Assessment and characterization of the total geometric uncertainty in Gamma Knife radiosurgery using polymer gels.

PURPOSE: This work proposes and implements an experimental methodology, based on polymer gels, for assessing the total geometric uncertainty and characterizing its contributors in Gamma Knife (GK) radiosurgery. METHODS: A treatment plan consisting of 26, 4-mm GK single shot dose distributions, covering an extended region of the Leksell stereotactic space, was prepared and delivered to a polymer gel filled polymethyl methacrylate (PMMA) head phantom (16 cm diameter) used to accurately reproduce every link in the GK treatment chain. The center of each shot served as a "control point" in the assessment of the GK total geometric uncertainty, which depends on (a) the spatial dose delivery uncertainty of the PERFEXION GK unit used in this work, (b) the spatial distortions inherent in MR images commonly used for target delineation, and (c) the geometric uncertainty contributor associated with the image registration procedure performed by the Leksell GammaPlan (LGP) treatment planning system (TPS), in the case that registration is directly based on the apparent fiducial locations depicted in each MR image by the N-shaped rods on the Leksell localization box. The irradiated phantom was MR imaged at 1.5 T employing a T2-weighted pulse sequence. Four image series were acquired by alternating the frequency encoding axis and reversing the read gradient polarity, thus allowing the characterization of the MR-related spatial distortions. RESULTS: MR spatial distortions stemming from main field (B0) inhomogeneity as well as from susceptibility and chemical shift phenomena (also known as sequence dependent distortions) were found to be of the order of 0.5 mm, while those owing to gradient nonlinearities (also known as sequence independent distortions) were found to increase with distance from the MR scanner isocenter extending up to 0.47 mm at an Euclidean distance of 69.6 mm. Regarding the LGP image registration procedure, the corresponding average contribution to the total geometric uncertainty ranged from 0.34 to 0.80 mm. The average total geometric uncertainty, which also includes the GK spatial dose delivery uncertainty, was found equal to (0.88 ± 0.16), (0.88 ± 0.26), (1.02 ± 0.09), and (1.15 ± 0.24) mm for the MR image series acquired with the read gradient polarity (direction) set toward right, left, posterior, and anterior, respectively. CONCLUSIONS: The implemented methodology seems capable of assessing the total geometric uncertainty, as well as of characterizing its contributors, ascribed to the entire GK treatment delivery (i.e., from MR imaging to GK dose delivery) for an extended region of the Leksell stereotactic space. Results obtained indicate that the selection of both the frequency encoding axis and the read gradient polarity during MRI acquisition may affect the magnitude as well as the spatial components of the total geometric uncertainty.

Dosimetric accuracy of a deterministic radiation transport based (192)Ir brachytherapy treatment planning system. Part III. Comparison to Monte Carlo simulation in voxelized anatomical computational models.

PURPOSE: To compare TG43-based and Acuros deterministic radiation transport-based calculations of the BrachyVision treatment planning system (TPS) with corresponding Monte Carlo (MC) simulation results in heterogeneous patient geometries, in order to validate Acuros and quantify the accuracy improvement it marks relative to TG43. METHODS: Dosimetric comparisons in the form of isodose lines, percentage dose difference maps, and dose volume histogram results were performed for two voxelized mathematical models resembling an esophageal and a breast brachytherapy patient, as well as an actual breast brachytherapy patient model. The mathematical models were converted to digital imaging and communications in medicine (DICOM) image series for input to the TPS. The MCNP5 v.1.40 general-purpose simulation code input files for each model were prepared using information derived from the corresponding DICOM RT exports from the TPS. RESULTS: Comparisons of MC and TG43 results in all models showed significant differences, as reported previously in the literature and expected from the inability of the TG43 based algorithm to account for heterogeneities and model specific scatter conditions. A close agreement was observed between MC and Acuros results in all models except for a limited number of points that lay in the penumbra of perfectly shaped structures in the esophageal model, or at distances very close to the catheters in all models. CONCLUSIONS: Acuros marks a significant dosimetry improvement relative to TG43. The assessment of the clinical significance of this accuracy improvement requires further work. Mathematical patient equivalent models and models prepared from actual patient CT series are useful complementary tools in the methodology outlined in this series of works for the benchmarking of any advanced dose calculation algorithm beyond TG43.

On the output factor measurements of the CyberKnife iris collimator small fields: Experimental determination of the k(Q(clin),Q(msr) ) (f(clin),f(msr) ) correction factors for microchamber and diode detectors.

PURPOSE: To measure the output factors (OFs) of the small fields formed by the variable aperture collimator system (iris) of a CyberKnife (CK) robotic radiosurgery system, and determine the k(Q(clin),Q(msr) ) (f(clin),f(msr) ) correction factors for a microchamber and four diode detectors. METHODS: OF measurements were performed using a PTW PinPoint 31014 microchamber, four diode detectors (PTW-60017, -60012, -60008, and the SunNuclear EDGE detector), TLD-100 microcubes, alanine dosimeters, EBT films, and polymer gels for the 5 mm, 7.5 mm, 10 mm, 12.5 mm, and 15 mm iris collimators at 650 mm, 800 mm, and 1000 mm source to detector distance (SDD). The alanine OF measurements were corrected for volume averaging effects using the 3D dose distributions registered in polymer gel dosimeters. k(Q(clin),Q(msr) ) (f(clin),f(msr) ) correction factors for the PinPoint microchamber and the diode dosimeters were calculated through comparison against corresponding polymer gel, EBT, alanine, and TLD results. RESULTS: Experimental OF results are presented for the array of dosimetric systems used. The PinPoint microchamber was found to underestimate small field OFs, and a k(Q(clin),Q(msr) ) (f(clin),f(msr) ) correction factor ranging from 1.127 ± 0.022 (for the 5 mm iris collimator) to 1.004 ± 0.010 (for the 15 mm iris collimator) was determined at the reference SDD of 800 mm. The PinPoint k(Q(clin),Q(msr) ) (f(clin),f(msr) ) correction factor was also found to increase with decreasing SDD; k(Q(clin),Q(msr) ) (f(clin),f(msr) ) values equal to 1.220 ± 0.028 and 1.077 ± 0.016 were obtained for the 5 mm iris collimator at 650 mm and 1000 mm SDD, respectively. On the contrary, diode detectors were found to overestimate small field OFs and a correction factor equal to 0.973 ± 0.006, 0.954 ± 0.006, 0.937 ± 0.007, and 0.964 ± 0.006 was measured for the PTW-60017, -60012, -60008 and the EDGE diode detectors, respectively, for the 5 mm iris collimator at 800 mm SDD. The corresponding correction factors for the 15 mm iris collimator were found equal to 0.997 ± 0.010, 0.994 ± 0.009, 0.988 ± 0.010, and 0.986 ± 0.010, respectively. No correlation of the diode k(Q(clin),Q(msr) ) (f(clin),f(msr) ) correction factors with SDD was observed. CONCLUSIONS: This work demonstrates an experimental procedure for the determination of the k(Q(clin),Q(msr) ) (f(clin),f(msr) ) correction factors required to obtain small field OF results of increased accuracy.

Dosimetric accuracy of a deterministic radiation transport based 192Ir brachytherapy treatment planning system. Part II: Monte Carlo and experimental verification of a multiple source dwell position plan employing a shielded applicator.

PURPOSE: The aim of this work is the dosimetric validation of a deterministic radiation transport based treatment planning system (BRACHYVISION v. 8.8, referred to as TPS in the following) for multiple 192Ir source dwell position brachytherapy applications employing a shielded applicator in homogeneous water geometries. METHODS: TPS calculations for an irradiation plan employing seven VS2000 192Ir high dose rate (HDR) source dwell positions and a partially shielded applicator (GM11004380) were compared to corresponding Monte Carlo (MC) simulation results, as well as experimental results obtained using the VIP polymer gel-magnetic resonance imaging three-dimensional dosimetry method with a custom made phantom. RESULTS: TPS and MC dose distributions were found in agreement which is mainly within +/- 2%. Considerable differences between TPS and MC results (greater than 2%) were observed at points in the penumbra of the shields (i.e., close to the edges of the "shielded" segment of the geometries). These differences were experimentally verified and therefore attributed to the TPS. Apart from these regions, experimental and TPS dose distributions were found in agreement within 2 mm distance to agreement and 5% dose difference criteria. As shown in this work, these results mark a significant improvement relative to dosimetry algorithms that disregard the presence of the shielded applicator since the use of the latter leads to dosimetry errors on the order of 20%-30% at the edge of the "unshielded" segment of the geometry and even 2%-6% at points corresponding to the potential location of the target volume in clinical applications using the applicator (points in the unshielded segment at short distances from the applicator). CONCLUSIONS: Results of this work attest the capability of the TPS to accurately account for the scatter conditions and the increased attenuation involved in HDR brachytherapy applications employing multiple source dwell positions and partially shielded applicators.

On the implementation of a recently proposed dosimetric formalism to a robotic radiosurgery system.

PURPOSE: The aim of this work is to implement a recently proposed dosimetric formalism for nonstandard fields to the calibration and small field output factor measurement of a robotic stereotactic radiosurgery system. METHODS: Reference dosimetry measurements were performed in the nonstandard, 60 mm diameter machine specific reference (msr) field using a Farmer ion chamber, five other cylindrical chambers with cavity lengths ranging from 16.25 down to 2.7 mm, and alanine dosimeters. Output factor measurements were performed for the 5, 7.5, 10, and 15 mm field sizes using microchambers, diode detectors, alanine dosimeters, TLD microcubes, and EBT Gafchromic films. Measurement correction factors as described in the proposed formalism were calculated for the ion chamber and diode detector output factor measurements based on published Monte Carlo data. Corresponding volume averaging correction factors were calculated for the alanine output factor measurements using 3D dose distributions, measured with polymer gel dosimeters. RESULTS: Farmer chamber and alanine reference dosimetry results were found in close agreement, yielding a correction factor of k(Q(msr),Q)(f(msr),f(ref)) = 0.999 +/- 0.016 for the chamber readings. These results were also found to be in agreement within experimental uncertainties with corresponding results obtained using the shorter cavity length ionization chambers. The mean measured dose values of the latter, however, were found to be consistently greater than that of the Farmer chamber. This finding, combined with an observed inverse relationship between the mean measured dose and chamber cavity length that follows the trend predicted by theoretical volume averaging calculations in the msr field, implies that the Farmer k(Q(msr),Q)(f(msr),f(ref)) correction is greater than unity. Regarding the output factor results, deviations as large as 33% were observed between the different dosimeters used. These deviations were substantially decreased when appropriate correction factors were applied to the measured microchamber, diode, and alanine values. After correction, all diode and microchamber measured output factors agreed within 1.6% with the corresponding alanine measurements, and within 3.1% with the TLD measurements. The weighted mean output factors were 0.681 +/- 0.001, 0.824 +/- 0.001, 0.875 +/- 0.001, and 0.954 +/- 0.001 for the 5, 7.5, 10, and 15 mm beams, respectively. CONCLUSIONS: The comparison of Farmer chamber measurements versus alanine reference dosimetry validates the use of the former for dosimetry in the msr field of this treatment delivery system. The corresponding results of this work obtained using chambers with different cavity lengths, combined with previous literature findings, suggest that a k(Q(msr),Q)(f(msr),f(ref)) Farmer chamber dose response correction factor of 1.01 may improve calibration measurement accuracy when using the proposed dosimetric formalism. The k(Q(msr),Q)(f(msr),f(ref)) correction factor is within 0.5% from unity for ion chambers with cavity lengths less than 10 mm. Substantial improvements in small field output factor measurement accuracy can be obtained when using microchambers and diodes by applying appropriately calculated correction factors to the detector measurements according to the proposed dosimetric formalism, and their routine use is therefore recommended.

Dosimetric accuracy of a deterministic radiation transport based 192Ir brachytherapy treatment planning system. Part I: single sources and bounded homogeneous geometries.

PURPOSE: The aim of this work is to validate a deterministic radiation transport based treatment planning system (TPS) for single 192Ir brachytherapy source dosimetry in homogeneous water geometries. METHODS: TPS results were obtained using the deterministic radiation transport option of a BRACHYVISION v. 8.8 system for three characteristic source designs (VS2000, GMPlus HDR, and GMPlus PDR) with each source either centered in a 15 cm radius spherical water phantom, or positioned at varying distance away from the phantom center. Corresponding MC simulations were performed using the MCNPX code v.2.5.0 and source geometry models prepared using information provided by the manufacturers. RESULTS: Comparison in terms of the AAPM TG-43 dosimetric formalism quantities, as well as dose rate distributions per unit air kerma strength with a spatial resolution of 0.1 cm, yielded close agreement between TPS and MC results for the sources centered in the phantom. Besides some regions close to the source longitudinal axes where discrepancies could be characterized as systematic, overall agreement for all three sources studied is comparable to the statistical (type A) uncertainty of MC simulations (1% at the majority of points in the geometry increasing to 2%-3% at points lying both away from the source center and close to the source longitudinal axis). A corresponding good agreement was also found between TPS and MC results for the sources positioned away from the phantom center. CONCLUSIONS: Results of this work attest the capability of the TPS to accurately account for the scatter conditions regardless of the size or shape of a given geometry of dosimetric interest, and the position of a source within it. This is important since, as shown in the literature and summarized also in this work, these factors could introduce a significant dosimetric effect that is currently ignored in clinical treatment planning. It is concluded that the implementation of the deterministic radiation transport option of the BRACHYVISION v. 8.8 system for 192Ir brachytherapy dosimetry in homogeneous water geometries yields results of comparable accuracy to the golden standard of Monte Carlo simulation, in clinically viable calculation times.

Gamma knife output factor measurements using VIP polymer gel dosimetry.

PURPOSE: Water equivalent polymer gel dosimeters and magnetic resonance imaging were employed to measure the output factors of the two smallest treatment fields available in a Gamma Knife model C radiosurgery unit, those formed employing the 4 and 8 mm final collimator helmets. METHODS: Three samples of the VIP normoxic gel formulation were prepared and irradiated so that a single shot of the field whose output factor is to be measured and a single shot of the reference 18 mm field were delivered in each one. Emphasis is given to the development and benchmarking of a refined data processing methodology of reduced uncertainty that fully exploits the 3D dose distributions registered in the dosimeters. RESULTS: Polymer gel results for the output factor of the 8 mm collimator helmet are found to be in close agreement with the corresponding value recommended by the vendor (0.955 +/- 0.007 versus 0.956, respectively). For the 4 mm collimator helmet, however, polymer gel results suggest an output factor 3% lower than the value recommended by the vendor (0.841 +/- 0.009 versus 0.870, respectively). CONCLUSIONS: A comparison with corresponding measurements published in the literature indicates that output factor results of this work are in agreement with those obtained using dosimetric systems which, besides fine spatial resolution and lack of angular and dose rate dependence of the dosimeter's response, share with polymer gels the favorable characteristic of minimal radiation field perturbation.

Dosimetric characterization of CyberKnife radiosurgical photon beams using polymer gels.

Dose distributions registered in water equivalent, polymer gel dosimeters were used to measure the output factors and off-axis profiles of the radiosurgical photon beams employed for CyberKnife radiosurgery. Corresponding measurements were also performed using a shielded silicon diode commonly employed for CyberKnife commissioning, the PinPoint ion chamber, and Gafchromic EBT films, for reasons of comparison. Polymer gel results of this work for the output factors of the 5, 7.5, and 10 mm diameter beams are (0.702 +/- 0.029), (0.872 +/- 0.039), and (0.929 +/- 0.041), respectively. Comparison of polymer gel and diode measurements shows that the latter overestimate output factors of the two small beams (5% for the 5 mm beam and 3% for the 7.5 mm beams). This is attributed to the nonwater equivalence of the high atomic number silicon material of the diode detector. On the other hand, the PinPoint chamber is found to underestimate output factors up to 10% for the 5 mm beam due to volume averaging effects. Polymer gel and EBT film output factor results are found in close agreement for all beam sizes, emphasizing the importance of water equivalence and fine detector sensitive volume for small field dosimetry. Relative off-axis profile results are in good agreement for all dosimeters used in this work, with noticeable differences observed only in the PinPoint estimate of the 80%-20% penumbra width, which is relatively overestimated.

On the use of high dose rate 192Ir and 169Yb sources with the MammoSite radiation therapy system.

Ample literature exists on the dose overestimation by commercially available treatment planning systems in MammoSite applications using high dose rate 192Ir sources for partial breast brachytherapy as monotherapy, due to their inability to predict the dose reduction caused by the radiographic contrast solution in the balloon catheter. In this work Monte Carlo simulation is used to verify the dose rate reduction in a balloon breast applicator which does not vary significantly with distance and it is 1.2% at the prescription distance for the reference simulated geometry of 10% diluted radiographic contrast media and 2.5 cm balloon radius. Based on these findings and the minimal hardening of the initially emitted photon spectrum for 192Ir, a simple analytical method is proposed and shown capable for correcting dosimetry planning in clinical applications. Simulations are also performed to assess the corresponding dose reduction in applications of balloon breast applicators using high dose rate 169Yb sources that have recently become available. Results yield a far more significant and distance dependent dose reduction for 169Yb (on the order of 20% at the prescription distance for the abovementioned reference simulation geometry). This dose reduction cannot be accounted for using simple analytical methods as for 192Ir due to the significant hardening of the initially emitted 169Yb photons within the diluted radiographic contrast media. Combined with results of previous works regarding the effect of altered scatter conditions (relative to treatment planning system assumptions) on breast treatment planning accuracy, which is more pronounced for 169Yb relative to 192Ir, these findings call for the amendment of dose treatment planning systems before using 169Yb high dose rate sources in balloon breast applicators.

On the use of high dose rate Ir192 and Yb169 sources with the MammoSite® radiation therapy system.

Ample literature exists on the dose overestimation by commercially available treatment planning systems in MammoSite® applications using high dose rate Ir192 sources for partial breast brachytherapy as monotherapy, due to their inability to predict the dose reduction caused by the radiographic contrast solution in the balloon catheter. In this work Monte Carlo simulation is used to verify the dose rate reduction in a balloon breast applicator which does not vary significantly with distance and it is 1.2% at the prescription distance for the reference simulated geometry of 10% diluted radiographic contrast media and 2.5cm balloon radius. Based on these findings and the minimal hardening of the initially emitted photon spectrum for Ir192, a simple analytical method is proposed and shown capable for correcting dosimetry planning in clinical applications. Simulations are also performed to assess the corresponding dose reduction in applications of balloon breast applicators using high dose rate Yb169 sources that have recently become available. Results yield a far more significant and distance dependent dose reduction for Yb169 (on the order of 20% at the prescription distance for the abovementioned reference simulation geometry). This dose reduction cannot be accounted for using simple analytical methods as for Ir192 due to the significant hardening of the initially emitted Yb169 photons within the diluted radiographic contrast media. Combined with results of previous works regarding the effect of altered scatter conditions (relative to treatment planning system assumptions) on breast treatment planning accuracy, which is more pronounced for Yb169 relative to Ir192, these findings call for the amendment of dose treatment planning systems before using Yb169 high dose rate sources in balloon breast applicators.

Comparison of radiation shielding requirements for HDR brachytherapy using 169Yb and 192Ir sources.

169Yb has received a renewed focus lately as an alternative to 192Ir sources for high dose rate (HDR) brachytherapy. Following the results of a recent work by our group which proved 169Yb to be a good candidate for HDR prostate brachytherapy, this work seeks to quantify the radiation shielding requirements for 169Yb HDR brachytherapy applications in comparison to the corresponding requirements for the current 192Ir HDR brachytherapy standard. Monte Carlo simulation (MC) is used to obtain 169Yb and 192Ir broad beam transmission data through lead and concrete. Results are fitted to an analytical equation which can be used to readily calculate the barrier thickness required to achieve a given dose rate reduction. Shielding requirements for a HDR brachytherapy treatment room facility are presented as a function of distance, occupancy, dose limit, and facility workload, using analytical calculations for both 169Yb and 192Ir HDR sources. The barrier thickness required for 169Yb is lower than that for 192Ir by a factor of 4-5 for lead and 1.5-2 for concrete. Regarding 169Yb HDR brachytherapy applications, the lead shielding requirements do not exceed 15 mm, even in highly conservative case scenarios. This allows for the construction of a lead door in most cases, thus avoiding the construction of a space consuming, specially designed maze. The effects of source structure, attenuation by the patient, and scatter conditions within an actual treatment room on the above-noted findings are also discussed using corresponding MC simulation results.

Polymer gel dosimetry for the TG-43 dosimetric characterization of a new 125I interstitial brachytherapy seed.

In this work, a polymer gel-magnetic resonance (MR) imaging method is employed for the dosimetric characterization of a new 125I low dose rate seed (IsoSeed model I25.S17). Two vials filled with PABIG gel were prepared in-house and one new seed as well as one commercially available 125I seed of similar dose rate and well-known dosimetric parameters (IsoSeed model I25.S06) were positioned in each vial. Both seeds in each vial were MR scanned simultaneously on days 11 and 26 after implantation. The data obtained from the known seed in each vial are used to calibrate the gel dose response which, for the prolonged irradiation duration necessitated by the investigated dose rates, depends on the overall irradiation time. Data for this study are presented according to the AAPM TG-43 dosimetric formalism. Polymer gel results concerning the new seed are compared to corresponding, published dosimetric results obtained, for the purpose of the new seed clinical implementation, by our group using the established methods of Monte Carlo (MC) simulation and thermo-luminescence dosimetry (TLD). Polymer gel dosimetry yields an average dose rate constant value of lambda = (0.921 +/- 0.031) cGy h(-1) U(-1) relative to (MC)lambda = (0.929 +/- 0.014) cGy h(-1) U(-1), (TLD)lambda = (0.951 +/- 0.044) cGy h(-1) U(-1) and the average value of Lambda = (0.940 +/- 0.051) cGy h(-1) U(-1) proposed for the clinical implementation of the new seed. Results for radial dose function, g(L)(r), and anisotropy function, F(r, theta), also agree with corresponding MC calculations within experimental uncertainties which are smaller for the polymer gel method compared to TLD. It is concluded that the proposed polymer gel-magnetic resonance imaging methodology could be used at least as a supplement to the established techniques for the dosimetric characterization of new low energy and low dose rate interstitial brachytherapy seeds.

Monte Carlo and thermoluminescence dosimetry of the new IsoSeed model I25.S17 125I interstitial brachytherapy seed.

Monte Carlo simulation and experimental thermoluminescence dosimetry were utilized for the dosimetric characterization of the new IsoSeed model I25.S17 125I interstitial brachytherapy seed. The new seed design is similar to that of the selectSeed and 6711 seeds, with the exception of its molybdenum marker. Full dosimetric data are presented following the recommendations in the Update of the AAPM Task Group 43 report (TG-43U1). A difference of 3.3% was found between Monte Carlo dose rate constant results calculated by air kerma strengths from simulations using a point detector and a detector resembling the solid angle subtended to the seed by the Wide Angle Free Air Chamber (WAFAC) in the primary standard calibration geometry. Following the TG-43U1 recommendations, an average value of lambdaMC = (0.929 +/- 0.014) cGy h(-1) U(-1) was adopted for the new seed. This value was then averaged with the measured value of lambdaEXP = (0.951 +/- 0.044) cGy h(-1) U(-1) to yield the proposed dose rate constant for the new seed that is equal to lambda = (0.940 +/- 0.051) cGy h(-1) U(-1). The Monte Carlo calculated radial dose function and two-dimensional (2-D) anisotropy function results for the new seed were found in agreement with experimental results to within statistical uncertainty of repeated measurements. Monte Carlo simulations were also performed for 125I seeds of similar geometry and dimensions for the purpose of comparison. The new seed presents dosimetric characteristics that are very similar to that of the selectSeed. In comparison to the most extensively studied Amersham 6711 seed, the new one presents similar dosimetric characteristics with a slightly reduced dose rate constant (1.5%).

An evaluation of the TSE MR sequence for time efficient data acquisition in polymer gel dosimetry of applications involving high doses and steep dose gradients.

The use of magnetic resonance imaging as a readout method for polymer gel dosimetry commonly involves long imaging sessions, particularly when high spatial resolution is required in all three dimensions, for the investigation of dose distributions with steep dose gradients and stringent dose delivery specifications. In this work, a volume selective turbo spin echo (TSE) pulse sequence is compared to the established Carr-Purcell-Meiboom-Gill (CPMG) multiecho acquisition with regard to providing accurate dosimetric results in significantly reduced imaging times. Polyethylene glycol diacrylate based (PABIG) gels were irradiated and subsequently scanned to obtain R2 relaxation rate measurements, using a CPMG multiecho sequence and a dual echo TSE utilizing an acceleration (turbo) factor of 64. R2 values, plotted against corresponding Monte Carlo dose calculations, provided calibration data of PABIG gels dose response over a wide dose range. A linear R2 versus dose relationship was demonstrated for both sequences with TSE results presenting reduced dose sensitivity. Although TSE data were found to deviate from linearity at lower doses compared to CPMG data, a relatively wide dynamic dose range of response extending up to approximately 100 Gy was observed for both sequences. The TSE and CPMG sequences were evaluated with a brachytherapy irradiation using a high dose rate 192Ir source and a gamma knife stereotactic radiosurgery irradiation with a single 4 mm collimator helmet shot. Dosimetric results obtained with the TSE and CPMG are shown to compare equally well with the expected dose distributions for these irradiations. The 60-fold scan time reduction achieved with TSE implies that this sequence could prove to be a useful tool for the introduction of polymer gel dosimetry in clinical radiation therapy applications involving high doses and steep dose gradients.

Polymer gel dosimetry close to an 125I interstitial brachytherapy seed.

Despite its advantages, the polymer gel-magnetic resonance imaging (MRI) method has not, as yet, been successfully employed in dosimetry of low energy/low dose rate photon-emitting brachytherapy sources such as 125I or 103Pd interstitial seeds. In the present work, two commercially available 125I seed sources, each of approximately 0.5 U, were positioned at two different locations of a polymer gel filled vial. The gel vial was MR scanned with the sources in place 19 and 36 days after seed implantation. Calibration curves were acquired from the coupling of MRI measurements with accurate Monte Carlo dose calculations obtained simulating the exact experimental setup geometry and materials. The obtained gel response data imply that while linearity of response is sustained, sensitivity (calibration curve slope) is significantly increased (approximately 60%) compared to its typical value for the 192Ir (or 60Co and 6 MV LINAC) photon energies. Water equivalence and relative energy response corrections of the gel cannot account for more than 3-4% of this increase, which, therefore, has to be mainly attributed to physicochemical processes related to the low dose rate of the sources and the associated prolonged irradiation time. The calibration data obtained from one 125I source were used to provide absolute dosimetry results for the other 125I source, which were found to agree with corresponding Monte Carlo calculations within experimental uncertainties. It is therefore suggested that, regardless of the underlying factors accounting for the gel dose response to 125I irradiations, polymer gel dosimetry of new 125I or 103Pd sources should be carried out as originally proposed by Heard and Ibbot (2004 J. Phys.: Conf. Ser. 3 221-3), i.e., by irradiating the same gel sample with the new low dose rate source, as well as with a well-characterized low dose rate source which will provide the dose calibration curve for the same irradiation conditions.

Three-dimensional dose verification of the clinical application of gamma knife stereotactic radiosurgery using polymer gel and MRI.

This work seeks to verify multi-shot clinical applications of stereotactic radiosurgery with a Leksell Gamma Knife model C unit employing a polymer gel-MRI based experimental procedure, which has already been shown to be capable of verifying the precision and accuracy of dose delivery in single-shot gamma knife applications. The treatment plan studied in the present work resembles a clinical treatment case of pituitary adenoma using four 8 mm and one 14 mm collimator helmet shots to deliver a prescription dose of 15 Gy to the 50% isodose line (30 Gy maximum dose). For the experimental dose verification of the treatment plan, the same criteria as those used in the clinical treatment planning evaluation were employed. These included comparison of measured and GammaPlan calculated data, in terms of percentage isodose contours on axial, coronal and sagittal planes, as well as 3D plan evaluation criteria such as dose-volume histograms for the target volume, target coverage and conformity indices. Measured percentage isodose contours compared favourably with calculated ones despite individual point fluctuations at low dose contours (e.g., 20%) mainly due to the effect of T2 measurement uncertainty on dose resolution. Dose-volume histogram data were also found in a good agreement while the experimental results for the percentage target coverage and conformity index were 94% and 1.17 relative to corresponding GammaPlan calculations of 96% and 1.12, respectively. Overall, polymer gel results verified the planned dose distribution within experimental uncertainties and uncertainty related to the digitization process of selected GammaPlan output data.

Dose verification of single shot gamma knife applications using VIPAR polymer gel and MRI.

This work describes an experimental procedure with potential to assess the overall accuracy associated with gamma knife clinical applications, from patient imaging and dosimetry planning to patient positioning and dose delivery using the automated positioning system of a Leksell Gamma Knife model C. The VIPAR polymer gel-MRI dosimetry method is employed due to its inherent three-dimensional feature and linear dose response over the range of gamma knife applications. Different polymer gel vials were irradiated with single shot gamma knife treatment plans using each of the four available collimator helmets to deliver a maximum dose of 30 Gy. Percentage relative dose results are presented not only in the form of one-dimensional profiles but also planar isocontours and isosurfaces in three dimensions. Experimental results are compared with corresponding Gammaplan treatment planning system calculations as well as acceptance test radiochromic film measurements. A good agreement, within the experimental uncertainty, is observed between measured and expected dose distributions. This experimental uncertainty is of the order of one imaging pixel in the MRI gel readout session (<1 mm) and allows for the verification of single shot gamma knife applications in terms of acceptance specifications for precision in beam alignment and accuracy. Averaging net R(2) results in the dose plateau of the 4 mm and 18 mm collimator irradiated gel vials, which were MR scanned in the same session, provides a crude estimate of the 4 mm output factor which agrees within errors with the default value of 0.870.

A dosimetric comparison of 169Yb versus 192Ir for HDR prostate brachytherapy.

For the purpose of evaluating the use of 169Yb for prostate High Dose Rate brachytherapy (HDR), a hypothetical 169Yb source is assumed with the exact same design of the new microSelectron source replacing the 192Ir active core by pure 169Yb metal. Monte Carlo simulation is employed for the full dosimetric characterization of both sources and results are compared following the AAPM TG-43 dosimetric formalism. Monte Carlo calculated dosimetry results are incorporated in a commercially available treatment planning system (SWIFT), which features an inverse treatment planning option based on a multiobjective dose optimization engine. The quality of prostate HDR brachytherapy using the real 192Ir and hypothetical 169Yb source is compared in a comprehensive analysis of different prostate implants in terms of the multiobjective dose optimization solutions as well as treatment quality indices such as Dose Volume Histograms (DVH) and the Conformal Index (COIN). Given that scattering overcompensates for absorption in intermediate photon energies and distances in the range of interest to prostate HDR brachytherapy, 169Yb proves at least equivalent to 192Ir irrespective of prostate volume. This has to be evaluated in view of the shielding requirements for the 169Yb energies that are minimal relative to that for 192Ir.

A monte carlo dosimetry study of vaginal 192Ir brachytherapy applications with a shielded cylindrical applicator set.

A durable recommendation for brachytherapy treatment planning systems to account for the effect of tissue, applicator and shielding material heterogeneities exists. As different proposed approaches have not been integrated in clinical treatment planning routine yet, currently utilized systems disregard or, most commonly, do not fully account for the aforementioned effects. Therefore, it is of interest to evaluate the efficacy of current treatment planning in clinical applications susceptible to errors due to heterogeneities. In this work the effect of the internal structure as well as the shielding used with a commercially available cylindrical shielded applicator set (Nucletron part # 084.320) for vaginal and rectum treatments is studied using three-dimensional Monte Carlo simulation for a clinical treatment plan involving seven source dwell positions of the classic microSelectron HDR 192Ir source. Results are compared to calculations of a treatment planning system (Plato BPS v.14.2.7), which assumes homogeneous water medium and applies a constant, multiplicative transmission factor only at points lying in the shadow of the shield. It is found that the internal structure of the applicator (which includes stainless steel, air and plastic materials) with no shield loaded does not affect the dose distribution relative to homogeneous water. In the unshielded side of the applicator with a 90 degrees, 180 degrees, or 270 degrees tungsten alloy shield loaded, an overestimation of treatment planning system calculations relative to Monte Carlo results was observed which is both shield and position dependent. While significant (up to 15%) at increased distances, which are not of major clinical importance, this overestimation does not affect dose prescription distances by more than 3%. The inverse effect of approx. 3% dose increase at dose prescription distances is observed for stainless steel shields. Regarding the shielded side of the applicator, it is shown that the default treatment planning system transmission factors for tungsten alloy result in a consistent dose over-estimation thus constituting a safe approach given the nature of associated clinical applications. Stainless steel is shown to be an ineffective shielding material with transmission factors reaching up to 0.68 at increased distances irrespective of shield geometry.

Polymer gel water equivalence and relative energy response with emphasis on low photon energy dosimetry in brachytherapy.

The water equivalence and stable relative energy response of polymer gel dosimeters are usually taken for granted in the relatively high x-ray energy range of external beam radiotherapy based on qualitative indices such as mass and electron density and effective atomic number. However, these favourable dosimetric characteristics are questionable in the energy range of interest to brachytherapy especially in the case of lower energy photon sources such as 103Pd and 125I that are currently utilized. In this work, six representative polymer gel formulations as well as the most commonly used experimental set-up of a LiF TLD detector-solid water phantom are discussed on the basis of mass attenuation and energy absorption coefficients calculated in the energy range of 10 keV-10 MeV with regard to their water equivalence as a phantom and detector material. The discussion is also supported by Monte Carlo simulation results. It is found that water equivalence of polymer gel dosimeters is sustained for photon energies down to about 60 keV and no corrections are needed for polymer gel dosimetry of 169Yb or 192Ir sources. For 125I and 103Pd sources, however, a correction that is source-distance dependent is required. Appropriate Monte Carlo results show that at the dosimetric reference distance of 1 cm from a source, these corrections are of the order of 3% for 125I and 2% for 103Pd. These have to be compared with corresponding corrections of up to 35% for 125I and 103Pd and up to 15% even for the 169Yb energies for the experimental set-up of the LiF TLD detector-solid water phantom.