Positions of radiation isocenter and the couch rotation center established by Winston-Lutz and optical measurements.

PURPOSE: To compare x-ray and optical imaging methods for measuring the relative position of radiation isocenter and couch rotation center. To show the impact of radiation isocenter size and target motion on the margins for target contours. METHODS: Winston-Lutz measurements are made using EPID images. Image analysis was done with public domain software, ImageJ, and spreadsheets written in Microsoft Excel. A comparison between the center of a high density test object and center of the MLC collimated beam is used to judge the relative position of the radiation isocenter in space for gantry and couch rotation. Additionally, motion of the target with couch rotation is determined with an optical imaging system. Five different accelerators, two TrueBeams, a Trilogy, and two VersaHDs, were assessed by Winston-Lutz and optical methods. RESULTS: The shift in the radiation isocenter with gantry rotation is found to be a tri-axial ellipsoid. Shifts in the target position with respect to radiation isocenter with couch rotation were between 0.4 and 0.6 mm. The Winston-Lutz and optical method determination of couch rotation center agreed within measurement uncertainty. CONCLUSIONS: Image analysis yields precise data on linear accelerator radiation isocenter and rotation centers of the couch. The Winston-Lutz and optical methods agreed within measurement uncertainty.

Evaluation of Dose Accuracy in the Near-Surface Region for Whole Breast Irradiation Techniques in a Multi-institutional Consortium.

PURPOSE: To assess the accuracy of dose calculations in the near-surface region for different treatment planning systems (TPSs), treatment techniques, and energies to improve clinical decisions for patients receiving whole breast irradiation (WBI). METHODS AND MATERIALS: A portable custom breast phantom was designed for dose measurements in the near-surface regions. Treatment plans of varying complexities were created at 8 institutions using 4 different TPSs on an anonymized patient data set (50 Gy in 25 fractions) and peer reviewed by participants. The plans were recalculated on the phantom data set. The phantom was aligned with predetermined shifts and laser marks or cone beam computed tomography, and the irradiation was performed using a variety of linear accelerators at the participating institutions. Dose was measured with radiochromic film placed at 0.5 and 1.0 cm depth and 3 locations per depth within the phantom. The film was scanned and analyzed >24 hours postirradiation. RESULTS: The percentage difference between the mean of the measured and calculated dose across the participating centers was -0.2 % ± 2.9%, with 95% of measurements within 6% agreement. No significant differences were found between the mean of the calculated and measured dose for all TPSs, treatment techniques, and energies at all depths and laterality investigated. Furthermore, no significant differences were observed between the mean of measured dose and the prescription dose of 2 Gy per fraction. CONCLUSION: These results demonstrate that dose calculations for clinically relevant WBI plans are accurate to within 6% of measurements in the near-surface region for various complexities, TPSs, linear accelerators, and beam energies. This work lays the necessary foundation for future studies investigating the correlation between near-surface dose and acute skin toxicities.

Optically stimulated luminescent dosimeters stable response to dose after repeated bleaching.

PURPOSE: To investigate the dose response of optically stimulated luminescent dosimeters (OSLDs), and how this response changes with repeated use, increased accumulated dose, and bleaching light with or without a UV component. To devise a method to stabilize dose response characteristics of OSLDs that are used repeatedly. To decrease measurement uncertainty. METHODS: Optically stimulated luminescent dosimeters irradiations were made using a linear accelerator and Ir-192. The OSLDs (InLight nanoDots) dose response was characterized for these various irradiations under the batch, single use, method and the repeated irradiation method. Some nanoDots were preirradiated with hundreds of Gray of dose with Ir-192 gamma rays. Repeated use OSLDs were bleached with lights that had different UV content. A special bleaching light was fabricated and used that had the same spectrum as the light in the OSLD reader. RESULTS: New, never irradiated, nanoDots had their characteristics altered by illumination with bleaching light that had a UV component. Each new nanoDot had unique sensitivity to dose as well as a unique linearity factor, which was supra-linear. NanoDots that were irradiated and bleached repeatedly had changes in low and high dose sensitivity that was altered if the bleaching light had UV in its spectrum. For nanoDots that have been preirradiated with up to 1500 Gy of dose, their dose response was supra-linear for bleaching light without UV content and infra-linear for light with UV content. Preirradiated nanoDots that were bleached with light without UV content had stable dose sensitivity (±1.5%), stable linearity factor (±3.5%) for over 10 bleaching cycles, nonlinear response that was quadratic in dose, and dose measurement uncertainty of ±1.4% for 277 measurements. CONCLUSIONS: The UV component in bleaching light has an impact on the dose sensitivity characteristics shown by new or repeatedly irradiated nanoDots. Each new nanoDot has a unique sensitivity to dose as well as a unique linearity factor, which was supra-linear. As nanoDots accumulate dose with repeated use they change sensitivity to low and high dose very differently based on the UV content of the bleaching light. For nanoDots that have been preirradiated with hundreds of Gray of dose their dose response was supra-linear for bleaching light without UV content and infra-linear for light that has UV content. NanoDots can be used repeatedly and have stable dose response characteristics if they are preirradiated and bleached with light without UV content. Dose can be measured with an uncertainty of 1.4%, which is a threefold reduction of the uncertainty found with the single use batch method recommended by the manufacturer.

PIN diodes for radiation therapy use: Their construction, characterization, and implementation.

PURPOSE: Development and implementation of a PIN diode measurement system that can measure dose on the surface of a patient, which can be compared to dose calculated by a treatment planning system. Measurements are to be possible for static or rotational photon beams and electrons. Simple calibration procedures are to be devised that require a minimum set of correction factors. METHODS: Readily available PIN type photodiodes are fabricated into devices that can be used for detection of ionizing radiation. Single or dual PIN diodes are soldered onto flexible shielded cables for static and rotational irradiation use. Diode signals are measured with an electrometer with zero input bias voltage. Diode temperature is determined by operating it as a thermistor. Linac photon and electron dose is measured. A commercial treatment planning system is used for calculating dose expected in various test geometries. RESULTS: The scanning and surface diodes have an intrinsic buildup of 0.3 mm water equivalence and the IMRT device a buildup of 1.5 mm. Correction factors are determined for changes in diode sensitivity with the following factors: dose-per-pulse, dose rate, angle of radiation incidence, temperature, and field size. The surface or IMRT diode detector measurements agree within 1.0% with Eclipse calculations. CONCLUSIONS: Clinically useable dose detection devices can be fabricated from PIN type photodiodes. These diodes are used to measure dose at the surface of a patient or under bolus. Correction factors are unnecessary if a surface or IMRT type device is chosen for use with static orthogonal or rotational IMRT delivered beams, respectively.

Angular dependence of dose sensitivity of nanoDot optically stimulated luminescent dosimeters in different radiation geometries.

PURPOSE: A type of in vivo dosimeter, an optically stimulated luminescent dosimeter, OSLD, may have dose sensitivity that depends on the angle of incidence of radiation. This work measures how angular dependence of a nanoDot changes with the geometry of the phantom in which irradiation occurs and with the intrinsic structure of the nanoDot. METHODS: The OSLDs used in this work were nanoDot dosimeters (Landauer, Inc., Glenwood, IL), which were read with a MicroStar reader (Landauer, Inc., Glenwood, IL). Dose to the OSLDs was delivered by 6 MV x-rays. NanoDots with various intrinsic sensitivities were irradiated in numerous phantoms that had geometric shapes of cylinders, rectangles, and a cube. RESULTS: No angular dependence was seen in cylindrical phantoms, cubic phantoms, or rectangular phantoms with a thickness to width ratio of 0.3 or 1.5. An angular dependence of 1% was observed in rectangular phantoms with a thickness to width of 0.433-0.633. A group of nanoDots had sensitive layers with mass density of 2.42-2.58 g/cm(3) and relative sensitivity of 0.92-1.09 and no difference in their angular dependence. Within experimental uncertainty, nanoDot measurements agree with a parallel-plate ion chamber at a depth of maximum dose. CONCLUSIONS: When irradiated in cylindrical, rectangular, and cubic phantoms, nanoDots show a maximum angular dependence of 1% or less at an incidence angle of 90°. For a sample of 78 new nanoDots, the range of their relative intrinsic sensitivity is 0.92-1.09. For a sample of ten nanoDots, on average, the mass in the sensitive layer is 73.1% Al2O3:C and 26.9% polyester. The mass density of the sensitive layer of a nanoDot disc is between 2.42 and 2.58 g/cm(3). The angular dependence is not related to Al2O3:C loading of the nanoDot disc. The nanoDot at the depth of maximum dose has no more angular dependence than a parallel-plate ion chamber.

Quality assurance measurements for high-dose-rate brachytherapy without film.

The purpose of this study was to develop new and modified tools that allow HDR brachytherapy quality assurance tests to be carried out efficiently without film, video cameras, stopwatches, and mechanical rulers; and to devise methods that use these new tools for daily and quarterly check procedures, which are efficient and provide increased accuracy compared to previous methods. The HDR brachytherapy system tested was the GammaMedplus iX, Ir-192 HDR. Various catheters and treatment applicators designed for this system were tested. To measure the absolute position of the source, a simple tool was built that uses a Plexiglas frame, a template for applicator positioning, and a diode for radiation detection. For daily reproducibility and source strength tests, modifications were made of a Model 70008, HDR brachytherapy Ir-192 quality assurance tool, which is used with the HDR-1000-Plus well-type reentrant chamber. Measurement procedures and analysis protocols were developed that use the Microsoft Excel spreadsheet program. Independent determination of source positions was made with a computer video camera and radiochromic film. Using the new tool, for a straight catheter the measured source position is found to be within ± 0.1 mm of the mechanically set distance, for a ring applicator ± 0.3 mm, for a tandem ± 0.2 mm, and for an ovoid ± 0.2 mm. Using the modified insert, daily dwell position can be determined with an accuracy of 0.3 mm and timer accuracy can be determined with an accuracy of 0.3% over a 20 s time frame. The time needed to carry out quarterly tests is estimated to be reduced by two- to four-fold compared to previous methods. New and modified equipment and procedures have been developed for measuring HDR brachytherapy dwell position and dwell times efficiently with high accuracy. The equipment described in this work can be built and modifications can be made in most clinics. Location of dwell position can be determined in straight catheters and ring and ovoid applicators. Timer linearity and accuracy can be determined. Source strength can be confirmed. Measurement efficiency is improved compared to previous methods that used film, video cameras, mechanical rulers, and stopwatches.

In vivo measurements for high dose rate brachytherapy with optically stimulated luminescent dosimeters.

PURPOSE: To show the feasibility of clinical implementation of OSLDs for high dose-rate (HDR) in vivo dosimetry for gynecological and breast patients. To discuss how the OSLDs were characterized for an Ir-192 source, taking into account low gamma energy and high dose gradients. To describe differences caused by the dose calculation formalism of treatment planning systems. METHODS: OSLD irradiations were made using the GammaMedplus iX Ir-192 HDR, Varian Medical Systems, Milpitas, CA. BrachyVision versions 8.9 and 10.0, Varian Medical Systems, Milpitas, CA, were used for calculations. Version 8.9 used the TG-43 algorithm and version 10.0 used the Acuros algorithm. The OSLDs (InLight Nanodots) were characterized for Ir-192. Various phantoms were created to assess calculated and measured doses and the angular dependence and self-absorption of the Nanodots. Following successful phantom measurements, patient measurements for gynecological patients and breast cancer patients were made and compared to calculated doses. RESULTS: The OSLD sensitivity to Ir-192 compared to 6 MV is between 1.10 and 1.25, is unique to each detector, and changes with accumulated dose. The measured doses were compared to those predicted by the treatment planning system and found to be in agreement for the gynecological patients to within measurement uncertainty. The range of differences between the measured and Acuros calculated doses was -10%-14%. For the breast patients, there was a discrepancy of -4.4% to +6.5% between the measured and calculated doses at the skin surface when the Acuros algorithm was used. These differences were within experimental uncertainty due to (random) error in the location of the detector with respect to the treatment catheter. CONCLUSIONS: OSLDs can be successfully used for HDR in vivo dosimetry. However, for the measurements to be meaningful one must account for the angular dependence, volume-averaging, and the greater sensitivity to Ir-192 gamma rays than to 6 MV x-rays if 6 MV x-rays were used for OSLD calibration. The limitations of the treatment planning algorithm must be understood, especially for surface dose measurements. Use of in vivo dosimetry for HDR brachytherapy treatments is feasible and has the potential to detect and prevent gross errors. In vivo HDR brachytherapy should be included as part of the QA for a HDR brachytherapy program.

Dependence of diode sensitivity on the pulse rate of delivered radiation.

PURPOSE: It has been reported that diode sensitivity decreases by as much as 2% when the average dose rate set at the accelerator console was decreased from 600 to 40 MU∕min. No explanation was given for this effect in earlier publications. This work is a detailed investigation of this phenomenon: the change of diode sensitivity versus the rate of delivery of dose pulses in the milliseconds and seconds range. METHODS: X-ray beams used in this work had nominal energies of 6 and 15 MV and were generated by linear accelerators. The average dose rate was varied from 25 to 600 MU∕min, which corresponded to time between microsecond-long dose pulses of 60-2.7 ms, respectively. The dose-per-pulse, dpp, was changed by positioning the detector at different source-to-detector distance. A variety of diodes fabricated by a number of manufacturers were tested in this work. Also, diodes in three different MapCHECKs (Sun Nuclear, Melbourne, FL) were tested. RESULTS: For all diodes tested, the diode sensitivity decreases as the average dose rate is decreased, which corresponds to an increase in the pulse period, the time between radiation pulses. A sensitivity decrease as large as 5% is observed for a 60-ms pulse period. The diode sensitivity versus the pulse period is modeled by an empirical exponential function. This function has a fitting parameter, t(eff), defined as the effective lifetime. The values of t(eff) were found to be 1.0-14 s, among the various diodes. For all diodes tested, t(eff) decreases as the dpp decreases and is greater for 15 MV than for 6 MV x rays. The decrease in diode sensitivity after 20 s without radiation can be reversed by as few as 60 radiation pulses. CONCLUSIONS: A decrease in diode sensitivity occurs with a decrease in the average dose rate, which corresponds to an increase in the pulse period of radiation. The sensitivity decrease is modeled by an empirical exponential function that decreases with an effective lifetime, t(eff), of 1.0-14 s. t(eff) varies widely for different diodes, dpp, and x-ray energy. It is hypothesized that the capture of excess minority carriers by charge traps, cause the observed decrease in diode sensitivity. Also, it is hypothesized that the slow reopening of these traps occurs in the hundreds of milliseconds to seconds range at ambient temperature and this underlies the slow decrease in the diode sensitivity. Calibration of a diode is best done at the average dose rate with which it will be used. This is easily accomplished for radiation deliveries in which the average dose rate is a constant. However, for a VMAT delivery the average dose rate is a variable. For measurements made under these conditions diodes can be calibrated with a median or average dose rate which splits the difference in diode sensitivity that is known to occur with changes in average dose rate.

In vivo dosimetry with optically stimulated luminescent dosimeters, OSLDs, compared to diodes; the effects of buildup cap thickness and fabrication material.

PURPOSE: For external beam in vivo measurements, the dosimeter is normally placed on the patient's skin, and the dose to a point of interest inside the patient is derived from surface measurements. In order to obtain accurate and reliable measurements, which correlate with the dose values predicted by a treatment planning system, a dosimeter needs to be at a point of electronic equilibrium. This equilibrium is accomplished by adding material (buildup) above the detector. This paper examines the use of buildup caps in a clinical setting for two common detector types: OSLDs and diodes. Clinically built buildup-caps and commercially available hemispherical caps are investigated. The effects of buildup cap thickness and fabrication material on field-size correction factors, C(FS), are reported, and differences between the effects of thickness and fabrication material are explained based on physical parameters. METHODS: Measurements are made on solid water phantoms for 6 and 15 MV x-ray beams. Two types of dosimeters are used: OSLDs, InLight∕OSL Nanodot dosimeters (Landauer, Inc., Glenwood, IL) and a P-type surface diode (Standard Imaging, Madison, WI). Buildup caps for these detectors were fabricated out of M3, a water-equivalent material, and sheet-metal stock of Al, Cu, and Pb. Also, commercially available hemispherical buildup caps made of plastic water and brass (Landauer, Inc., Glenwood, IL) were used with Nanodots. OSLDs were read with an InLight microStar reader (Landauer, Inc., Glenwood, IL). Dose calculations were carried out with the XiO treatment planning system (CMS∕Elekta, Stockholm) with tissue heterogeneity corrections. RESULTS: For OSLDs and diodes, when measurements are made with no buildup cap a change in C(FS) of 200% occurs for a field-size change from 3 cm × 3 cm to 30 cm × 30 cm. The change in C(FS) is reduced to about 4% when a buildup cap with wall thickness equal to the depth of maximum dose is used. Buildup caps with larger wall thickness do not cause further reduction in C(FS). The buildup cap fabrication material has little or no effect on C(FS). The perturbation to the delivered dose caused by placing a detector with a buildup cap on the surface of a patient is measured to be 4%-7%. A comparison between calculated dose and dose measured with a Nanodot and a diode for 6 and 15 MV x-rays is made. When C(FS) factors are carefully determined and applied to measurements made on a phantom, the differences between measured and calculated doses were found to be between ±1.3%. CONCLUSIONS: OSLDs and diodes with appropriate buildup caps can be used to measure dose on the surface of a patient and predict the delivered dose to depth dmax in a range of ±1.3% for 100 cGy. The buildup cap: can be fabricated from any material examined in this work, is best with wall thickness dmax, and causes a perturbation to the delivered dose of 4%-7% when the wall thickness is dmax. OSLDs and diodes with buildup caps can both give accurate measurements of delivered dose.

MapCHECK used for rotational IMRT measurements: step-and-shoot, TomoTherapy, RapidArc.

PURPOSE: To measure patient-specific-QA dose distributions with a 2D array of diodes, the MapCHECK, for the dose delivered, with step-and-shoot and rotational IMRT. METHODS: Two MapCHECKs were used that had different styles of diode connection. These MapCHECKs were used in their original manufactured configuration and in a modified configuration. The modification made in the clinic consists of filling air gaps with sheets of Lucite that had custom-machined slots for the diodes and by adding pieces of copper to offset the intrinsic asymmetry of the diodes. The MapCHECKs were housed in a tight-fitting phantom fabricated from solid water. Measurements were made on IMRT treatment plans delivered with Varian linear accelerators with step-and-shoot and RapidArc methods, and a TomoTherapy machine with helical delivery. Patient plans and QA plans were developed with the XiO, Eclipse, and TomoTherapy planning systems. All MapCHECK data were analyzed with its commercially available software. RESULTS: Kilovoltage CT imaging of the MapCHECK in its phantom has streak artifacts from high atomic number components. These artifacts must be corrected in order to obtain accurate calculation of dose. The original MapCHECK is found to have an angular dependence of +/- 20%. A modification of the MapCHECK has been made that reduces the angular dependence to +/- 2%. Proper compensation for attenuation by the treatment couch is also necessary for accurate results. The modified MapCHECK has been successfully used for doing patient-specific QA for IMRT treatments delivered with step-and-shoot, TomoTherapy, and RapidArc methods. Treatment plans that require large amounts of fluence from the 90 degrees and 270 degrees directions have significantly better QA measurements when made with modified MapCHECKs. CONCLUSIONS: When properly modified, the MapCHECK response becomes isotropic. It can then be used for patient-specific QA measurements for IMRT treatments delivered with step-and-shoot and rotational techniques such as helical Tomotherapy and RapidArc.

Changes in optically stimulated luminescent dosimeter (OSLD) dosimetric characteristics with accumulated dose.

PURPOSE: A new type of in vivo dosimeter, an optically stimulated luminescent dosimeter (OSLD), has now become commercially available for clinical use. The OSLD is a plastic disk infused with aluminum oxide doped with carbon (Al2O3:C). Crystals of Al2O3:C, when exposed to ionizing radiation, store energy that is released as luminescence (420 nm) when the OSLD is illuminated with stimulation light (540 nm). The intensity of the luminescence depends on the dose absorbed by the OSLD and the intensity of the stimulation light. The effects of accumulated dose on OSLD response were investigated. METHODS: The OSLDs used in this work were nanodot dosimeters, which were read with a MicroStar reader (Landauer, Inc., Glenwood, IL). Dose to the OSLDs was delivered by 6 MV x rays and gamma rays from Co-60 and Ir-192. The signal on the OSLDs after irradiation is removed by optical annealing with a 150 W tungsten-halogen lamp or a 14 W compact fluorescent lamp was investigated. RESULTS: It was found that OSLD response to dose was supralinear and this response was altered with the amount of accumulated dose to the OSLD. The OSLD response can be modeled by a quadratic and an exponential equation. For accumulated doses up to 60 Gy, the OSLD sensitivity (counts/dose) decreases and the extent of supralinear increases. Above 60 Gy of accumulated dose the sensitivity increases and the extent of supralinearity decreases or reaches a plateau, depending on how the OSLDs were optically annealed. With preirradiation of OSLDs with greater than 1 kGy, it is found that the sensitivity reaches a plateau 2.5 folds greater than that of an OSLD with no accumulated dose and the supralinearity disappears. A regeneration of the luminescence signal in the dark after full optical annealing occurs with a half time of about two days. The extent of this regeneration signal depends on the amount of accumulated dose. CONCLUSIONS: For in vivo dosimetric measurements, a precision of +/- 0.5% can be achieved if the sensitivity and extent of supralinearity is established for each OSLD and use. Methods are presented for accomplishing this task.

Angular dependence of dose sensitivity of surface diodes.

Commercially available surface diodes are found to have as great as +/-12% change in sensitivity with the angle of incidence of radiation. This work is a study of the cause of angular dependence in diode sensitivity and how it can be decreased. A number of different surface diodes were used in these measurements: A commercially available diode and four prototype diodes. A number of the diodes were constructed with the silicon chip, the die, mounted on a circuit board that had a plane of copper on its back side. These diodes had angular dependence of sensitivity as great as +/- 10%. It was hypothesized that the copper plane on the circuit board was the cause of the anisotropy in sensitivity of the diodes. To test this hypothesis, diodes with a new design [Patent No. 61/035,257 (pending)], without a copper back plane, were fabricated and characterized in this work. These diodes were found to have the following characteristics: A dependence on incident angle of radiation of +/- 3.6%; after 10 kGy of pre-irradiation, a 1.6% change in sensitivity for a 260-fold change in dose per pulse; an areal density of 0.08 g/cm2.

Direct aperture optimization-based intensity-modulated radiotherapy for whole breast irradiation.

PURPOSE: To investigate the technical and dosimetric advantages and the efficacy of direct aperture optimized intensity-modulated radiation therapy (DAO-IMRT) over standard (e.g., beamlet optimized) IMRT and conventional three-dimensional conformal radiotherapy (3D-CRT) for whole breast irradiation in supine and prone positions. METHODS AND MATERIALS: We retrospectively designed DAO-IMRT plans for 15 breast cancer patients in supine (10 patients) and prone (5 patients) positions with a goal of uniform dose coverage of the whole breast. These DAO-IMRT plans were compared with standard IMRT using beamlet optimization and conventional 3D-CRT plans using wedges. All plans used opposed tangential beam arrangements. RESULTS: In all cases, the DAO-IMRT plans were equal to or better than those generated with 3D-CRT and standard beamlet-IMRT. For supine cases, DAO-IMRT provided higher uniformity index (UI, defined as the ratio of the dose to 95% of breast volume to the maximum dose) than either 3D-CRT (0.88 vs. 0.82; p = 0.026) or beamlet-IMRT (0.89 vs. 0.85; p = 0.003). Direct aperture optimized IMRT also gave lower lung doses than either 3D-CRT (V20 = 7.9% vs. 8.6%; p = 0.024) or beamlet-IMRT (V20 = 8.4% vs. 9.7%; p = 0.0008) for supine patients. For prone patients, DAO-IMRT provided higher UI than either 3D-CRT (0.89 vs. 0.83; p = 0.027) or beamlet-IMRT (0.89 vs. 0.85; p = 0.003). The planning time for DAO-IMRT was approximately 75% less than that of 3D-CRT. The monitor units for DAO-IMRT were approximately 60% less than those of beamlet-IMRT. CONCLUSION: Direct aperture optimized IMRT improved the overall quality of dose distributions as well as the planning and delivery efficiency for treating whole breast in both supine and prone positions.

Characterization of optically stimulated luminescent dosimeters, OSLDs, for clinical dosimetric measurements.

Optically stimulated luminescent dosimeters, OSLDs, are plastic disks infused with aluminum oxide doped with carbon (Al2O3 : C). These disks are encased in a light-tight plastic holder. Crystals of Al2O3 : C when exposed to ionizing radiation store energy that is released as luminescence (420 nm) when the OSLD is illuminated with stimulation light (540 nm). The intensity of the luminescence depends on the dose absorbed by the OSLD and the intensity of the stimulation light. OSLDs used in this work were InLight/OSL Dot dosimeters, which were read with a MicroStar reader (Landauer, Inc., Glenwood, IL). The following are dosimetric properties of the OSLD that were determined: After a single irradiation, repeated readings cause the signal to decrease by 0.05% per reading; the signal could be discharged by greater than 98% by illuminating them for more than 45 s with a 150 W tungsten-halogen light; after irradiation there was a transient signal that decayed with a 0.8 min halftime; after the transient signal decay the signal was stable for days; repeated irradiations and readings of an individual OSLD gave a signal with a coefficient of variation of 0.6%; the dose sensitivity of OSLDs from a batch of detectors has a coefficient of variation of 0.9%, response was linear with absorbed dose over a test range of 1-300 cGy; above 300 cGy a small supra-linear behavior occurs; there was no dose-per-pulse dependence over a 388-fold range; there was no dependence on radiation energy or mode for 6 and 15 MV x rays and 6-20 MeV electrons; for Ir-192 gamma rays OSLD had 6% higher sensitivity; the dose sensitivity was unchanged up to an accumulated dose of 20 Gy and thereafter decreased by 4% per 10 Gy of additional accumulated dose; dose sensitivity was not dependent on the angle of incidence of radiation; the OSLD in its light-tight case has an intrinsic buildup of 0.04 g/cm2; dose sensitivity of the OSLD was not dependent on temperature at the time of irradiation in the range of 10-40 degrees C. The clinical use of OSLDs for in vivo dosimetric measurements is shown to be feasible.

Measurement of head scatter factors of linear accelerators with columnar miniphantoms.

The measurement of linear accelerator head scatter factors or in-air output factors, Sc, with columnar miniphantoms is refined in this work. Columnar miniphantoms are constructed from water equivalent materials: solid water and M3, and materials with higher mass density and atomic number: copper and lead. The change in the value of Sc from a 4-cm X 4-cm to a 40-cm X 40-cm field is different by 22% +/- 3%, 18% +/- 2%, and 10% +/- 3% for 6, 15, and 23 MV x rays, respectively, when measured with water equivalent or lead miniphantoms of 10 gm/cm2 depth. Based on measurements of transmission factors in solid-water miniphantoms of different depths, it is demonstrated that the beam energy spectra decreases in energy with increased field size. These changes in beam energy spectra alter the transmission and scatter of radiation and buildup of the dose in the miniphantom even if the miniphantom is made of water-equivalent material. These changes underlie the alteration in Sc when measured by miniphantoms fabricated from materials of different atomic number. It is shown that miniphantoms designed with a depth just adequate to stop contamination electrons will minimize these distortions due to transmission and scatter of radiation and buildup of dose in the miniphantom. Use of a miniphantom constructed from water-equivalent material with a depth appropriate for the x-ray energy being measured is the preferred method for determining Sc for dosimetry in water.

Initial experience of FDG-PET/CT guided IMRT of head-and-neck carcinoma.

PURPOSE: The purpose of this study is to evaluate the impact of (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) fused with planning computed tomography (CT) on tumor localization, which guided intensity-modulated radiotherapy (IMRT) of patients with head-and-neck carcinoma. METHODS AND MATERIALS: From October 2002 through April 2005, we performed FDG-PET/CT guided IMRT for 28 patients with head-and-neck carcinoma. Patients were immobilized with face masks that were attached with five fiducial markers. FDG-PET and planning CT scans were performed on the same flattop table in one session and were then fused. Target volumes and critical organs were contoured, and IMRT plans were generated based on the fused images. RESULTS: All 28 patients had abnormal increased uptake in FDG-PET/CT scans. PET/CT resulted in CT-based staging changes in 16 of 28 (57%) patients. PET/CT fusions were successfully performed and were found to be accurate with the use of the two commercial planning systems. Volume analysis revealed that the PET/CT-based gross target volumes (GTVs) were significantly different from those contoured from the CT scans alone in 14 of 16 patients. In addition, 16 of 28 patients who were followed for more than 6 months did not have any evidence of locoregional recurrence in the median time of 17 months. CONCLUSION: Fused images were found to be useful to delineate GTV required in IMRT planning. PET/CT should be considered for both initial staging and treatment planning in patients with head-and-neck carcinoma.

Distortion of magnetic resonance images used in gamma knife radiosurgery treatment planning: implications for acoustic neuroma outcomes.

OBJECTIVE: To quantify the image distortion of our series of acoustic neuromas treated with gamma knife radiosurgery. STUDY DESIGN: Retrospective chart and digital radiographic file review with quantitative assessment of gamma knife treatment plans. SETTING: Tertiary referral center. PATIENTS: Patients undergoing gamma knife radiosurgery for the treatment of acoustic neuromas. INTERVENTION: Gamma knife radiosurgery. MAIN OUTCOME MEASURES: Gamma knife treatment plans containing magnetic resonance images were reviewed at each axial, sagittal, and coronal slice. The length of the greatest displacement of the treatment plan was measured and the volume of the treatment plan that fell outside of the internal auditory canal calculated. Known clinical measurements of audiometric, vestibular, facial, and trigeminal nerve functions were then compared with current measurements of tumor size. RESULTS: Twenty-two of the 23 patients had measurable image shifts on the axial images. The range of the image shift was 0 to 5.8 mm, with a mean shift of 1.92 +/- 1.29 mm (+/- standard deviation). Tumor volumes of the treatment plan that fell outside of the internal auditory canal ranged from 0 to 414 mm, with a mean of 90.5 mm. The mean percentage that fell outside of the internal auditory canal was 16.7% of total tumor volume (range, 2.4-77.6%). We could not draw any consistent correlations between degree of image shift and continued tumor growth or objective examination values. CONCLUSION: We have demonstrated a small but potentially significant shift in the treatment plan of gamma knife radiosurgery when based on magnetic resonance images. Although the image shift does not seem to affect the growth of the acoustic neuromas or auditory or facial nerve function, longer term follow-up is required to fully appreciate the true impact of this image shift.

Effect of image uncertainty on the dosimetry of trigeminal neuralgia irradiation.

OBJECTIVE: Our objective was to quantify the uncertainty in localization of the trigeminal nerve (TGN) with magnetic resonance imaging (MRI) and computed tomography (CT) and to determine the effect of this uncertainty on gamma-knife dose delivery. METHODS: An MR/CT test phantom with 9, 0.6-mm diameter, copper rings was devised. The absolute ring positions in stereotactic space were determined by the angiographic module of the LGP software. The standard deviation, sigma, in the difference between the absolute and MR-measured or CT-measured coordinates of the rings was determined. The trigeminal nerve in 52 previously treated patients was contoured and expanded by 1sigma and 2sigma margins to model the uncertainty in the location of the nerve. For gamma-knife treatment, a single isocenter was used and was located at the distal cisternal portion of the trigeminal nerve root. Irradiation methods included a 4-mm collimator, 90 Gy to isocenter and a 4&8-mm collimator, 70 Gy to isocenter. A patient outcome survey that sampled pain relief and morbidity was done. RESULTS: The MR coordinate sigma was 0.7 mm left-right, 0.8 mm anterior-posterior, and 0.6 mm superior-inferior, and the CT coordinate sigma was 0.4 mm left-right, 0.2 mm anterior-posterior, and 0.2 mm superior-inferior. A 45% higher dose line covered the TGN with the 4&8-mm method. No significant increase in pain reduction or morbidity occurred. CONCLUSIONS: The uncertainty of target location by MRI is more than twice that found in CT imaging. The 4&8-mm collimator method covers the trigeminal root cross section with a higher isodose line than does the 4-mm method. This higher dose did not significantly reduce pain or increase morbidity.

Dosimetric advantages of IMRT simultaneous integrated boost for high-risk prostate cancer.

PURPOSE: A sequential two-phase process, initial and boost irradiation, is the common practice for the radiotherapy management of high-risk prostate cancer. In this work, we explore the feasibility of using intensity modulated radiation therapy (IMRT) simultaneous integrated boost (SIB), a single-phase process, to simultaneously deliver high dose to the prostate and lower dose to the pelvic nodes. In addition, we introduce the concept of voxel-equivalent dose for the comparison of treatment plans. METHODS AND MATERIALS: The SIB is designed to deliver the same dose (e.g., 45 Gy, 25 x 1.8 Gy) as the conventional method to the pelvic nodes and to deliver higher doses to prostate in the same 25 fractions (i.e., hypofractionation). The equivalent uniform dose (EUD) was used to determine suitable SIB fractionations that deliver the biologically equivalent doses to prostate. For tumor, the EUD was estimated based on the linear quadratic (LQ) model. The most recent LQ parameters derived from clinical data for prostate cancer were used. The sensitivity of LQ parameters was evaluated. The EUD for normal tissue was computed based on the widely used Lyman model. To be able to consider biologic effectiveness spatially (e.g., voxel by voxel), we propose a new concept, termed the voxel-equivalent dose (VED). The calculation of VED was similar to that for EUD, except that it was done within a voxel. To demonstrate dosimetric feasibility and advantages of the proposed IMRT SIB, we have performed a retrospective planning study on selected patient cases using commercial IMRT and three-dimensional (3D) planning systems. Four treatment scenarios were considered: (1) the conventional 3D plan for initial whole-pelvic irradiation and subsequent conventional 3D boost plan for prostate gland, (2) the conventional 3D plan for initial whole-pelvic irradiation and subsequent IMRT boost plan for prostate, (3) IMRT plan for initial whole-pelvic irradiation and subsequent IMRT boost plan for prostate, and (4) IMRT SIB. EUDs and VED-based dose-volume histograms for prostate, pelvic nodes, small bowel, rectum, bladder, and other tissue for all 4 scenarios were compared. RESULTS: A series of equivalent hypofractionation regimens suitable for the IMRT SIB were obtained for high-risk prostate cancer. For example, the conventional treatment regimen of 42 x 1.8 Gy (EUD = 75.4 Gy) would be equivalent to a SIB regimen of 25 x 2.54 Gy. From the comparison of 3D VED dose distributions and dose-volume histograms between the SIB and the conventional two-phase irradiation, we found that the SIB offers better or equivalent dose conformity to prostate and pelvic nodes and better sparing to the critical structures. For example, for the 4 treatment scenarios with a prostate EUD of 75.4 Gy, the corresponding rectal EUDs are 67.1 (3D + 3D), 65.6 Gy (3D + IMRT), 63.7 Gy (IMRT + IMRT), and 62.0 Gy (SIB). CONCLUSIONS: A new IMRT simultaneous integrated boost strategy that irradiates prostate via hypofractionation while irradiating pelvic nodes with the conventional fractionation is proposed for high-risk prostate cancer. Compared to the conventional two-phase treatment, the proposed SIB technique offers potential advantages, including better sparing of critical structures, more efficient delivery, shorter treatment duration, and better biologic effectiveness.

A 2-D diode array and analysis software for verification of intensity modulated radiation therapy delivery.

An analysis is made of a two-dimensional array of diodes that can be used for measuring dose generated in a plane by a radiation beam. This measuring device is the MapCHECK Model 1175 (Sun Nuclear, Melbourne, FL). This device has 445 N-type diodes in a 22 x 22 cm2 2-D array with variable spacing. The entire array of diodes is easily calibrated to allow for measurements in absolute dose. For IMRT quality assurance, each beam is measured individually with the beam central axis oriented perpendicular to the plane of diodes. Software is available to do the analytical comparison of measurements versus dose distributions calculated by a treatment planning system. Comparison criteria of percent difference and distance-to-agreement are defined by the operator. Data are presented that show the diode array has linear response when beam fluence changes by over 300-fold, which is typical of the level of modulation in intensity modulated radiation therapy, IMRT, beams. A linear dependence is also shown for a 100-fold change in monitors units delivered. Methods for how this device can be used in the clinic for quality assurance of IMRT fields are described. Measurements of typical IMRT beams that are modulated by compensators and MLCs are presented with comparisons to treatment planning system dose calculations. A time analysis is done for typical IMRT quality assurance measurements. The setup, calibration, and analysis time for the 2-D diode array are on the order of 20 min, depending on numbers of fields. This is significantly less time than required to do similar analysis with radiographic film. The 2-D diode array is ideal for per-plan quality assurance after an IMRT system is fully commissioned.