A method for time-independent film dosimetry: Can we obtain accurate patient-specific QA results at any time postirradiation?

AIM: The aim of this work was twofold. (1) To investigate and present a comparison between EBT3 and EBT-XD in terms of postirradiation color changes. (2) Create an automated workflow to allow radiochromic film (EBT3/XD) to be scanned and converted to dose accurately at any postirradiation time. MATERIALS AND METHODS: Ten GafChromic EBT-XD calibration films were exposed in 2 Gy increments up to 18 Gy. Calibrates were then scanned at 5-min intervals postirradiation over 24 h using an AutoHotKey script, resulting in 288 TIFF images. Following the 24-h scanning period, a MATLAB script was used to automatically read the tiff images and create a series of 288 calibration curves distinct in time which is termed as the "Temporal Calibration Model" (TCM). The model is saved as a series of polynomial fit coefficients to net optical density as a function of dose, timestamped in 5-min increments. Ten patient-specific film measurements (5 × EBT-XD and 5 × EBT3) were then carried out and scanned using the same 5-min scan intervals from 5 min postirradiation to 24 h postirradiation. The TCM was then automatically applied using eFilmQA software to convert the patient-specific QA films to dose by applying the relevant calibration curve from the TCM, corresponding to the arbitrary postirradiation time that the film was scanned. Each dose plane at postirradiation scan intervals of 5 min up to 20 h was then compared to the ground-truth dose plane using gamma analysis. RESULTS: Gamma pass rates using the TCM at time t, normalized to the pass rate after 20 h postirradiation, were found to have a maximum coefficient of variation of 3% over any postirradiation time. Conversely, not using the TCM resulted in coefficients of variation of up to 39%. Clinical implementation of this method showed an average accuracy of 2.8% when comparing the clinical result to the TCM result. CONCLUSIONS: We have developed a methodology that allows radiochromic film to be accurately used as a dosimeter at any arbitrary scan postirradiation time, whereas previously, waiting periods of 16-24 h before readout were needed to ensure the postirradiation changes had stabilized. The creation of a TCM can enable results from radiochromic film measurements to be obtained quickly postirradiation. Using a conventional single calibration curve generated at 20 h postirradiation can result in gamma pass-rate difference of up to 75% for measurement films scanned at a much shorter postirradiation time.

Assessment of HDR brachytherapy-replicating prostate radiotherapy planning for tomotherapy, cyberknife and VMAT.

A dosimetric study was undertaken to assess the ability of Cyberknife (CK), Volumetric Modulated Arc Therapy (VMAT), and TomoTherapy (Tomo) to generate treatment plans that mimic the dosimetry of high dose-rate brachytherapy (HDR BT) for prostate cancer. The project aimed to assess the potential of using stereotactic body radiotherapy (SBRT) for boost treatment of high-risk prostate cancer patients where HDR BT in combination with conformal external beam radiotherapy (EBRT) is the standard of care. The datasets of 6 prostate patients previously treated with HDR BT were collated. VMAT, CK, and TomoTherapy treatment plans were generated for each dataset using the target and organ-at-risk structures as defined by the Radiation Oncologist during the HDR BT treatment process. The HDR BT plan isodoses were also converted into planning structures to assist the other modalities to achieve a HDR BT-like dose distribution. CK plans were created using both the iris collimator (IC) and a multileaf collimator (MLC). Comparison of the techniques was made based on dose-volume indices. Each plan was created at centres experienced using the respective treatment planning systems (TPS). Planning target volume (PTV V100%), i.e., the volume of the planning target volume (PTV) receiving 100% of the relative dose, in VMAT and TomoTherapy SBRT plans was higher than HDR BT plans. PTV V150% and V200%, i.e., volume of the PTV receiving 150% and 200% of the relative dose, were approached on all the CK MLC and TomoTherapy SBRT plans. However, it is not presently achievable for "virtual brachytherapy" SBRT to replicate the same high intraprostatic doses as HDR BT while meeting the constraints on the organs-at-risk (OARs). Half of the CK IC plans achieved PTV V150% but this was at the expense of high rectal dose. TomoTherapy and CK MLC plans achieved PTV V150% and V200% but the bladder dose was higher compared to CK IC plans. VMAT exhibited excellent PTV coverage based on V100 and OAR sparing, but without any ability to achieve the high intra-prostatic doses of HDR (V150% and V200%). SBRT techniques can be used to deliver hypofractionated radiotherapy to the PTV V100%. Based on the comparison of "physical" dose distributions, SBRT cannot presently achieve the same high intraprostatic doses as HDR BT while respecting the OAR constraints. SBRT still remains an attractive treatment option for delivering hypofractionated treatments for prostate cancer compared to HDR BT, in particular as it is less invasive and less resource intensive. Long-term outcomes of clinical trials comparing HDR BT and SBRT "prostate boosts" may show whether the high intraprostatic doses are clinically significant and correlate with outcomes.

Reducing shield thickness and backscattered radiation using a multilayered shield for 6­10 MeV electron beams.

Intraoral and external electron shields used in radiotherapy are designed to minimize radiation exposure to non-treatment tissue. Sites where shields are used include but are not limited to, the treatment of lips, cheeks and ears whilst shielding the underlying oral cavity, tongue, gingival or temporal region. A commonly known and published effect, concerns the enhancement in dose that can occur on the beam side on an electron shield caused by an increase in electron backscatter radiation. In this work a lead shield has been designed incorporating copper, aluminium and wax in a step down filter arrangement to minimise backscatter whilst minimizing overall shield thickness for better clinical setup and ease of use. For electron beams ranging from 6 to 10 MeV, a standard shield design of 4 mm lead, 0.6 mm copper, 1.0 mm aluminium and 1.5 mm wax (3.1 mm added filtration, 7.1 mm total thickness) provided adequate backscatter and transmission reduction to match a standard 4.5 mm lead and 10 mm wax (total thickness 14.5 mm) electron shield. Dose enhancement values of no more than 10 % were measured utilising this shield design with a 50 % reduction in shield thickness. The thinner shield will not only allow easier patient set up but should be tolerated better by patients when mucosal reactions occur as they place less physical pressure on these sites during treatment due to their smaller size.