Skin dose in chest wall radiotherapy with bolus: a Monte Carlo study

Monte Carlo simulations are used to investigate skin dose resulting from chest wall radiotherapy with bolus. A simple model of a female thorax is developed, which includes a 2 mm-thick skin layer. Two representative 6 MV source models are considered: a tangents source model consisting of a parallel opposed pair of medial and lateral fields and subfields, and an arc source model. Tissue equivalent (TE) boluses (thicknesses of 3, 5 and 10 mm) and brass mesh bolus are considered. Skin dose distributions depend on incident photon obliquity: for tangents, radiation is incident more obliquely, resulting in longer path lengths through the bolus and higher skin dose compared to the arc source model in most cases. However, for thicker TE boluses, attenuation of oblique photons becomes apparent. Brass bolus and 3 mm TE bolus result in similar mean skin dose. This relatively simple computational model allows for consideration of different bolus thicknesses, materials and usage schedules based on desired skin dose and choice of either tangents or an arc beam technique. For example, using a 5 mm TE bolus every second treatment would result in mean skin doses of 89% and 85% for tangents and the arc source model, respectively. The hot spot metric D[Formula: see text] would be 103% and 99%, respectively.

In search of a one plan solution for VMAT post-mastectomy chest wall irradiation

PURPOSE

This study was designed to evaluate skin dose in both VMAT and tangent treatment deliveries for the purpose of identifying suitable bolus use protocols that should produce similar superficial doses.

METHODS

Phantom measurements were used to investigate skin dose in chest wall radiotherapy with and without bolus for 3D and rotational treatment techniques. Optically stimulated luminescence dosimeters (OSLDs) with and without housing and EBT3 film were used. Superflab (3, 5, and 10 mm) and brass mesh were considered. Measured doses were compared with predictions by the Eclipse treatment planning system. Patient measurements were also performed and the bolusing effect of hospital gowns and blankets were highlighted. The effect of flash for VMAT plans was considered experimentally by using 2 mm couch shifts.

RESULTS

For tangents, average skin doses without bolus were 0.64 (EBT3), 0.62 (bare OSLD), 0.77 (jacketed OSLD), and 0.68 (Eclipse) as a fraction of prescription. For VMAT, doses without bolus were 0.53 (EBT3), 0.53 (bare OSLD), 0.64 (jacketed OSLD), and 0.60 (Eclipse). For tangents, the average doses with different boluses as measured by EBT3 were 0.99 (brass mesh), 1.02 (3 mm), 1.03 (5 mm), and 1.07 (10 mm). For VMAT with bolus, average doses as measured by EBT3 were 0.83 (brass), 0.96 (3 mm), 1.03 (5 mm), and 1.04 (10 mm). Eclipse doses agreed with measurements to within 5% of measurements for all Superflab thicknesses and within 15% of measurements for no bolus. The presence of a hospital gown and blanket had a bolusing effect that increased the surface dose by approximately 10%.

CONCLUSIONS

Results of this work allow for consideration of different bolus thicknesses, materials, and usage schedules based on desired skin dose and choice of either tangents or an arc beam techniques.

Impact of edema and seed movement on the dosimetry of prostate seed implants

This article summarizes current knowledge concerning the characterization of prostatic edema and intra-prostatic seed movement as these relate to dosimetry of permanent prostate implants, and reports the initial application to clinical data of a new edema model used in calculating pre- and post-implant dose distributions. Published edema magnitude and half-life parameters span a broad range depending on implant technique and measurement uncertainty, hence clinically applicable values should be determined locally. Observed intra-prostatic seed movements appear to be associated with particular aspects of implant technique and could be minimized by technique modification. Using an extended AAPM TG-43 formalism incorporating the new edema model, relative dose error RE associated with neglecting edema was calculated for three I-125 seed implants (18.9 cc, 37.6 cc, 60.2 cc) performed at our center. Pre- and post-plan RE average values and ranges in a 50 × 50 × 50 mm(3) calculation volume were similar at ~2% and ~0-3.5%, respectively, for all three implants; however, the spatial distribution of RE varied for different seed configurations. Post-plan values of D90 and V100 for prostate were reduced by ~2% and ~1%, respectively. In cases where RE is not clinically negligible as a consequence of large edema magnitude and / or use of Pd-103 seeds, the dose calculation method demonstrated here can be applied to account for edema explicitly and there by improve the accuracy of clinical dose estimates.

Thick, segmented CdWO4-photodiode detector for cone beam megavoltage CT: a Monte Carlo study of system design parameters

Megavoltage (MV) imaging detectors have been the focus of research by many groups in recent years. We have been working with segmented CdWO4 crystals in contact with photodiodes in our lab. The present study uses both x-ray and optical photon transport Monte Carlo simulations to analyze the effects of scintillation crystal height, septa material, beam divergence, and beam spectrum on the modulation transfer function, MTF(f) and zero frequency detective quantum efficiency, DQE(0), of a theoretical area detector. The theoretical detector is comprised of tall, segmented CdWO4 crystals and two dimensional photodiode arrays with a pitch of 1 mm and a fill factor of 72%. Increasing the crystal height above 10 mm does not result in an improvement in the DQE(0) if the reflection coefficient of the septa is less than 0.8. For a reflection coefficient of 0.975 for the septa, there is a continual gain in the DQE(0) up to 30 mm tall crystals. Similar calculations show that employing a 3.5 MV beam without a flattening filter increases the DQE(0) for 20 mm tall crystals by 9% compared to a typical 6 MV beam with a flattening filter. The severe degradations due to beam divergence on MTF(f) are quantified and suggest the use of focused detectors in MV imaging. It is found that when the effect of optical photons is considered, the presence of divergence can appear as a shift in the location of the input signal as well as loss of spatial resolution.

A bench-top megavoltage fan-beam CT using CdWO4-photodiode detectors. I. System description and detector characterization

We describe the components of a bench-top megavoltage computed tomography (MVCT) scanner that uses an 80-element detector array consisting of CdWO4 scintillators coupled to photodiodes. Each CdWO4 crystal is 2.75 x 8 x 10 mm3. The detailed design of the detector array, timing control, and multiplexer are presented. The detectors show a linear response to dose (dose rate was varied by changing the source to detector distance) with a correlation coefficient (R2) nearly unity with the standard deviation of signal at each dose being less than 0.25%. The attenuation of a 6 MV beam by solid water measured by this detector array indicates a small, yet significant spectral hardening that needs to be corrected before image reconstruction. The presampled modulation transfer function is strongly affected by the detector's large pitch and a large improvement can be obtained by reducing the detector pitch. The measured detective quantum efficiency at zero spatial frequency is 18.8% for 6 MV photons which will reduce the dose to the patient in MVCT applications. The detector shows a less than a 2% reduction in response for a dose of 24.5 Gy accumulated in 2 h; however, the lost response is recovered on the following day. A complete recovery can be assumed within the experimental uncertainty (standard deviation <0.5%); however, any smaller permanent damage could not be assessed.

A bench-top megavoltage fan-beam CT using CdWO4-photodiode detectors. II. Image performance evaluation

Megavoltage computed tomography (MVCT) is a potential imaging tool for positioning and dose delivery verification during image guided radiotherapy. The problem with many MVCT detectors, however, is their low detective quantum efficiency (DQE) which leads to poor low contrast resolution (LCR) and high image noise. This makes separating the tumors from the soft tissue background difficult. This manuscript describes the imaging performance of our bench-top MVCT scanner that uses an 80-element detector array consisting of CdWO4-photodiode elements with a DQE of 19% in 6 MV and 26% in Co60 beams [T. T. Monajemi, S. Steciw, B. G. Fallone, and S. Rathee, "Modelling scintillator-photodiodes as detectors for megavoltage CT," Med. Phys. 31, 1225-1234 (2004)] at zero frequency. The imaging experiments presented were carried out mainly in a Co60 teletherapy unit, while the beam hardening characteristics of the system were also presented for a 6 MV beam. During image evaluation, persistent ring artifacts, caused by air gaps at the ends of the eight-element detector blocks, were removed by using a calibration procedure. The measured contrast of a low contrast target with a 20 mm diameter was determined to be independent of dose, between 2.1 and 17 cGy. The measured LCR of a target with a nominal contrast of 2.8% was reduced from 2.3% to 1.2% when the contrast target diameter was reduced from 15 to 5 mm, using 17 cGy for imaging. The signal to noise ratio of this system is shown to be proportional to the square root of dose. Most importantly, a low contrast target with a diameter of 6 mm and a nominal contrast level of 1.5% is resolved with a radiation dose of 2.1 cGy in the Co60 beam. The spatial resolution in the Co60 beam is limited to one line pair per centimeter mainly due to the size of the Co60 source.

Modeling scintillator-photodiodes as detectors for megavoltage CT

The use of cadmium tungstate (CdWO4) and cesium iodide [CsI(Tl)] scintillation detectors is studied in megavoltage computed tomography (MVCT). A model describing the signal acquired from a scintillation detector has been developed which contains two steps: (1) the calculation of the energy deposited in the crystal due to MeV photons using the EGSnrc Monte Carlo code; and (2) the transport of the optical photons generated in the crystal voxels to photodiodes using the optical Monte Carlo code DETECT2000. The measured detector signals in single CdWO4 and CsI(Tl) scintillation crystals of base 0.275 x 0.8 cm2 and heights 0.4, 1, 1.2, 1.6 and 2 cm were, generally, in good agreement with the signals calculated with the model. A prototype detector array which contains 8 CdWO4 crystals, each 0.275 x 0.8 x 1 cm3, in contact with a 16-element array of photodiodes was built. The measured attenuation of a Cobalt-60 beam as a function of solid water thickness behaves linearly. The frequency dependent modulation transfer function [MTF(f)], noise power spectrum [NPS(f)], and detective quantum efficiency [DQE(f)] were measured for 1.25 MeV photons (in a Cobalt-60 beam). For 6 MV photons, only the MTF(f) was measured from a linear accelerator, where large pulse-to-pulse fluctuations in the output of the linear accelerator did not allow the measurement of the NPS(f). A two-step Monte Carlo simulation was used to model the detector's MTF(f), NPS(f) and DQE(f). The DQE(0) of the detector array was found to be 26% and 19% for 1.25 MeV and 6 MV photons, respectively. For 1.25 MeV photons, the maximum discrepancies between the measured and modeled MTF(f), relative NPS(f) and the DQE(f) were found to be 1.5%, 1.2%, and 1.9%, respectively. For the 6 MV beam, the maximum discrepancy between the modeled and the measured MTF(f) was found to be 2.5%. The modeling is sufficiently accurate for designing appropriate detectors for MVCT.