Technical Note: Real-time image-guided adaptive radiotherapy of a rigid target for a prototype fixed beam radiotherapy system.

PURPOSE: Fixed beam radiotherapy systems utilize couch movement and rotation instead of gantry rotation in order to simplify linear accelerator design. We investigate the ability to deliver fixed beam treatments with the same level of clinical accuracy as conventional (rotating beam) treatments using real-time image guidance to maintain this accuracy in the presence of rigid target motion. METHODS: A prototype fixed beam radiotherapy system was built using a standard linac with the beam fixed in the vertical position and a computer controlled rotation stage that rotated a rigid phantom about the superior-inferior axis. Kilovoltage Intrafraction Monitoring (KIM) and real-time beam adaptation with MLC tracking was applied to a five-field IMRT treatment plan with motion introduced to the phantom. The same IMRT treatment was also delivered with real-time adaptation using the conventional rotating beam geometry. Film dosimetry was used to measure the dose delivered with a fixed beam compared to a rotating beam, as well as to compare treatments delivered with and without real-time adaptation. RESULTS: The dose distributions were found to be equivalent between the fixed beam and rotating beam geometry for real-time adaptive radiotherapy using KIM and MLC tracking beam adaptation. Gamma analysis on the films showed agreement >98% using a 2%/2 mm criteria with adaptation for static shifts and periodic motion. CONCLUSIONS: Fixed beam treatments with real-time beam adaptation are dosimetrically equivalent to conventional treatments with a rotating beam, even in the presence of rigid target motion. This suggests that, for a rigid target, the high clinical accuracy of real-time adaptive radiotherapy can be achieved with simpler beam geometry.

Small field dosimetric characterization of a new 160-leaf MLC.

The goal of this work was to perform a 6 MV small field characterization of the new Agility 160-leaf multi-leaf collimator (MLC) from Elekta. This included profile measurement analysis and central axis relative output measurements using various diode detectors and an air-core fiber optic scintillation dosimeter (FOD). Data was acquired at a depth of 10.0 cm for field sizes of 1.0, 0.9, 0.8, 0.7, 0.6 and 0.5 cm. Three experimental data sets, comprised of five readings, were made for both the relative output and profile measurements. Average detector-specific output ratios (OR[overline](f(clin))(det))) were calculated with respect to a field size of 3.0 cm and small field replacement correction factors (k(f(clin),f(msr))(Q(clin),Q(msr))) derived for the diodes using the scintillation dosimeter readings as the baseline. The standard experimental uncertainty on OR[overline](f(clin))(det)) was calculated at a 90% confidence interval and the coefficient of variation (CV) used to characterize the detector-specific measurement precision. The positional accuracy of the collimation system was also investigated by analyzing the repeated profile measurements and field width constancy investigated as a function of collimator rotation. For comparison the output and profile measurements were repeated using the Elekta 80-leaf MLCi2 on a beam matched linac at 6 MV. The measured OR[overline](f(clin))(det)) varied as a function of detector and MLC design. At the smallest field size the standard experimental uncertainty on OR[overline](f(clin))(det)) was consistent across all detectors at approximately 0.5% and 1.0% for Agility and MLCi2 collimators respectively. The CV associated with the FOD measurements were greater than that of the diodes but did not translate into increased measurement uncertainty. At the smallest field size, the diode detector correction factors were approximately 2% greater for MLCi2 than that required for the Agility. Profile data revealed the Agility MLC to have a greater positional reproducibility than both the MLCi2 and the linac diaphragms (jaws), as also reflected in the experimental uncertainties on OR[overline](f(clin))(det)). The relative output, profile widths and associated uncertainties were all found to differ between the two MLC systems investigated, as were the field size specific diode detector replacement correction factors. The data also clearly showed that the Agility 160-leaf MLC performs to a tighter positional tolerance than the MLCi2.

Twisted pair of optic fibers for background removal in radiation fields.

In many situations in which an optic fiber carries a signal through a radiation field, an unwanted background signal is produced consisting of fluorescent and/or Cerenkov light. This presents a major problem in the measurement of the light signal, for example, in scintillation dosimetry of medical therapeutic beams. In this paper, we demonstrate a new method of measuring and removing the background signal through the use of a twisted pair of optic fibers. The twisted pair consists of a fiber carrying the scintillation signal that is twisted with a second optic fiber to form a double helix. The two twisted fibers will experience the same radiation environment provided the periodicity of the twist is correlated to the dose rate gradient. An expression for the required twist periodicity is presented. A scintillation dosimeter with a twisted pair optic fiber was tested in a megavoltage beam and found to accurately measure its beam characteristics. The twisted pair approach is not restricted to medical applications and can be used in many situations in which optical signals are carried through radiation fields.

A method to remove residual signals in fibre optic luminescence dosimeters.

Whenever a fibre optic is used to convey a light signal through a radiation field, it is likely that an unwanted background signal will arise from Cerenkov or fluorescent light which will contaminate the signal. In luminescence dosimetry of high energy beams, when a fibre optic is used to convey the signal from the radiation field to the detector, Cerenkov light is the dominant contributor to the background signal and must be corrected for. In this work, a novel method is demonstrated to separate the signal from the unwanted background. A remotely operated shutter is used to block the signal, allowing the residual background in the fibre optic to be quantified. This background is subtracted from the total measurement acquired in a subsequent irradiation, enabling the luminescence signal to be extracted. Two types of shutter mechanism are considered: an electro-mechanical device to intercept the light path and an LCD device to block the light by cross-polarization. Both shutters were characterized and incorporated into a fibre optic dosimetry system used to measure the radiation dose produced by external beam radiation linear accelerators. The dosimeter using each of the shutters in turn was exposed to a 6 MV photon beam to determine their performance, including the measurement of field size dependent output factors. The mechanical shutter determined the output factors to within 0.29% of those measured with an ionization chamber, whereas the LCD shutter gave results that deviated by up to 2.4%. The switching precision of both shutters was good with standard deviations of less than 0.25% and both were able to completely block the light signal when closed. The use of shutters could therefore be applied to any fibre optic based system to quantify and remove a reproducible background arising from any source including ambient, fluorescent and Cerenkov light.

Plastic scintillation dosimetry: comparison of three solutions for the Cerenkov challenge.

In scintillation dosimetry, a Cerenkov background signal is generated when a conventional fibre optic is exposed to radiation produced by a megavoltage linear accelerator. Three methods of measuring dose in the presence of Cerenkov background are compared. In the first method, a second background fibre is used to estimate the Cerenkov signal in the signal fibre. In the second method, a colour camera is used to measure the combined scintillation and Cerenkov light in two wavelength ranges and a mathematical process is used to extract the scintillation signal. In the third method, a hollow air core light guide is used to carry the scintillation signal through the primary radiation field. In this paper, the strengths and weaknesses of each dosimetry system are identified and recommendations for the optimum method for common clinical dosimetry situations are made.