An open-source software for monitoring intrafraction motion during external beam radiation therapy based on superimposition of contours of projected ROIs on cine-MV images.

PURPOSE: To present an open-source software (https://github.com/CHUSRadOncPhys/FluoMV) for monitoring intrafraction motion that is based on the visualization of superimposed contours of projected region-of-interests from DICOM RTSTRUCT files on cine-MV images acquired and displayed in real-time during radiation therapy delivery. Clinical use with prostate gold fiducial markers is presented. METHODS: Projections of regions of interest (ROI) in the reference frame of the electronic portal imaging device are computed offline for different gantry angles before the first treatment fraction. During treatment delivery, the contrast of portal images is automatically adjusted using a histogram equalization algorithm. The projections associated with the current gantry angle are then superimposed on the images in real time. This allows the therapist to evaluate if the imaged structures of interest remain within their respective contours during treatment delivery and to potentially interrupt the treatment if deemed necessary. The spatial accuracy of the method was evaluated by imaging a ball bearing phantom in a set-up where the position of the projected ROI is highly sensitive to gantry angle errors. The visibility of fiducial markers during one fraction of seven different volumetric modulated arc therapy (VMAT) prostate treatments is characterized. RESULTS: The geometric validation showed a negligible systematic error µ < 0.1 mm for the position of the projections. The random errors associated with the time accuracy of the gantry angle readout were characterized by standard deviations σ ≤ 0.6 mm. The VMAT clinical treatments showed that the fiducial markers were frequently visible, allowing for a meaningful clinical use. CONCLUSIONS: The results demonstrate that the method presented is sufficiently accurate to be used for intrafraction monitoring of patients. The fact that this method could be implemented on many modern linacs at little to no cost and with no additional dose delivered to the patients makes this solution very attractive for improving patient care and safety in radiation therapy.

Accurate calibration of a polymer gel dosimeter with a plastic scintillation detector.

PURPOSE: Three dimensional dose polymer gel dosimetry measurements provide unique information on sophisticated dose distributions. In this study, the authors propose a novel method to improve the accuracy of polymer gel dosimeters by inserting a plastic scintillation detector (PSD) to provide a dose reference. METHODS: PSD dosimeters were calibrated using chromatic deconvolution and then inserted into polyacrylanide gel (PAG) dosimeters. The gel and the PSDs were immersed into water and irradiated with 6 MV wedge filtered beams to obtain a wide range of dose variation. Calibration vials containing the same gel were also irradiated to generate a standard calibration curve. The distribution of magnetic nuclear transverse relaxation rate (R2) values of the gel was determined with a multislice multiecho MRI sequence at 1.5 T. Another calibration curve was obtained by assigning the R2 values in the gel surrounding the scintillators to the dose determined by the PSDs. A reference calibration point from a PSD located in a low dose gradient area served to correct the standard calibration method yielding three novel calibration methods. The results were compared with EBT2 GAFCHROMIC film measurements acquired in the same condition and with the Pinnacle3 treatment planning dose calculations, RESULTS: The mean absolute error of the standard calibration method ranged from 6.1 to 12.4%. The corresponding gamma index (3%/3 mm distance to agreement) criterion was satisfied for only 56% of the pixels in the middle slice of the gel compared to Pinnacle3 dose calculations and to EBT2 film measurements in the center part of the field. Calibration methods using a PSD reduced the mean absolute error to less than 4%; this value was under 2.6% for one of the three methods. In that case, 98% of the pixels satisfied the gamma index criterion. CONCLUSIONS: The accuracy of PAG dosimeters may be highly improved using one reference dose point measurement using a plastic scintillation detector. The best calibration procedure corrected the slope of the calibration curve derived from the calibration vials to match the R2 value around a PSD calibration, while keeping the R2 value at 0 Gy constant.