Prognostic Role of Biologically Active Volume of Disease in Patients With Metastatic Lung Adenocarcinoma.

BACKGROUND: Number of metastatic sites can identify patient populations with non-small cell lung cancer (NSCLC) that benefit from aggressive therapy. Total volume of disease is also relevant. We evaluated the prognostic impact of biologically active volume of disease (BaVD) on patients with metastatic lung adenocarcinoma. MATERIALS AND METHODS: Positron emission tomography/computerized tomography (PET/CT) scans from patients with newly diagnosed lung adenocarcinoma prior to starting any therapy were identified. SUV thresholds of 3 and 4 were used to auto-contour all FDG avid areas. Kaplan-Meier analysis and Cox regression were performed to examine influence on OS. RESULTS: One hundred forty-eight patients were included in the analysis. The median BaVD when using an SUV threshold of 3 was 122.8 mL. The median BaVD when using an SUV threshold of 4 was 46.2 mL When stratified by median BaVD using an SUV of 3, median OS was higher for patients with <=122.8 mL (2.12 years) compared to patients with >122.8 mL (1.46 years) (log-rank P = .001). Similarly, when stratified by median BaVD using an SUV of 4, median OS was higher for patients with <=46.2 mL (1.91 years; 95% CI: 1.65-3.22 years) compared to patients with >46.2 mL (1.48 years; 95% CI: 1.07-1.80 years) (log-rank P = .007). On multivariable analysis, BaVD was significantly associated with OS when using an SUV threshold of 3 (HR: 20.169, P < .001) and 4 (HR: 4.117, P < .001). CONCLUSION: BaVD is an important prognostic factor in metastatic lung adenocarcinoma and may aid identification of patients with limited disease who may be candidates for more aggressive therapies.

Automatic organ contour check: One essential step in autonomous treatment planning.

Geometric and nomenclature errors are commonly encountered in automated treatment planning. We describe a novel algorithm to extract organ geometry relationships from patient structure DICOM data to construct a database that can be used to detect organ contour inaccuracies including relational and naming errors. Twenty-five sets of head and neck patients' treatment plan data (CT, structures) were retrospectively retrieved from our institution. For each dataset, various organs were contoured and verified by experienced physicians. The relative position and orientation between organs were extracted from each patient and the data were used to construct an organ relationship database model. The model was tested using a dataset originating from an in-house organ renaming software that often-introduced organ contour naming mismatches. As part of the validation test, the renamed organs relative positions were compared with the database model to identify mismatches. Within the forty head and neck patients, we extracted the geometric relationship between 201 organ pairs. The average number of unique types of organ pairs (for example, left parotid with left eye is one type of organ pair) stored in the database was 12. Fifteen head and neck structure sets automatically renamed using our in-house organ renaming tool was used as validation data. All of the 30 random assigned wrong name labels present in these structure sets were identified using the established organ geometry relationship database. We successfully constructed a head and neck organ geometry relationship database and validated it in a contour naming quality assurance process. This novel scheme can be expanded to the entire body and shows a great potential in automatic plan physics QA procedure. It should be one essential QA step in an autonomous treatment planning process.

A pilot study of function-based radiation therapy planning for lung cancer using hyperpolarized xenon-129 ventilation MRI.

PURPOSE: Radiation-induced lung injury (RILI) is a common side effect in patients with non-small cell lung cancer (NSCLC) treated with radiotherapy. Minimizing irradiation into highly functional areas of the lung may reduce the occurrence of RILI. The aim of this study is to evaluate the feasibility and utility of hyperpolarized xenon-129 magnetic resonance imaging (MRI), an imaging tool for evaluation of the pulmonary function, to guide radiotherapy planning. METHODS: Ten locally advanced NSCLC patients were recruited. Each patient underwent a simulation computed tomography (CT) scan and hyperpolarized xenon-129 MRI, then received 64 Gyin 32 fractions for radiotherapy. Clinical contours were drawn on CT. Lung regions with good ventilation were contoured based on the MRI. Two intensity-modulated radiation therapy plans were made for each patient: an anatomic plan (Plan-A) based on CT alone and a function-based plan (Plan-F) based on CT and MRI results. Compared to Plan-A, Plan-F was generated with two additional steps: (1) beam angles were carefully chosen to minimize direct radiation entering well-ventilated areas, and (2) additional optimization criteria were applied to well-ventilated areas to minimize dose exposure. V20Gy , V10Gy , V5Gy , and the mean dose in the lung were compared between the two plans. RESULTS: Plan-A and Plan-F were both clinically acceptable and met similar target coverage and organ-at-risk constraints (p > 0.05) except for the ventilated lungs. Compared with Plan-A, V5Gy (Plan-A: 30.7 ± 11.0%, Plan-F: 27.2 ± 9.3%), V10Gy (Plan-A: 22.0 ± 8.6%, Plan-F: 19.3 ± 7.0%), and V20Gy (Plan-A: 12.5 ± 5.6%, Plan-F: 11.0 ± 4.1%) for well-ventilated lung areas were significantly reduced in Plan-F (p < 0.05). CONCLUSION: In this pilot study, function-based radiotherapy planning using hyperpolarized xenon-129 MRI is demonstrated to be feasible in 10 patients with NSCLC with the potential to reduce radiation exposure in well-ventilated areas of the lung defined by hyperpolarized xenon-129 MRI.

Setup Accuracy in Craniospinal Irradiation: Implications for Planning Treatment Volume Margins.

PURPOSE: Craniospinal irradiation (CSI) using tomotherapy has advantages over standard 3-dimensional techniques. However, there is a paucity of published data on craniospinal setup reproducibility to guide appropriate planning treatment volume (PTV) margins. We sought to evaluate the setup accuracy of patients undergoing CSI to optimize PTV margins. METHODS AND MATERIALS: We measured residual setup deviation between simulation computed tomography (CT) and daily megavoltage CT after couch shifts made by therapists after megavoltage CT-based image registration for 10 patients who completed CSI at our institution. Translational displacement values were recorded at the sella, top of T1, and top of L5 in the anteroposterior (AP) and lateral planes. Systematic and random error were calculated from displacement values. Using z score analysis, we calculated minimal PTV margins to encompass 90% of recorded fractions at each level. We evaluated whether patient characteristics predict for increased setup error using standard statistical techniques. RESULTS: The mean setup deviation in the AP plane across all treatments was 2.49, 3.40, and 3.83 mm at the sella, T1, and L5, respectively. Mean lateral setup error was 2.86, 4.02, and 5.46 mm at the sella, T1, and L5, respectively. Systematic error ranged from 0.75 to 1.01 mm at the sella, 1.09 to 1.37 mm at T1, and 1.30 to 1.50 mm at L5. Random error ranged from 1.35 to 1.41 mm at the sella, 1.48 to 1.73 mm at T1, and 2.26 to 2.37 mm at L5. The minimum margin to cover 90% of the treatments was 6.4, 8.2, and 10.5 mm at the sella, T1, and L5, respectively. There appeared to be a correlation between older age and lateral setup error in the L spine approaching statistical significance (R, 0.629; P = .052). CONCLUSIONS: Setup error increases in the caudal direction of the spine and is greater in the lateral plane compared with the AP plane. We recommend a PTV margin of 5 to 7 mm in the brain and 10 mm in the spine.

Clinical assessment of geometric distortion for a 0.35T MR-guided radiotherapy system.

PURPOSE: To estimate the overall spatial distortion on clinical patient images for a 0.35 T MR-guided radiotherapy system. METHODS: Ten patients with head-and-neck cancer underwent CT and MR simulations with identical immobilization. The MR images underwent the standard systematic distortion correction post-processing. The images were rigidly registered and landmark-based analysis was performed by an anatomical expert. Distortion was quantified using Euclidean distance between each landmark pair and tagged by tissue interface: bone-tissue, soft tissue, or air-tissue. For baseline comparisons, an anthropomorphic phantom was imaged and analyzed. RESULTS: The average spatial discrepancy between CT and MR landmarks was 1.15 ± 1.14 mm for the phantom and 1.46 ± 1.78 mm for patients. The error histogram peaked at 0-1 mm. 66% of the discrepancies were <2 mm and 51% <1 mm. In the patient data, statistically significant differences (p-values < 0.0001) were found between the different tissue interfaces with averages of 0.88 ± 1.24 mm, 2.01 ± 2.20 mm, and 1.41 ± 1.56 mm for the air/tissue, bone/tissue, and soft tissue, respectively. The distortion generally correlated with the in-plane radial distance from the image center along the longitudinal axis of the MR. CONCLUSION: Spatial distortion remains in the MR images after systematic distortion corrections. Although the average errors were relatively small, large distortions observed at bone/tissue interfaces emphasize the need for quantitative methods for assessing and correcting patient-specific spatial distortions.

Clinical utility of Gafchromic film in an MRI-guided linear accelerator.

BACKGROUND: The purpose of this study is to comprehensively evaluate the suitability of Gafchromic EBT3 and EBT-XD film for dosimetric quality assurance in 0.35 T MR-guided radiotherapy. METHODS: A 0.35 T magnetic field strength was utilized to evaluate magnetic field effects on EBT3 and EBT-XD Gafchromic films by studying the effect of film exposure time within the magnetic field using two timing sequences and film not exposed to MR, the effect of magnetic field exposure on the crystalline structure of the film, and the effect of orientation of the film with respect to the bore within the magnetic field. The orientation of the monomer crystal was qualitatively evaluated using scanning electron microscopy (SEM) compared to unirradiated film. Additionally, dosimetric impact was evaluated through measurements of a series of open field irradiations (0.83 × 0.83-cm2 to 19.92 × 19.92-cm2) and patient specific quality assurance measurements. Open fields were compared to planned dose and an independent dosimeter. Film dosimetry was applied to twenty conventional and twenty stereotactic body radiotherapy (SBRT) patient specific quality assurance cases. RESULTS: No visual changes in crystal orientation were observed in any evaluated SEM images nor were any optical density differences observed between films irradiated inside or outside the magnetic field for both EBT3 and EBT-XD film. At small field sizes, the average difference along dose profiles measured in film compared to the same points measured using an independent dosimeter and to predicted treatment planning system values was 1.23% and 1.56%, respectively. For large field sizes, the average differences were 1.91% and 1.21%, respectively. In open field tests, the average gamma pass rates were 99.8% and 97.2%, for 3%/3 mm and 3%/1 mm, respectively. The median (interquartile range) 3%/3 mm gamma pass rates in conventional QA cases were 98.4% (96.3 to 99.2%), and 3%/1 mm in SBRT QA cases were 95.8% (95.0 to 97.3%). CONCLUSIONS: MR exposure at 0.35 T had negligible effects on EBT3 and EBT-XD Gafchromic film. Dosimetric film results were comparable to planned dose, ion chamber and diode measurements.

Comparative evaluation of treatment plan quality for a prototype biology-guided radiotherapy system in the treatment of nasopharyngeal carcinoma.

We aimed to compare prototype treatment plans for a new biology-guided radiotherapy (BgRT) machine in its intensity-modulated radiation therapy (IMRT) mode with those using existing IMRT delivery techniques in treatment of nasopharyngeal carcinoma (NPC). We retrospectively selected ten previous NPC patients treated in 33 fractions according to the NRG-HN001 treatment protocol. Three treatment plans were generated for each patient: a helical tomotherapy (HT) plan with a 2.5-cm jaw, a volumetric modulated arc therapy (VMAT) plan using 2 to 4 6-MV arc fields, and a prototype IMRT plan for a new BgRT system which uses a 6-MV photon beam on a ring gantry that rotates at 60 rotations per minute with a couch that moves in small incremental steps. Treatment plans were compared using dosimetric parameters to planning target volumes (PTVs) and organs at risk (OARs) as specified by the NRG-HN001 protocol. Plans for the three modalities had comparable dose coverage, mean dose, and dose heterogeneity to the primary PTV, while the prototype IMRT plans had greater dose heterogeneity to the non-primary PTVs, with the average homogeneity index ranging from 1.28 to 1.50 in the prototype plans. Six of all the 7 OAR mean dose parameters were lower with statistical significance in the prototype plans compared to the HT and VMAT plans with the other mean dose parameter being comparable, and all the 18 OAR maximum dose parameters were comparable or lower with statistical significance in the prototype plans. The average left and right parotid mean doses in the prototype plans were 10.5 Gy and 10.4 Gy lower than those in the HT plans, respectively, and were 5.1 Gy and 5.2 Gy lower than those in the VMAT plans, respectively. Compared to that with the HT and VMAT plans, the treatment time was longer with statistical significance with the prototype IMRT plans. Based on dosimetric comparison of ten NPC cases, the prototype IMRT plans achieved comparable or better critical organ sparing compared to the HT and VMAT plans for definitive NPC radiotherapy. However, there was higher dose heterogeneity to non-primary targets and longer estimated treatment time with the prototype plans.

Large field of view distortion assessment in a low-field MR-linac.

PURPOSE: MR-guided radiation therapy (RT) offers unparalleled soft tissue contrast for localization and target tracking. However, MRI distortions may be detrimental to high precision RT. This work characterizes the gradient nonlinearity (GNL) and total distortions over the first year of clinical operation of a 0.35T MR-linac. METHODS: For GNL characterization, an in-house large field of view (FOV) phantom (60 × 42.5 × 55 cm3 , >6000 spherical landmarks) was configured and scanned at four timepoints with forward/reverse read polarities (Gradient Echo sequence, FA/TR/TE = 28°/30 ms/6 ms). GNL was measured in Anterior-Posterior (AP), Left-Right (LR), and Superior-Inferior (SI) frequency-encoding directions based on deviation of the auto-segmented landmark centroids between rigidly registered MR and CT images and assessed based on radial distance from magnet isocenter. Total distortion was assessed using a 30 × 30 cm2 grid phantom oriented along the cardinal axes over >1 year of operation. RESULTS: The scanner's spatial integrity within the first ~10 months was stable (maximum total distortion variation = 10/6/8%, maximum distortion = 1.41/0.99/1.56 mm in Axial/Coronal/Sagittal planes, respectively). GNL distortions measured during this time period <10 cm from isocenter were (-0.74, 0.45), (-0.67, 0.53), and (-0.86, 0.70) mm in AP/LR/SI directions. In the 10-20 cm range, <1.5% of the distortions exceeded 2 mm in the AP and LR axes while <4% of the distortions exceeded 2 mm for SI. After major repairs and magnet re-shim, detectable changes were observed in total and GNL distortions (20% reduction in AP and 36% increase in SI direction in the 20-25 cm range). Across all timepoints and axes, 38-53% of landmarks in the 20-25 cm range were displaced by >1 mm. CONCLUSIONS: GNL distortions were negligible within a 10 cm radius from isocenter. However, in the periphery, non-negligible distortions of up to ~7 mm were observed, which may necessitate GNL corrections for MR-IGRT for treatment sites distant from magnet isocenter.

Respiratory motion-resolved, self-gated 4D-MRI using Rotating Cartesian K-space (ROCK): Initial clinical experience on an MRI-guided radiotherapy system.

PURPOSE: To optimize and evaluate the respiratory motion-resolved, self-gated 4D-MRI using Rotating Cartesian K-space (ROCK-4D-MRI) method in a 0.35 T MRI-guided radiotherapy (MRgRT) system. METHODS AND MATERIALS: The study included seven patients with abdominal tumors treated on the MRgRT system. ROCK-4D-MRI and 2D-CINE, was performed immediately after one of the treatment fractions. Motion quantification based on 4D-MRI was compared with those based on 2D-CINE. The image quality of 4D-MRI was evaluated against 4D-CT. The gross tumor volumes (GTV) were defined based on individual respiratory phases of both 4D-MRI and 4D-CT and compared for their variability over the respiratory cycle. RESULT: The motion measurements based on 4D-MRI matched well with 2D-CINE, with differences of 1.04 ±â€¯0.52 mm in the superior-inferior and 0.54 ±â€¯0.21 mm in the anterior-posterior directions. The image quality scores of 4D-MRI were significantly higher than 4D-CT, with better tumor contrast (3.29 ±â€¯0.76 vs. 1.86 ±â€¯0.90) and less motion artifacts (3.57 ±â€¯0.53 vs. 2.29 ±â€¯0.95). The GTVs were more consistent in 4D-MRI than in 4D-CT, with significantly smaller GTV variability (9.31 ±â€¯4.58% vs. 34.27 ±â€¯23.33%). CONCLUSION: Our study demonstrated the clinical feasibility of using the ROCK-4D-MRI to acquire high quality, respiratory motion-resolved 4D-MRI in a low-field MRgRT system. The 4D-MRI image could provide accurate dynamic information for radiotherapy treatment planning.

An efficient model to guide prospective T2-weighted 4D magnetic resonance imaging acquisition.

PURPOSE: To establish a mathematical model to guide prospective T2-weighted four-dimensional magnetic resonance imaging (4DMRI) acquisition and to propose an efficient solution to expedite prospective T2-weighted 4DMRI acquisition. METHODS: Prospective T2-weighted 4DMRI acquisition was characterized by a mathematical model with 4DMRI acquisition time as the objective function and completeness of the image set, acquisition timing, image contrast, and image artifacts as constraints. Given the irregular nature of human respiration, an efficient solution based on the greedy strategy (ESGS) was proposed. The efficiency of the ESGS method was validated using healthy human subjects. Comparisons were made with the previous 4DMRI method incorporating the prefixed-order respiratory state splitting (PO-RSS) technique. RESULTS: 4DMRI image sets acquired using the ESGS and PO-RSS methods had similar image quality. The average time to acquire a 4DMRI image set covering 60 slices at 10 respiratory states was reduced by 30%, from 13.1 min using the PO-RSS method to 9.0 min using the ESGS method. It was demonstrated that high-quality T2-weighted 4DMRI could be obtained within a reasonable amount of time and all slices within each of the three-dimensional volumes were indeed acquired at the same respiratory state. CONCLUSIONS: The ESGS method substantially reduces the acquisition time for T2-weighted 4DMRI, making it ready for clinical evaluation to obtain abdominal tumor motion for radiotherapy treatment planning.

A Prospective 4π Radiation Therapy Clinical Study in Recurrent High-Grade Glioma Patients.

PURPOSE: To evaluate the feasibility, safety, dosimetric benefits, delivery efficiency, and patient comfort in the clinical implementation of 4π radiation therapy. METHODS AND MATERIALS: Eleven patients with recurrent high-grade glioma were recruited for the trial. 4π plans integrating beam orientation and fluence-map optimization were created using an in-house column-generation algorithm. The collision-free beam solution space throughout the 4π steradian was determined using a computer-aided-design model of the Varian TrueBeam system and a human subject. Twenty beams were optimized for each case and imported into Eclipse for intensity modulated radiation therapy planning. Beam orientations with neighboring couch kicks were merged for increased delivery efficiency, generating plans with an average of 16 beam orientations. Volumetric modulated arc therapy (VMAT) plans with 3-4 arcs were also generated for each case, and the plan achieving superior dosimetric quality was selected for treatment. Patient comfort was surveyed after every fraction. Multiple 2-dimensional X-ray images were obtained to measure intrafractional motion. RESULTS: Of 11 patients, 9 were treated with 4π. Mean and maximum organ at risk doses were equal or significantly lower (P < .05) with 4π than with VMAT. Particularly substantial dose reduction of 2.92 Gy in the average accumulated brainstem maximum dose enabled treatments that would otherwise not satisfy safe dose constraints with VMAT. One patient was not treated because neither plan met the dosimetric criteria. The other was treated with VMAT owing to comparable dosimetry resulting from a planning target volume located in a separate co-plane superior to organs at risk. Treatments were well tolerated, with an average patient comfort score of 8.6/10. Intrafractional motion was <1.5 mm for all delivered fractions, and the average delivery time was 34.1 minutes. CONCLUSIONS: The feasibility, safety, dosimetric benefits, delivery efficiency, and patient comfort of 4π radiation therapy have been clinically demonstrated with a prospective clinical trial. The results elucidate the potential and challenges of wider clinical implementations.

A comparative study of automatic image segmentation algorithms for target tracking in MR-IGRT.

On-board magnetic resonance (MR) image guidance during radiation therapy offers the potential for more accurate treatment delivery. To utilize the real-time image information, a crucial prerequisite is the ability to successfully segment and track regions of interest (ROI). The purpose of this work is to evaluate the performance of different segmentation algorithms using motion images (4 frames per second) acquired using a MR image-guided radiotherapy (MR-IGRT) system. Manual con-tours of the kidney, bladder, duodenum, and a liver tumor by an experienced radiation oncologist were used as the ground truth for performance evaluation. Besides the manual segmentation, images were automatically segmented using thresholding, fuzzy k-means (FKM), k-harmonic means (KHM), and reaction-diffusion level set evolution (RD-LSE) algorithms, as well as the tissue tracking algorithm provided by the ViewRay treatment planning and delivery system (VR-TPDS). The performance of the five algorithms was evaluated quantitatively by comparing with the manual segmentation using the Dice coefficient and target registration error (TRE) measured as the distance between the centroid of the manual ROI and the centroid of the automatically segmented ROI. All methods were able to successfully segment the bladder and the kidney, but only FKM, KHM, and VR-TPDS were able to segment the liver tumor and the duodenum. The performance of the thresholding, FKM, KHM, and RD-LSE algorithms degraded as the local image contrast decreased, whereas the performance of the VP-TPDS method was nearly independent of local image contrast due to the reference registration algorithm. For segmenting high-contrast images (i.e., kidney), the thresholding method provided the best speed (< 1 ms) with a satisfying accuracy (Dice = 0.95). When the image contrast was low, the VR-TPDS method had the best automatic contour. Results suggest an image quality determination procedure before segmentation and a combination of different methods for optimal segmentation with the on-board MR-IGRT system.

High-quality t2-weighted 4-dimensional magnetic resonance imaging for radiation therapy applications.

PURPOSE: The purpose of this study was to improve triggering efficiency of the prospective respiratory amplitude-triggered 4-dimensional magnetic resonance imaging (4DMRI) method and to develop a 4DMRI imaging protocol that could offer T2 weighting for better tumor visualization, good spatial coverage and spatial resolution, and respiratory motion sampling within a reasonable amount of time for radiation therapy applications. METHODS AND MATERIALS: The respiratory state splitting (RSS) and multi-shot acquisition (MSA) methods were analytically compared and validated in a simulation study by using the respiratory signals from 10 healthy human subjects. The RSS method was more effective in improving triggering efficiency. It was implemented in prospective respiratory amplitude-triggered 4DMRI. 4DMRI image datasets were acquired from 5 healthy human subjects. Liver motion was estimated using the acquired 4DMRI image datasets. RESULTS: The simulation study showed the RSS method was more effective for improving triggering efficiency than the MSA method. The average reductions in 4DMRI acquisition times were 36% and 10% for the RSS and MSA methods, respectively. The human subject study showed that T2-weighted 4DMRI with 10 respiratory states, 60 slices at a spatial resolution of 1.5 × 1.5 × 3.0 mm(3) could be acquired in 9 to 18 minutes, depending on the individual's breath pattern. Based on the acquired 4DMRI image datasets, the ranges of peak-to-peak liver displacements among 5 human subjects were 9.0 to 12.9 mm, 2.5 to 3.9 mm, and 0.5 to 2.3 mm in superior-inferior, anterior-posterior, and left-right directions, respectively. CONCLUSIONS: We demonstrated that with the RSS method, it was feasible to acquire high-quality T2-weighted 4DMRI within a reasonable amount of time for radiation therapy applications.

Magnetic resonance imaging-based treatment planning for prostate cancer: Use of population average tissue densities within the irradiated volume to improve plan accuracy.

PURPOSE: The purpose of this study was to investigate the feasibility of using population average tissue densities within the irradiated volume to improve the dosimetric accuracy of magnetic resonance imaging-based treatment plans for prostate cancer. METHODS AND MATERIALS: Computed tomography images and radiation therapy treatment plans from 20 patients with prostate cancer were reviewed retrospectively. Patient anatomy was segmented into fat, nonfat soft tissue, and bone. Population average tissue densities within the irradiated volume were obtained. Two bulk density override plans were generated using the tissue densities reported in International Commission on Radiation Units & Measurements Report 46 and those obtained in this study, respectively. Both plans were compared to the clinically approved computed tomography-based plan to assess dosimetric accuracy. RESULTS: The population average tissue densities within the irradiated volume obtained in this study were found to be different from those reported in International Commission on Radiation Units & Measurements Report 46. Use of the population average tissue densities within the irradiated volume reduced dosimetric errors for all dose metrics, for example, V100 (percentage of prostate volume receiving 100% of the prescription dose; 0.32% vs 1.73%), D95 (dose covering 95% of the target volume; 0.32% vs 0.92%), D50 (dose covering 50% of the target volume; 0.30% vs 0.89%), and maximum dose to bladder (0.37% vs 0.78%), rectum (0.35% vs 0.95%), and penile bulb (0.23% vs 0.49%). All improvements were statistically significant. CONCLUSIONS: Use of population average tissue densities within the irradiated volume by the density override technique can improve the dosimetric accuracy of magnetic resonance imaging-based treatment plans for prostate cancer.

Temporal signal stability of KCl:Eu(2+) storage phosphor dosimeters.

PURPOSE: Current KCl:Eu(2+) prototype dosimeters require a wait time of 12 h between irradiation and dosimetric readout. Although irradiating the dosimeters in the evening and reading on the following day works well in the clinical schedule, reducing the wait time to few hours is desirable. The purposes of this work are to determine the origin of the unstable charge-storage centers and to determine if these centers respond to optical or thermal excitation prior to dosimetric readout. METHODS: Pellet-style KCl:Eu(2+) dosimeters were fabricated in-house for this study. A 6 MV photon beam was used to irradiate the dosimeters. After x ray irradiation, dosimeters were subjected to external excitation with near-infrared (NIR) light, ultraviolet (UV) light, or thermal treatment. Photostimulated luminescence (PSL) signal's temporal stability was subsequently measured at room temperature over a few hours using a laboratory PSL readout system. The dosimeters were also placed in a cryostat to measure the temperature dependence of the temporal stability down to 10 K. RESULTS: Strong F-band was present in the PSL stimulation spectrum, indicating that F-centers were the electron-storage centers in KCl:Eu(2+) where an electron was stored at a chlorine anion vacancy. Due to deep energy-depth (2.2 eV), F-centers were probably not responsible for the fast fading in the first a few hours post x ray irradiation. In addition, weak NIR bands were present. However, there was no change in PSL stabilization rate with intense NIR excitation, suggesting that the NIR bands played no role in the PSL fading. At temperatures lower than 77 K there was almost no signal fading with time. Noticeable PSL was observed for undoped KCl samples at room temperature, suggesting that Cl(2) (-) V(k) centers served as hole-storage centers for both undoped and doped KCl where a hole was trapped by a chlorine molecular ion. V(k) centers were stable at low temperature and became mobile at room temperature, probably causing the observed PSL fading with time. On the other hand, V(k) center could be stabilized by Eu(2+) activator or oxygen in the lattice, leading to the stable component in the PSL. A thermal process at elevated temperatures (60 °C or higher) was able to significantly accelerate the migration process resulting in a fast stabilization of PSL. However, this could not be accomplished using intense UV excitation. CONCLUSIONS: Thermal treatment enables KCl:Eu(2+) prototypes to be ready for readout in 1 h without the need of applying a large time-dependent correction factor. However, this cannot be achieved using optical preexcitation.