Real-time in vivo dosimetry for SBRT prostate treatment using plastic scintillating dosimetry embedded in a rectal balloon: a case study

Feasibility study of a scintillation sheet-based detector for fluence monitoring during external photon beam radiotherapy

PURPOSE

This study evaluated the properties of a scintillation sheet-based dosimetry system for beam monitoring with high spatial resolution, including the effects of this system on the treatment beam. The dosimetric characteristics and feasibility of this system for clinical use were also evaluated.

METHODS

The effects of the dosimetry system on the beam were evaluated by measuring the percentage depth doses, dose profiles, and transmission factors. Fifteen treatment plans were created, and the influence of the dosimetry system on these clinical treatment plans was evaluated. The performance of the system was assessed by determining signal linearity, dose rate dependence, and reproducibility. The feasibility of the system for clinical use was evaluated by comparing intensity distributions with reference intensity distributions verified by quality assurance.

RESULTS

The spatial resolution of the dosimetry system was found to be 0.43 mm/pixel when projected to the isocenter plane. The dosimetry system attenuated the intensity of 6 MV beams by about 1.1%, without affecting the percentage depth doses and dose profiles. The response of the dosimetry system was linear, independent of the dose rate used in the clinic, and reproducible. Comparison of intensity distributions of evaluation treatment fields with reference intensity distributions showed that the 1%/1 mm average gamma passing rate was 99.6%.

CONCLUSIONS

The dosimetry system did not significantly alter the beam characteristics, indicating that the system could be implemented by using only a transmission factor. The dosimetry system is clinically suitable for monitoring treatment beam delivery with higher spatial resolution than other transmission detectors.

Mixed 3D-2D Perovskite Flexible Films for the Direct Detection of 5 MeV Protons

This study reports on a novel, flexible, proton beam detector based on mixed 3D-2D perovskite films deposited by solution onto thin plastic foils. The 3D-2D mixture allows to obtain micrometer-thick and highly uniform films that constitute the detector's active layer. The devices demonstrate excellent flexibility with stable electric transport properties down to a bending radius of 3.1 mm. The detector is characterized under a 5 MeV proton beam with fluxes in the range [4.5 × 105 - 1.4 × 109 ] H+ cm-2 s-1 , exhibiting a stable response to repetitive irradiation cycles with sensitivity up to (290 ± 40) nC Gy-1 mm-3 and a limit of detection down to (72±2) µGy s-1 . The detector radiation tolerance is also assessed up to a total of 1.7 × 1012 protons impinging on the beam spot area, with a maximum variation of the detector's response of 14%.

Towards in vivo Dosimetry for Prostate Radiotherapy with a Transperineal Ultrasound Array: A Simulation Study

X-ray-induced acoustic computed tomography (XACT) is a promising imaging modality to monitor the position of the radiation beam and the deposited dose during external beam radiotherapy delivery. The purpose of this study was to investigate the feasibility of using a transperineal ultrasound transducer array for XACT imaging to guide the prostate radiotherapy. A customized two-dimensional (2D) matrix ultrasound transducer array with 10000 (100×100 elements) ultrasonic sensors with a central frequency of 1 MHz was designed on a 5 cm×5 cm plane to optimize three-dimensional (3D) volumetric imaging. The CT scan and dose treatment plan for a prostate patient undergoing intensity modulated radiation therapy (IMRT) were obtained. In-house simulation was developed to model the time varying X-ray induced acoustic (XA) signals detected by the transperineal ultrasound array. A 3D filtered back projection (FBP) algorithm has been used for 3D XACT image reconstruction. Results of this study will greatly enhance the potential of XACT imaging for real time in vivo dosimetry during radiotherapy.

Direct detection of 5-MeV protons by flexible organic thin-film devices

The direct detection of 5-MeV protons by flexible organic detectors based on thin films is here demonstrated. The organic devices act as a solid-state detector, in which the energy released by the protons within the active layer of the sensor is converted into an electrical current. These sensors can quantitatively and reliably measure the dose of protons impinging on the sensor both in real time and in integration mode. This study shows how to detect and exploit the energy absorbed both by the organic semiconducting layer and by the plastic substrate, allowing to extrapolate information on the present and past irradiation of the detector. The measured sensitivity, S = (5.15 ± 0.13) pC Gy^-1, and limit of detection, LOD = (30 ± 6) cGy s^-1, of the here proposed detectors assess their efficacy and their potential as proton dosimeters in several fields of application, such as in medical proton therapy.

Feasibility of improving patient's safety with in vivo dose tracking in intracavitary and interstitial HDR brachytherapy

PURPOSE

The in vivo dosimetric monitoring in HDR brachytherapy is important for improving patient safety. However, there are very limited options available for clinical application. In this study, we present a new in vivo dose measurement system with a plastic scintillating detector (PSD) for GYN HDR brachytherapy.

METHODS

An FDA approved PSD system, called OARtrac (AngioDynamics, Latham, NY), was used with various applicators for in vivo dose measurements for GYN patients. An institutional workflow was established for the clinical implementation of the dosimetric system. Action levels were proposed based on the measurement and system uncertainty for measurement deviations. From October 2018 to September 2019, a total of 75 measurements (48 fractions) were acquired from 14 patients who underwent HDR brachytherapy using either a multichannel cylinder, Venezia applicator, or Syed-Neblett template. The PSDs were placed in predetermined catheters/channels. A planning CT was acquired for treatment planning in Oncentra (Elekta, Version-4.5.2) TPS. The PSDs were contoured on the CT images, and the PSD D_90% values were used as the expected doses for comparison with the measured doses.

RESULTS

The mean difference from patient measurements was -0.22% ± 5.98%, with 26% being the largest deviation from the expected value (Syed case). Large deviations were observed when detectors were placed in the area where dose rates were less than 1 cGy/s.

CONCLUSIONS

The establishment of clinical workflow for the in vivo dosimetry for both the intracavitary and interstitial GYN HDR brachytherapy will potentially improve the safety of the patient treatment.

Real-time in vivo dosimetry system based on an optical fiber-coupled microsized photostimulable phosphor for stereotactic body radiation therapy

PURPOSE

To develop an in vivo dosimeter system for stereotactic body radiation therapy (SBRT) that can perform accurate and precise real-time measurements, using a microsized amount of a photostimulable phosphor (PSP), BaFBr:Eu²⁺ .

METHODS

The sensitive volume of the PSP was 1.26 × 10^-5  cm³ . The dosimeter system was designed to apply photostimulation to the PSP after the decay of noise signals, in synchronization with the photon beam pulse of a linear accelerator (LINAC), to eliminate the noise signals completely using a time separation technique. The noise signals included stem signals, and radioluminescence signals generated by the PSP. In addition, the dosimeter system was built on a storage-type dosimeter that could read out a signal after an arbitrary preset number of photon beam pulses were incident. First, the noise and photostimulated luminescence (PSL) signal decay times were measured. Subsequently, we confirmed that the PSL signals could be exclusively read out within the photon beam pulse interval. Finally, using a water phantom, the basic characteristics of the dosimeter system were demonstrated under SBRT conditions, and the feasibility for clinical application was investigated. The reproducibility, dose linearity, dose-rate dependence, temperature dependence, and angular dependence were evaluated. The feasibility was confirmed by measurements at various dose gradients and using a representative treatment plan for a metastatic liver tumor. A clinical plan was created with a two-arc beam volumetric modulated arc therapy using a 10 MV flattening filter-free photon beam. For the water phantom measurements, the clinical plan was compiled into a plan with a fixed gantry angle of 0°. To evaluate the energy dependence during SBRT, the percent depth dose (PDD) was measured and compared with those calculated via Monte Carlo (MC) simulations.

RESULTS

All the PSL signals could be read out while eliminating the noise signals within the minimum pulse interval of the LINAC. Stable real-time measurements could be performed with a time resolution of 56 ms (i.e., number of pulses = 20). The dose linearity was good in the dose range of 0.01-100 Gy. The measurements agreed within 1% at dose rates of 40-2400 cGy/min. The temperature and angular dependence were also acceptable since these dependencies had only a negligible effect on the measurements in SBRT. At a dose gradient of 2.21 Gy/mm, the measured dose agreed with that calculated using a treatment planning system (TPS) within the measurement uncertainties due to the probe position. For measurements using a representative treatment plan, the measured dose agreed with that calculated using the TPS within 0.5% at the center of the beam axis. The PDD measurements agreed with the MC calculations to within 1% for field sizes <5 × 5 cm² .

CONCLUSION

The in vivo dosimeter system developed using BaFBr:Eu²⁺ is capable of real-time, accurate, and precise measurement under SBRT conditions. The probe is smaller than a conventional dosimeter, has excellent spatial resolution, and can be valuable in SBRT with a steep dose distribution over a small field. The developed PSP dosimeter system appears to be suitable for in vivo SBRT dosimetry.

Estimating dose delivery accuracy in stereotactic body radiation therapy: A review of in-vivo measurement methods

Stereotactic body radiation therapy (SBRT) has been recognized as a standard treatment option for many anatomical sites. Sophisticated radiation therapy techniques have been developed for carrying out these treatments and new quality assurance (QA) programs are therefore required to guarantee high geometrical and dosimetric accuracy. This paper focuses on recent advances on in-vivo measurements methods (IVM) for SBRT treatment. More specifically, all of the online QA methods for estimating the effective dose delivered to patients were compared. Determining the optimal IVM for performing SBRT treatments would reduce the risk of errors that could jeopardize treatment outcome. A total of 89 papers were included. The papers were subdivided into the following topics: point dosimeters (PD), transmission detectors (TD), log file analysis (LFA), electronic portal imaging device dosimetry (EPID), dose accumulation methods (DAM). The detectability capability of the main IVM detectors/devices were evaluated. All of the systems have some limitations: PD has no spatial data, EPID has limited sensitivity towards set-up errors and intra-fraction motion in some anatomical sites, TD is insensitive towards patient related errors, LFA is not an independent measure, DAMs are not always based on measures. In order to minimize errors in SBRT dose delivery, we recommend using synergic combinations of two or more of the systems described in our review: on-line tumor position and patient information should be combined with MLC position and linac output detection accuracy. In this way the effects of SBRT dose delivery errors will be reduced.