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.

COMP report: CPQR technical quality control guidelines for Gamma Knife radiosurgery.

The Canadian Organization of Medical Physicists (COMP), in close partnership with the Canadian Partnership for Quality Radiotherapy (CPQR), has developed a series of Technical Quality Control (TQC) guidelines for radiation treatment equipment. These guidelines outline the performance objectives that equipment should meet in order to ensure an acceptable level of radiation treatment quality. The TQC guidelines have been rigorously reviewed and field tested in a variety of Canadian radiation treatment facilities. The development process enables rapid review and update to keep the guidelines current with changes in technology (the most updated version of this guideline can be found on the CPQR website). This particular TQC details recommended quality control testing for Gamma Knife radiosurgery.

Gamma Knife irradiation method based on dosimetric controls to target small areas in rat brains.

PURPOSE: Targeted and whole-brain irradiation in humans can result in significant side effects causing decreased patient quality of life. To adequately investigate structural and functional alterations after stereotactic radiosurgery, preclinical studies are needed. The purpose of this work is to establish a robust standardized method of targeted irradiation on small regions of the rat brain. METHODS: Euthanized male Fischer rats were imaged in a stereotactic bed, by computed tomography (CT), to estimate positioning variations relative to the bregma skull reference point. Using a rat brain atlas and the stereotactic bregma coordinates obtained from CT images, different regions of the brain were delimited and a treatment plan was generated. A single isocenter treatment plan delivering ≥ 100 Gy in 100% of the target volume was produced by Leksell GammaPlan using the 4 mm diameter collimator of sectors 4, 5, 7, and 8 of the Gamma Knife unit. Impact of positioning deviations of the rat brain on dose deposition was simulated by GammaPlan and validated with dosimetric measurements. RESULTS: The authors' results showed that 90% of the target volume received 100 ± 8 Gy and the maximum of deposited dose was 125 ± 0.7 Gy, which corresponds to an excellent relative standard deviation of 0.6%. This dose deposition calculated with GammaPlan was validated with dosimetric films resulting in a dose-profile agreement within 5%, both in X- and Z-axes. CONCLUSIONS: The authors' results demonstrate the feasibility of standardizing the irradiation procedure of a small volume in the rat brain using a Gamma Knife.

Performance assessment of a 2D array of plastic scintillation detectors for IMRT quality assurance.

The purposes of this work are to assess the performance of a 2D plastic scintillation detectors array prototype for quality assurance in intensity-modulated radiation therapy (IMRT) and to determine its sensitivity and specificity to positioning errors of one multileaf collimator (MLC) leaf and one MLC leaf bank by applying the principles of signal detection theory. Ten treatment plans (step-and-shoot delivery) and one volumetric modulated arc therapy plan were measured and compared to calculations from two treatment-planning systems (TPSs) and to radiochromic films. The averages gamma passing rates per beam found for the step-and-shoot plans were 95.8% for the criteria (3%, 2 mm), 97.8% for the criteria (4%, 2 mm), and 98.1% for the criteria (3%, 3 mm) when measurements were compared to TPS calculations. The receiver operating characteristic curves for the one leaf errors and one leaf bank errors were determined from simulations (theoretical upper limits) and measurements. This work concludes that arrays of plastic scintillation detectors could be used for IMRT quality assurance in clinics. The use of signal detection theory could improve the quality of dosimetric verifications in radiation therapy by providing optimal discrimination criteria for the detection of different classes of errors.

Dosimetric performance and array assessment of plastic scintillation detectors for stereotactic radiosurgery quality assurance.

PURPOSE: To compare the performance of plastic scintillation detectors (PSD) for quality assurance (QA) in stereotactic radiosurgery conditions to a microion-chamber (IC), Gafchromic EBT2 films, 60 008 shielded photon diode (SD) and unshielded diodes (UD), and assess a new 2D crosshair array prototype adapted to small field dosimetry. METHODS: The PSD consists of a 1 mm diameter by 1 mm long scintillating fiber (BCF-60, Saint-Gobain, Inc.) coupled to a polymethyl-methacrylate optical fiber (Eska premier, Mitsubishi Rayon Co., Ltd., Tokyo, Japan). Output factors (S(c,p)) for apertures used in radiosurgery ranging from 4 to 40 mm in diameter have been measured. The PSD crosshair array (PSDCA) is a water equivalent device made up of 49 PSDs contained in a 1.63 cm radius area. Dose profiles measurements were taken for radiosurgery fields using the PSDCA and were compared to other dosimeters. Moreover, a typical stereotactic radiosurgery treatment using four noncoplanar arcs was delivered on a spherical phantom in which UD, IC, or PSD was placed. Using the Xknife planning system (Integra Radionics Burlington, MA), 15 Gy was prescribed at the isocenter, where each detector was positioned. RESULTS: Output Factors measured by the PSD have a mean difference of 1.3% with Gafchromic EBT2 when normalized to a 10 × 10 cm(2) field, and 1.0% when compared with UD measurements normalized to the 35 mm diameter cone. Dose profiles taken with the PSD crosshair array agreed with other single detectors dose profiles in spite of the presence of the 49 PSDs. Gamma values comparing 1D dose profiles obtained with PSD crosshair array with Gafchromic EBT2 and UD measured profiles shows 98.3% and 100.0%, respectively, of detector passing the gamma acceptance criteria of 0.3 mm and 2%. The dose measured by the PSD for a complete stereotactic radiosurgery treatment is comparable to the planned dose corrected for its SD-based S(c,p) within 1.4% and 0.7% for 5 and 35 mm diameter cone, respectively. Furthermore, volume averaging of the IC can be observed for the 5 mm aperture where it differs by as much as 9.1% compared to the PSD measurement. The angular dependency of the UD is also observed, unveiled by an under-response around 2.5% of both 5 and 35 mm apertures. CONCLUSIONS: Output Factors and dose profiles measurements performed, respectively, with the PSD and the PSDCA were in agreement with those obtained with the UD and EBT2 films. For stereotactic radiosurgery treatment verification, the PSD gives accurate results compared to the planning system and the IC once the latter is corrected to compensate for the averaging effect of the IC. The PSD provides precise results when used as a single detector or in a dense array, resulting in a great potential for stereotactic radiosurgery QA measurements.

A new water-equivalent 2D plastic scintillation detectors array for the dosimetry of megavoltage energy photon beams in radiation therapy.

PURPOSE: The objective of this work is to present a new 2D plastic scintillation detectors array (2D-PSDA) designed for the dosimetry of megavoltage (MV) energy photon beams in radiation therapy and to characterize its basic performance. METHODS: We developed a 2D detector array consisting of 781 plastic scintillation detectors (PSDs) inserted into a plane of a water-equivalent phantom. The PSDs were distributed on a 26 × 26 cm(2) grid, with an interdetector spacing of 10 mm, except for two perpendicular lines centered on the detection plane, where the spacing was 5 mm. Each PSD was made of a 1 mm diameter by 3 mm long cylindrical polystyrene scintillating fiber coupled to a clear nonscintillating plastic optical fiber. All of the light signals emitted by the PSDs were read simultaneously with an optical system at a rate of one measurement per second. We characterized the performance of the optical system, the angular dependency of the device, and the perturbation of dose distributions caused by the hundreds of PSDs inserted into the phantom. We also evaluated the capacity of the system to monitor complex multileaf collimator (MLC) sequences such as those encountered in step-and-shoot intensity modulated radiation therapy (IMRT) plans. We compared our results with calculations performed by a treatment planning system and with measurements taken with a 2D ionization chamber array and with a radiochromic film. RESULTS: The detector array that we developed allowed us to measure doses with an average precision of better than 1% for cumulated doses equal to or greater than 6.3 cGy. Our results showed that the dose distributions produced by the 6-MV photon beam are not perturbed (within ±1.1%) by the presence of the hundreds of PSDs located into the phantom. The results also showed that the variations in the beam incidences have little effect on the dose response of the device. For all incidences tested, the passing rates of the gamma tests between the 2D-PSDA and the treatment planning system were higher than 97.5% when the standard clinical tolerances of 3% or 3 mm were used. Excellent agreement was obtained between the doses measured and calculated when we used the 2D-PSDA for monitoring a MLC sequence from a step-and-shoot IMRT plan. CONCLUSIONS: We demonstrated the feasibility of using a large number of PSDs in a new 2D-PSDA for the dosimetry of MV energy photon beams in radiation therapy. The excellent precision, accuracy, and low angular dependence of the device indicate that such a prototype could potentially be used as a high-accuracy quality assurance tool for IMRT and arc therapy patient plan verification. The homogeneity and water-equivalence of the prototype we built suggest that this technology could be extended to multiple detection planes by arranging the fibers into more complex orientations, opening the possibility for 3D dosimetry with PSDs.

Extraction of depth-dependent perturbation factors for silicon diodes using a plastic scintillation detector.

PURPOSE: This work presents the experimental extraction of the perturbation factor in megavoltage electron beams for three models of silicon diodes (IBA Dosimetry, EFD and SFD, and the PTW 60012 unshielded) using a plastic scintillation detector (PSD). METHODS: The authors used a single scanning PSD mounted on a high-precision scanning tank to measure depth-dose curves in 6-, 12-, and 18-MeV clinical electron beams. They also measured depth-dose curves using the IBA Dosimetry, EFD and SFD, and the PTW 60012 unshielded diodes. The authors used the depth-dose curves measured with the PSD as a perturbation-free reference to extract the perturbation factors of the diodes. RESULTS: The authors found that the perturbation factors for the diodes increased substantially with depth, especially for low-energy electron beams. The experimental results show the same trend as published Monte Carlo simulation results for the EFD diode; however, the perturbations measured experimentally were greater. They found that using an effective point of measurement (EPOM) placed slightly away from the source reduced the variation of perturbation factors with depth and that the optimal EPOM appears to be energy dependent. CONCLUSIONS: The manufacturer recommended EPOM appears to be incorrect at low electron energy (6 MeV). In addition, the perturbation factors for diodes may be greater than predicted by Monte Carlo simulations.

Spectral method for the correction of the Cerenkov light effect in plastic scintillation detectors: a comparison study of calibration procedures and validation in Cerenkov light-dominated situations.

PURPOSE: The purposes of this work were: (1) To determine if a spectral method can accurately correct the Cerenkov light effect in plastic scintillation detectors (PSDs) for situations where the Cerenkov light is dominant over the scintillation light and (2) to develop a procedural guideline for accurately determining the calibration factors of PSDs. METHODS: The authors demonstrate, by using the equations of the spectral method, that the condition for accurately correcting the effect of Cerenkov light is that the ratio of the two calibration factors must be equal to the ratio of the Cerenkov light measured within the two different spectral regions used for analysis. Based on this proof, the authors propose two new procedures to determine the calibration factors of PSDs, which were designed to respect this condition. A PSD that consists of a cylindrical polystyrene scintillating fiber (1.6 mm3) coupled to a plastic optical fiber was calibrated by using these new procedures and the two reference procedures described in the literature. To validate the extracted calibration factors, relative dose profiles and output factors for a 6 MV photon beam from a medical linac were measured with the PSD and an ionization chamber. Emphasis was placed on situations where the Cerenkov light is dominant over the scintillation light and on situations dissimilar to the calibration conditions. RESULTS: The authors found that the accuracy of the spectral method depends on the procedure used to determine the calibration factors of the PSD and on the attenuation properties of the optical fiber used. The results from the relative dose profile measurements showed that the spectral method can correct the Cerenkov light effect with an accuracy level of 1%. The results obtained also indicate that PSDs measure output factors that are lower than those measured with ionization chambers for square field sizes larger than 25 x 25 cm2, in general agreement with previously published Monte Carlo results. CONCLUSIONS: The authors conclude that the spectral method can be used to accurately correct the Cerenkov light effect in PSDs. The authors confirmed the importance of maximizing the difference of Cerenkov light production between calibration measurements. The authors also found that the attenuation of the optical fiber, which is assumed to be constant in the original formulation of the spectral method, may cause a variation of the calibration factors in some experimental setups.

Extraction of depth-dependent perturbation factors for parallel-plate chambers in electron beams using a plastic scintillation detector.

PURPOSE: This work presents the experimental extraction of the overall perturbation factor PQ in megavoltage electron beams for NACP-02 and Roos parallel-plate ionization chambers using a plastic scintillation detector (PSD). METHODS: The authors used a single scanning PSD mounted on a high-precision scanning tank to measure depth-dose curves in 6, 12, and 18 MeV clinical electron beams. The authors also measured depth-dose curves using the NACP-02 and PTW Roos chambers. RESULTS: The authors found that the perturbation factors for the NACP-02 and Roos chambers increased substantially with depth, especially for low-energy electron beams. The experimental results were in good agreement with the results of Monte Carlo simulations reported by other investigators. The authors also found that using an effective point of measurement (EPOM) placed inside the air cavity reduced the variation of perturbation factors with depth and that the optimal EPOM appears to be energy dependent. CONCLUSIONS: A PSD can be used to experimentally extract perturbation factors for ionization chambers. The dosimetry protocol recommendations indicating that the point of measurement be placed on the inside face of the front window appear to be incorrect for parallel-plate chambers and result in errors in the R50 of approximately 0.4 mm at 6 MeV, 1.0 mm at 12 MeV, and 1.2 mm at 18 MeV.

A design methodology using signal-to-noise ratio for plastic scintillation detectors design and performance optimization.

PURPOSE: The design of novel plastic scintillation detectors (PSDs) is impeded by the lack of a suitable framework to simulate and predict their performance. The authors propose to use the signal-to-noise ratio (SNR) to model the performance of PSDs that use charge-coupled devices (CCDs) as photodetectors. METHODS: In PSDs using CCDs, the SNR is inversely related to the normalized standard deviation of the dose measurement. Thus, optimizing the SNR directly optimizes the system's precision. In this work, a model of SNR as a function of the system parameters is derived for optical fiber-based PSD systems. Furthermore, this proposed model is validated using experimental results. A formula for the efficiency of fiber coupling to CCDs is derived and used to simulate the performance of a PSD under varying magnifications. RESULTS: The proposed model is shown to simulate the experimental performance of an actual PSD to a suitable degree of accuracy under various conditions. CONCLUSIONS: The SNR constitutes a useful tool to simulate the dosimetric precision of PSDs. Using the SNR model, recommendations for the design and optimization of PSDs are provided. Using the same framework, recommendations for non-fiber-based PSDs are also provided.

Clinical prototype of a plastic water-equivalent scintillating fiber dosimeter array for QA applications.

A clinical prototype of a scintillating fiber dosimeter array for quality assurance applications is presented. The array consists of a linear array of 29 plastic scintillation detectors embedded in a water-equivalent plastic sheet coupled to optical fibers used to guide optical photons to a charge coupled device (CCD) camera. The CCD is packaged in a light-tight, radiation-shielded housing designed for convenient transport. A custom designed connector is used to ensure reproducible mechanical positioning of the optical fibers relative to the CCD. Profile and depth dose characterization measurements are presented and show that the prototype provides excellent dose measurement reproducibility (+/-0.8%) in-field and good accuracy (+/-1.6% maximum deviation) relative to the dose measured with an IC10 ionization chamber.