DVH analysis using a transmission detector and model-based dose verification system as a comprehensive pretreatment QA tool for VMAT plans: Clinical experience and results.

PURPOSE: Dose volume histogram (DVH)-based analysis is utilized as a pretreatment quality assurance tool to determine clinical relevance from measured dose which is difficult in conventional gamma-based analysis. In this study, we report our clinical experience with an ionization-based transmission detector and model-based verification system, using DVH analysis, as a comprehensive pretreatment QA tool for complex volumetric modulated arc therapy plans. METHODS AND MATERIALS: Seventy-three subsequent treatment plans categorized into four clinical sites (Head and Neck, Thorax, Abdomen, and Pelvis) were evaluated. The average dose (Dmean ) and dose received by 1% (D1 ) of the planning target volumes (PTVs) and organs at risks (OARs) calculated using the treatment planning system (TPS) were compared to a computed (model-based) and reconstructed dose, from the measured fluence, using DVH analysis. The correlation between gamma (3% 3 mm) and DVH-based analysis for targets was evaluated. Furthermore, confidence and action limits for detector and verification systems were established. RESULTS: Linear regression confirmed an excellent correlation between TPS planned and computed dose using a model-based verification system (r2  = 1). The average percentage difference between TPS calculated and reconstructed dose for PTVs achieved using DVH analysis for each site is as follows: Head and Neck - 0.57 ± 2.8% (Dmean ) and 2.6 ± 2.7% (D1 ), Abdomen - 0.19 ± 2.8% and 1.64 ± 2.2%, Thorax - 0.24 ± 2.1% and 3.12 ± 2.8%, Pelvis 0.37 ± 2.4% and 1.16 ± 2.3%, respectively. The average percentage of passed gamma values achieved was above 95% for all cases. However, no correlation was observed between gamma passing rates and DVH difference (%) for PTVs (r2  = 0.11). The results demonstrate a confidence limit of 5% (Dmean and D1 ) for PTVs using DVH analysis for both computed and reconstructed dose distribution. CONCLUSION: DVH analysis of treatment plan using a model-based verification system and transmission detector provided useful information on clinical relevance for all cases and could be used as a comprehensive pretreatment patient-specific QA tool.

Iron-based radiochromic systems for UV dosimetry applications.

Phototherapy treatment using ultraviolet (UV) A and B light sources has long existed as a treatment option for various skin conditions. Quality control for phototherapy treatment recommended by the British Association of Dermatologists and British Photodermatology Group generally focused on instrumentation-based dosimetry measurements. The purpose of this study was to present an alternative, easily prepared dosimeter system for the measurement of UV dose and as a simple quality assurance technique for phototherapy treatments. Five different UVA-sensitive radiochromic dosimeter formulations were investigated and responded with a measurable and visible optical change both in solution and in gel form. Iron(III) reduction reaction formulations were found to be more sensitive to UVA compared to iron(II) oxidation formulations. One iron(III) reduction formulation was found to be especially promising due to its sensitivity to UVA dose, ease of production, and linear response up to a saturation point.

Quantitative 3D Determination of Radiosensitization by Bismuth-Based Nanoparticles.

The nanoparticle-induced dose enhancement effect has been shown to improve the therapeutic efficacy of ionizing radiation in external beam radiotherapy. Whereas previous studies have focused on gold nanoparticles (AuNPs), no quantitative studies have been conducted to investigate the potential superiority of other high atomic number (Z) nanomaterials such as bismuth-based nanoparticles. The aims of this study were to experimentally validate and quantify the dose enhancement properties of commercially available bismuth-based nanoparticles (bismuth oxide (Bi2O3-NPs) and bismuth sulfide (Bi2S3-NPs)), and investigate their potential superiority over AuNPs in terms of radiation dose enhancement. Phantom cuvettes doped with and without nanoparticles where employed for measuring radiation dose enhancement produced from the interaction of radiation with metal nanoparticles. Novel 3D phantoms were employed to investigate the 3D spatial distribution of ionising radiation dose deposition. The phantoms were irradiated with kilovoltage and megavoltage X-ray beams and optical absorption changes were measured using a spectrophotometer and optical CT scanner. The radiation dose enhancement factors (DEFs) obtained for 50 nm diameter Bi2O3-NPs and AuNPs were 1.90 and 1.77, respectively, for 100 kV energy and a nanoparticle concentration of 0.5 mM. In addition, the DEFs of 5 nm diameter Bi2S3-NPs and AuNPs were determined to be 1.38 and 1.51, respectively, for 150 kV energy and a nanoparticle concentration of 0.25 mM. The results demonstrate that both bismuth-based nanoparticles can enhance the effects of radiation. For 6 MV energy the DEFs for all the investigated nanoparticles were lower (< 15%) than with kilovoltage energy.

Feasibility of hydrogel fiducial markers for in vivo proton range verification using PET.

Biocompatible/biodegradable hydrogel polymers were immersed in 18O-enriched water and 16O-water to create 18O-water hydrogels and 16O-water hydrogels. In both cases, the hydrogels were made of ~91 wt% water and ~9 wt% polymer. In addition, 5-8 µm Zn powder was suspended in 16O-water and 18O-enriched water and cross-linked with hydrogel polymers to create Zn/16O-water hydrogels (30/70 wt%, ~9 wt% polymer) and Zn/18O-water hydrogels (10/90 wt%), respectively. A block of extra-firm 'wet' tofu (12.3 × 8.8 × 4.9 cm, ρ ≈ 1.05 g cm−3) immersed in water was injected with Zn/16O-water hydrogels (0.9 ml each) at four different depths using an 18-gauge needle. Similarly, Zn/18O-water hydrogels (0.9 ml) were injected into a second tofu phantom. As a reference, both 16O-water hydrogels (1.8 ml) and 18O-water hydrogels (0.9 ml) in Petri dishes were irradiated in a 'dry' environment. The hydrogels in the wet tofu phantoms and dry Petri dishes were scanned via CT and images were used for treatment planning. Then, they were positioned at the proton distal dose fall-off region and irradiated (2 Gy) followed by PET/CT imaging.Notably high PET signals were observed only in 18O-water hydrogels in the dry environment. The visibility of the Zn/16O-water hydrogels injected into the tofu phantom was outstanding in CT images, but these hydrogels provided no noticeable PET signals. The visibility of the Zn/18O-water hydrogels in the wet tofu were excellent on CT and moderate on PET; however, the PET signals were weaker than those in the dry environment, possibly owing to 18O-water leaching out. The hydrogel markers studied here could be used to develop universal PET/CT fiducial markers. Their PET visibility (attributed more to activated 18O-water than Zn) after proton irradiation can be used for proton therapy/range verification. More investigation is needed to slow down the leaching of 18O-water.

Experimental determination of the influence of oxygen on the PRESAGE® dosimeter.

It is generally accepted that the PRESAGE(®) radiochromic dosimeter is not sensitive to oxygen, however, this claim has not been supported or verified experimentally. Therefore, the aim of this study was to experimentally determine the potential influence of oxygen on dose sensitivity of the PRESAGE(®) dosimeter and its reporting system. Batches of PRESAGE(®) and its radical initiator-leuco dye reporting system were prepared in aerobic and anaerobic conditions. The anaerobic batches were deoxygenated by bubbling nitrogen through the dosimeter precursors or reporting system for 10 min. The dosimeters and reporting systems were prepared in spectrophotometric cuvettes and glass vials, respectively, and were irradiated with 6 MV photons to various radiation doses. Changes in optical density of the dosimeters and reporting system before and after irradiation were measured using a spectrophotometer. The overall results show that oxygen has some influence on the dosimetric characteristics of PRESAGE(®), although the radical initiator does appear to oxidize the leucomalachite green even in the presence of oxygen. Deoxygenation of the reporting system leads to an increase in sensitivity to radiation dose by ~30% when compared to the non-deoxygenated system. A minor increase in sensitivity (~5%) was also achieved by deoxygenating the PRESAGE(®) precursor prior to casting. In addition, dissolved oxygen measurements revealed low levels of dissolved oxygen (0.40 ± 0.04 mg l(-1)) in the polyurethane precursor used to fabricate the PRESAGE(®) dosimeters, as compared to water (8.60 ± 0.03 mg l(-1)) and the reporting system alone (1.30 ± 0.10 mg l(-1)). The results suggest that the presence of oxygen does not inhibit the radiochromic properties of the PRESAGE(®) system. However, deoxygenation of the dosimeter precursors prior to casting improves the dosimeters dose sensitivity by ~5%, which might be particularly useful for measuring low radiation doses. Nevertheless, we believe this is not sufficient enough to recommend the deoxygenation of commercial PRESAGE(®) precursor prior to casting. In addition, there were no observed changes in the dose linearity, absorption spectrum and post-response photofading characteristics of the PRESAGE(®) under the conditions investigated.

Dose variations caused by setup errors in intracranial stereotactic radiotherapy: a PRESAGE study.

Stereotactic radiotherapy (SRT) requires tight margins around the tumor, thus producing a steep dose gradient between the tumor and the surrounding healthy tissue. Any setup errors might become clinically significant. To date, no study has been performed to evaluate the dosimetric variations caused by setup errors with a 3-dimensional dosimeter, the PRESAGE. This research aimed to evaluate the potential effect that setup errors have on the dose distribution of intracranial SRT. Computed tomography (CT) simulation of a CIRS radiosurgery head phantom was performed with 1.25-mm slice thickness. An ideal treatment plan was generated using Brainlab iPlan. A PRESAGE was made for every treatment with and without errors. A prescan using the optical CT scanner was carried out. Before treatment, the phantom was imaged using Brainlab ExacTrac. Actual radiotherapy treatments with and without errors were carried out with the Novalis treatment machine. Postscan was performed with an optical CT scanner to analyze the dose irradiation. The dose variation between treatments with and without errors was determined using a 3-dimensional gamma analysis. Errors are clinically insignificant when the passing ratio of the gamma analysis is 95% and above. Errors were clinically significant when the setup errors exceeded a 0.7-mm translation and a 0.5° rotation. The results showed that a 3-mm translation shift in the superior-inferior (SI), right-left (RL), and anterior-posterior (AP) directions and 2° couch rotation produced a passing ratio of 53.1%. Translational and rotational errors of 1.5mm and 1°, respectively, generated a passing ratio of 62.2%. Translation shift of 0.7mm in the directions of SI, RL, and AP and a 0.5° couch rotation produced a passing ratio of 96.2%. Preventing the occurrences of setup errors in intracranial SRT treatment is extremely important as errors greater than 0.7mm and 0.5° alter the dose distribution. The geometrical displacements affect dose delivery to the tumor and the surrounding normal tissues.

Novel multicompartment 3-dimensional radiochromic radiation dosimeters for nanoparticle-enhanced radiation therapy dosimetry.

PURPOSE: Gold nanoparticles (AuNps), because of their high atomic number (Z), have been demonstrated to absorb low-energy X-rays preferentially, compared with tissue, and may be used to achieve localized radiation dose enhancement in tumors. The purpose of this study is to introduce the first example of a novel multicompartment radiochromic radiation dosimeter and to demonstrate its applicability for 3-dimensional (3D) dosimetry of nanoparticle-enhanced radiation therapy. METHODS AND MATERIALS: A novel multicompartment phantom radiochromic dosimeter was developed. It was designed and formulated to mimic a tumor loaded with AuNps (50 nm in diameter) at a concentration of 0.5 mM, surrounded by normal tissues. The novel dosimeter is referred to as the Sensitivity Modulated Advanced Radiation Therapy (SMART) dosimeter. The dosimeters were irradiated with 100-kV and 6-MV X-ray energies. Dose enhancement produced from the interaction of X-rays with AuNps was calculated using spectrophotometric and cone-beam optical computed tomography scanning by quantitatively comparing the change in optical density and 3D datasets of the dosimetric measurements between the tissue-equivalent (TE) and TE/AuNps compartments. The interbatch and intrabatch variability and the postresponse stability of the dosimeters with AuNps were also assessed. RESULTS: Radiation dose enhancement factors of 1.77 and 1.11 were obtained using 100-kV and 6-MV X-ray energies, respectively. The results of this study are in good agreement with previous observations; however, for the first time we provide direct experimental confirmation and 3D visualization of the radiosensitization effect of AuNps. The dosimeters with AuNps showed small (<3.5%) interbatch variability and negligible (<0.5%) intrabatch variability. CONCLUSIONS: The SMART dosimeter yields experimental insights concerning the spatial distributions and elevated dose in nanoparticle-enhanced radiation therapy, which cannot be performed using any of the current methods. The authors concluded that it can be used as a novel independent method for nanoparticle-enhanced radiation therapy dosimetry.