Fiducial detection and registration for 3D IMRT QA with organ-specific dose information.

PURPOSE: Two-dimensional (2D) IMRT QA has been widely performed in Radiation Oncology clinic. However, concerns regarding its sensitivity in detecting delivery errors and its clinical meaning have been raised in publications. In this study, a robust methodology of three-dimensional (3D) IMRT QA using fiducial registration and structure-mapping was proposed to acquire organ-specific dose information. METHODS: Computed tomography (CT) markers were placed on the PRESAGE dosimeter as fiducials before CT simulation. Subsequently, the images were transferred to the treatment planning system to create a verification plan for the examined treatment plan. Patient's CT images were registered to the CT images of the dosimeter for structure mapping according to the positions of the fiducials. After irradiation, the 3D dose distribution was read-out by an optical-CT (OCT) scanner with fiducials shown on the OCT dose images. An automatic localization algorithm was developed in MATLAB to register the markers in the OCT images to those in the CT images of the dosimeter. SlicerRT was used to show and analyze the results. Fiducial registration error was acquired by measuring the discrepancies in 20 fiducial registrations, and thus the fiducial localization error and target registration error (TRE) was estimated. RESULTS: Dosimetry comparison between the calculated and measured dose distribution in various forms were presented, including 2D isodose lines comparison, 3D isodose surfaces with patient's anatomical structures, 2D and 3D gamma index, dose volume histogram and 3D view of gamma failing points. From the analysis of 20 fiducial registrations, fiducial registration error was measured to be 0.62 mm and fiducial localization error was calculated to be 0.44 mm. Target registration uncertainty of the proposed methodology was estimated to be within 0.3 mm in the area of dose measurement. CONCLUSIONS: This study proposed a robust methodology of 3D measurement-based IMRT QA for organ-specific dose comparison and demonstrated its clinical feasibility.

Dosimetric characterization of a body-conforming radiochromic sheet.

PURPOSE: A novel radiochromic PRESAGE sheet (Heuris Inc.) with 3 mm thickness has been developed as a measurement tool for 2D dosimetry. Its inherent ability to conform to irregular surfaces makes this dosimeter advantageous for patient surface dosimetry. This study is a comprehensive investigation into the PRESAGE sheet's dosimetric characteristic, accuracy and its potential use as a dosimeter for clinical applications. METHODS: The characterization of the dosimeter included evaluation of the temporal stability of the dose linearity, reproducibility, measurement uncertainties, dose rate, energy, temperature and angular dependence, lateral response artifacts, percent depth dose curve, and 2D dose measurement. Dose distribution measurements were acquired for regular square fields on a flat and irregular surface and an irregular modulated field on the smooth surface. All measurements were performed using an Epson 11000XL high-resolution scanner. RESULTS: The examined dosimeters exhibit stable linear response, standard error of repeated measurements within 2%, negligible dose rate, energy, and angular dependence. The same linear dose response was measured while the dosimeter was in contact with a heated water surface. Gamma test and histogram analysis of the dose difference between PRESAGE and EBT3 film, PRESAGE and the treatment planning system (TPS) were used to evaluate the measured dose distributions. The PRESAGE sheet dose distributions showed good agreement with EBT3 film and TPS. A discrepancy smaller than the statistical error of the two dosimeters was reported. CONCLUSIONS: This study established a full dosimetric characterization of the PRESAGE sheets with the purpose of laying the foundation for future clinical uses. The results presented here for the comparison of this novel dosimeter with those currently in use reinforce the possibility of using this dosimeter as an alternative for irregular surface dose measurements.

Detection of therapeutic radiation in three-dimensions.

For over the last twenty years there has been a multitude of sophisticated three-dimensional radiation delivery procedures developed which requires a corresponding verification of the impact on patients. This article reviews the state of the art in the development of chemical detectors used to characterize the three-dimensional shape of therapeutic radiation. These detectors are composed of polyurethane, radical initiator and a leuco dye, which is radiolytically oxidized to a dye absorbing at 630 nm.

Comprehensive stereotactic radiosurgery platform characterization: A novel end-to-end approach with anthropomorphic 3D dosimetry.

BACKGROUND: Stereotactic radiosurgery (SRS) is a widely employed strategy for intracranial metastases, utilizing linear accelerators and volumetric modulated arc therapy (VMAT). Ensuring precise linear accelerator performance is crucial, given the small planning target volume (PTV) margins. Rapid dose falloff is vital to minimize brain radiation necrosis. Despite advances in SRS planning, tools for end-to-end testing of SRS treatments are lacking, hindering confidence in the procedure. PURPOSE: This study introduces a novel end-to-end three-dimensional (3D) anthropomorphic dosimetry system for characterization of a radiosurgery platform, aiming to measure planning metrics, dose gradient index (DGI), brain volumes receiving at least 10 and 12 Gy (V10, V12), as well as assess delivery uncertainties in multitarget treatments. The study also compares metrics from benchmark plans to enhance understanding and confidence in SRS treatments. METHODS: The developed anthropomorphic 3D dosimetry system includes a modified Stereotactic End-to-End Verification (STEEV) phantom with a customized insert integrating 3D dosimeters and a fiber optic CT scanner. Labview and MATLAB programs handle optical scanning, image preprocessing, and dosimetric analysis. SlicerRT is used for 3D dose visualization and analysis. A film stack insert was used to validate the 3D dosimeter measurements at specific slices. Benchmark plans were developed and measured to investigate off-axis errors, dose spillage, small field dosimetry, and multi-target delivery. RESULTS: The accuracy of the developed 3D dosimetry system was rigorously assessed using radiochromic films. Two two-dimensional (2D) dose planes, extracted from the 3D dose distribution, were compared with film measurements, resulting in high passing rates of 99.9% and 99.6% in gamma tests. The mean relative dose difference between film and 3D dosimeter measurements was -1%, with a standard deviation of 2.2%, well within dosimeter uncertainties. In the first module, evaluating single-isocenter multitarget treatments, a 1.5 mm dose distribution shift was observed when targets were 7 cm off-axis. This shift was attributed to machine mechanical errors and image-guided system uncertainties, indicating potential limitations in conventional gamma tests. The second module investigated discrepancies in intermediate-to-low dose spillage, revealing higher measured doses in the connecting region between closely positioned targets. This discrepancy was linked to uncertainties in treatment planning system (TPS) modeling of out-of-field dose and multileaf collimator (MLC) characteristics, resulting in lower DGI values and higher V10 and V12 values compared to TPS calculations. In the third module, irradiating multiple targets showed consistent V10 and V12 values within 1 cm3 agreement with dose calculations. However, lower DGI values from measurements compared to calculations suggested intricacies in the treatment process. Conducting vital end-to-end testing demonstrated the anthropomorphic 3D dosimetry system's capacity to assess overall treatment uncertainty, offering a valuable tool for enhancing treatment accuracy in radiosurgery platforms. CONCLUSIONS: The study introduces a novel anthropomorphic 3D dosimetry system for end-to-end testing of a radiosurgery platform. The system effectively measures plan quality metrics, captures mechanical errors, and visualizes dose discrepancies in 3D space. The comprehensive evaluation capability enhances confidence in the commissioning and verification process, ensuring patient safety. The system is recommended for commissioning new radiosurgery platforms and remote auditing of existing programs.

Water and tissue equivalence of a new PRESAGE(®) formulation for 3D proton beam dosimetry: a Monte Carlo study.

PURPOSE: To evaluate the water and tissue equivalence of a new PRESAGE(®) 3D dosimeter for proton therapy. METHODS: The GEANT4 software toolkit was used to calculate and compare total dose delivered by a proton beam with mean energy 62 MeV in a PRESAGE(®) dosimeter, water, and soft tissue. The dose delivered by primary protons and secondary particles was calculated. Depth-dose profiles and isodose contours of deposited energy were compared for the materials of interest. RESULTS: The proton beam range was found to be ≈27 mm for PRESAGE(®), 29.9 mm for soft tissue, and 30.5 mm for water. This can be attributed to the lower collisional stopping power of water compared to soft tissue and PRESAGE(®). The difference between total dose delivered in PRESAGE(®) and total dose delivered in water or tissue is less than 2% across the entire water∕tissue equivalent range of the proton beam. The largest difference between total dose in PRESAGE(®) and total dose in water is 1.4%, while for soft tissue it is 1.8%. In both cases, this occurs at the distal end of the beam. Nevertheless, the authors find that PRESAGE(®) dosimeter is overall more tissue-equivalent than water-equivalent before the Bragg peak. After the Bragg peak, the differences in the depth doses are found to be due to differences in primary proton energy deposition; PRESAGE(®) and soft tissue stop protons more rapidly than water. The dose delivered by secondary electrons in the PRESAGE(®) differs by less than 1% from that in soft tissue and water. The contribution of secondary particles to the total dose is less than 4% for electrons and ≈1% for protons in all the materials of interest. CONCLUSIONS: These results demonstrate that the new PRESAGE(®) formula may be considered both a tissue- and water-equivalent 3D dosimeter for a 62 MeV proton beam. The results further suggest that tissue-equivalent thickness may provide better dosimetric and geometric accuracy than water-equivalent thickness for 3D dosimetry of this proton beam.

Commissioning a CT-compatible LDR tandem and ovoid applicator using Monte Carlo calculation and 3D dosimetry.

PURPOSE: To determine the geometric and dose attenuation characteristics of a new commercially available CT-compatible LDR tandem and ovoid (T&O) applicator using Monte Carlo calculation and 3D dosimetry. METHODS: For geometric characterization, we quantified physical dimensions and investigated a systematic difference found to exist between nominal ovoid angle and the angle at which the afterloading buckets fall within the ovoid. For dosimetric characterization, we determined source attenuation through asymmetric gold shielding in the buckets using Monte Carlo simulations and 3D dosimetry. Monte Carlo code MCNP5 was used to simulate 1.5 × 10(9) photon histories from a (137)Cs source placed in the bucket to achieve statistical uncertainty of 1% at a 6 cm distance. For 3D dosimetry, the distribution about an unshielded source was first measured to evaluate the system for (137)Cs, after which the distribution was measured about sources placed in each bucket. Cylindrical PRESAGE(®) dosimeters (9.5 cm diameter, 9.2 cm height) with a central channel bored for source placement were supplied by Heuris Inc. The dosimeters were scanned with the Duke Large field of view Optical CT-Scanner before and after delivering a nominal dose at 1 cm of 5-8 Gy. During irradiation the dosimeter was placed in a water phantom to provide backscatter. Optical CT scan time lasted 15 min during which 720 projections were acquired at 0.5° increments, and a 3D distribution was reconstructed with a (0.05 cm)(3) isotropic voxel size. The distributions about the buckets were used to calculate a 3D distribution of transmission rate through the bucket, which was applied to a clinical CT-based T&O implant plan. RESULTS: The systematic difference in bucket angle relative to the nominal ovoid angle (105°) was 3.1°-4.7°. A systematic difference in bucket angle of 1°, 5°, and 10° caused a 1% ± 0.1%, 1.7% ± 0.4%, and 2.6% ± 0.7% increase in rectal dose, respectively, with smaller effect to dose to Point A, bladder, sigmoid, and bowel. For 3D dosimetry, 90.6% of voxels had a 3D γ-index (criteria = 0.1 cm, 3% local signal) below 1.0 when comparing measured and expected dose about the unshielded source. Dose transmission through the gold shielding at a radial distance of 1 cm was 85.9% ± 0.2%, 83.4% ± 0.7%, and 82.5% ± 2.2% for Monte Carlo, and measurement for left and right buckets, respectively. Dose transmission was lowest at oblique angles from the bucket with a minimum of 56.7% ± 0.8%, 65.6% ± 1.7%, and 57.5% ± 1.6%, respectively. For a clinical T&O plan, attenuation from the buckets leads to a decrease in average Point A dose of ∼3.2% and decrease in D(2cc) to bladder, rectum, bowel, and sigmoid of 5%, 18%, 6%, and 12%, respectively. CONCLUSIONS: Differences between dummy and afterloading bucket position in the ovoids is minor compared to effects from asymmetric ovoid shielding, for which rectal dose is most affected. 3D dosimetry can fulfill a novel role in verifying Monte Carlo calculations of complex dose distributions as are common about brachytherapy sources and applicators.

Water equivalence evaluation of PRESAGE(®) formulations for megavoltage electron beams: a Monte Carlo study.

To investigate the radiological water equivalency of three different formulations of the radiochromic, polyurethane based dosimeter PRESAGE(®) for three dimensional (3D) dosimetry of electron beams. The EGSnrc/BEAMnrc Monte Carlo package was used to model 6-20 MeV electron beams and calculate the corresponding doses delivered in the three different PRESAGE(®) formulations and water. The depth of 50 % dose and practical range of electron beams were determined from the depth dose calculations and scaling factors were calculated for these electron beams. In the buildup region, a 1.0 % difference in dose was found for all PRESAGE(®) formulations relative to water for 6 and 9 MeV electron beams while the difference was negligible for the higher energy electron beams. Beyond the buildup region (at a depth range of 22-26 mm for the 6 MeV beam and 38 mm for the 9 MeV beam), the discrepancy from water was found to be 5.0 % for the PRESAGE(®) formulations with lower halogen content than the original formulation, which was found to have a discrepancy of up to 14 % relative to water. For a 16 MeV electron beam, the dose discrepancy from water increases and reaches about 7.0 % at 70 mm depth for the lower halogen content PRESAGE(®) formulations and 20 % at 66 mm depth for the original formulation. For the 20 MeV electron beam, the discrepancy drops to 6.0 % at 90 mm depth for the lower halogen content formulations and 18 % at 85 mm depth for the original formulation. For the lower halogen content PRESAGE(®), the depth of 50 % dose and practical range of electrons differ from water by up to 3.0 %, while the range of differences from water is between 6.5 and 8.0 % for the original PRESAGE(®) formulation. The water equivalent depth scaling factor required for the original formulation of PRESAGE(®) was determined to be 1.07-1.08, which is larger than that determined for the lower halogen content formulations (1.03) over the entire beam energy range of electrons. All three of the PRESAGE(®) formulations studied require a depth scaling factor to convert depth in PRESAGE(®) to water equivalent depth for megavoltage electron beam dosimetry. Compared to the original PRESAGE(®) formulation, the lower halogen content formulations require a significantly smaller scaling factor and are thus recommended over the original PRESAGE(®) formulation for electron beam dosimetry.

Commissioning and benchmarking a 3D dosimetry system for clinical use.

PURPOSE: A 3D dosimetry system is described which consists of two parts: a radiochromic plastic dosimeter PRESAGE (which responds to absorbed dose with a linear change in optical-density) and the Duke large-field-of-view optical-CT scanner (DLOS). The DLOS/PRESAGE system has recently been commissioned and benchmarked for clinical use and, in particular, for verification and commissioning of complex radiation treatments. METHODS: DLOS commissioning involved determining the dynamic range, spatial resolution, noise, temporal, and other characteristics of the light source and imaging components. Benchmarking tests were performed on the combined DLOS/PRESAGE system to establish baseline dosimetric performance. The tests consisted of delivering simple radiation treatments to PRESAGE dosimeters, and comparing the measured 3D relative dose distributions with the known gold standard. The gold standard distribution was obtained from machine beam-data or the treatment planning system (TPS). All studies used standardized procedures to ensure consistency. RESULTS: For commissioning, isotropic spatial resolution was submillimeter (MTF > 0.5 for frequencies of 1.5 lp/mm) and the dynamic range was -60 dB. Flood field uniformity was within 10% and stable after 45 min of warm-up. Stray-light is small, due to telecentricity, but even the residual can be removed through deconvolution by a point-spread-function. For benchmarking, the mean 3D passing NDD (normalized dose distribution) rate (3%, 3mm, 5% dose threshold) over the benchmark data sets was 97.3% +/- 0.6% (range 96%-98%), which is on par with other planar dosimeters used in external beam radiation therapy indicating excellent agreement. Noise was low at < 2% of maximum dose (4-12 Gy) for 2 mm reconstructions. The telecentric design was critical to enabling fast imaging with minimal stray-light artifacts. CONCLUSIONS: This work presents the first comprehensive benchmarking of a 3D dosimetry system for clinical use. The DLOS/PRESAGE benchmark tests show consistently good agreement to simple known distributions. The system produces accurate isotropic 2 mm dose data over clinical volumes (e.g., 16 cm diameter phantoms, 12 cm height), in under 15 min. It represents a uniquely useful and versatile new tool for commissioning and verification of complex therapy treatments.

Investigation of radiological properties and water equivalency of PRESAGE dosimeters.

PURPOSE: PRESAGE is a dosimeter made of polyurethane, which is suitable for 3D dosimetry in modern radiation treatment techniques. Since an ideal dosimeter is radiologically water equivalent, the authors investigated water equivalency and the radiological properties of three different PRESAGE formulations that differ primarily in their elemental compositions. Two of the formulations are new and have lower halogen content than the original formulation. METHODS: The radiological water equivalence was assessed by comparing the densities, interaction probabilities, and radiation dosimetry properties of the three different PRESAGE formulations to the corresponding values for water. The relative depth doses were calculated using Monte Carlo methods for 50, 100, 200, and 350 kVp and 6 MV x-ray beams. RESULTS: The mass densities of the three PRESAGE formulations varied from 5.3% higher than that of water to as much as 10% higher than that of water for the original formulation. The probability of photoelectric absorption in the three different PRESAGE formulations varied from 2.2 times greater than that of water for the new formulations to 3.5 times greater than that of water for the original formulation. The mass attenuation coefficient for the three formulations is 12%-50% higher than the value for water. These differences occur over an energy range (10-100 keV) in which the photoelectric effect is the dominant interaction. The collision mass stopping powers of the relatively lower halogen-containing PRESAGE formulations also exhibit marginally better water equivalency than the original higher halogen-containing PRESAGE formulation. Furthermore, the depth dose curves for the lower halogen-containing PRESAGE formulations are slightly closer to that of water for a 6 MV beam. In the kilovoltage energy range, the depth dose curves for the lower halogen-containing PRESAGE formulations are in better agreement with water than the original PRESAGE formulation. CONCLUSIONS: Based on the results of this study, the new PRESAGE formulations with lower halogen content are more radiologically water equivalent overall than the original formulation. This indicates that the new PRESAGE formulations are better suited to clinical applications and are more accurate dosimeters and phantoms than the original PRESAGE formulation. While correction factors are still needed to convert the dose measured by the dosimeter to an absorbed dose in water in the kilovoltage energy range, these correction factors are considerably smaller for the new PRESAGE formulations compared to the original PRESAGE and the existing polymer gel dosimeters.

Commissioning a small-field biological irradiator using point, 2D, and 3D dosimetry techniques.

PURPOSE: To commission a small-field biological irradiator, the XRad225Cx from Precision x-Ray, Inc., for research use. The system produces a 225 kVp x-ray beam and is equipped with collimating cones that produce both square and circular radiation fields ranging in size from 1 to 40 mm. This work incorporates point, 2D, and 3D measurements to determine output factors (OF), percent-depth-dose (PDD) and dose profiles at multiple depths. METHODS: Three independent dosimetry systems were used: ion-chambers (a farmer chamber and a micro-ionisation chamber), 2D EBT2 radiochromic film, and a novel 3D dosimetry system (DLOS∕PRESAGE®). Reference point dose rates and output factors were determined from in-air ionization chamber measurements for fields down to ∼13 mm using the formalism of TG61. PDD, profiles, and output factors at three separate depths (0, 0.5, and 2 cm), were determined for all field sizes from EBT2 film measurements in solid water. Several film PDD curves required a scaling correction, reflecting the challenge of accurate film alignment in very small fields. PDDs, profiles, and output factors were also determined with the 3D DLOS∕PRESAGE® system which generated isotropic 0.2 mm data, in scan times of 20 min. RESULTS: Surface output factors determined by ion-chamber were observed to gradually drop by ∼9% when the field size was reduced from 40 to 13 mm. More dramatic drops were observed for the smallest fields as determined by EBT∼18% and ∼42% for the 2.5 mm and 1 mm fields, respectively. PRESAGE® and film output factors agreed well for fields <20 mm (where 3D data were available) with mean deviation of 2.2% (range 1%-4%). PDD values at 2 cm depth varied from ∼72% for the 40 mm field, down to ∼55% for the 1 mm field. EBT and PRESAGE® PDDs agreed within ∼3% in the typical therapy region (1-4 cm). At deeper depths the EBT curves were slightly steeper (2.5% at 5 cm). These results indicate good overall consistency between ion-chamber, EBT2 and PRESAGE® measured OFs, PDDs, and profiles. CONCLUSIONS: The combination of independent 2D and 3D measurements was found to be valuable to ensure accurate and comprehensive commissioning. Film measurements were time consuming and challenging due to the difficulty of film alignment in small fields. PRESAGE® 3D measurements were comprehensive and efficient, because alignment errors are negligible, and all parameters for multiple fields could be obtained from a single dosimeter and scan. However, achieving accurate superficial data (within 4 mm) is not yet feasible due to optical surface artifacts.

An investigation into a new re-useable 3D radiochromic dosimetry material, Presage.

PURPOSE: To investigate the dosimetric properties of a new Presage formulation which exhibits a reversible color change on exposure to radiation. Presage(REU) offers the intriguing possibility of the first re-useable 3D dosimetry material. METHOD AND MATERIALS: Small volumes of Presage(REU) in 1×1×5cm optical cuvettes were irradiated and re-irradiated under a variety of conditions and times to investigate a range of properties including re-usability, dose-rate dependence, dose sensitivity, temporal response, energy sensitivity, and temperature dependence. RESULTS: The radiation induced change in optical density (OD) was found to be linear with dose after initial and subsequent irradiations. After the first irradiation OD was observed to clear in ~2 weeks when stored at room temperature. 3 subsequent irradiations of the same cuvettes showed a very similar strong OD response, although there was a significant increase between this response and that achieve at initial irradiation. CONCLUSION: The Presage(REU) formulation shows strong potential as the first re-useable 3D dosimetry material. When dosimeters are stored at room temperature (~22°C) clearing can occur in 2-3 weeks.

RadBall Technology Testing in the Savannah River Site's Health Physics Instrument Calibration Laboratory.

The United Kingdom's National Nuclear Laboratory (NNL) has developed a radiation-mapping device that can locate and quantify radioactive hazards within contaminated areas of the nuclear industry. The device, known as RadBall(™), consists of a colander-like outer collimator that houses a radiation-sensitive polymer sphere. The collimator has over two hundred small holes; thus, specific areas of the polymer sphere are exposed to radiation becoming increasingly more opaque in proportion to the absorbed dose. The polymer sphere is imaged in an optical-CT scanner that produces a high resolution 3D map of optical attenuation coefficients. Subsequent analysis of the optical attenuation data provides information on the spatial distribution of sources in a given area forming a 3D characterization of the area of interest. The RadBall(™) technology has been deployed in a number of technology trials in nuclear waste reprocessing plants at Sellafield in the United Kingdom and facilities of the Savannah River National Laboratory (SRNL). This paper summarizes the tests completed at SRNL Health Physics Instrument Calibration Laboratory (HPICL).

RadBall Technology Testing and MCNP Modeling of the Tungsten Collimator.

The United Kingdom's National Nuclear Laboratory (NNL) has developed a remote, non-electrical, radiation-mapping device known as RadBall(™), which can locate and quantify radioactive hazards within contaminated areas of the nuclear industry. RadBall(™) consists of a colander-like outer shell that houses a radiation-sensitive polymer sphere. The outer shell works to collimate radiation sources and those areas of the polymer sphere that are exposed react, becoming increasingly more opaque, in proportion to the absorbed dose. The polymer sphere is imaged in an optical-CT scanner, which produces a high resolution 3D map of optical attenuation coefficients. Subsequent analysis of the optical attenuation matrix provides information on the spatial distribution of sources in a given area forming a 3D characterization of the area of interest. RadBall(™) has no power requirements and can be positioned in tight or hard-to reach locations. The RadBall(™) technology has been deployed in a number of technology trials in nuclear waste reprocessing plants at Sellafield in the United Kingdom and facilities of the Savannah River National Laboratory (SRNL). This study focuses on the RadBall(™) testing and modeling accomplished at SRNL.

3D isocentricity analysis for clinical linear accelerators.

PURPOSE: To perform a three-dimensional (3D) concurrent isocentricity measurement of a clinical linear accelerator's (linac) using a single 3D dosimeter, PRESAGE. METHODS: A 3D dosimeter, PRESAGE, set up on the treatment couch of a Varian TrueBeam LINAC using the setup lasers, was irradiated under gantry angles of 0 ∘ , 50 ∘ , 160 ∘ , and 270 ∘ with the couch fixed at 0 ∘ and subsequently, under couch angles of 10 ∘ , 330 ∘ , 300 ∘ , and 265 ∘ with the gantry fixed at 270 ∘ . The 1 cm 2 (at 100 cm SAD) square fields were delivered at 6 MV with 800 MU/field. After irradiation, the dosimeter was scanned using a single-beam optical scanner and images were reconstructed with submillimeter resolution using filtered back-projection. Postprocessing was used to extract views parallel to the star-shot planes from which beam trajectories and the smallest circles enclosing these were drawn and extracted. These circles and information from the view orthogonal to both star-shots were used to represent the rotational centers as spheroids. The linac isocenter was defined by the distribution of midpoints between any, randomly selected, points lying inside the center spheroids defined by the table and gantry rotations; isocenter location and size were defined by the average midpoint and the distribution's semi-axes. Collimator rotations were not included in this study. RESULTS: Relative to the setup center defined by lasers, the table and gantry rotation center coordinates (lat., long., vert.) were measured in units of millimeters, to be (-0.24, 0.18, -0.52) and (0.10, 0.53, -0.52), respectively. Displacements from the setup center were 0.60 and 0.75 mm for the table and gantry centers, while the distance between them measured 0.49 mm. The linac's radiation isocenter was calculated to be at (-0.07, -0.17, 0.51) relative to the setup lasers and its size was found to be most easily described by a spheroid prolate in vertical direction with semi-axis lengths of 0.13 and 0.23 mm for the lateral-longitudinal and vertical directions, respectively. CONCLUSIONS: This study demonstrates how to measure the location and sizes of rotational centers in 3D with one setup. The proposed method provides a more comprehensive view on the isocentricity of LINAC than the conventional two-dimensional film measurements. Additionally, a new definition of isocenter and its size was proposed.

Temperature dependence and temporal stability of stacked radiochromic sheets for three-dimensional dose verification.

PURPOSE: Recently a novel radiochromic sheet dosimeter, termed as PRESAGE sheets, consisting of leuco crystal violet dye and radical initiator had been developed and characterized. This study examines the dosimeter's temporal stability and storage temperature dependence postirradiation, and its applicability for dose verification in three dimensions (3D) as a stack dosimeter. METHODS: PRESAGE sheets were irradiated using 6 MV photons at a dose range of 0-20 Gy with the change in optical density measured using a flatbed scanner. Following their irradiation, PRESAGE sheets were stored in different temperature environments (-18 °C, 4 °C, and 22 °C) and scanned at different time points, ranging from 1 to 168 h postirradiation, to track changes in measured signal and linearity of dose response. Multiple PRESAGE sheets were bound together to create a 12 × 13 × 8.7 cm3 film stack, with EBT3 film inserted between the sheets in the central region of the stack, that was treated using a clinical VMAT plan. Based on the results from the time and storage temperature study, two-dimensional (2D) relative dose distribution measurements in PRESAGE were acquired promptly following irradiation at selected planes in the coronal, sagittal, and axial orientation of the film stack and compared to the treatment planning system calculations in their respective axes. Dose distribution measurements on the coronal axis of the stack dosimeter were also independently verified using EBT3 film. RESULTS: The dose response was observed to be linear (R2 > 0.995) with sheets stored in colder temperatures retaining their signal and dose response sensitivity for extended periods postirradiation. Sheets stored in 22 °C environment should be measured within an hour postirradiation. Sheets stored in a 4 °C and -18 °C environment can be scanned up to 20- and 72 h postirradiation, respectively, while preserving the integrity of their dose response sensitivity and linearity of dose response within a mean absolute percent error of 2.0%. For instance, at 20 h postirradiation the dose response sensitivity for sheets stored in a -18 °C, 4 °C, and 22 °C temperature environment was measured to be 97%, 91%, and 77% of their original values measured within an hour postirradiation, respectively. The 2D gamma pass rate for central slices exceed 95% for PRESAGE film stack compared with treatment planning system on selected planes in the axial, coronal, and sagittal orientation and EBT3 film in the coronal orientation using a 2D gamma index of 2%/2mm. The gamma pass rate in comparing the calculated dose distribution with the measured dose distribution from PRESAGE-LCV was observed to decrease in sheets scanned at later elapsed times postirradiation. In one example, the gamma pass rate for 2%/2mm criteria in the coronal plane was observed to decrease from 97.7% pass rate when scanned within an hour postirradiation to 92.1% pass rate when scanned at 20 h postirradiation under room temperature conditions. CONCLUSIONS: This is the first study to demonstrate that the temporal stability of PRESAGE sheets can be enhanced through its storage in colder temperature environments postirradiation and that sheets as a film stack dosimeter hold promise for precise relative dose distribution measurements in 3D where advanced optical CT is unavailable.

Investigation of the feasibility of relative 3D dosimetry in the Radiologic Physics Center Head and Neck IMRT phantom using presage/optical-CT.

This study presents the application of the Presage/optical-CT 3D dosimetry system for relative dosimetry in the Radiologic Physics Center (RPC) Head and Neck (H&N) IMRT phantom. Performance of the system was evaluated by comparison with the "gold-standard" RPC credentialing test. A modified Presage cylindrical insert was created that extended the capability of the RPC H&N phantom to 3D dosimetry. The RPC phantom was taken through the entire treatment planning procedure with both the standard RPC insert and the modified Presage insert. An IMRT plan was created to match the desired dose constraints of the credentialing test. This plan was delivered twice to the RPC phantom: first containing the standard insert, and then again containing the Presage insert. After irradiation, the standard insert was sent for routine credentialing analysis; including point dose measurements (TLD) and planar Gafchromic EBT film measurement. The 3D dose distribution from Presage was read out at Duke using the OCTOPUS 5X optical-CT scanner. The Presage distribution was compared with gold-standard EBT measurement (determined by the RPC) and the calculated Eclipse distribution. The agreement between the normalized EBT, Presage, and Eclipse distributions, in the central axial plane was evaluated using profiles and gamma-map comparisons (4% dose difference and 3 mm distance to agreement). Profiles showed good agreement between EBT, Presage, and Eclipse distributions. 2D gamma-map comparisons between all three modalities showed at least 98% pass rate. The excellent agreement between Presage and EBT in the central plane established Presage as a standard against which to evaluate the accuracy of the 3D calculated Eclipse distribution. A gamma comparison between normalized Presage and Eclipse 3D distributions gave an overall pass rate of approximately 94%. In conclusion, the Presage/optical-CT system was found to be feasible for relative 3D dosimetry in the RPC IMRT H&N phantom. The potential to extend the RPC IMRT credentialing procedure to 3D may be feasible provided accurate calibration to dose (Gy) and robustness to shipping stress are demonstrated.

An investigation of a novel reusable radiochromic sheet for 2D dose measurement.

PURPOSE: Radiochromic film remains a useful and versatile clinical dosimetry tool. Current film options are single use. Here, we introduce a novel prototype two-dimensional (2D) radiochromic sheet, which optically clears naturally at room temperature after irradiation and can be reused. We evaluate the sheets for potential as a 2D dosimeter and as a radiochromic bolus with capability for dose measurement. METHODS: A novel derivative of reusable Presage® was manufactured into thin sheets of 5 mm thickness. The sheets contained 2% cumin-leucomalachitegreen-diethylamine (LMG-DEA) and plasticizer (up to 25% by weight). Irradiation experiments were performed to characterize the response to megavoltage radiation, including dose sensitivity, temporal decay rate, consistency of repeat irradiations, intra and inter-sheet reproducibility, multi-modality response (electrons and photons), and temperature sensitivity (22°C to 36°C). The local change in optical-density (ΔOD), before and after radiation, was obtained with a flat-bed film scanner and extracting the red channel. Repeat scanning enabled investigation of the temporal decay of ΔOD. Additional studies investigated clinical utility of the sheets through application to IMRT treatment plans (prostate and a TG119 commissioning plan), and a chest wall electron boost treatment. In the latter test, the sheet performed as a radiochromic bolus. RESULTS: The radiation induced OD change in the sheets was found to be proportional to dose and to exponentially decay to baseline in ~24 h (R2 = 0.9986). The sheet could be reused and had similar sensitivity (within 1% after the first irradiation) for at least eight irradiations. Importantly, no memory of previous irradiations was observed within measurement uncertainty. The consistency of dose response from photons (6 and 15 MV) and electrons (6-20 MeV) was found to be within calibration uncertainty (~1%). The dose sensitivity of the sheets had a temperature dependence of 0.0012 ΔOD/°C. For the short (1 min) single field IMRT QA verification, good agreement was observed between the Presage sheet and EBT film (gamma pass rate 97% at 3% 3 mm dose-difference and distance-to-agreement tolerance, with a 10% threshold). For the longer (~13 min) TG-119 9-field IMRT verification the gamma agreement was lower at 93% pass rate at 5% 3 mm, 10% threshold, when compared with Eclipse. The lower rate is attributed to uncertainty arising from signal decay during irradiation and indicates a current limitation. For the electron cutout treatment, both Presage and EBT agreed well (within 2% RMS difference) but differed from the Eclipse treatment plan (~7% RMS difference) indicating some limitations to the Eclipse modeling in this case. The worst case estimates of uncertainty introduced by the signal decay for deliveries of 2, 5, and 10 min are 0.6%, 1.4%, and 2.8% respectively. CONCLUSIONS: Reusable Presage sheets show promise for 2D dose measurement and as a radiochromic bolus for in vivo dose measurement. The current prototype is suitable for deliveries of length up to 5 min, where the uncertainty introduced by signal decay is anticipated to be ~1% (worst case 1.4%), or for longer deliveries where there is no temporal modulation (e.g. physical compensators, or open beams). Additionally, spatial resolution is limited by sheet thickness and scanner resolution, resulting in a practical resolution of 0.8 mm.

An investigation of the accuracy of an IMRT dose distribution using two- and three-dimensional dosimetry techniques.

Complex dose delivery techniques like intensity-modulated radiation therapy (IMRT) require dose measurement in three dimensions for comprehensive validation. Previously, we demonstrated the feasibility of the "PRESAGE/optical-computed tomography (CT)" system for the three-dimensional verification of simple open beam dose distributions where the planning system was known to be accurate. The present work extends this effort and presents the first application of the PRESAGE/optical-CT system for the verification of a complex IMRT distribution. A highly modulated 11 field IMRT plan was delivered to a cylindrical PRESAGE dosimeter (16 cm in diameter and 11 cm in height), and the dose distribution was readout using a commercial scanning-laser optical-CT scanner. Comparisons were made with independent GAFCHROMIC EBT film measurements, and the calculated dose distribution from a commissioned treatment planning system (ECLIPSE). Isodose plots, dose profiles, gamma maps, and dose-volume histograms were used to evaluate the agreement. The isodose plots and dose profiles from the PRESAGE/optical-CT system were in excellent agreement with both the EBT measurements and the ECLIPSE calculation at all points except within 3 mm of the outer edge of the dosimeter where an edge artifact occurred. Excluding this 3 mm rim, gamma map comparisons show that all three distributions mutually agreed to within a 3% (dose difference) and 3 mm (distance-to-agreement) criteria. A 96% gamma pass ratio was obtained between the PRESAGE and ECLIPSE distributions over the entire volume excluding this rim. In conclusion, for the complex IMRT plan studied, and in the absence of inhomogeneities, the ECLIPSE dose calculation was found to agree with both independent measurements, to within 3%, 3 mm gamma criteria.

Investigating the effect of a magnetic field on dose distributions at phantom-air interfaces using PRESAGE® 3D dosimeter and Monte Carlo simulations.

Dosimetric quality assurance (QA) of the new Elekta Unity (MR-linac) will differ from the QA performed of a conventional linac due to the constant magnetic field, which creates an electron return effect (ERE). In this work we aim to validate PRESAGE® dosimetry in a transverse magnetic field, and assess its use to validate the research version of the Monaco TPS of the MR-linac. Cylindrical samples of PRESAGE® 3D dosimeter separated by an air gap were irradiated with a cobalt-60 unit, while placed between the poles of an electromagnet at 0.5 T and 1.5 T. This set-up was simulated in EGSnrc/Cavity Monte Carlo (MC) code and relative dose distributions were compared with measurements using 1D and 2D gamma criteria of 3% and 1.5 mm. The irradiation conditions were adapted for the MR-linac and compared with Monaco TPS simulations. Measured and EGSnrc/Cavity simulated profiles showed good agreement with a gamma passing rate of 99.9% for 0.5 T and 99.8% for 1.5 T. Measurements on the MR-linac also compared well with Monaco TPS simulations, with a gamma passing rate of 98.4% at 1.5 T. Results demonstrated that PRESAGE® can accurately measure dose and detect the ERE, encouraging its use as a QA tool to validate the Monaco TPS of the MR-linac for clinically relevant dose distributions at tissue-air boundaries.

Dosimetric and geometric characteristics of a small animal image-guided irradiator using 3D dosimetry/optical CT scanner.

PURPOSE: The precise dosimetric and geometric characteristics of small animal irradiators are essential to achieving reproducible dose delivery, especially in cases where image-guidance is utilized. Currently, radiochromic film is the established measurement tool used to evaluate beam characteristics for these systems. However, only 2D information can be acquired with film. This study characterized both the dosimetric and geometric properties of the small animal research radiation platform (SARRP, Xstrahl) for commissioning purposes using a 3D radiochromic dosimetry system with a submillimeter resolution optical computed tomography (OCT) scanner. METHODS: Like a modern clinical linear accelerator, the SARRP features both a beam delivery system and a cone beam computed tomography (CBCT) imaging system. Dosimetric and geometric characteristics of the SARRP were studied using EBT3 radiochromic film and 3D PRESAGE dosimeters. Dosimetric measurements included percent depth dose (PDD) curves and beam profiles. For geometric evaluation, the isocenter sizes of the treatment stage and gantry rotations as well as their coincidence were measured using star shot patterns. A commercial Epson Expression 11000XL flatbed scanner was used for readout of irradiated EBT3 films at 300 dpi resolution. Each irradiated PRESAGE dosimeter was scanned using a submillimeter resolution single laser beam OCT scanner. Acquired data were reconstructed with a resolution of 0.3 mm/pixel. RESULTS: PDD data measured from films and 3D dosimeters agree to within ±3% for depths up to 5 cm, for both 3 × 3 and 10 × 10 mm2 fixed collimation. Profiles were analyzed at 10, 20, and 30 mm depth for 3 × 3 mm2 and 10 × 10 mm2 fields. The FWHM measurements for both dosimeters agreed to within 0.01 mm, and the penumbras agreed to within 0.1 mm for 3 × 3 mm2 and 0.5 mm for 10 × 10 mm2 . Gantry and treatment stage isocenter sizes were determined to be 0.21 and 0.43 mm using EBT3 film, and 1.72 and 0.75 mm using PRESAGE dosimeters. Absolute isocenter shifts, evaluated with 3D phantoms, were 0.80 mm for the gantry rotation isocenter (treatment isocenter) with respect to the laser-defined setup isocenter, and 0.71 mm for the gantry rotation isocenter relative to treatment stage rotation isocenter (CBCT isocenter). The difference between CBCT isocenter and laser-defined setup isocenter was 0.68 mm. CONCLUSIONS: This study demonstrated that 3D PRESAGE dosimeters can be used for verification of precise targeting for the SARRP. This 3D dosimetry system can be utilized to obtain information on both geometric and dosimetric properties, as well as acquire beam data parameters for the purpose of commissioning image-guided small animal irradiator systems.