The need for, and implementation of, image guidance in radiation therapy.

The introduction of image guidance in radiation therapy and its subsequent innovations have revolutionised the delivery of cancer treatment. Modern imaging systems can supplement and often replace the historical practice of relying on external landmarks and laser alignment systems. Rather than depending on markings on the patient's skin, image-guided radiation therapy (IGRT), using techniques such as computed tomography (CT), cone beam CT, MV on-board imaging (OBI), and kV OBI, allows the patient to be positioned based on the internal anatomy. These advances in technology have enabled more accurate delivery of radiation doses to anatomically complex and temporally changing tumour volumes, while simultaneously sparing surrounding healthy tissues. While these imaging modalities provide excellent bony anatomy image quality, magnetic resonance imaging (MRI) surpasses them in soft tissue image contrast for better visualisation and tracking of soft tissue tumours with no additional radiation dose to the patient. However, the introduction of MRI into a radiotherapy facility has a number of complications, including the influence of the magnetic field on the dose deposition, as well as the effects it can have on dosimetry systems. The development and introduction of these new IGRT techniques will be reviewed, and the benefits and disadvantages of each will be described.

Reference dosimetry in magnetic fields: formalism and ionization chamber correction factors.

PURPOSE: Magnetic resonance imaging-guided radiotherapy (MRIgRT) provides superior soft-tissue contrast and real-time imaging compared with standard image-guided RT, which uses x-ray based imaging. Several groups are developing integrated MRIgRT machines. Reference dosimetry with these new machines requires accounting for the effects of the magnetic field on the response of the ionization chambers used for dose calibration. Here, the authors propose a formalism for reference dosimetry with integrated MRIgRT devices. The authors also examined the suitability of the TPR10 (20) and %dd(10)x beam quality specifiers in the presence of magnetic fields and calculated detector correction factors to account for the effects of the magnetic field for a range of detectors. METHODS: The authors used full-head and point-source Monte Carlo models of an MR-linac along with detailed detector models of an Exradin A19, an NE2571, and several PTW Farmer chambers to calculate magnetic field correction factors for six commercial ionization chambers in three chamber configurations. Calculations of ionization chamber response (performed with geant4) were validated with specialized Fano cavity tests. %dd(10)x values, TPR10 (20) values, and Spencer-Attix water-to-air restricted stopping power ratios were also calculated. The results were further validated against measurements made with a preclinical functioning MR-linac. RESULTS: The TPR10 (20) was found to be insensitive to the presence of the magnetic field, whereas the relative change in %dd(10)x was 2.4% when a transverse 1.5 T field was applied. The parameters chosen for the ionization chamber calculations passed the Fano cavity test to within ∼0.1%. Magnetic field correction factors varied in magnitude with detector orientation with the smallest corrections found when the chamber was parallel to the magnetic field. CONCLUSIONS: Reference dosimetry can be performed with integrated MRIgRT devices by using magnetic field correction factors, but care must be taken with the choice of beam quality specifier and chamber orientation. The uncertainties achievable under this formalism should be similar to those of conventional formalisms, although this must be further quantified.

Independent dose per monitor unit review of eight U.S.A. proton treatment facilities.

PURPOSE: Compare the dose per monitor unit at different proton treatment facilities using three different dosimetry methods. METHODS: Measurements of dose per monitor unit were performed by a single group at eight facilities using 11 test beams and up to six different clinical portal treatment sites. These measurements were compared to the facility reported dose per monitor unit values. RESULTS: Agreement between the measured and reported doses was similar using any of the three dosimetry methods. Use of the ICRU 59 ND,w based method gave results approximately 3% higher than both the ICRU 59 NX and ICRU 78 (TRS-398) ND,w based methods. CONCLUSIONS: Any single dosimetry method could be used for multi-institution trials with similar conformity between facilities. A multi-institutional trial could support facilities using both the ICRU 59 NX based and ICRU 78 (TRS-398) ND,w based methods but use of the ICRU 59 ND,w based method should not be allowed simultaneously with the other two until the difference is resolved.

Three-Dimensional Dosimetry of a Beta-Emitting Radionuclide Using PRESAGE Dosimeters.

Three-dimensional dose distributions from liquid brachytherapy were measured using PRESAGE(®) dosimeters. The dosimeters were exposed to Y-90 for 5.75 days and read by optical tomography. The distributions are consistent with estimates from beta dose kernels.

The US radiation dosimetry standards for 60Co therapy level beams, and the transfer to the AAPM accredited dosimetry calibration laboratories.

This work reports the transfer of the primary standard for air kerma from the National Institute of Standards and Technology (NIST) to the secondary laboratories accredited by the American Association of Physics in Medicine (AAPM). This transfer, performed in August of 2003, was motivated by the recent revision of the NIST air-kerma standards for 60Co gamma-ray beams implemented on July 1, 2003. The revision involved a complete recharacterization of the two NIST therapy-level 60Co gamma-ray beam facilities, resulting in new values for the air-kerma rates disseminated by the NIST. Some of the experimental aspects of the determination of the new air-kerma rates are briefly summarized here; the theoretical aspects have been described in detail by Seltzer and Bergstrom ["Changes in the U.S. primary standards for the air-kerma from gamma-ray beams," J. Res. Natl. Inst. Stand. Technol. 108, 359-381 (2003)]. The standard was transferred to reference-class chambers submitted by each of the AAPM Accredited Dosimetry Calibration Laboratories (ADCLs). These secondary-standard instruments were then used to characterize the 60Co gamma-ray beams at the ADCLs. The values of the response (calibration coefficient) of the ADCL secondary-standard ionization chambers are reported and compared to values obtained prior to the change in the NIST air-kerma standards announced on July 1, 2003. The relative change is about 1.1% for all of these chambers, and this value agrees well with the expected change in chambers calibrated at the NIST or at any secondary-standard laboratory traceable to the new NIST standard.

Reference photon dosimetry data: a preliminary study of in-air off-axis factor, percentage depth dose, and output factor of the Siemens Primus linear accelerator.

The dosimetric characteristics for modern computer-controlled linear accelerators with the same make, model, and nominal energy are known to be very similar, as long as the machines are unaltered from the manufacturer's original specifications. In this preliminary study, a quantitative investigation of the similarity in the basic photon dosimetry data from the Siemens Primus linear accelerators at eight different institutions is reported. The output factor, percentage depth dose (PDD), and in-air off-axis factor (OAF) for the 6 and 18 MV photon beams measured or verified by the Radiological Physics Center (RPC) were analyzed. The RPC-measured output factors varied by less than about 2% for each field size. The difference between the maximum and minimum RPC-verified PDD values at each depth was less than about 3%. The difference between the maximum and minimum RPC-measured in-air OAF was no more than 4% at all off-axis distances considered in this study. These results strongly suggest that it is feasible to establish a reference photon dosimetry data set for each make, model, and nominal energy, universally applicable to those machines unaltered from the manufacturers' original specifications, within a clinically acceptable tolerance (e.g., approximately +/-2%).

TG-51: experience from 150 institutions, common errors, and helpful hints.

The Radiological Physics Center (RPC) is a resource to the medical physics community for assistance regarding dosimetry procedures. Since the publication of the AAPM TG-51 calibration protocol, the RPC has responded to numerous phone calls raising questions and describing areas in the protocol where physicists have had problems. At the beginning of the year 2000, the RPC requested that institutions participating in national clinical trials provide the change in measured beam output resulting from the conversion from the TG-21 protocol to TG-51. So far, the RPC has received the requested data from approximately 150 of the approximately 1300 institutions in the RPC program. The RPC also undertook a comparison of TG-21 and TG-51 and determined the expected change in beam calibration for ion chambers in common use, and for the range of photon and electron beam energies used clinically. Analysis of these data revealed two significant outcomes: (i) a large number (approximately 1/2) of the reported calibration changes for photon and electron beams were outside the RPC's expected values, and (ii) the discrepancies in the reported versus the expected dose changes were as large as 8%. Numerous factors were determined to have contributed to these deviations. The most significant factors involved the use of plane-parallel chambers, the mixing of phantom materials and chambers between the two protocols, and the inconsistent use of depth-dose factors for transfer of dose from the measurement depth to the depth of dose maximum. In response to these observations, the RPC has identified a number of circumstances in which physicists might have difficulty with the protocol, including concerns related to electron calibration at low energies (R50<2 cm), and the use of a cylindrical chamber at 6 MeV electrons. In addition, helpful quantitative hints are presented, including the effect of the prescribed lead filter for photon energy measurements, the impact of shifting the chamber depth for photon depth-dose measurements, and the impact of updated stopping-power data used in TG-51 versus that used in TG-21, particularly for electron calibrations.

Predictability of electron cone ratios with respect to linac make and model.

In the past, the Radiological Physics Center (RPC) has developed standard sets of photon depth-dose and wedge-factor data, specific to the make, model, and wedge design of the linear accelerator (linac). In this paper, the RPC extends the same concept to electron-cone ratios. Since 1987, the RPC has measured and documented cone-ratio (CR) values during on-site dosimetry review visits to institutions participating in National Cancer Institute cooperative clinical trials. Data have been collected for approximately 500 electron beams from a wide spectrum of linac models. The analysis presented in this paper indicates that CR values are predictable to 2% to 3% (two standard deviations) for a given make and model of linac with a few exceptions. The analysis also revealed some other interesting systematics. For some models, such as the Varian Clinac 2500 and the Elekta/Philips SL18, SL20, and SL25, CR values were nearly identical for cone sizes 15 cm x 15 cm (or 14 cm x 14 cm) and 20 cm x 20 cm across the range of available energies. Certain models of the same make of linac, such as the Mevatron MD, KD, and 6700 series models or the Clinac 2100 and 2300 models, exhibited indistinguishable CRs. Irrespective of linac model, two consistent general trends were observed: namely, an increase in CR value with incident beam energy for cone sizes smaller than 10 cm x 10 cm and a decrease with energy for cone sizes larger than 10 cm x 10 cm. These data are valuable to the RPC as a quality assurance remote-monitoring tool to identify potential dosimetry errors. The physics community will also find the data useful in several ways: as a redundant check for clinical values in use, to validate the values measured during commissioning of new machines or to ensure consistency of values measured during annual quality assurance procedures.

Dosimetric characteristics of a new 125I brachytherapy source.

125I brachytherapy sources are being used for interstitial implants in tumor sites such as the prostate. Recently, a new 125I source has been introduced, which has a design different from that of other sources presently on the market. Dosimetric characteristics of this source, including dose rate constant, radial dose function, and anisotropy function, were determined experimentally following the AAPM Task Group 43 recommendations. The characteristics were related to the 1999 NIST calibration assigned to this source [SK,99std]. Measurements were performed in a solid water phantom using LiF thermoluminescent dosimeters. For these measurements, slabs of solid water phantom material were machined to accommodate the source and LiF TLD chips of dimensions (3.1 x 3.1 x 0.8 mm3) and (1.0 x 1.0 x 1.0 mm3). The TLD chips were surrounded by at least 10 cm of solid water phantom material to provide full scattering conditions. The results indicated a dose rate constant, lambda, of 0.88 +/- 0.07cGyh(-1)U(-1) for the new 1251 source as compared to 0.98 and 1.04 cGy h(-1)U(-1) for the Nycomed/Amersham model 6711 and 6702 seeds, respectively. Per TG-43, the values reported here represent the dose absorbed by water at 1 cm from the source in a water medium. The radial dose function, g(r), of the new 125I source was measured at distances ranging from 0.5 to 10 cm. The anisotropy function, F(r,theta), of the new 125I source was measured at distances of 2 and 5 cm from the source center. Calculations of anisotropy and radial dose function were also made using a Monte Carlo code. These calculations were made for both solid water and liquid water, the former to validate the Monte Carlo code and the latter to provide results in liquid water for clinical use. All data compared favorably with those from the Nycomed/Amersham models 6711 and 6702 sources.

Dosimetric characteristics of the Pharma Seed model BT-125-I source.

125I brachytherapy sources are being used with increasing frequency for interstitial implants in tumor sites, especially the prostate. Recently, a new 125I source design has become commercially available for clinical applications. Dosimetric characteristics (i.e., dose rate constant, radial dose function, and anisotropy function) of this source were experimentally and theoretically determined following the AAPM Task Group 43 (TG-43) recommendations and were related to the 1999 NIST calibration assigned to this source [S(k), 99std]. Measurements were performed in a Solid Water phantom using LiF thermoluminescent dosimeters. The measured data were used to validate the Monte Carlo simulations that were performed in Solid Water using the PTRAN code. The Monte Carlo calculations were then performed in liquid water to obtain the dosimetric information for clinical applications in accordance with TG-43 recommendations. The results indicated that the dose rate constant, lambda, of the Pharma Seed model BT-125-I 125I source was 0.90 +/- 0.06 cGy h(-1) U(-1) using thermoluminescent dosimeter (TLD) measurements and 0.92 +/- 0.03 cGy h(-1) U(-1) using Monte Carlo simulations in Solid Water. The calculated value in liquid water was found to be 0.95 +/- 0.03 cGy h(-1) U(-1). The radial dose function, g(r), of the new 125I source was measured at distances ranging from 0.5 to 10 cm using LiF TLD in Solid Water phantom material. The Monte Carlo simulations were performed for distances ranging from 0.1 to 10 cm from the source center in Solid Water and liquid water. The anisotropy function, F(r, theta), was measured at distances of 2, 5, and 7 cm from the source center and calculated at distances of 0.5, 1, 2, 3, 5, and 7 cm from the source center. The anisotropy constant, phi(an), of the Pharma Seed source in water was found to be 0.975. Complete dosimetric data are described in this manuscript. Per TG-43, the values reported in water should be used for clinical treatment planning systems.

High-dose spatially-fractionated radiation (GRID): a new paradigm in the management of advanced cancers.

PURPOSE: With the advent of megavoltage radiation, the concept of spatially-fractionated (SFR) radiation has been abandoned for the last several decades; yet, historically, it has been proven to be safe and effective in delivering large cumulative doses (> 100 Gy) of radiation in the treatment of cancer. SFR radiation has been adapted to megavoltage beams using a specially constructed grid. This study evaluates the toxicity and effectiveness of this approach in treatment of advanced and bulky cancers. METHODS AND MATERIALS: From January 1995 through March 1998, 71 patients with advanced bulky tumors (tumor sizes > 8 cm) were treated with SFR high-dose external beam megavoltage radiation using a GRID technique. Sixteen patients received GRID treatments to multiple sites and a total of 87 sites were irradiated. A 50:50 GRID (open to closed area) was utilized, and a single dose of 1,000-2,000 cGy (median 1,500 cGy) to Dmax was delivered utilizing 6 MV photons. Sixty-three patients received high-dose GRID therapy for palliation (pain, mass, bleeding, or dyspnea). In 8 patients, GRID therapy was given as part of a definitive treatment combined with conventionally-fractionated external beam irradiation (dose range 5,000-7,000 cGy) followed by subsequent surgery. Forty-seven patients were treated with GRID radiation followed by additional fractionated external beam irradiation, and 14 patients were treated with GRID alone. Thirty-one treatments were delivered to the abdomen and pelvis, 30 to the head and neck region, 15 to the thorax, and 11 to the extremities. RESULTS: For palliative treatments, a 78% response rate was observed for pain, including a complete response (CR) of 19.5%, and a partial response (PR) of 58.5% in these large bulky tumors. A 72.5% response rate was observed for mass effect (CR 14.6%, PR 52.9%). The response rate observed for bleeding was 100% (50% CR, 50% PR) and for dyspnea, a 60% PR rate only. A relatively higher response rate (CR 23.3%, PR 60%) was observed in patients who received GRID treatment in the head and neck area. No grade 3 late skin, subcutaneous, mucosal, GI, or CNS complications were observed in any patient in spite of these high doses. In the 8 patients who received GRID treatment for definitive treatment, a clinical CR was observed in 5 patients (62.5%) and a pathological complete response was confirmed in the operative specimen in 4 patients (50%). CONCLUSION: The efficacy and safety of using a large fraction of SFR radiation was confirmed by this study and substantiates our earlier results. In selected patients with bulky tumors (> 8 cm), SFR radiation can be combined with fractionated external beam irradiation to yield improved local control of disease, both for palliation and selective definitive treatment, especially where conventional treatment alone has a limited chance of success.

Effect of hyaluronidase on albumin diffusion in lung interstitium.

Albumin diffusion measured in an isolated segment of rabbit lung interstitium with a radioactive tracer ((125)I-albumin) technique was independent of albumin concentration and similar to the free diffusion of albumin in water (Qiu et al, 1998. J Appl Physiol 85: 575-583). We studied the effect of hyaluronidase on the diffusion of albumin. Isolated rabbit lungs were inflated with silicon rubber by way of airways and blood vessels, and two chambers were bonded to the sides of a approximately 0.5-cm thick slab enclosing a vessel with an interstitial cuff. One chamber was filled with 2 g/dl albumin solution containing (125)I-albumin and 0.02 g/dl hyaluronidase. Unbound (125)I was removed from the tracer by dialysis before use. The other chamber filled with Ringer's solution was placed within a NaI(Tl) scintillation detector. Diffusion of tracer was measured continuously for 120 h. Albumin diffusion coefficient (D) and interstitial area (A) were obtained by fitting the tracer-time curve with the theoretical solution of the equation describing one-dimension diffusion of a solute across a membrane. D averaged 5.2 x 10(-7) cm(2)/s for albumin diffusion with hyaluronidase, 20% less than that measured previously without hyaluronidase. Hyaluronidase had no effect on A. Results indicated an interaction between albumin and interstitial hyaluronan that was the opposite of the steric effect on albumin excluded volume measured in solution.

Effect of concentration and hyaluronidase on albumin diffusion across rabbit mesentery.

OBJECTIVE: To measure the diffusion coefficient of albumin through rabbit mesentery using the steady-state flux of radioactive tracer 125I-albumin. The effect of albumin concentration and testicular hyaluronidase were also studied. METHODS: Mesenteric tissue was bonded between two plates, exposing a 7 mm diameter surface, with two chambers on either side. One chamber was filled with a test solution of albumin containing the radioactive tracer and the other with lactated Ringer solution. The solutions in both chambers were stirred with small magnetic cylinders. The chamber filled with lactated Ringer solution was placed in a well-type NaI(Tl) detector, and the radiation emitted from the tracer that diffused across the mesentery was monitored continuously for 9 hours. The diffusion coefficient (D) was calculated using Fick's law of diffusion. The diffusion coefficient was measured at albumin concentration differences (delta C) between approximately 0 and 10 g/dL. The diffusion coefficient was also measured with testicular hyaluronidase at three different albumin-concentration differences. RESULTS: The diffusion coefficient increased significantly (P < 0.0001) approximately three-fold from a mean value of 2.2 x 10(-8) +/- 1.2 x 10(-8) (SD) cm2/s at 0-0.5 g/dL delta C to 5.9 x 10(-8) +/- 1.1 x 10(-8) (SD) cm2/s at 10 g/dL delta C. The values are much less than the free diffusion coefficient of albumin (6 x 10(-7) cm2/s). Testicular hyaluronidase added to the albumin solution decreased D by approximately 60%, but did not eliminate the increase in D with delta C. CONCLUSIONS: The increase in D with delta C and the reduced D with hyaluronidase were attributed to a reduced albumin-excluded volume caused by an interaction between albumin and hyaluronan. Further studies are required to define this interaction.

Hydraulic conductivity, albumin reflection and diffusion coefficients of pig mediastinal pleura.

Hydraulic conductivity (L), albumin reflection coefficient (sigma), and albumin diffusion coefficient (D) were measured across pig mediastinal pleura. The tissue (7 mm diameter) was bonded between two chambers. Flow (Q) of lactated Ringer solution between the chambers was measured in turn at driving pressures (DeltaP) of 2, 4, and 6 cm H(2)O. Value of L was proportional to the slope of the Q-DeltaP curve. Then Q was measured in turn at three albumin osmotic pressure differences (Deltapi equivalent to -1, -2, and -3 g/dl albumin concentration difference, DeltaC) with DeltaP constant at either 2, 3, 4, or 6 cm H(2)O. From Starling's equation, magnitude of sigma was the slope of the Q-Deltapi curve divided by the slope of the Q-DeltaP curve. We measured the diffusion of 0, 2, 5, and 10 g/dl albumin with tracer (125)I-albumin. Tracer mass (M) that diffused across the pleura was measured for 10 h using a well-type NaI(T1) detector. D was calculated from the slope of the M-time curve. Values of L averaged 2.0 x 10(-8) cm(3). s(-1). dyne(-1) (n = 23). Values of sigma were small (0.02-0.05) and sigma increased as flow increased 20-fold. D (n = 24) increased 3-fold from 2.7 x 10(-8) cm(2)/s as DeltaC increased from 0 to 10 g/dl. The small values of sigma indicated that mediastinal pleura provided little restriction to the passage of protein.

Effect of concentration on albumin diffusion in lung interstitium.

The transport of macromolecules through the lung interstitium depends on both bulk transport of fluid and diffusion. In the present study, we studied the diffusion of albumin. Isolated rabbit lungs were inflated with silicon rubber via airways and blood vessels, and two chambers were bonded to the sides of a 0.5-cm-thick slab that enclosed a vessel with an intersititial cuff. One chamber was filled with either albumin solution (2 or 5 g/dl) containing tracer 125I-albumin or with tracer 125I-albumin alone; the other was filled with Ringer solution. Unbound 125I was removed from the tracer by dialysis before use. The chamber with Ringer solution was placed in the well of a NaI(Tl) scintillation detector. Diffusion of tracer through the interstitium was measured continuously for 60 h. Tracer mass (M) showed a time (t) delay followed by an increase to a steady-state flow (dM/dt constant). Albumin diffusion coefficient (D) was given by L2/(6T), where T was the time intercept of the steady-state M-t line at zero M, and L was interstitial length. Interstitial cuff thickness-to-vessel radius ratio (Th0/R) was estimated by using Fick's law for steady-state diffusion. Both D and Th0/R were independent of albumin concentration. D averaged 6.6 x 10(-7) cm2/s, similar to the free D for albumin. Values of Th0/R averaged 0.047 +/- 0.024 (SD), near the values measured histologically. Thus pulmonary interstitial constituents offered no restriction to the diffusion of albumin.

Reproduction of radiologic images on plain paper.

Skyrocketing health care costs and pressures from managed care have combined to promote cost-cutting strategies in radiology and radiation oncology departments. A study was conducted to evaluate the use of a high-resolution laser printer for printing plain-paper images as substitutes for both original and duplicate radiologic film images. A variety of radiologic images were used to evaluate the image reproduction capabilities of the printer in terms of linearity, detail, and contrast. In many cases, printed images had a quality comparable to that of the original images. Six computed tomographic (CT) scans and six radiation therapy simulator radiographs were compared with printed reproductions by each of seven board-certified radiation oncologists, who rated the reproductions as acceptable for documentation, acceptable for diagnostic purposes (CT scans only), or unacceptable. Ninety-five percent of printed CT images and 90% of printed simulation images were rated acceptable for documentation. The quality of printed images of radiation therapy port films was not quantitatively measured but was improved by adjusting image contrast and brightness and using various image enhancement techniques. The use of printed images is less expensive than that of processed film and eliminates the environmental, time, storage, and delivery problems associated with film. Technologic advances in imaging, networking, and printing have made possible the inexpensive duplication of medical images.

Uncertainty of calibrations at the accredited dosimetry calibration laboratories.

The American Association of Physicists in Medicine, through a subcommittee (formerly Task Group 3) of the Radiation Therapy Committee, has accredited five laboratories to perform calibrations of instruments used to calibrate therapeutic radiation beams. The role of the accredited dosimetry calibration laboratories (ADCLs) is to transfer a calibration factor from an instrument calibrated by the National Institute of Standards and Technology (NIST) to a customer's instrument. It is of importance to the subcommittee, to physicists using the services of the ADCLs, and to the ADCLs themselves, to know the uncertainty of instrument calibrations. The calibration uncertainty has been analyzed by asking the laboratories to provide information about their calibration procedures. Estimates of uncertainty by two procedures were requested: Type A are uncertainties derived as the standard deviations of repeated measurements, while type B are estimates of uncertainties obtained by other methods, again expressed as standard deviations. Data have been received describing the uncertainty of each parameter involved in calibrations, including those associated with measurements of charge, exposure time, and air density, among others. These figures were combined with the uncertainty of NIST calibrations, to arrive at an overall uncertainty which is expressed at the two-standard deviation level. For cable-connected instruments in gamma-ray and x-ray beams of HVL > 1 mm Al, the figure has an upper bound of approximately 1.2%.

Three-dimensional visualization and measurement of conformal dose distributions using magnetic resonance imaging of BANG polymer gel dosimeters.

PURPOSE/OBJECTIVE: The measurement of complex dose distributions (those created by irradiation through multiple beams, multiple sources, or multiple source dwell positions) requires a dosimeter that can integrate the dose during a complete treatment. Integrating dosimeter devices generally are capable of measuring only dose at a point (ion chamber, diode, TLD) or in a plane (film). With increasing use of conformal dose distributions requiring shaped, noncoplanar beams, there will be an increased requirement for a dosimeter that can record and display a 3D dose distribution. The use of a 3D dosimeter will be required to confirm the accuracy of treatment plans produced by the current generation of 3D treatment-planning computers. METHODS AND MATERIALS: The use of a Fricke-infused gel and magnetic resonance imaging (MRI) to demonstrate the localization of stereotactic beams has been demonstrated (11). The recently developed BANG polymer gel dosimetry system (MGS Research, Inc., Guilford, CT), based on radiation-induced chain polymerization of acrylic monomers dispersed in a tissue-equivalent gel, surpasses the Fricke-gel method by providing accurate, quantitative dose distribution data that do not deteriorate with time (6, 9). The improved BANG2 formulation contains 3% N,N'-methylene-bisacrylamide, 3% acrylic acid, 1% sodium hydroxide, 5% gelatin, and 88% water, where all percentages are by weight. The gel was poured into volumetric flasks, of dimensions comparable to a human head. The gels were irradiated with complex beam arrangements, similar to those used for conformal radiation therapy. Images of the gels were acquired using a Siemens 1.5T imager and a Hahn spin-echo pulse sequence (90 degrees-tau-180 degrees-tau-acquire, for different values of tau). The images were transferred via network to a Macintosh computer for which a data analysis and display program was written. The program calculates R2 maps on the basis of multiple TE images, using a monoexponential nonlinear least-squares fit based on the Levenberg-Marquardt algorithm. The program also creates a dose-to-R2 calibration function by fitting a polynomial to a set of dose and R2 data points, obtained from gels irradiated in test tubes to known doses. This function can then be applied to any other R2 map, so that a dose map can be computed and displayed. RESULTS: Through exposure to known doses of radiation, the gel has been shown to respond linearly with dose in the range of 0 to 10 Gy, and its response is independent of the beam energy or modality. Dose distributions have been imaged in orthogonal planes, and can be displayed in a convenient form for comparison with isodose plans. The response of the gel is stable; the gel can be irradiated at any time after its manufacture, and imaging can be conducted any time following a brief interval after irradiation. CONCLUSION: The polymer gel dosimeter has been shown to be a valuable device for displaying three-dimensional dose distributions. The imaged dose distribution can be compared easily with calculated dose distributions, to validate a treatment planning system. In the future, gels may be prepared in anthropomorphic phantoms, to confirm unique patient dose distributions.

Dosimetric characteristics of a new high-intensity 192Ir source for remote afterloading.

A new high-intensity 192Ir source has recently become commercially available for remote afterloading brachytherapy treatment. The dosimetric characteristics (dose rate constant, radial dose function, and anisotropy function) of this source were experimentally determined through the application of AAPM Task Group 43 recommendations. Complete dosimetric data are presented in this manuscript.