A comparison of organs at risk doses in GYN intracavitary brachytherapy for different tandem lengths and bladder volumes.

The purpose of this study was to investigate the concurrent effects of tandem length and bladder volume on dose to pelvic organs at risk (OARs) in HDR intracavitary brachytherapy treatment of cervical cancer. Twenty patients with locally advanced cervical cancer were selected for brachytherapy using Rotterdam applicators. The patients were CT scanned twice with empty and full bladder. Two treatment plans were prepared on each of the image sets. Patients were categorized into two groups; those treated with a tandem length of 4 cm or smaller (T ≤ 4 cm) and those with tandem length larger than 4 cm (T > 4 cm). Only one tandem tip angle of 30° was studied. Dose-volume histograms (DVHs) of OARs were calculated and compared. Bladder dose was significantly affected by both bladder volume and tandem physical length for T ≤ 4 cm. This was reflected on the values obtained for D2cm³, D1cm³, and D0.1cm³ for both empty and full bladder cases. When T > 4 cm, no correlation could be established between variations in bladder dose and blad-der volume. Rectum dose was generally lower when the bladder was empty and T > 4 cm. Dose to sigmoid was increased when T > 4 cm; this increase was larger when the bladder was full. Our results suggest that, for tandems longer than 4 cm, keeping the bladder empty may reduce the dose to rectum and sigmoid. This is contrary to cases where a shorter than 4 cm tandem is used in which a full bladder (about 50-120 cm³) tends to result in a lower dose to rectum and sigmoid. Attention should be given to doses to sigmoid with long tandem lengths, as a larger tandem generally results in a larger dose to sigmoid.

Evaluating the utility of "3D Slicer" as a fast and independent tool to assess intrafractional organ dose variations in gynecological brachytherapy.

PURPOSE: To demonstrate the utility of "3D Slicer" for easy treatment verification by comparing dose-volume histograms (DVHs) calculated on pretreatment and posttreatment images. METHODS AND MATERIALS: Thirty cervical cancer patients were CT scanned twice: first for treatment planning and a second time after the dose delivery. The initial plan was manually duplicated on the posttreatment image set in Flexiplan treatment planning system, and DVH parameters were calculated. Pretreatment and posttreatment images, organ structures, and plan data were exported from the treatment planning system to 3D Slicer to validate DVH parameter calculation with 3D Slicer. The gamma analysis was used to compare Flexiplan and 3D Slicer DVHs. Posttreatment images were rigidly fused on the initial CT to automatically transfer the data of the pretreatment plan onto the posttreatment images. DVH parameters were calculated in 3D Slicer for both image sets, and their relative variations were compared. RESULTS: In calculating DVH parameter variations, no significant differences were observed between Flexiplan and 3D Slicer. Where the registration accuracy was better than 0.03, they returned similar results for D2 cm(3) of bladder, rectum, and sigmoid. Mean and standard deviation of DVH parameters were calculated on pretreatment and posttreatment images for several organs; both the manually duplicated plan and the automatically registered plan in SlicerRT returned comparable relative variations of these parameters. For 88% of the organs, more than 95% of the DVH dose bins passed the gamma analysis. CONCLUSIONS: We tested an automated DVH assessment method with an imaging freeware, 3D Slicer, for use in image-guided adaptive brachytherapy. SlicerRT is a viable verification tool to report and detect DVH variations between different contoured images series.

Preliminary studies on the role and reactions of tetrakis(hydroxymethyl)phosphonium chloride in polyacrylamide gel dosimeters.

A major source of dosimetric inaccuracy in normoxic polymer gel dosimeters is local variations in the concentration of oxygen scavenger. Currently, a phosphorus compound, tetrakis(hydroxymethyl)phosphonium chloride (THPC), is the oxygen scavenger of choice in most polymer gel dosimetry studies. Reactions of THPC in a gel dosimeter are not limited to oxygen. It can possibly be consumed in reacting with gelling agent, water free-radicals and polymer radicals before, during and after irradiation, hence affecting the dose response of the dosimeter in several ways. These reactions are not fully known or understood. It is our hypothesis that THPC not only scavenges radical species but also modifies the morphology of the gelatin network and of the polymer, possibly by intervening in the polymerization of monomers. These hypotheses are investigated in an anoxic acrylamide-based gel dosimeter. Scanning electron microscopy results indicate gelatin pores decreasing from 70 to 40 µm and a very different radiation-induced polymer structure in samples containing THPC; Fourier-transform Raman spectroscopy shows a two-fold reduction in the dose constants of monomer consumption; however, a significant change in the relative dose constants of monomer consumption as a function of dose could not be detected.

Severe dose inaccuracies caused by an oxygen-antioxidant imbalance in normoxic polymer gel dosimeters.

Two oxygen scavengers have been successfully tested to produce normoxic polymer gel dosimeters under normal atmospheric conditions. The first is ascorbic acid and the second is a chloride (also sulfate) salt of tetrakis (hydroxymethyl) phosphonium. These antioxidants, added to the dosimeter during gel preparation, chemically remove dissolved oxygen that otherwise inhibits propagation of the polymerization reaction during irradiation of the dosimeter. These gel dosimeters are radiosensitive after manufacture under normoxic conditions. However, we show herein that the accuracy of the dosimetric measurement is compromised due to chemical reactions of the antioxidant with radicals. In addition, we provide evidence that both antioxidant and oxygen act as radical scavengers that affect the amount of polymer formed in the gel dosimeter. This can result in important dose inaccuracies in both methacrylic acid-based and acrylamide-based normoxic dosimeter gels.

Investigating potential physicochemical errors in polymer gel dosimeters.

Measurement errors in polymer gel dosimetry can originate either during irradiation or scanning. One concern related to the exothermic nature of polymerization reaction was that the heat released in polymer gel dosimeters during irradiation modifies their dose response. In this paper, the effect of heat released from the exothermal polymerization reaction on the dose response of a number of dosimeters was studied. In addition, we investigated whether heat-generated geometric distortion existed in newly proposed gel dosimeters that contain highly thermoresponsive polymers. Our results suggest that despite a significant internal temperature increase in some gel compositions, their dose responses are not affected when oxygen is well expelled mechanically from the gel mixture. We also report on significant pre-irradiation instability in some recently developed polymer gel dosimeters but that geometric distortions were not observed. Data obtained by a set of small calibration vials are compared to those obtained from larger phantoms, and potential physicochemical causes of deviations between them are identified.