Feasibility of a Novel 3D Dosimetry System for Commissioning of Single Isocenter Multitarget SRS Treatment

Abstract

<h3>Purpose/Objective(s)</h3> Verification of Single Isocenter Multitarget SRS treatments (SIM-SRS) is uniquely challenging due to the combination of high dose, steep dose gradients and the requirement for very high spatial accuracy. Here we demonstrate the feasibility of a novel 3D dosimetry system for uniquely comprehensive dosimetry validation and commissioning of this exceptionally challenging technique. <h3>Materials/Methods</h3> The 3D dosimetry system utilizes a new commercially available radiochromic gel dosimeter and a state-of-art in-house telecentric optical-CT readout system DLOS (Duke Large Field of View telecentric Optical CT Scanner). The system was used to quantify the accuracy in 3D and in high resolution (isotropic 1mm) of two SIM-SRS treatments: a simpler two target treatment, and a more complex 5 target treatment. The SIM-SRS plans were created on patient anatomy and then recalculated on a CT of a 15cm diameter dosimeter, with isocenter placed such that each target was located within the dosimeter. Both treatments were delivered to the dosimeters which are gellan gum based radiochromic dosimeters containing a water-soluble tetrazolium salt which reduces into an insoluble formazan dye (with associated color change) under ionizing radiation. Optical-CT readout of the dosimeters pre and post irradiation enabled a high-resolution comprehensive evaluation of the accuracy of delivery. The DLOS is a bi-telecentric system which enables highest accuracy optical-CT readout through strong scatter and stray light rejection. The measured optical density distribution was spatially registered to the dose from the planning system and converted to dose via a calibration curve. Independent verification of treatment accuracy was also performed with a commercial Monte Carlo dose calculation algorithm. <h3>Results</h3> For the 2-target plan, the measured dose agreed with the planning system with a Gamma-Index passing rate of 99.88%, 99.27%, and 92.75%, using a 3%/3mm, 3%/2mm, 5%/1mm criteria, respectively. For the 5-target plan, the Gamma-Index passing rate was 99.59%, 97.35%, and 93.82%, using a 3%/3mm, 3%/2mm, 5%/1mm criteria, respectively. In comparison, the dose calculated using Monte Carlo agreed with the planning system with a Gamma-Index passing rate of 100.0% using 3%/1mm for both the 2 target and 5 target plans. Mean dose for the PTVs of the 2-target plan was within –0.71% and –1.53%. Mean dose for the PTVs of the 5-target plan was within (1.08±0.97)%. <h3>Conclusion</h3> This study demonstrates the feasibility of a new 3D dosimetry tool for verification of advanced radiation treatments. Application to SIM-SRS treatments has demonstrated excellent agreement between measured and predicted dose in the phantom. The combination of DLOS optical-CT with Clearview dosimeters was found to be important in obtaining accurate 3D dosimetry. The method introduced here is anticipated to be applicable to a wide range of clinically challenging treatment techniques.