A new DOSXYZnrc method for Monte Carlo simulations of 4D dose distributions.

The purpose of this study is to present a novel method for generating Monte Carlo 4D dose distributions in a single DOSXYZnrc simulation. During a standard simulation, individual energy deposition events are summed up to generate a 3D dose distribution and their associated temporal information is discarded. This means that in order to determine dose distributions as a function of time, separate simulations would have to be run for each interval of interest. Consequently, it has not been clinically feasible until now to routinely perform Monte Carlo simulations of dose rate, time-resolved dose accumulation, or electronic portal imaging devices (EPID) cine-mode images for volumetric modulated arc therapy (VMAT) plans. To overcome this limitation, we modified DOSXYZnrc and defined new input and output variables that allow a time-like parameter associated with each particle history to be binned in a user-defined manner. Under the new code version, computation times are the same as for a standard simulation, and the time-integrated 4D dose is identical to the standard 3D dose. We present a comparison of scintillator measurements and Monte Carlo simulations for dose rate during a VMAT beam delivery, a study of dose rate in a VMAT total body irradiation plan, and simulations of transit (through-patient) EPID cine-mode images.

Stereotactic Body Radiotherapy for Large Unresectable Hepatocellular Carcinomas - A Single Institution Phase II Study.

AIMS: To evaluate the safety and efficacy of liver stereotactic body radiotherapy (SBRT) in the treatment of unresectable hepatocellular carcinomas (HCC) measuring >5 cm. MATERIALS AND METHODS: Between November 2013 and February 2016, 13 patients with unresectable HCC (>5 cm), ineligible for other local treatments, with a Child-Pugh score (CPS) ≤ B7, were enrolled into a single-institution phase II study. SBRT was delivered by volumetric-modulated arc radiotherapy. Radiological response was reported using modified Response Evaluation Criteria in Solid Tumours criteria and toxicities graded by Common Terminology Criteria for Adverse Events v4 criteria. RESULTS: Sixteen hepatomas (median size 7.5 cm, range 5.1-9.7 cm) were treated in 13 patients. The baseline CPS was A5/6 in nine patients (69%) and B7 in four patients (31%). Five patients (38%) received previous liver-directed treatment. The median prescribed dose was 45 Gy (range 40-45 Gy) in five fractions. The median follow-up was 17.7 months. The 1-year local control rate was 92%. The median overall survival was 17.7 months and the 1-year overall survival was 62%. The median time to local progression was not reached. Five patients (39%) had an increase in CPS by two or more points at 3 months. Overall, there were 10 grade 3 acute toxicities occurring in seven patients, of which six were haematological. Quality of life remained clinically stable or improved at 3 months in 61.5% and 53.8% of patients based on the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 Global Health Score and Functional Assessment of Cancer Therapy - Hepatobiliary version 4 score, respectively. CONCLUSIONS: In our cohort, SBRT to unresectable large HCC tumours provided excellent local control with acceptable toxicities. Regional recurrence remained the major cause of failure. Further studies are warranted to examine the role for SBRT in combination with other modalities to maximise disease control in the liver.

Novel Gd3+-doped silica-based optical fiber material for dosimetry in proton therapy.

Optical fibers hold promise for accurate dosimetry in small field proton therapy due to their superior spatial resolution and the lack of significant Cerenkov contamination in proton beams. One known drawback for most scintillation detectors is signal quenching in areas of high linear energy transfer, as is the case in the Bragg peak region of a proton beam. In this study, we investigated the potential of innovative optical fiber bulk materials using the sol-gel technique for dosimetry in proton therapy. This type of glass is made of amorphous silica (SiO[Formula: see text]) and is doped with Gd[Formula: see text] ions and possesses very interesting light emission properties with a luminescence band around 314 nm when exposed to protons. The fibers were manufactured at the University of Lille and tested at the TRIUMF Proton Therapy facility with 8.2-62.9 MeV protons and 2-6 nA of extracted beam current. Dose-rate dependence and quenching were measured and compared to other silica-based fibers also made by sol-gel techniques and doped with Ce[Formula: see text] and Cu[Formula: see text]. The three fibers present strong luminescence in the UV (Gd) or visible (Cu,Ce) under irradiation, with the emission intensities related directly to the proton flux. In addition, the 0.5 mm diameter Gd[Formula: see text]-doped fiber shows superior resolution of the Bragg peak, indicating significantly reduced quenching in comparison to the Ce[Formula: see text] and Cu[Formula: see text] fibers with a Birks' constant, k[Formula: see text], of (0.0162 [Formula: see text] 0.0003) cm/MeV in comparison to (0.0333 [Formula: see text] 0.0006) cm/MeV and (0.0352 [Formula: see text] 0.0003) cm/MeV, respectively. To our knowledge, this is the first report of such an interesting k[Formula: see text] for a silica-based optical fiber material, showing clearly that this fiber presents lower quenching than common plastic scintillators. This result demonstrates the high potential of this inorganic fiber material for proton therapy dosimetry.

Stereotactic Body Radiotherapy for Small Unresectable Hepatocellular Carcinomas.

AIMS: Stereotactic body radiotherapy (SBRT) is an option for the treatment of hepatocellular carcinoma (HCC) in patients ineligible for standard local therapies. This study reports on the safety and efficacy of SBRT in small HCC tumours (≤5 cm) in the province of British Columbia. MATERIALS AND METHODS: Between March 2011 and July 2015, 31 patients with Child-Pugh Class A or B, with small HCCs measuring ≤5 cm were treated with SBRT at our institution. Primary end points were local control, progression-free survival, overall survival and toxicity. RESULTS: Thirty-four hepatomas (median size 3.3 cm, range 1.3-5.0 cm) were treated. The median follow-up was 18.3 months. Twenty-six patients (84%) had received previous liver-directed treatments. Most patients (88%) were treated with 45 Gy in three or five fractions. Six patients (19%) had worsened Child-Pugh score by two or more points during follow-up; overall 32% of patients experienced ≥ grade 3 + toxicities. One-year local control and overall survival were 94 and 84%, respectively. One-year progression-free survival was 49%; 81% of patients with disease progression received further HCC therapy. On univariate analysis, small tumour size predicted for improved overall survival (P = 0.01) whereas prescription biological equivalent dose (BED10) ≥100Gy10 approached significance (P = 0.06). CONCLUSION: SBRT provides high local control to small inoperable HCC. SBRT can be delivered safely even after previous liver-directed therapies and further liver therapies can follow treatment with SBRT. Although overall 32% of patients experienced ≥ grade 3 + toxicities, and 19% had a deterioration in Child-Pugh score of two or more points, these changes were mainly transient with minimal clinical impact. Despite excellent local control, disease progression outside of the irradiated site remains prominent. Further studies are warranted to examine combined therapy approaches to maximise disease control.

Characterization of the exradin W1 plastic scintillation detector for small field applications in proton therapy.

Accurate dosimetry in small field proton therapy is challenging, particularly for applications such as ocular therapy, and suitable detectors for this purpose are sought. The Exradin W1 plastic scintillating fibre detector is known to out-perform most other detectors for determining relative dose factors for small megavoltage photon beams used in radiotherapy but its potential in small proton beams has been relatively unexplored in the literature. The 1 mm diameter cylindrical geometry and near water equivalence of the W1 makes it an attractive alternative to other detectors. This study examines the dosimetric performance of the W1 in a 74 MeV proton therapy beam with particular focus on detector response characteristics relevant to relative dose measurement in small fields suitable for ocular therapy. Quenching of the scintillation signal is characterized and demonstrated not to impede relative dose measurements at a fixed depth. The background cable-only (Cerenkov and radio-fluorescence) signal is 4 orders of magnitude less than the scintillation signal, greatly simplifying relative dose measurements. Comparison with other detectors and Monte Carlo simulations indicate that the W1 is useful for measuring relative dose factors for field sizes down to 5 mm diameter and shallow spread out Bragg peaks down to 6 mm in depth.

Dose measurements for dental cone-beam CT: a comparison with MSCT and panoramic imaging.

To date there is a lack of published information on appropriate methods to determine patient doses from dental cone-beam computed tomography (CBCT) equipment. The goal of this study is to apply and extend the methods recommended in the American Association of Physicists in Medicine (AAPM) Report 111 for CBCT equipment to characterize dose and effective dose for a range of dental imaging equipment. A protocol derived from the one proposed by Dixon et al (2010 Technical Report 111, American Association of Physicist in Medicine, MD, USA), was applied to dose measurements of multi-slice CT, dental CBCT (small and large fields of view (FOV)) and a dental panoramic system. The computed tomography dose index protocol was also performed on the MSCT to compare both methods. The dose distributions in a cylindrical polymethyl methacrylate phantom were characterized using a thimble ionization chamber and Gafchromic™ film (beam profiles). Gafchromic™ films were used to measure the dose distribution in an anthropomorphic phantom. A method was proposed to extend dose estimates to planes superior and inferior to the central plane. The dose normalized to 100 mAs measured in the center of the phantom for the large FOV dental CBCT (11.4 mGy/100 mAs) is two times lower than that of MSCT (20.7 mGy/100 mAs) for the same FOV, but approximately 15 times higher than for a panoramic system (0.6 mGy/100 mAs). The effective dose per scan (in clinical conditions) found for the dental CBCT are 167.60 ± 3.62, 61.30 ± 3.88 and 92.86 ± 7.76 mSv for the Kodak 9000 (fixed scan length of 3.7 cm), and the iCAT Next Generation for 6 cm and 13 cm scan lengths respectively. The method to extend the dose estimates from the central slice to superior and inferior slices indicates a good agreement between theory and measurement. The Gafchromic™ films provided useful beam profile data and 2D distributions of dose in phantom.

Poster - Thur Eve - 30: Comparison of treatment planning and delivery performance of VMAT versus IMRT.

The purpose of this study was to determine whether VMAT (Varian RapidArc ™) treatment planning and delivery performance is in compliance with accepted quality assurance tolerances developed for sliding window IMRT. We present an analysis of data for over 1300 patients treated with VMAT and IMRT over a period of three years. Data was acquired on 6 dosimetrically matched linacs for sites including head and neck, brain, gynaecological, and a variety of other cancer cases treated with 6 MV. We have demonstrated that it is possible to dosimetrically match multiple Varian iX linacs with the millennium series MLC using a sliding gap and intercept test. QA is performed by Monte Carlo simulation and ion chamber measurement comparisons with Varian Eclipse TPS as well as linac log file analysis of MLC positions, gantry angles and monitor units on each patient. Point dose and 3D gamma analysis indicate that agreement between Eclipse and measurement or Monte Carlo calculation is site specific, with the dosimetric leaf gap parameter in Eclipse optimized for the most frequently treated site Point dose agreement within 2% and gamma pass rate of > 95% (3%/ 3 mm) is achievable for all sites for both IMRT and VMAT. Linac log file analysis indicates that planned MLC positions are achieved within 2 mm >99.7% of the time for both sliding window IMRT and VMAT. Planned gantry angles are achieved within 0.6 mm 99.8% of the time and planned MU's within 0.1 mm are achieved 99.8% of the time for VMAT.

A Monte Carlo model of the Varian IGRT couch top for RapidArc QA.

The objectives of this study are to evaluate the effect of couch attenuation on quality assurance (QA) results and to present a couch top model for Monte Carlo (MC) dose calculation for RapidArc treatments. The IGRT couch top is modelled in Eclipse as a thin skin of higher density material with a homogeneous fill of foam of lower density and attenuation. The IGRT couch structure consists of two longitudinal sections referred to as thick and thin. The Hounsfield Unit (HU) characterization of the couch structure was determined using a cylindrical phantom by comparing ion chamber measurements with the dose predicted by the treatment planning system (TPS). The optimal set of HU for the inside of the couch and the surface shell was found to be respectively -960 and -700 HU in agreement with Vanetti et al (2009 Phys. Med. Biol. 54 N157-66). For each plan, the final dose calculation was performed with the thin, thick and without the couch top. Dose differences up to 2.6% were observed with TPS calculated doses not including the couch and up to 3.4% with MC not including the couch and were found to be treatment specific. A MC couch top model was created based on the TPS geometrical model. The carbon fibre couch top skin was modelled using carbon graphite; the density was adjusted until good agreement with experimental data was observed, while the density of the foam inside was kept constant. The accuracy of the couch top model was evaluated by comparison with ion chamber measurements and TPS calculated dose combined with a 3D gamma analysis. Similar to the TPS case, a single graphite density can be used for both the thin and thick MC couch top models. Results showed good agreement with ion chamber measurements (within 1.2%) and with TPS (within 1%). For each plan, over 95% of the points passed the 3D gamma test.

Mega-voltage versus kilo-voltage cone beam CT used in image guided radiation therapy: comparative study of microdosimetric properties.

Mega-voltage computed tomography (MVCT) and kilo-voltage cone beam CT (CBCT) are routinely used in image-guided radiation therapy. In current practice, doses from MVCT and CBCT are reported with no correction for radiation quality. In this study, we compared microdosimetric properties as well as doses for MVCT and CBCT. Monte Carlo simulation codes BEAMnrc and DOSXYZnrc were used to simulate a Varian CBCT 125 kVp photon beam and primary electron spectra for CT sets of two patients. The revised Oak Ridge Electron transport Code (NOREC) was used to simulate electron tracks in liquid water. C++ code was developed to compute lineal energy in a sphere of 1 µm diameter. Dose-mean lineal energy-based quality factors were calculated for critical organs in-field. The estimated quality factor for CBCT is up to a factor of 1.3 times that of MV beams.

Complexity and accuracy of image registration methods in SPECT-guided radiation therapy.

The use of functional imaging in radiotherapy treatment (RT) planning requires accurate co-registration of functional imaging scans to CT scans. We evaluated six methods of image registration for use in SPECT-guided radiotherapy treatment planning. Methods varied in complexity from 3D affine transform based on control points to diffeomorphic demons and level set non-rigid registration. Ten lung cancer patients underwent perfusion SPECT-scans prior to their radiotherapy. CT images from a hybrid SPECT/CT scanner were registered to a planning CT, and then the same transformation was applied to the SPECT images. According to registration evaluation measures computed based on the intensity difference between the registered CT images or based on target registration error, non-rigid registrations provided a higher degree of accuracy than rigid methods. However, due to the irregularities in some of the obtained deformation fields, warping the SPECT using these fields may result in unacceptable changes to the SPECT intensity distribution that would preclude use in RT planning. Moreover, the differences between intensity histograms in the original and registered SPECT image sets were the largest for diffeomorphic demons and level set methods. In conclusion, the use of intensity-based validation measures alone is not sufficient for SPECT/CT registration for RTTP. It was also found that the proper evaluation of image registration requires the use of several accuracy metrics.

Technical considerations for implementation of x-ray CT polymer gel dosimetry.

Gel dosimetry is the most promising 3D dosimetry technique in current radiation therapy practice. X-ray CT has been shown to be a feasible method of reading out polymer gel dosimeters and, with the high accessibility of CT scanners to cancer hospitals, presents an exciting possibility for clinical implementation of gel dosimetry. In this study we report on technical considerations for implementation of x-ray CT polymer gel dosimetry. Specifically phantom design, CT imaging methods, imaging time requirements and gel dose response are investigated. Where possible, recommendations are made for optimizing parameters to enhance system performance. The dose resolution achievable with an optimized system is calculated given voxel size and imaging time constraints. Results are compared with MRI and optical CT polymer gel dosimetry results available in the literature.

Effects of gel composition on the radiation induced density change in PAG polymer gel dosimeters: a model and experimental investigations.

Due to a density change that occurs in irradiated polyacrylamide gel (PAG), x-ray computed tomography (CT) has emerged as a feasible method of performing polymer gel dosimetry. However, applicability of the technique is currently limited by low sensitivity of the density change to dose. This work investigates the effect of PAG composition on the radiation induced density change and provides direction for future work in improving the sensitivity of CT polymer gel dosimetry. A model is developed that describes the PAG density change (delta(rho)gel) as a function of both polymer yield (%P) and an intrinsic density change, per unit polymer yield, that occurs on conversion of monomer to polymer (delta(rho)polymer). %P is a function of the fraction of monomer consumed and the weight fraction of monomer in the unirradiated gel (%T). Applying the model to experimental CT and Raman spectroscopic data, two important fundamental properties of the response of PAG density to dose (delta(rho)gel dose response) are discovered. The first property is that delta(rho)polymer)depends on PAG %C (cross-linking fraction of total monomer) such that low and high %C PAGs exhibit a higher deltarho(polymer)than do more intermediate %C PAGs. This relationship is opposite to the relationship of polymer yield to %C and is explained by the effect of %C on the type of polymer formed. The second property is that the delta(rho)gel dose response is linearly dependent on %T. From the model, the inference is that, at least for %T < or = 2%, monomer consumption and delta(rho)polymer depend solely on %C. In terms of optimizing CT polymer gel dosimetry for high sensitivity, these results indicate that delta(rho)polymer can be expected to vary with each polymer gel system and thus should be considered when choosing a polymer gel for CT gel dosimetry. However, delta(rho)polymerand %P cannot be maximized simultaneously and maximizing %P, by choosing gels with intermediate %C and high %T, is found to have the greatest impact on increasing the sensitivity of PAG density to dose. As such, future research into new gel formulations for high sensitivity CT polymer gel dosimetry should focus on gels that exhibit an intrinsic density change and maximizing polymer yield in these systems.

Relative effectiveness of polyacrylamide gel dosimeters applied to proton beams: Fourier transform Raman observations and track structure calculations.

The feasibility of using polyacrylamide gel (PAG) to characterize a clinically relevant 74 MeV proton beam has been considered. Fourier transform Raman spectroscopy has been used to measure the response (i.e., consumption of monomer) of PAG exposed to the central and end portions of a spread out Bragg peak (SOBP), i.e., in two regions with measurable difference in proton linear energy transfer (LET). The response curve in each region was compared with a typical 6 MV x-ray irradiated gel response curve, thus arriving at a gel "relative effectiveness" (RE) in each of the two regions. In addition, the theory of track structure, which is typically used to calculate a detector RE, is shown to give reasonable agreement when compared with the experimental results. Both experimental and track structure results indicate a decrease in gel response when irradiated with protons, as compared with the x-ray response. In addition, both sets of results indicate a variation in gel response between the mid and end SOBP regions, thus illuminating the dependence of gel response to proton LET. The physical phenomenon causing a lower proton versus x-ray gel response may be understood by considering the track structure calculations, which indicate that gel radiosensitive elements close to the track of a proton (i.e., within 1.5 x 10(-6) cm) are saturated. This saturation is due to the high delta-ray doses deposited in these regions. The track calculations are extended to other situations (e.g., raw BP, different gel compositions) where experimental determination of RE is difficult or time consuming. Results again indicate a gel response dependent on position in the depth dose curve (i.e., LET). Overall, this study illuminates the difficulty in using polyacrylamide gel to extract quantitative dose maps when exposed to proton radiation.

CT gel dosimetry technique: comparison of a planned and measured 3D stereotactic dose volume.

This study presents a 3D dose mapping of complex dose distributions using an x-ray computed tomography (CT) polymer gel dosimetry technique. Two polyacrylamide gels (PAGs) of identical composition were irradiated with the same four arc stereotactic treatment to maximum doses of 15 Gy (PAG1) and 8 Gy (PAG2). The PAGs were CT imaged using a previously defined protocol that involves image averaging and background subtraction to improve image quality. For comparison with the planned isodose distribution, the PAG images were converted to relative dose maps using a CT number-dose calibration curve or simple division. The PAG images were then co-registered with the planning CT images in the BrainLab treatment planning software which automatically provides reconstructed sagittal and coronal images for 3D evaluation of measured and planned dose. The hypo-intense high dose region in both sets of gel images agreed with the planned 80% isodose contour and was shifted by up to 1.5 and 3.0 mm in the axial and reconstructed planes, respectively. This demonstrates the ability of the CT gel technique to accurately localize the high dose region produced by the stereotactic treatment. The resulting agreement of the measured relative dose volume for PAG1 was within 3.0 mm for the 50% and 80% isodose surfaces. However, the dose contrast was too low in PAG2 to allow for accurate definition of measured relative dose surfaces. Thus, a PAG should be irradiated to higher doses if quantitative relative dose information is required. Unfortunately, this implies use of an additional PAG and its CT number dose response since doses greater than 8-10 Gy fall outside the linear regions of the response.

Effects of crosslinker fraction in polymer gel dosimeters using FT Raman spectroscopy.

Radiation-induced chemical changes in polyacrylamide gels (PAGs) used in 3D radiation dosimetry have been studied using Fourier transform Raman spectroscopy. Consumption of monomer and crosslinker were characterized for polymer gel dosimeters with initial fraction of crosslinker (%C) varying from to 100%. Results indicate that the rate of monomer/crosslinker consumption is highly nonlinear over %C. This indicates that maximum polymer gel dosimeter sensitivity (i.e. slope of the monomer consumption curves) is dependent not only on initial %C but also on dose range. For low-dose regions (<5 Gy) 30%C PAGs are the most sensitive dosimeters, their maximum sensitivity being a factor of 1.8 times greater than 50%C PAGs. In mid-dose range (S-15 Gy), however, 50%C PAGs are the most sensitive dosimeters, being potentially a factor of 1.3 more sensitive than any other PAG studied. In high-dose regions (> 15 Gy) 70%C PAGs are at least 1.5 times more sensitive than any other PAG studied. A qualitative model is presented which helps to explain the variation in overall monomer consumption rate as a function of initial %C. The variation in the shapes (i.e. mathematical course) of the consumption curves for different %C PAGs is, in part, qualitatively explained by consideration of the average number of monomer to crosslinker molecules available for reaction in each PAG as it is irradiated to higher doses. Finally, we demonstrate the importance of an existing polymer network on the subsequent monomer consumption rate in a 50%C PAG.

The treatment of choroidal melanoma with 198 Au plaque brachytherapy.

BACKGROUND: Seventy-nine consecutive patients with primary choroidal melanoma were treated with 198 Au plaque brachytherapy at the British Columbia Cancer Agency (BCCA) between 1992 and 1998 with perioperative ultrasound to confirm plaque placement. Seventy-seven of the 79 patients were analyzable for this study. RESULTS: Five year actuarial disease specific survival, enucleation free survival, and local control are 95, 94, and 98%, respectively. There were four melanoma related deaths, all secondary to liver metastases. CONCLUSIONS: The BCCA experience in selected patients with choroidal melanomas treated with 198Au plaque brachytherapy has resulted in excellent survival and local control with minimal significant toxicity while preserving the globe. Our results using 198 Au seeds are comparable to other series using 125I, 60Co, and 106Ru at other centers.

Characterization of monomer/crosslinker consumption and polymer formation observed in FT-Raman spectra of irradiated polyacrylamide gels.

Fourier transform Raman spectroscopy was undertaken in the study of irradiated polyacrylamide gels (PAGs) used in 3D radiation dosimetry. By employing correlation techniques, monomer and crosslinker consumption were characterized in the spectra as a function of absorbed dose. The consumption of both monomer and crosslinker is monoexponential up to 13 Gy, although the rates of consumption differ for the two molecules. A sensitivity parameter, D0, in the exponential function has been used to characterize this difference. Up to 13 Gy, D0(acr) = 12 +/- 2 Gy while D0(bis) = 8.0 +/- 0.5 Gy, indicating that bis is consumed at a greater rate than acrylamide and that bis is the limiting factor in the onset of gel saturation, for a gel composition of 6% by weight total monomer (6%T) and where 3% of the total monomer is crosslinker (50%C). Direct evidence of polymer formation was observed in the Raman spectra of irradiated PAG. Polymer formation is monoexponential to a dose of 13 Gy, with a sensitivity parameter of D0(poly) = 14 +/- 2 Gy. This is in good agreement with the consumption rate of acrylamide. The exponential nature of the polymer formation observed here is compared with existing MRI and x-ray CT dose response measurements previously reported to be linear. The results confirm previous studies indicating that Raman spectroscopy provides a direct and useful tool for characterization of irradiated PAG.

Polymer gel dosimetry using x-ray computed tomography: a feasibility study.

A new three-dimensional dosimetry technique using x-ray computed tomography (CT) to analyse polymer gels is proposed. The CT imaging is sensitive to radiation-induced density changes that occur within irradiated polyacrylamide gel (PAG). In this preliminary study, a CT imaging protocol is developed to optimize CT images of PAG; the response of PAG CT number to dose (N(CT)-dose response) and the reproducibility of the response are investigated, and the use of CT to analyse PAG is compared with MRI. Experiments were conducted using two 1.5 l cylindrical PAG phantoms (3% acrylamide, 3% bis and 5% gelatin by weight), one irradiated with four intersecting 10 MV photon beams and the other with 10 sets of 6 MV parallel opposed circular radiosurgery fields. The final imaging protocol involves using optimum CT parameters (120 kVp and 200 mAs for our GE HiSpeed CT/i scanner), image averaging and background subtraction. The N(CT)-dose response is reproducible, linear up to 800-1000 cGy and is relatively insensitive to the gel temperature during imaging. The dose resolution is approximately 50 cGy for an image thickness of 10 mm. Despite the low dose resolution, preliminary results indicate that this CT technique provides accurate localization of high dose gradients such as those observed in stereotactic radiosurgery. Thus, given the availability and speed of CT scanners, the technique has the potential to be a valuable and practical 3D dose verification tool in radiation therapy.

Correcting for rf inhomogeneities in multiecho pulse sequence MRI dosimetry.

The growing interest in using MRI to measure distributions of dose in specialized materials has prompted the need to improve existing methods for measuring NMR relaxation rates throughout large volume phantoms. The change in transverse relaxation rate (R2) has proven to be a more sensitive measure of dose than longitudinal relaxation rate (R1) in some materials; however, the accuracy of R2 measurements is limited by the presence of artifacts resulting from imperfect MRI tip angles throughout large phantoms. A novel echo quotient technique allowing accurate measurement of changes in R2 (delta R2) in regions of imperfect tip angle is presented. Application of this technique to the measurement of a dynamically wedged photon beam dose distribution demonstrates the improved accuracy of the echo quotient technique compared with other methods. Agreement of the MRI data with film and ion chamber data is within 2.5% throughout the volume of interest, indicating the potential for delta R2 MRI dosimetry to become a clinically useful tool.

A spin-spin relaxation rate investigation of the gelatin ferrous sulphate NMR dosimeter.

Spin-spin NMR relaxation rate in the ferrous sulphate gelatin dosimeter has been studied in terms of pH, gelatin concentration, the addition of benzoic acid, and sample size. It is demonstrated that R2 is more sensitive to changes in Fe3+ ion concentration than R1 when measuring at frequencies of 64 and 100 MHz. pH has an important effect on dose response curves, and oxygen depletion occurs significantly more rapidly in FeSO4 gelatin than in the liquid FeSO4, resulting in a saturation dose of approximately 80 Gy at depths greater than approximately 3 mm in phantom. The concentration of gelatin can be increased to 12% by weight, and the dosimeter will continue to exhibit a linear dose response. Sensitivity is maintained at higher gel concentrations by pH compensation. Addition of low-concentration benzoic acid to the system does not alter the dose response of the gelatin FeSO4 system. Finally, spontaneous oxidation of Fe2+ ions does not significantly alter the shape of dose response curves but does result in increases in R2 by up to 4% per day.