid water phantom of 24 x 24 x 20 cm, having the same geometry as the water tank for the gel phantom, was used for EDR2 film and ion chamber measurements. Root mean square (rms) deviations for both dose difference and distance-to-agreement (DTA) were used in three-dimensional analysis of the dose distribution comparison between treatment planning calculations and the gel measurement. Comparison of planar dose distributions among gel dosimeter, film, and the treatment planning system showed that the isodose lines were in good agreement on selected planes in axial, coronal, and sagittal orientations. Absolute point-dose verification was performed with ion chamber measurements at four different points, varying from 48% to 110% of the prescribed dose. The measured and calculated doses were found to agree to within 4.2% at all measurement points. For the comparison between the gel measurement and treatment planning calculations, rms deviations were 2%-6% for dose difference and 1-3 mm for DTA, at 60%-110% doses levels. The results from this study show that optical CT based polymer gel dosimetry has the potential to provide a high resolution, accurate, three-dimensional tool for IMRT dose distribution verification.

Optimization of the imaging protocol of an X-ray CT scanner for evaluation of normoxic polymer gel dosimeters

X-ray computer tomography (CT) has previously been reported as an evaluation tool for polymer gel (PAG) dosimeters. In this study, the imaging protocol of a Siemens Emotion X-ray CT scanner was optimized to evaluate PAGAT normoxic gel dosimeters. The scan parameters were optimized as 130 kV and 150 mA with a slice thickness of 3 mm for smaller fields and 5 mm for larger fields of irradiation. The number of images to be averaged to reduce noise to an acceptable level was concluded to be 25. It was also concluded that the total monomer concentration required is 7% with 10 mM THP to obtain a maximum change in CT number at dose levels up to 15 Gy for evaluation with X-ray CT. Optimal scan parameters may vary with X-ray CT scanner. Hence the imaging protocol of each scanner to be used for evaluating polymer gels requires individual optimization for the purposes of gel dosimetry evaluation.

Adaptation of radiation field analyser (RFA) as optical CT scanner for gel dosimetry

Optical scanning is one of the emerging evaluation tools used for obtaining dose distributions in gel dosimetry. A radiation field analyzer adapted into an optical CT scanner to evaluate an irradiated Fricke gel has been already reported by others. This prototype optical CT scanner functions like a first generation x-ray CT scanner in the translate-rotate fashion. A similar scanner was constructed in our department for optical scanning of irradiated FX gel. At first, an aquarium was constructed and fitted into the water phantom of the RFA with provision to place the gel phantom to be scanned along with a light source and detector. The movements of the RFA were utilized to scan the gel phantom. A scan of a cuvette filled with colored solution was carried out and the resulting images were reconstructed and profiles obtained to evaluate the working of the optical scanner. A scan of the gel phantom was then obtained to evaluate the performance of the scanner. Thus a radiation field analyzer (DYNASCAN) was successfully adapted to an optical scanner to evaluate Fricke gels in our department.

A preliminary study of the novel application of normoxic polymer gel dosimeters for the measurement of CTDI on diagnostic x-ray CT scanners

Computer tomography dose index (CTDI) is a measurement undertaken during acceptance testing and subsequent quality assurance measurements of diagnostic x-ray CT scanners for the determination of patient dose. Normoxic polymer gel dosimeters have been used for the first time to measure dose and subsequently CTDI during acceptance testing of a CT scanner and compared with the conventional ionization chamber measurement for a range of imaging protocols. The normoxic polymer gel dosimeter was additionally used to simultaneously determine slice-width dose profiles and CTDI in the transaxial plane, the measurements of which are usually determined with thermoluminescent dosimetry or film. The resulting CTDI for all slice widths calculated from the normoxic polymer gel dosimeter were within corresponding ionization chamber CTDI values. Slice-width dose-profiles full-width half-maximum values from the normoxic polymer gel dosimeter were compared to the slice sensitivity profiles and were within the tolerances of the manufacturer. Normoxic polymer gel dosimeters have been shown to be a useful device for determining CTDI and dose distributions for CT equipment, and provide additional information not possible with just the use of an ionization chamber.

The dose response of normoxic polymer gel dosimeters measured using X-ray CT

X-ray CT was used to determine the dose response of normoxic polymer gel dosimeters. Normoxic polymer gel dosimeters were manufactured and irradiated up to 150 Gy. Up to 50 CT images were acquired on a Toshiba Aquilion Multislice CT scanner using protocols for 80 kV and 135 kV to determine dose response. HU-dose sensitivity, the linear regression of data for the HU versus dose for the linear part of the curve up to 60 Gy was 0.38+/-0.07 HU Gy(-1) for 135 kV and 0.37+/-0.01 HU Gy(-1) for 80 kV. Dose resolution was found to be < 1.3 Gy for an absorbed dose range up to 70 Gy for 135 kV, similar to that measured previously for polyacrylamide gel (PAG). Although the HU-dose sensitivity was lower than that previously measured for PAG gel dosimeters it had a greater range of absorbed dose indicating that normoxic polymer gel dosimeters have potential in CT gel dosimetry.

Evaluation of the dosimetric performance of BANG3® polymer gel

New radiotherapy techniques call for three-dimensional dosimetric methods with high spatial resolution. Radiation sensitive gels read out using MRI T(2) mapping provide an extremely promising option, and commercially available BANG polymer gels provide a convenient route into gel dosimetry. Gel dosimetry is dependent on the ability to calibrate gel response against radiation dose. This in turn is dependent on the reproducibility of response both between gels irradiated to the same dose and for a single gel sample over time. This study aims to evaluate the performance of a commercially available BANG gel. Our experimental arrangement gave excellent precision of radiation delivery (<0.2%) and reproducibility of T(2) measurement (<0.5%). Seven groups of 10 test tubes containing BANG3 gel were irradiated in 0.5 Gy steps between 0 and 3 Gy. A further four groups of four samples were irradiated in 2 Gy steps between 4 and 10 Gy. The gel samples were identical and derived from the same manufacturing batch. MR imaging was carried out four days after irradiation and then at weekly intervals for four weeks. Short-term variation in gel response can readily be corrected using reference samples. Longer term systematic drift of the gel calibration curve was observed relative to reference samples prepared in-house for quality assurance purposes. This implies that read-out of the calibration gels and dosimetry phantom must be performed at the same time after irradiation, or errors of up to 25% may be incurred. Precision of gel response did not change significantly over time. The observation of significantly different T(2) values both prior to irradiation and following irradiation to the same dose (variation up to 15%) illustrates the current difficulties associated with BANG3 gel calibration and constrains the practical utility of these commercially available gels for clinical radiation dosimetry.

Development and optimization of a 2-hydroxyethylacrylate MRI polymer gel dosimeter

In this study, radiation induced changes in a polymer gel dosimeter manufactured using 2-hydroxyethylacrylate (HEA) and N,N'-methylene-bisacrylamide (BIS) were investigated using magnetic resonance imaging (MRI) and FT-Raman spectroscopy. The variation in magnetic resonance relaxation time (T2) with absorbed dose was modelled assuming fast exchange of magnetization. Overall good agreement between the model and experimental data was obtained. However, comparison with FT-Raman data suggests that not all the protons attached to the polymer contribute to the relaxation process. Furthermore, for certain compositions improved agreement with experimental data was achieved when a lower fraction of polymer protons available for exchange with water was assumed in the low dose region. This indicates that the T2 value is influenced by the composition and topology of the formed polymer, which may vary with absorbed dose. The concept of percentage dose resolution (Dp delta, %) was introduced to enable optimization of gel compositions for use in relative dosimetry applications. This concept was applied to demonstrate the effects of varying the gelatine concentration, the total fraction of monomer/crosslinker (%T) and the relative fraction of crosslinker (%C) on gel performance in HEA gels as well as compare the performance of HEA and a standard polyacrylamide gel (PAG). The percentage dose resolution was improved for all HEA gels compared to the PAG dosimeter containing 3% acrylamide and 3% BIS. Increasing the total concentration of monomer was shown to have the largest single effect. In the range of doses of interest for clinical radiation therapy, Dp delta, % for the optimal HEA gel (4% HEA, 4% BIS) was lower than 2.3%, compared to 3.8% for the PAG dosimeter.

Optical projection tomography

Optical projection tomography is a new approach for three-dimensional (3-D) imaging of small biological specimens. It fills an imaging gap between MRI and confocal microscopy, being most suited to specimens that are from 1 to 10 mm across. The tomographic principles of optical projection tomography (OPT) are explained, its most important applications in biomedical research explored, and comparisons drawn of its pros and cons compared to a number of alternative imaging technologies.

Measurement of ultrasonic attenuation coefficient in polymer gel dosimeters

A technique is described for investigation of the ultrasonic attenuation coefficient for evaluation of absorbed dose in polymer gel dosimeters. Using this technique the attenuation coefficient as a function of absorbed dose in PAG and MAGIC polymer gel dosimeters was measured. The ultrasonic attenuation coefficient dose sensitivity for PAG was found to be 2.9 +/- 0.3 dB m(-1) Gy(-1) and for MAGIC gel 4.2 +/- 0.3 dB m(-1) Gy(-1). Unlike previous studies of ultrasonic attenuation in polymer gel dosimeters this technique enables a direct measure of the attenuation coefficient.