Dosimetric characterization of CyberKnife radiosurgical photon beams using polymer gels

Dose distributions registered in water equivalent, polymer gel dosimeters were used to measure the output factors and off-axis profiles of the radiosurgical photon beams employed for CyberKnife radiosurgery. Corresponding measurements were also performed using a shielded silicon diode commonly employed for CyberKnife commissioning, the PinPoint ion chamber, and Gafchromic EBT films, for reasons of comparison. Polymer gel results of this work for the output factors of the 5, 7.5, and 10 mm diameter beams are (0.702 +/- 0.029), (0.872 +/- 0.039), and (0.929 +/- 0.041), respectively. Comparison of polymer gel and diode measurements shows that the latter overestimate output factors of the two small beams (5% for the 5 mm beam and 3% for the 7.5 mm beams). This is attributed to the nonwater equivalence of the high atomic number silicon material of the diode detector. On the other hand, the PinPoint chamber is found to underestimate output factors up to 10% for the 5 mm beam due to volume averaging effects. Polymer gel and EBT film output factor results are found in close agreement for all beam sizes, emphasizing the importance of water equivalence and fine detector sensitive volume for small field dosimetry. Relative off-axis profile results are in good agreement for all dosimeters used in this work, with noticeable differences observed only in the PinPoint estimate of the 80%-20% penumbra width, which is relatively overestimated.     

Dose verification of single shot gamma knife applications using VIPAR polymer gel and MRI

This work describes an experimental procedure with potential to assess the overall accuracy associated with gamma knife clinical applications, from patient imaging and dosimetry planning to patient positioning and dose delivery using the automated positioning system of a Leksell Gamma Knife model C. The VIPAR polymer gel-MRI dosimetry method is employed due to its inherent three-dimensional feature and linear dose response over the range of gamma knife applications. Different polymer gel vials were irradiated with single shot gamma knife treatment plans using each of the four available collimator helmets to deliver a maximum dose of 30 Gy. Percentage relative dose results are presented not only in the form of one-dimensional profiles but also planar isocontours and isosurfaces in three dimensions. Experimental results are compared with corresponding Gammaplan treatment planning system calculations as well as acceptance test radiochromic film measurements. A good agreement, within the experimental uncertainty, is observed between measured and expected dose distributions. This experimental uncertainty is of the order of one imaging pixel in the MRI gel readout session (<1 mm) and allows for the verification of single shot gamma knife applications in terms of acceptance specifications for precision in beam alignment and accuracy. Averaging net R(2) results in the dose plateau of the 4 mm and 18 mm collimator irradiated gel vials, which were MR scanned in the same session, provides a crude estimate of the 4 mm output factor which agrees within errors with the default value of 0.870.     

An evaluation of the dosimetric performance characteristics of N-vinylpyrrolidone-based polymer gels

The aim of this work was to investigate the dosimetric performance properties of the N-vinylpyrrolidone argon (VIPAR) based polymer gel as a dosimetric tool in clinical radiotherapy. VIPAR gels with a larger concentration of gelatin than the standard recipe were manufactured and irradiated up to 68 Gy using a 6 and 18 MV linear accelerator. Using MRI, the R2-dose response was recorded at different imaging sessions within a 34 day time period post-irradiation. The R2-dose response was found to be linear between 5 and 68 Gy. Although dose sensitivity did not show significant variation with time, the measured R2-dose values showed an increasing trend, which was less evident beyond 17 days. At one day post-irradiation, calculated dose standard uncertainties at 20 Gy and 56 Gy were 2.2% and 1.7%, providing a dose resolution of 0.45 Gy and 0.97 Gy, respectively. Although these values fulfilled the 2% limit of ICRU, when gels were imaged at one day post-irradiation, it was shown that the temporal evolution of the R2 values deteriorated the per cent standard uncertainty and the dose resolution by approximately 57%, when imaged 17 days post-irradiation. Variation in the coagulation temperature of the gels did not impact the R2-dose sensitivity. This study has shown that the VIPAR gel has the properties of a dosimetric tool required in clinical radiotherapy, especially in applications where a wide dose dynamic range is employed. For results with the lowest per cent uncertainty and the optimum dose resolution, the dosimetry gels used in this work should be MR scanned at one day post-irradiation. Furthermore, a preliminary study on the R2-dose response of a new normoxic N-vinylpyrrolidone-based polymer gel showed that it could potentially replace the traditional VIPAR gel formulation, while preserving the wide dynamic dose response inherent to that monomer.     

Direct measurement of electron contamination in cobalt beams using a charge detector

A method is described in some detail for measuring the magnitude and penetration of the electron contamination in photon beams using a pancake charge detector. It is shown that the response of the detector to a photon beam can be separated from the component due to the electron contamination. In the present work, the detector is used to measure the electron fluence in a 60Co photon beam. This fluence is subsequently converted to dose by comparison with the fluence and dose measured from a pure electron beam (90Sr). This study proves, within experimental error, that the observed changes in the buildup region, with the collimator opening for both filtered and unfiltered 60Co beams, are due to electron, rather than photon, contamination.     

Evaluation of polymer gels and MRI as a 3-D dosimeter for intensity-modulated radiation therapy.

BANG gel (MGS Research, Inc., Guilford, CT) has been evaluated for measuring intensity-modulated radiation therapy (IMRT) dose distributions. Treatment plans with target doses of 1500 cGy were generated by the Peacock IMRT system (NOMOS Corp., Sewickley, PA) using test target volumes. The gels were enclosed in 13 cm outer diameter cylindrical glass vessels. Dose calibration was conducted using seven smaller (4 cm diameter) cylindrical glass vessels irradiated to 0-1800 cGy in 300 cGy increments. Three-dimensional maps of the proton relaxation rate R2 were obtained using a 1.5 T magnetic resonance imaging (MRI) system (Siemens Medical Systems, Erlangen, Germany) and correlated with dose. A Hahn spin echo sequence was used with TR = 3 s, TE = 20 and 100 ms, NEX = 1, using 1 x 1 x 3 mm3 voxels. The MRI measurements were repeated weekly to identify the gel-aging characteristics. Ionization chamber, thermoluminescent dosimetry (TLD), and film dosimetry measurements of the IMRT dose distributions were obtained to compare against the gel results. The other dosimeters were used in a phantom with the same external cross-section as the gel phantom. The irradiated R2 values of the large vessels did not precisely track the smaller vessels, so the ionization chamber measurements were used to normalize the gel dose distributions. The point-to-point standard deviation of the gel dose measurements was 7.0 cGy. When compared with the ionization chamber measurements averaged over the chamber volume, 1% agreement was obtained. Comparisons against radiographic film dose distribution measurements and the treatment planning dose distribution calculation were used to determine the spatial localization accuracy of the gel and MRI. Spatial localization was better than 2 mm, and the dose was accurately determined by the gel both within and outside the target. The TLD chips were placed throughout the phantom to determine gel measurement precision in high- and low-dose regions. A multidimensional dose comparison tool that simultaneously examines the dose-difference and distance-to-agreement was used to evaluate the gel in both low-and high-dose gradient regions. When 3% and 3 mm criteria were used for the comparisons, more than 90% of the TLD measurements agreed with the gel, with the worst of 309 TLD chip measurements disagreeing by 40% of the criteria. All four MRI measurement session gel-measured dose distributions were compared to evaluate the time behavior of the gel. The low-dose regions were evaluated by comparison with TLD measurements at selected points, while high-dose regions were evaluated by directly comparing measured dose distributions. Tests using the multidimensional comparison tool showed detectable degradation beyond one week postirradiation, but all low-dose measurements passed relative to the test criteria and the dose distributions showed few regions that failed.     

Fabrication of a cell array on ultrathin hydrophilic polymer gels utilising electron beam irradiation and UV excimer laser ablation

Most of the surface patterning methods currently applied are based on lithography techniques and microfabrication onto silicon or glass substrates. Here we report a novel method to prepare patterned surfaces on polystyrene substrates by grafting ultrathin cell-repellent polymer layers utilising both electron beam (EB) polymerisation and local laser ablation techniques for microfabrication. Polyacrylamide was grafted onto tissue culture polystyrene (TCPS) dishes using EB irradiation. Water contact angles for these PAAm-grafted TCPS surfaces were less than 10 degrees (costheta = 0.99) with PAAm grafted amounts of 1.6 microg/cm(2) as determined by ATR/FT-IR. UV excimer laser (ArF: 193 nm) ablation resulted in the successful fabrication of micropatterned surfaces composed of hydrophilic PAAm and hydrophobic basal polystyrene layers. Bovine carotid artery endothelial cells adhered only to the ablated domains after pretreatment of the patterned surfaces with 15 microg/mL fibronectin at 37 degrees C. The ablated domain sizes significantly influenced the number of cells occupying each domain. Cell patterning functionality of the patterned surfaces was maintained for more than 2 months without loss of pattern fidelity, indicating that more durable cell arrays can be obtained compared to those prepared by self-assembled monolayers of alkanethiols, as described in previous reports. The surface fabrication techniques presented here can be utilised for the preparation of cell-based biosensors as well as tissue engineering constructs.     

Coherent-Compton scattering for the assessment of bone mineral content using heavily filtered x-ray beams

The feasibility of using heavily filtered x-ray beams to assess trabecular bone mineral content has been investigated by measuring the ratio of coherent to incoherent scattered x-rays with a high purity Ge detector. The technique uses the strong dependence of coherent scattering on the effective atomic number of the scattering medium. With an x-ray beam filtered with a high-atomic-number filter, a spectrum characterised by a sharp discontinuity at the K-absorption edge is produced. Analysis of the spectral shape after scattering allows the coherent to Compton scattering ratio to be obtained. Theoretical and experimental results from phantom studies are presented and a comparison made between the results obtained with x-ray beams and radionuclide sources respectively. The influence of overlying tissue thickness on the sensitivity of the measurements is demonstrated.     

Measurement of dose distributions using film in therapeutic electron beams

The feasibility of using film dosimetry data as the input data for patient treatment planning was evaluated. The central-axis depth dose and the off-axis ratios obtained from film measurements in a solid phantom were compared with those of ion-chamber measurements in water. Two techniques were used to generate isodose distributions. The first technique used only the film data, i.e., the central-axis depth dose and the off-axis ratios used for the reconstruction were determined from the film optical density (corrected for film nonlinearity). In the second technique, the central-axis depth dose measured by an ion chamber in a water phantom was combined with the off-axis ratios measured using film in the "solid water" phantom. The resulting isodose distributions from both techniques were compared with the ion-chamber measurements in water for 7-, 12-, and 18-MeV electrons, and the second technique showed better agreement with the ion-chamber measurements than did the first technique. The differences were within a clinically acceptable range.     

Evaluation of the dosimetric performance of BANG3 polymer gel

New radiotherapy techniques call for three-dimensional dosimetric methods with high spatial resolution. Radiation sensitive gels read out using MRI T(2) mapping provide an extremely promising option, and commercially available BANG polymer gels provide a convenient route into gel dosimetry. Gel dosimetry is dependent on the ability to calibrate gel response against radiation dose. This in turn is dependent on the reproducibility of response both between gels irradiated to the same dose and for a single gel sample over time. This study aims to evaluate the performance of a commercially available BANG gel. Our experimental arrangement gave excellent precision of radiation delivery (<0.2%) and reproducibility of T(2) measurement (<0.5%). Seven groups of 10 test tubes containing BANG3 gel were irradiated in 0.5 Gy steps between 0 and 3 Gy. A further four groups of four samples were irradiated in 2 Gy steps between 4 and 10 Gy. The gel samples were identical and derived from the same manufacturing batch. MR imaging was carried out four days after irradiation and then at weekly intervals for four weeks. Short-term variation in gel response can readily be corrected using reference samples. Longer term systematic drift of the gel calibration curve was observed relative to reference samples prepared in-house for quality assurance purposes. This implies that read-out of the calibration gels and dosimetry phantom must be performed at the same time after irradiation, or errors of up to 25% may be incurred. Precision of gel response did not change significantly over time. The observation of significantly different T(2) values both prior to irradiation and following irradiation to the same dose (variation up to 15%) illustrates the current difficulties associated with BANG3 gel calibration and constrains the practical utility of these commercially available gels for clinical radiation dosimetry.     

Characteristics of electron beams from a medical microtron

The Instrument AB Scanditronix MM22 medical microtron provides ten electron beam energies from approximately 3 to 22 MeV. Isodose curves, depth dose curves, field uniformity, and other characteristics were measured in water and in polystyrene. The method of acceleration, dual scattering foil system, and collimation technique produce beams having features superior to many other medical electron accelerators. Maximum dose rates at isocenter varied from about 500 to over 900 cGy min-1, photon contamination from 0.6% to 4.1%, and surface doses from 70% to 95% of the maximum. Depth dose curves were indistinguishable from those with identical practical ranges of a scanned beam linac at energies less than 18 MeV, and field flatness was clearly superior to the scanned beam linac at standard treatment distances.     

Field matching of electron beams using plastic wedge penumbra generators.

We describe the use of polystyrene wedges to match adjacent electron beams with improved dose uniformity. These wedges were designed to increase the penumbra width at the field junction from about 1.5 to about 3.5 cm, to achieve dose uniformity. Measurements using thermoluminescent dosimeters (TLD) and therapy localization film showed that the use of polystyrene wedges (penumbra generators) produced only a small increase (less than 3%) in the surface dose and a small increase (less than 1%) in the x-ray contamination. Without wedges at the field junction, lateral mismatching of beam edges by 2 or 3 mm may introduce high dose variations (120% or more or 50% or less). Similar 2-3 mm set-up errors did not cause more than +/- 5% dose variations when plastic wedges were used to match the fields. These wedges are particularly useful when matching fields of different beam energies or matching fields on curved surfaces, such as the chest wall.     

Spatial inhomogeneity and dynamic fluctuations of polymer gels

Polymer gels have two types of concentration fluctuations; liquidlike and solidlike fluctuations. The former are time-dependent (thermal) fluctuations and the latter are time-independent spatial inhomogeneity. The static structure factor, obtained by small-angle X-ray (SAXS) or neutron scattering (SANS), consists of both contributions. Several methods which allow to decompose the static structure factor into the individual contributions are reviewed. In practice, however, the decomposition is not as easy as that predicted by the theory due to the lack of information about dynamic fluctuations. The dynamic light scattering technique (DLS), on the other hand, provides the complimentary information of the dynamic fluctuations. It will be shown that DLS becomes a powerful tool to distinguish the two contributions if it is coupled with ensemble averaging. In this article, recent developments of the structure investigation of polymer gels, particularly those of environmental sensitive polymer gels, are reviewed from both experimental and theoretical points of view. The advantage to use the environmental sensitive gels is that the structure of a gel can be examined as a function of its environmental parameters, e.g., temperature, concentration, and pH. Furthermore, the characteristic features of these environmental sensitive gels, such as a volume phase transition and phase separation, are extensively discussed in terms of the thermal fluctuations and the spatial inhomogeneity.     

Narrow stereotactic beam profile measurements using N-vinylpyrrolidone based polymer gels and magnetic resonance imaging

In this work, polymer gel-MRI dosimetry (using VIPAR gels), radiographic film and a PinPoint ion chamber were used for profile measurements of 6 MV x-ray stereotactic beams of 5 and 10 mm diameter. The VIPAR gel-MRI method exhibited a linear dose response up to 32 Gy. VIPAR gels were found to resolve the penumbra region quite accurately, provided that the in-plane image resolution of the related T2-map is adequate (< or = 0.53 mm). T2-map slice thickness had no significant effect on beam profile data. VIPAR measurements performed with a spatial resolution of 0.13 mm provided penumbra widths (80%-20% distance) of 1.34 and 1.70 mm for the 5 and 10 mm cones respectively. These widths were found to be significantly smaller than those obtained with the film (2.23 mm for the 5 mm cone, 2.45 mm for the 10 mm cone) and PinPoint (2.25 mm for the 5 mm cone, 2.52 mm for the 10 mm cone) methods. Regarding relative depth dose measurements, good correlation between VIPAR gel and PinPoint data was observed. In conclusion, polymer gel-MRI dosimetry can provide relatively accurate profile data for very small beams used in stereotactic radiosurgery since it can overcome, to some extent, the problems related to the finite size of conventional detectors.     

Evaluation of film and thermoluminescent dosimetry of high-energy electron beams in heterogeneous phantoms.

Film and thermoluminescent dosimetry (TLD) are investigated in heterogeneous phantoms irradiated by high-energy electron beams. Both film and TLD are practical dosimeters for multiple and moving beam radiotherapy. The accuracy and precision of these dosimeters for radiation dose measurements in homogeneous water-equivalent phantoms has been discussed in the literature. However, film and TLD are often used for dose measurements in heterogeneous phantoms. In those situations perturbations are produced which are related to the density and atomic number of the phantom material and the physical size and orientation of the dosimeter. In our experiments the relative dose measurements in homogeneous phantoms were the same regardless of dosimeter or dosimeter orientation. However, significant differences were observed between the dose measurements within the inhomogeneity. These differences were influenced by the type and orientation of the dosimeter in addition to the properties of the heterogeneity. These differences could be reproduced with Monte Carlo calculations and modeling of the experimental conditions.     

Monte Carlo simulation of electron beams from an accelerator head using PENELOPE

The Monte Carlo code PENELOPE has been used to simulate electron beams from a Siemens Mevatron KDS linac with nominal energies of 6, 12 and 18 MeV. Owing to its accuracy, which stems from that of the underlying physical interaction models, PENELOPE is suitable for simulating problems of interest to the medical physics community. It includes a geometry package that allows the definition of complex quadric geometries, such as those of irradiation instruments, in a straightforward manner. Dose distributions in water simulated with PENELOPE agree well with experimental measurements using a silicon detector and a monitoring ionization chamber. Insertion of a lead slab in the incident beam at the surface of the water phantom produces sharp variations in the dose distributions, which are correctly reproduced by the simulation code. Results from PENELOPE are also compared with those of equivalent simulations with the EGS4-based user codes BEAM and DOSXYZ. Angular and energy distributions of electrons and photons in the phase-space plane (at the downstream end of the applicator) obtained from both simulation codes are similar, although significant differences do appear in some cases. These differences, however, are shown to have a negligible effect on the calculated dose distributions. Various practical aspects of the simulations, such as the calculation of statistical uncertainties and the effect of the 'latent' variance in the phase-space file, are discussed in detail.     

3D dose verification in 192Ir HDR prostate monotherapy using polymer gels and MRI

VIPAR polymer gels and 3D MRI techniques were evaluated for their ability to provide experimental verification of 3D dose distributions in a simulation of a 192Ir prostate monotherapy clinical application. A real clinical treatment plan was utilized, generated by post-irradiation, CT based calculations derived from Plato BPS and Swift treatment planning systems. The simulated treatment plan involved the use of 10 catheters and 39 source positions within a glass vessel of appropriate dimensions, homogeneously filled with the VIPAR gel. 3D high resolution MR scanning of the gel produced T2 relaxation time maps, from which 3D dose distributions were derived via an appropriate calibration procedure. Results were compared to corresponding dose distributions obtained from the Plato and Swift treatment planning systems. Quantitative comparison, on a point by point basis, was based on user adopted acceptance criteria of 5% dose-difference and 3 mm distance-to-agreement. Significant deviations between experimental and calculated dose distributions were found for doses lower than 50% due to the reduced dose resolution of the method in the low dose, low dose gradient region. Measurement errors were observed at 1.0-1.5 mm around each catheter due to MR imaging susceptibility artifacts. For most remaining points the acceptance criteria were fulfilled. Systematic offsets of the order of 1-2 mm, observed between measured and corresponding calculated isocontours at specific segments, are attributed to the 1 mm uncertainty in catheter reconstruction and 1 mm uncertainty in the alignment of the MR and CT imaging planes.     

Energy constancy checking for electron beams using a wedge-shaped solid phantom combined with a beam profile scanner

An energy constancy checking method is presented which involves a specially designed wedge-shaped solid phantom in combination with a multiple channel ionization chamber array known as the Thebes device. Once the phantom/beam scanner combination is set up, measurements for all electron energies can be made and evaluated without re-entering the treatment room. This is also valid for the readjustment of beam energies which are found to deviate from required settings. The immediate presentation of the measurements is in the form of crossplots which resemble depth dose profiles. The evaluation of the measured data can be performed using a hand-held calculator, but processing of the measured signals through a PC-type computer is advisable. The method is insensitive to usual fluctuations in beam flatness. The sensitivity and reproducibility of the method are more than adequate. The method may also be used in modified form for photon beams.     

Preparation and characterization of cross-linked collagen-phospholipid polymer hybrid gels

2-methacryloyloxyethyl phosphorylcholine (MPC)-immobilized collagen gel was developed. Using 1-ethyl-3-(3-dimethyl aminopropyl)-1-carbodiimide hydrochloride (EDC) and N-hydroxysuccinimide (NHS), we cross-linked a collagen film in 2-morpholinoethane sulfonic acid (MES) buffer (EN gel). EN gel was prepared under both pH 4.5 and pH 9.0 in order to observe changes in cross-linking ability. To cross-link MPC to collagen gel, poly(MPC-co-methacrylic acid) (PMA) having a carboxyl group side chain was chosen. E/N gel was added to the MES buffer having pre-NHS activated PMA to make MPC-immobilized collagen gel (MiC gel). MiC gel was prepared under both acidic and alkaline conditions to observe the changes in the cross-linking ability of PMA. X-ray photoelectron spectroscopy showed that the PMA was cross-linked with collagen under both acidic and alkaline conditions. Differential scanning calorimetry (DSC) results showed that the shrinkage temperature increased for the MiC gels and that the increase would be greater for the MiC gel prepared under alkaline conditions. The data showed that swelling would be less when the MiC gel was prepared under alkaline conditions. The biodegradation caused by collagenase was suppressed for the MiC gel prepared under alkaline conditions due to stable inter- and intrahelical networks.