Optically stimulated luminescent dosimetry for high dose rate brachytherapy

Dosimetric evaluation of a novel modular cell irradiation platform for multi-modality in vitro studies including high dose rate brachytherapy

PURPOSE

High dose-rate (HDR) brachytherapy is integral for the treatment of numerous cancers. Preclinical studies involving HDR brachytherapy are limited. We aimed to describe a novel platform allowing multi-modality studies with clinical HDR brachytherapy and external beam irradiators, establish baseline dosimetry standard of a preclinical orthovoltage irradiator, to determine accurate dosimetric methods.

METHODS

A dosimetric assessment of a commercial preclinical irradiator was performed establishing the baseline dosimetry goals for clinical irradiators. A 3D printed platform was then constructed with 14 brachytherapy channels at 1cm spacing to accommodate a standard tissue culture plate at a source-to-cell distance (SCD) of 1 cm or 0.4 cm. 4-Gy CT-based treatment plans were created in clinical treatment planning software and delivered to 96-well tissue culture plates using an Ir192 source or a clinical linear accelerator. Standard calculation models for HDR brachytherapy and external beam were compared to corresponding deterministic model-based dose calculation algorithms (MBDCAs). Agreement between predicted and measured dose was assessed with 2D-gamma passing rates to determine the best planning methodology.

RESULTS

Mean (±standard deviation) and median dose measured across the plate for the preclinical irradiator was 423.7 ± 8.5 cGy and 430.0 cGy. Mean percentage differences between standard and MBDCA dose calculations were 9.4% (HDR, 1 cm SCD), 0.43% (HDR, 0.4 cm SCD), and 2.4% (EBRT). Predicted and measured dose agreement was highest for MBDCAs for all modalities.

CONCLUSION

A 3D-printed tissue culture platform can be used for multi-modality irradiation studies with great accuracy. This tool will facilitate preclinical studies to reveal biologic differences between clinically relevant radiation modalities.

Angular dependence of the TL and OSL dosimeters in the clinical 6 MV photon Beam

The angular response of luminescent dosimeters (LD), in particular TLD and OSLD, has been compared by applying 6 MV X-ray photons from Versa HD clinical linear accelerator. The study admitted for the irradiation of TLD (n = 475) and OSLD (n = 475) under phantom set up in various gantry angles from 00 to ±900 and various field sizes from 10 x 10 cm2 to 30 x 30 cm2. The variance in the output was observed between 4.4% for TLD and 3.9% for OSLD. A significant deviation from the desired output was detected, towards the angle of incidents, at ±800 to ±900. Additionally, there is no evidence of variation in the dose measurement due to the difference in field size. These results demonstrate a good approximation to the vendor-specified tolerance limits, justifying the use of these LDs within angular incidents of radiation up to ±700. The TLD and OSLD better dose-response is achieved to a gantry angle up to ±700 from the perpendicular incidents. The result shows that both TLD and OSLD could be used as dosimeters for a treatment field that does not extend beyond ±700 beam angle.

Dosimetric impact of hollow intraoral stents for head and neck cancer radiotherapy: A phantom study

PURPOSE

To investigate the dosimetric impact of the calculation boundaries and dose calculation algorithms of radiotherapy in head and neck cancer patients with an opened oral cavity connected to the exterior by a hollow intraoral positioning stent.

METHODS AND MATERIALS

A homemade silicone phantom with an opened oral cavity was placed in a CIRS head phantom to model head and neck cancer patients with a hollow intraoral positioning stent. 3D-CRT plans were designed on CT images of the phantom in Monaco and Pinnacle3 treatment planning systems (TPSs) with the same beam parameters. The default boundary and manually extrapolated boundary were both adopted in these two TPSs to explore the dosimetric impact on treatment plans. The nanoDot™ optically stimulated luminescence dosimeters (OSLDs) were chosen to measure the planned dose surrounding the oral cavity of the head phantom after calibration.

RESULT

The doses in the air cavity and two measuring points at the joint area were dramatically changed from 0.0, 92.4 and 148.8 cGy to 177.8, 244.2 and 244.1 cGy in Monaco after adopting the extrapolated boundary. While the calculated doses at the same place were changed from 61.2, 143.7 and 198.3 cGy to 175.4, 234.7 and 233.2 cGy in Pinnacle3 with a similar calculation boundary. For the Monaco TPS, the relative errors compared to the OSLD measured doses were 2.94 ± 1.93%, 0.53 ± 8.64%, 2.65 ± 1.87% and 3.93 ± 1.69% at 4 measuring positions. In contrast, the relative errors 4.03 ± 1.93%, 4.85 ± 8.64%, 7.61 ± 1.87% and 5.61 ± 1.69% were observed in Pinnacle3 .

CONCLUSION

The boundary setting of an opened oral cavity in TPSs has a significant dosimetric impact on head and neck cancer radiotherapy. An extrapolated boundary should be manually set up to include the whole oral cavity in the dose calculation domain to avoid major dose deviations.

In Vivo Dosimetry for Superficial High Dose Rate Brachytherapy with Optically Stimulated Luminescence Dosimeters: A Comparison Study with Metal-Oxide-Semiconductor Field-Effect Transistors

The purpose of the study was to calibrate and commission optically-stimulated luminescence dosimeters (OSLDs) for in vivo measurements in contact-based 192Ir treatments for superficial high dose rate (HDR) brachytherapy in place of metal-oxide-semiconductor field-effect transistors (MOSFETs). Dose linearity and dose rate dependence were tested by varying source-to-OSLD distance and dwell time. Angular dependence was measured using a solid water phantom setup for OSLD rotation. A group of OSLDs were readout 34 consecutive times to test readout depletion while OSLDs were optically annealed using a mercury lamp for 34.7 h. End-to-end tests were performed using a Freiburg flap and Valencia applicator. OSLD measurements were compared to MOSFETs and treatment planning system (TPS) doses. OSLD response was supralinear for doses above 275 cGy. They were found to be independent of dose rate and dependent on the incident angle in edge-on scenarios. OSLDs exhibited minimal readout depletion and were successfully annealed after 24 h of illumination. Freiburg flap measurements agreed well with the TPS. For the Valencia, OSLDs showed to be the more accurate system over MOSFETs, with a maximum disagreement with the TPS being 0.09%. As such, OSLDs can successfully be used in place of MOSFETs for in vivo dosimetry for superficial HDR brachytherapy.

Impact of detector selection on commissioning of Leipzig surface applicators with improving immobilization in high-dose-rate brachytherapy

PURPOSE

Commission and treatment setup of Leipzig surface applicators, because of the steep dose gradient and lack of robust immobilization, is challenging. We aim to improve commissioning reliability by investigating the impact of detector choice on percentage depth dose (PDD) verifications, and to enhance accuracy and reproducibility in calibration/treatment setup through a simple and novel immobilization device.

METHODS AND MATERIALS

PDD distributions were measured with radiochromic films, optically stimulated luminescent dosimeters (OSLDs), a diode detector, and both cylindrical and parallel plate ionization chambers. The films were aligned to the applicators in parallel and transverse orientations. PDD data from a benchmarking Monte Carlo (MC) study were compared with the measured results, where surface doses were acquired from extrapolation. To improve setup accuracy and reproducibility, a custom-designed immobilization prototype device was made with cost-effective materials using a 3D printer.

RESULTS

The measured PDD data with different detectors had an overall good agreement (<±10%). The parallel plate ionization chamber reported unreliable doses for the smallest applicator. There was no remarkable dose difference between the two film setups. The two-in-one prototype device provided a rigid immobilization and a flexible positioning of the applicator. It enhanced accuracy and reproducibility in calibration and treatment setup.

CONCLUSION

We recommend using radiochromic films in the transverse orientation for a reliable and efficient PDD verification. The applicator's clinical applicability has been limited by a lack of robust immobilization. We expect this economical, easy-to-use prototype device can promote the use of Leipzig applicators in surface brachytherapy.

A disposable OSL dosimeter for in vivo measurement of rectum dose during brachytherapy

PURPOSE

We aimed to develop a disposable rectum dosimeter and to demonstrate its ability to measure exposure dose to the rectum during brachytherapy for cervical cancer treatment using high-dose rate ¹⁹² Ir. Our rectum dosimeter measures the dose with an optically stimulated luminescence (OSL) sheet which was furled to a catheter. The catheter we used is 6 mm in diameter; therefore, it is much less invasive than other rectum dosimeters. The rectum dosimeter developed in this study has the characteristics of being inexpensive and disposable. It is also an easy-to-use detector that can be individually sterilized, making it suitable for clinical use.

METHODS

To obtain a dose calibration curve, phantom experiments were performed. Irradiation was performed using a cubical acrylic phantom, and the response of the OSL dosimeter was calibrated with the calculation value predicted by the treatment planning system (TPS). Additionally, the dependence of catheter angle on the dosimeter position and repeatability were evaluated. We also measured the absorbed dose to the rectum of patients who were undergoing brachytherapy for cervical cancer (n = 64). The doses measured with our dosimeters were compared with the doses calculated by the TPS. In order to examine the causes of large differences between measured and planned doses, we classified the data into common and specific cases when performing this clinical study. For specific cases, the following three categories were considered: (a) patient movement, (b) gas in the vagina and/or rectum, and (c) artifacts in the X-ray image caused by applicators.

RESULTS

A dose calibration curve was obtained in the range of 0.1 Gy-10.0 Gy. From the evaluation of the dependence of catheter angle on the dosimeter position and repeatability, we determined that our dosimeter can measure rectum dose with an accuracy of 3.1% (k = 1). In this clinical study, we succeeded in measuring actual doses using our rectum dosimeter. We found that the deviation of the measured dose from the planned dose was derived to be 12.7% (k = 1); this result shows that the clinical study included large elements of uncertainty. The discrepancies were found to be due to patient motion during treatment, applicator movement after planning images were taken, and artifacts in the planning images.

CONCLUSIONS

We present the idea that a minimally invasive rectum dosimeter can be fabricated using an OSL sheet. Our clinical study demonstrates that a rectum dosimeter made from an OSL sheet has sufficient ability to evaluate rectum dose. Using this dosimeter, valuable information concerning organs at risk can be obtained during brachytherapy.

Dosimetric characterisation of the optically-stimulated luminescence dosimeter in cobalt-60 high dose rate brachytherapy system

This study investigates the characteristics and application of the optically-stimulated luminescence dosimeter (OSLD) in cobalt-60 high dose rate (HDR) brachytherapy, and compares the results with the dosage produced by the treatment planning system (TPS). The OSLD characteristics comprised linearity, reproducibility, angular dependence, depth dependence, signal depletion, bleaching rate and cumulative dose measurement. A phantom verification exercise was also conducted using the Farmer ionisation chamber and in vivo diodes. The OSLD signal indicated a supralinear response (R² = 0.9998). It exhibited a depth-independent trend after a steep dose gradient region. The signal depletion per readout was negligible (0.02%), with expected deviation for angular dependence due to off-axis sensitive volume, ranging from 1 to 16%. The residual signal of the OSLDs after 1 day bleached was within 1.5%. The accumulated and bleached OSLD signals had a standard deviation of ± 0.78 and ± 0.18 Gy, respectively. The TPS was found to underestimate the measured doses with deviations of 5% in OSLD, 17% in the Farmer ionisation chamber, and 7 and 8% for bladder and rectal diode probes. Discrepancies can be due to the positional uncertainty in the high-dose gradient. This demonstrates a slight displacement of the organ at risk near the steep dose gradient region will result in a large dose uncertainty. This justifies the importance of in vivo measurements in cobalt-60 HDR brachytherapy.

On the use of a single-fiber multipoint plastic scintillation detector for 192Ir high-dose-rate brachytherapy

PURPOSE

The goal of this study was to prove the feasibility of using a single-fiber multipoint plastic scintillation detector (mPSD) as an in vivo verification tool during (192)Ir high-dose-rate brachytherapy treatments.

METHODS

A three-point detector was built and inserted inside a catheter-positioning template placed in a water phantom. A hyperspectral approach was implemented to discriminate the different optical signals composing the light output at the exit of the single collection optical fiber. The mPSD was tested with different source-to-detector positions, ranging from 1 to 5 cm radially and over 10.5 cm along the longitudinal axis of the detector, and with various integration times. Several strategies for improving the accuracy of the detector were investigated. The device's accuracy in detecting source position was also tested.

RESULTS

Good agreement with the expected doses was obtained for all of the scintillating elements, with average relative differences from the expected values of 3.4 ± 2.1%, 3.0 ± 0.7%, and 4.5 ± 1.0% for scintillating elements from the distal to the proximal. A dose threshold of 3 cGy improved the general accuracy of the detector. An integration time of 3 s offered a good trade-off between precision and temporal resolution. Finally, the mPSD measured the radioactive source positioning uncertainty to be no more than 0.32 ± 0.06 mm. The accuracy and precision of the detector were improved by a dose-weighted function combining the three measurement points and known details about the geometry of the detector construction.

CONCLUSIONS

The use of a mPSD for high-dose-rate brachytherapy dosimetry is feasible. This detector shows great promise for development of in vivo applications for real-time verification of treatment delivery.