Radio-Fluorogenic Gel Dosimetry with Coumarin.

Gel dosimeters are attractive detectors for radiation therapy, with properties similar to biological tissue and the potential to visualize volumetric dose distributions. Radio-fluorogenesis is the yield of fluorescent chemical products in response to energy deposition from ionizing radiation. This report shares the development of a novel radio-fluorogenic gel (RFG) dosimeter, gelatin infused with coumarin-3-carboxlyic acid (C3CA), for the quantification of imparted energy. Aqueous solutions exposed to ionizing radiation result in the production of hydroxyl free radicals through water radiolysis. Interactions between hydroxyl free radicals and coumarin-3-carboxylic acid produce a fluorescent product. 7-hydroxy-coumarin-3-carboxylic acid has a blue (445 nm) emission following ultra-violet (UV) to near UV (365⁻405 nm) excitation. Effects of C3CA concentration and pH buffers were investigated. The response of the RFG was explored with respect to strength, type, and exposure rate of high-energy radiation. Results show a linear dose response relationship independent of energy and type, with a dose-rate dependency. This report demonstrates increased photo-yield with high pH and the utility of gelatin-RFG for phantom studies of radiation dosimetry.

A comparison of HDR near source dosimetry using a treatment planning system, Monte Carlo simulation, and radiochromic film.

This study aimed to investigate the high-dose rate Iridium-192 brachytherapy, including near source dosimetry, of a catheter-based applicator from 0.5mm to 1cm along the transverse axis. Radiochromic film and Monte Carlo (MC) simulation were used to generate absolute dose for the catheter-based applicator. Results from radiochromic film and MC simulation were compared directly to the treatment planning system (TPS) based on the American Association of Physicists in Medicine Updated Task Group 43 (TG-43U1) dose calculation formalism. The difference between dose measured using radiochromic film along the transverse plane at 0.5mm from the surface and the predicted dose by the TPS was 24%±13%. The dose difference between the MC simulation along the transverse plane at 0.5mm from the surface and the predicted dose by the TPS was 22.1%±3%. For distances from 1.5mm to 1cm from the surface, radiochromic film and MC simulation agreed with TPS within an uncertainty of 3%. The TPS under-predicts the dose at the surface of the applicator, i.e., 0.5mm from the catheter surface, as compared to the measured and MC simulation predicted dose. MC simulation results demonstrated that 15% of this error is due to neglecting the beta particles and discrete electrons emanating from the sources and not considered by the TPS, and 7% of the difference was due to the photon alone, potentially due to the differences in MC dose modeling, photon spectrum, scoring techniques, and effect of the presence of the catheter and the air gap. Beyond 1mm from the surface, the TPS dose algorithm agrees with the experimental and MC data within 3%.

Measurement of low-energy backscatter factors using GAFCHROMIC film and OSLDs.

Some of the lowest voltages used in radiotherapy are termed Grenz and superficial X-rays of ~ 20 and ~ 100 kVp, respectively. Dosimetrically, the surface doses from these beams are calculated with the use of a free in-air air kerma measurement combined with a backscatter factor and the appropriate ratio of mass energy absorption coefficients from the measurement material to water. Alternative tools to the standard ion chamber for measuring the BSF are GAFCHROMIC EBT2 film and optically stimulated luminescent dosimeter (OSLD) crystals made from Al2O3. The scope of this project included making three different backscatter measurements with an Xstrahl-D3100 X-ray unit on the Grenz ray and superficial settings. These measurements were with OSLDs, GAFCHROMIC EBT2 film, and a PTW ionization chamber. The varied measurement methods allowed for intercomparison to determine the accuracy of the results. The ion chamber measurement was the least accurate, as expected from previous experimental findings. GAFCHROMIC EBT2 film proved to be a useful tool which gave reasonable results, and Landauer OSLDs showed good results for smaller field sizes and an increasing overresponse with larger fields. The specific backscatter factors for this machine demonstrated values about 5% higher than the universal values suggested by the AAPM and IPEMB codes of practice for the 100 kVp setting. The 20 kvp measured data from both techniques showed general agreement with those found in the BJR Supplement No. 10, indicating that this unit's Grenz ray spectrum is similar to those used in previous experimental work.

Analysis of peripheral doses for base of tongue treatment by linear accelerator and helical TomoTherapy IMRT.

The purpose of this study was to compare the peripheral doses to various organs from a typical head and neck intensity-modulated radiation therapy (IMRT) treatment delivered by linear accelerator (linac) and helical TomoTherapy. Multiple human CT data sets were used to segment critical structures and organs at risk, fused and adjusted to an anthropomorphic phantom. Eighteen contours were designated for thermoluminescent dosimeter (TLD) placement. Following the RTOG IMRT Protocol 0522, treatment of the primary tumor and involved nodes (PTV70) and subclinical disease sites (PTV56) was planned utilizing IMRT to 70Gy and 56 Gy. Clinically acceptable treatment plans were produced for linac and TomoTherapy treatments. TLDs were placed and each treatment plan was delivered to the anthropomorphic phantom four times. Within 2.5 cm (one helical TomoTherapy field width) superior and inferior to the field edges, normal tissue doses were on average 45% lower using linear accelerator. Beyond 2.5 cm, the helical TomoTherapy normal tissue dose was an average of 52% lower. The majority of points proved to be statistically different using the Student's t-test with p > 0.05. Using one method of calculation, probability of a secondary malignancy was 5.88% for the linear accelerator and 4.08% for helical TomoTherapy. Helical TomoTherapy delivers more dose than a linac immediately above and below the treatment field, contributing to the higher peripheral doses adjacent to the field. At distances beyond one field width (where leakage is dominant), helical TomoTherapy doses are lower than linear accelerator doses.

Respiratory motion effects on whole breast helical tomotherapy.

The effects of intrafraction respiratory motion on nonhelical intensity-modulated radiotherapy have been well addressed in the literature, both theoretically and experimentally. However, the consequences of respiratory motion on helical tomotherapy, for patient-specific treatment plans, are less well known. Parameters specific to this treatment modality such as pitch, gantry speed, and degree of modulation may play prominent roles in radiation delivery with respect to intrafraction respiratory motion. This phantom-based study specifically addressed the effects of intrafraction respiratory motion on whole breast helical tomotherapy. A device capable of driving an acrylic phantom with reproducible, one-dimensional, anterior-posterior motion resembling a sinusoid of 4.6 mm crest-trough amplitude was developed. A plan to irradiate the corner of an acrylic phantom using parameters typical of a whole breast helical tomotherapy technique was developed using the TomoTherapy Hi-Art-II System. The treatment was delivered to the phantom, with Kodak EDR2 film in the axial plane, for each of the following conditions: (i) phantom at 270 degrees initial sinusoidal phase and 12 cycles/min motion, (ii) phantom at 270 degrees initial sinusoidal phase and 18 cycles/min motion, and (iii)-(v) phantom at 18 cycles/min motion with 0 degrees, 90 degrees, and 180 degrees initial sinusoidal phases. A measure of technique reproducibility was also performed for several irradiations with the phantom static at 270 degrees initial sinusoidal phase. Films were processed using a Kodak MIN-R mammography film processor, scanned with a Vidar NXR-16 Dosimetry Pro scanner and analyzed with RIT113 v.4.2 software. Films were compared to a reference film irradiated under the conditions of no motion and 270 degrees sinusoidal phase. For all comparisons, 5% dose difference threshold, 3% dose difference and 2 mm distance-to-agreement gamma analysis, and isodose plots were generated. The results of this study show a small area of greater than 5% decrease in dose at the phantom's anterior surface and a 1.5-3 mm posterior-medial shift of isodose lines in the penumbral and apex regions of the PTV. Frequency and phase effects are apparent within the PTV where dose varies with high spatial frequency. As the reference film was produced by delivering the treatment plan to the phantom static and in the position corresponding to maximum expiration, results are representative of extreme deviations between planned and delivered dose with respect to sinusoidal motion of clinically relevant magnitudes and frequencies.

A Monte Carlo brachytherapy study for dose distribution prediction in an inhomogeneous medium.

The purpose of this study was to present a theoretical analysis of how the presence of bone in interstitial brachytherapy affects dose rate distributions. This study was carried out using a Monte Carlo simulation of the dose distribution in homogeneous medium for 3 commonly used brachytherapy seeds. The 3 seeds investigated in this study are iridium-192 (192Ir) iodine-125 (125I), and palladium-103 (103Pd). The computer code was validated by comparing the specific dose rate (Lambda), the radial dose function g(r), and anisotropy function F(r,theta;) for all 3 seeds with the AAPM TG-43 dosimetry formalism and current literature. The 192Ir seed resulted in a dose rate of 1.115 +/- 0.001 cGy-hr(-1)-U(-1), the 125I seed resulted in a dose rate of 0.965 +/- 0.006 cGy/h(-1)/U(-1), and the 103Pd seed resulted in a dose rate of 0.671 +/- 0.002 cGy/h(-1)/U(-1). The results for all 3 seeds are in good agreement with the AAPM TG-43 and current literature. The validated computer code was then applied to a simple inhomogeneous model to determine the effect bone has on dose distribution from an interstitial implant. The inhomogeneous model showed a decrease in dose rate of 2% for the 192Ir, an increase in dose rate of 84% for 125I, and an increase in dose rate of 83% for the 103Pd at the surface of the bone nearest to the source.

Vascular brachytherapy for hemodialysis vascular access dysfunction: exploring an unmet clinical need.

Hemodialysis vascular access dysfunction is a major cause of morbidity and hospitalization in the hemodialysis population (230,000 patients in the United States) at a cost of well over 1 billion dollars per annum. Venous stenosis and thrombosis (due to venous neointimal hyperplasia), is the most common cause of hemodialysis vascular access dysfunction. At the clinical level, this manifests in the form of a 50%, one-year primary patency for new grafts, and a dismal 40% 3-month survival for thrombosed grafts. However, despite the magnitude of the clinical problem, there are currently no effective therapies for this condition. We and others have previously demonstrated that venous neointimal hyperplasia in polytetrafluoroethylene (PTFE) dialysis grafts is composed of smooth muscle cells/myofibroblasts, a perigraft macrophage layer and microvessels within the venous neointima. Interestingly, there is strong experimental evidence which demonstrates that radiation therapy blocks the proliferation and activation of all these cell types. In addition, endovascular radiation therapy has already been successfully used to prevent restenosis following coronary angioplasty. The BRAVO trial is a randomized, multi-center, double-blind clinical trial of endovascular radiation in PTFE dialysis grafts, sponsored by the Novoste Corporation. This trial is particularly significant as it is the first large multi-center study that is focused on testing a novel local intervention in the specific setting of dialysis access dysfunction. The rationale behind this study, and its design and the logistics involved, will also be described in this review.

Monte Carlo calculations of dose distribution for intramural delivery of radioisotopes using a direct injection balloon catheter.

PURPOSE: A unique method of delivering radiation dose to the coronary vessel wall to prevent restenosis is by direct injection of radioactive compounds into the vessel wall using a specially designed angioplasty balloon catheter. The radiation dose distribution resulting from such intramural delivery was investigated using Monte Carlo simulations. MATERIALS AND METHODS: The radioisotope source distribution was modeled for two configurations within the vessel wall: (1) uniform to a depth of 0.5 mm and (2) confined to discrete pools surrounding the delivery injection ports. Monte Carlo MCNP4B computer simulations were utilized to estimate the associated radiation dose distribution for the following radioisotopes: 188Re, 186Re, 32P, 153Sm, 111In, 123I, and 99mTc. RESULTS: For the uniform case where the radioisotopes are distributed uniformly to the depth of 0.5 mm into the vessel wall, an essentially constant radiation dose is delivered within the source distribution. Outside of the source volume, the dose falls off at a rate depending on the emission properties of the particular radioisotope. The nonuniform case involving discrete pools of activity showed the dose distribution being confined largely to the regions surrounding the delivery ports with significant regions between these ports receiving very little dose. CONCLUSIONS: Direct injection of selected radioisotopes into the arterial wall appears to represent a potentially effective method for delivering radiation dose for the prevention of restenosis. Sufficiently high doses may be obtained from relatively low activity and the dose falls off rapidly outside of the target area for certain radioisotopes.

External beam radiation attenuates venous neointimal hyperplasia in a pig model of arteriovenous polytetrafluoroethylene (PTFE) graft stenosis.

PURPOSE: Hemodialysis vascular access dysfunction is an enormous clinical problem that causes great morbidity and costs well over one billion dollars per annum. The vast majority of hemodialysis vascular access dysfunction occurs as a result of venous stenosis and thrombosis at the graft-vein anastomosis. At a cellular level, this venous stenosis is the result of venous neointimal hyperplasia (VNH). There are, unfortunately, no effective therapies for VNH. The purpose of this study was to assess the role of external radiation therapy in preventing VNH and venous stenosis. METHODS AND MATERIALS: Seven-centimeter polytetrafluoroethylene loop grafts were placed bilaterally between the femoral artery and vein of 12 Yorkshire Cross pigs. One side was treated with a single 16-Gy dose of external beam radiation with a linear accelerator, while the contralateral side served as an internal control. Swine were killed after 28 days, and the grafts were carefully dissected out and removed. Neointimal hyperplasia and luminal stenosis were then assessed morphometrically at the graft-vessel anastomoses. RESULTS: External beam radiation therapy significantly reduced the amount of luminal stenosis at the graft-vein anastomosis, with minimal local and systemic toxicity. CONCLUSIONS: External beam radiation therapy could be a useful and clinically relevant local treatment for venous stenosis in polytetrafluoroethylene dialysis grafts.