Dosimetric Tool Research Articles

Quality control of the stereotactic radiosurgery procedure with the alanine-EPR dosimetry

The SRS Technique is a procedure that uses ionizing radiation usually in a single dose or in a maximum number of five fractions for the treatment of intracranial lesions. Multiple brain metastases single-isocenter stereotactic radiosurgery (SRS) treatment is increasingly employed in radiotherapy services. In this treatment is required that the prescription dose be restricted to the lesion only and have a pronounced dose decay in the adjacent healthy tissue. An extensive quality control program must be employed to ensure the quality of the entire treatment procedure. The purpose of this study was to investigate the use of alanine-EPR dosimeters as a dosimetric tool for quality control of the stereotactic radiosurgery procedure using the Volume Modulated Arc Technique (VMAT). The results showed that the alanine-EPR response is linear with the radiation dose in the range from 2 to 100 Gy, with a low dose rate and energy dependencies. The results of the doses measured with alanine in relation to the planned value for the four lesions were concordant, with differences smaller than 1.2%. The experiment enabled a comprehensive assessment of the entire SRS procedure, encompassing both the treatment planning and irradiation phases. Consequently, both mechanical and dosimetric parameters can be evaluated concurrently, allowing for a comprehensive assessment of the total inaccuracy of the procedure.

Unbalanced core detector (UCD): a novel direct-reading dosimeter for FLASH radiotherapy

FLASH radiotherapy (FRT) is a novel radiotherapy technique based on dose rates that are several orders of magnitude greater than those used in conventional radiotherapy (40 Gy/s vs. 0.5–5 Gy/min). FRT is still in its preclinical and early clinical stage of development. However these studies indicate that FRT is more effective in sparing normal tissues from radiation-related side effects, as compared to conventional radiotherapy. This is the so-called "FLASH effect" and was observed with multi-MeV electron beams. Before FRT is made available to humans, more basic research is needed to fully understand its radiobiology fundamentals. Meanwhile, suitable radiation sources and dosimetric tools are gradually becoming available. Within this framework, INFN-LNF developed the Unbalanced Core Detector (UCD), a novel type of electron dosimeter designed to operate in the FRT domain. UCD main characteristics are the nearly isotropic response, the independence from the electron energy, the very high radiation resistance, the linearity up to dose rates of MGy/s and the possibility to record the time evolution of a single radiation pulse. UCD was tested using 7 and 9 MeV electron beams produced with the ElectronFlash accelerator from Sordina IORT Technologies (SIT S.p.A.) in Aprilia, Italy. UCD was used to measure dose distributions in a water phantom. The results well compare to those obtained with a flashDiamond detector from PTW.

Digital phantom versus patient-specific radiation dosimetry in adult routine thorax CT examinations.

The aim of this study was to compare the organ doses assessed through a digital phantom-based and a patient specific-based dosimetric tool in adult routine thorax computed tomography (CT) examinations with reference to physical dose measurements performed in anthropomorphic phantoms. Two Monte Carlo based dose calculation tools were used to assess organ doses in routine adult thorax CT examinations. These were a digital phantom-based dosimetry tool (NCICT, National Cancer Institute, USA) and a patient-specific individualized dosimetry tool (ImpactMC, CT Imaging GmbH, Germany). Digital phantoms and patients were classified in four groups according to their water equivalent diameter (Dw). Normalized to volume computed tomography dose index (CTDIvol), organ dose was assessed for lungs, esophagus, heart, breast, active bone marrow, and skin. Organ doses were compared to measurements performed using thermoluminescent detectors (TLDs) in two physical anthropomorphic phantoms that simulate the average adult individual as a male (Alderson Research Labs, USA) and as a female (ATOM Phantoms, USA). The average percent difference of NCICT to TLD and ImpactMC to TLD dose measurements across all organs in both sexes was 13% and 6%, respectively. The average±1 standard deviation in dose values across all organs with NCICT, ImpactMC, and TLDs was±0.06 (mGy/mGy),±0.19 (mGy/mGy), and±0.13 (mGy/mGy), respectively. Organ doses decreased with increasing Dw in both NCICT and ImpactMC. Organ doses estimated with ImpactMC were in closer agreement to TLDs compared to NCICT. This may be attributed to the inherent property of ImpactMC methodology to generate phantoms that resemble the realistic anatomy of the examined patient as opposed to NCICT methodology that incorporates an anatomical discrepancy between phantoms and patients.

Commissioning and Assessment of Radiation Field and Dose Inhomogeneity for a Dual X-ray Tube Cabinet Irradiator: To Ensure Accurate Dosimetry in Radiation Biology Experiments

PurposeStandardization of X-ray cabinet irradiators dose, geometry, and calibration reporting is an ongoing process. Multi-tube designs have been introduced onto the pre-clinical market and give a theoretical benefit but have not been widely assessed for use in pre-clinical irradiation conditions. The aim of this study was to report on our experience commissioning a dual x-ray source cabinet irradiator (CIXD, Xstrahl Limited, United Kingdom) and assess the dose distribution for various experimental conditions. Materials and MethodsHalf-value layer (HVL) measurement, profile measurements, and output calibration were performed with a calibrated ion chamber. Constancy measurements were performed twice daily over two weeks to assess output fluctuations. Film measurements were completed using solid water to assess percent depth dose and homogeneity within the field and within variable thickness of solid water and phosphate-buffered saline (PBS) solution. Film measurements were repeated for various arrangements of petri dishes filled with PBS or water and in a 3D printed mouse phantom. ResultsThe X-ray tubes measured in-air output was 1.27 Gy/min. The HVL was 1.7 mm Cu. The upper and lower tubes both exhibited the heel effect, but when operated simultaneously the effect was reduced. Ion chamber measurements revealed 15% dose inhomogeneity within the tray area (18 × 18 cm2). Film measurements in the petri dishes indicated minor non-uniformities with the arrangements of experimental apparatus. The mouse phantom with film agreed with ion chamber measurements for various phantom placement and orientations. ConclusionX-ray cell culture irradiation with the dual tube cabinet irradiation is efficient and robust when utilizing established dosimetric tools to confirm output and homogeneity. The conditions assumed for calibrations are often not maintained during experiments. We have confirmed that inhomogeneities are present for single tube use, however they are reduced with simultaneous tube use. Additional dosimetric monitoring should be performed for each unique irradiation setup.

Iterative Image Reconstruction Methodology in Optical CT Radiochromic Gel Dosimetry

Modern advancements in radiation therapy require paralleled advancements in the dosimetric tools used to verify dose distributions. Optical computed tomography (CT) imaged radiochromic gel dosimeters provide comprehensive, tissue equivalent, 3D dosimetric information with high spatial resolution and low imaging times. Traditional CT image reconstruction methods (filtered backprojection) do not account for light refraction within the optical CT system reducing the image quality. Iterative reconstruction methods make use of a system matrix that describes this light refraction thus, improving the reconstructed image quality. However, use of iterative reconstruction methods is not widespread, largely due to the impractical storage size of the required system matrix. Furthermore, current iterative reconstruction methods do not address the issue of image degradation due to a single detector element collecting light from multiple raypaths. For optical CT radiochromic gel dosimetry to be used effectively as a radiation therapy treatment plan verification tool, the system must be both practical and accurate. Thus, this work has two main objectives: (i) reduce the size of system matrices by means of polar coordinate discretization in lieu of the traditional Cartesian coordinate discretization, and (ii) reduce image degradation due to multiple raypaths by a novel approach to populating the system matrix that accounts for multiple raypaths.

Single-cell DNA sequencing-a potential dosimetric tool.

We hypothesised that single-cell whole-genome sequencing has the potential to detect mutational differences in the genomes of the cells that are irradiated with different doses of radiation and we set out to test our hypothesis using in silico and in vitro experiments. In this manuscript, we present our findings from a Monte Carlo single-cell irradiation simulation performed in TOPAS-nBio using a custom-built geometric nuclear deoxyribonucleic acid (DNA) model, which predicts a significant dose dependence of the number of cluster damages per cell as a function of radiation dose. We also present preliminary experimental results, obtained from single-cell whole-genome DNA sequencing analysis performed on cells irradiated with different doses of radiation, showing promising agreement with the simulation results.

Commissioning and Assessment of Radiation Field and Dose Inhomogeneity for a Dual X-Ray Tube Cabinet Irradiator: To Ensure Accurate Dosimetry in Radiation Biology Experiments

Standardization of X-ray cabinet irradiators calibration and dose reporting is an ongoing process. Multi-tube designs have been introduced and provide theoretical benefit but have not been assessed for pre-clinical irradiation conditions. This study was to report our experience commissioning a dual x-ray tube cabinet irradiator and assess dose distribution for various conditions. Homogeneity and percent depth dose (PDD) of various tube designs in single-tube setting have been previously reported, however multi-tube designs can overcome field asymmetry caused by the heel effect and improve dose fall-off at depth. Profile measurements and output calibration were performed with a calibrated ion chamber. We measured the percent-depth-dose (PDD) with film for each tube individually (PDDind) and both tubes simultaneously (PDDsim). To replicate conditions similar to petri dishes, we evaluated the range of attenuation and scatter under variable solid water thickness up to 9 mm with 3 mm build-up below (i.e., 1.2 cm total backscatter) under several geometries. The films were placed at a fixed position with variable amount of solid water placed above the film. We measured the output with variable water volumes with a 6 cm petri dish to simulate variable solution volumes that are frequently used during in vitro experiments. Film was also placed in a 3D printed mouse phantom with dimensions of (9.5 × 3.6 × 3.0 cm) and constructed to be roughly cylindrical. The dose in the 20 × 20 cm2 tray was within 8.4% of the central axis dose with both tubes. Dose rates decreased at the furthest points on the tray, but remained within 5% within the 15 × 15 cm2 central area. PDDsim with total 7.9 cm backscatter shows that the output is within 95% of the maximum dose at 4 cm depth. PDDsim with 1.2 cm backscatter is also within 95% of the maximum. The PDDind was less than 90% at 1.8 cm, which is similar to other single-tube systems. Slight increase in dose was seen with increasing solution; however, the doses were within 7% of the measured max dose at 6.3 mm depth. This agrees well with the solid water measurements. The results for both solid water and petri dish with variable medium is shown in Table 1. The 3D printed mouse phantom profiles for each plane showed results consistent with the ion chamber measurements. X-ray cell culture irradiation with dual-tube cabinet irradiation is robust when utilizing established dosimetric tools to confirm output and homogeneity. The conditions assumed for calibrations are often not maintained during experiments. We have confirmed that inhomogeneities are present for single tube use, however they are reduced with simultaneous tube use. Additional monitoring should be performed for each unique irradiation setup.

A personalized Monte Carlo study of tumor and critical organ doses for Trans-arterial Radioembolization patients.

Trans-arterial Radioembolization (TARE) is an intra-arterial treatment method for liver malignancies. In this procedure, the therapeutic tumor dose is significant for predicting the treatment effectiveness while the dose absorbed in an organ at risk provides an understanding of its tolerance to radiation. This study proposes a Monte Carlo (MC) approach for determining absorbed organ doses for patients undergoing TARE treatment. The technique is based on the use of a voxel-based partial body model generated for each patient from his/her anatomical image data to represent the critical body structures more realistically. These structures are first segmented from image slices to create an image block which is then incorporated into a radiation transport package (MCNP6.2) to perform MC simulations. When used along with the parameters specific to a patient's treatment, such as lung-shunt factor (LSF), tumor-to-normal liver ratio (TLR), fractional uptakes, and administered activity, this approach allowed more accurate simulation of radiation interactions and hence provided absorbed doses specific to a TARE patient. The MC method also calculated the absorbed doses in organs or tissues that were close to target tissues for which the MIRD formalism makes no predictions. MIRD calculations were found to overestimate the absorbed doses by as much as 11% in lungs, 5% in liver, and 20% in tumor volumes. This raises concerns about the treatment's efficacy when estimating the correct activity to be administered to a patient. When each patient simulation was repeated with a 90Y source spectrum to reflect the distribution of varying beta energies, the liver and the lungs were observed to receive relatively lower doses than those obtained with monoenergetic beta particles. Thus, it can be stated that the approach adopted in this study offers a more precise model of the patient's critical tissues and serves as a personalized dosimetric tool for TARE treatment planning.

An In-House 3D Voxel Dosimetric Tool to Compare Predictive and Post- Treatment Dosimetry in 90Y Radioembolization: A Proof of Concept.

The aim of this study was to implement an in-house dosimetric tool to assess tumour- absorbed doses in pre and post-dosimetry for 90Y radioembolization with resin spheres. To perform dosimetric calculations we set up a dosimetric procedure and developed homemade software to calculate tumour absorbed dose and dose volume histograms (DVHs). The method is based on a simplified voxel dosimetry for an estimated 3D absorbed dose and it can be applied to both 99mTc-MAA SPECT/CT and 90Y PET/CT acquisitions for pre and post-dosimetry. We tested the software performance in a retrospective study using the data of 22 patients with hepatocellular carcinoma who underwent radioembolization with 90Y resin spheres in the period 2016-2021. The software calculates tumour doses (mean, minimum and maximum doses) from voxel counts and dose-volume histograms (DVH_spect, DVH_pet) for both 99mTc-MAA SPECT/CT and 90Y PET/CT imaging. DVH_spect and DVH_pet data were analyzed and compared with the aim to assess an agreement between them. Concordance between dosimetric data were evaluated with the Wilcoxon Signed Ranked test, descriptive statistical analysis and Pearson correlation coefficient. The mean administrated activity was 1313 MBq (range 444 MBq - 2200 MBq). Tumour volumes ranged from 75 mL to 1012 mL. The mean absorbed dose for tumour volume was 161 ± 66 Gy (Dm_spect) and 173 ± 79 Gy (Dm_pet). From Wilcoxon Signed Rank Test the differences between the dosimetric data extrapolated from DVH_spect and DVH_pet results were not significant with α = 0.05 (two-sided test). A good linear correlation was found between 99mTc-MAA and 90Y dosimetric data (Pearson correlation coefficient 0.887 p < 0.001). Generally, DVHs calculated on 99mTc-MAA SPECT/CT and 90Y PET/CT gave comparable results, some discrepancies were observed particularly with those patients where SPECT and PET imaging presented a visual mismatching. A simplified 3D dosimetry methodology was implemented and tested retrospectively on patient data treated with 90Y resin spheres. Even if the clinical feasibility of our approach has to be further validated on an extended patient cohort, the preliminary results of our study highlight the potential of the implemented dosimetric tool for tumour dose assessment.

AAPM Task Group Report 307: Use of EPIDs for Patient-Specific IMRT and VMAT QA.

Electronic portal imaging devices (EPIDs) have been widely utilized for patient-specific quality assurance (PSQA) and their use for transit dosimetry applications is emerging. Yet there are no specific guidelines on the potential uses, limitations, and correct utilization of EPIDs for these purposes. The American Association of Physicists in Medicine (AAPM) Task Group 307 (TG-307) provides a comprehensive review of the physics, modeling, algorithms and clinical experience with EPID-based pre-treatment and transit dosimetry techniques. This review also includes the limitations and challenges in the clinical implementation of EPIDs, including recommendations for commissioning, calibration and validation, routine QA, tolerance levels for gamma analysis and risk-based analysis. Characteristics of the currently available EPID systems and EPID-based PSQA techniques are reviewed. The details of the physics, modeling, and algorithms for both pre-treatment and transit dosimetry methods are discussed, including clinical experience with different EPID dosimetry systems. Commissioning, calibration, and validation, tolerance levels and recommended tests, are reviewed, and analyzed. Risk-based analysis for EPID dosimetry is also addressed. Clinical experience, commissioning methods and tolerances for EPID-based PSQA system are described for pre-treatment and transit dosimetry applications. The sensitivity, specificity, and clinical results for EPID dosimetry techniques are presented as well as examples of patient-related and machine-related error detection by these dosimetry solutions. Limitations and challenges in clinical implementation of EPIDs for dosimetric purposes are discussed and acceptance and rejection criteria are outlined. Potential causes of and evaluations of pre-treatment and transit dosimetry failures are discussed. Guidelines and recommendations developed in this report are based on the extensive published data on EPID QA along with the clinical experience of the TG-307 members. TG-307 focused on the commercially available EPID-based dosimetric tools and provides guidance for medical physicists in the clinical implementation of EPID-based patient-specific pre-treatment and transit dosimetry QA solutions including intensity modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) treatments.

Dosimetric Study to Estimate Deviations in Delivered Radiation Dose due to Occluded Air Spaces in Vaginal Vault Brachytherapy Applications.

To develop a dosimetric tool to estimate the dose delivered in the presence of air pockets with EBT3 film while simulating the conditions of vaginal vault brachytherapy (VVBT) with 3.0 diameter cylindrical applicator at a prescription dose distance of 5mm from the surface of it. Six acrylic plates (10 cm x 10 cm, 0.5 cm thick) with four different types of slots were designed and produced locally. They can hold a cylindrical vaginal brachytherapy applicator in the centre, air equivalent material from the applicator's surface [(sizes 4.5 mm (A), 3.0 mm (B), and 2.0 mm (C)], EBT3 film at the prescribed dose distance, and holder rods. Plates were layered together with acrylic rods and assembled in a holding box in a water phantom. Three treatment plans done in TPS with prescription doses of 2 Gy, 3 Gy, and 4 Gy at 5.0 mm with a treatment length of 6 cm, and were executed in Co-60-based HDR brachytherapy unit (M/s SagiNova, Germany) with & without the placement of air equivalent material, and the dose received at slot locations A, B, & C were noted. The mean percentage deviation of measured dose without and with presence of air pocket at A, B and C was 13.9%, 11.0% and 6.4% respectively for all dose prescriptions. As the air pocket size expanded radially from 2.0 mm to 4.5 mm, the increase in dosage ranged from 6.4% to 13.9% which was due to the fact that the film was held at dosage prescription distance and the lack of attenuation of photons radially through air pocket. The present study can be carried out with a 3D printed phantom that simulates VVBT application having air pockets of different dimensions at different locations and also can be analyzed with Monte Carlo simulations.

Improved Cherenkov Imaging across a Wide Range of Skin Pigmentation Levels for the Inclusion of Diverse Patient Populations

<h3>Purpose/Objective(s)</h3> Cherenkov imaging has recently emerged as a tool to visualize radiation dose and detect treatment incidents in real-time. The principle relies on the proportionality between Cherenkov light emission and dose deposited within tissue, introducing an additional opportunity to use the image information as a 2D surface dose map. The Cherenkov-dose relationship is affected by tissue optical properties, and recent studies have utilized routine CT-scans to correct for optical attenuation due to fibroglandular and adipose tissues, and blood volume, in the breast. However, the bulk of the reported <i>in vivo</i> data is limited to light-skinned patients due to limitations of geographical demographics. It is well documented that melanin is an optical absorber of Cherenkov photons, yet no prior <i>in vivo</i> work has been done to characterize the effect of different skin tones on Cherenkov dosimetry. We hypothesize that skin color information can be used to correct Cherenkov images for optical attenuation relating to melanin absorption across a diverse patient population. <h3>Materials/Methods</h3> A multi-institutional partnership was developed aiming to collect data from a more diverse patient population. A time-gated, intensified CMOS camera installed in the ceiling of a treatment room collects Cherenkov images of breast RT patients during their treatment. A standard color camera module is mounted adjacent to the Cherenkov camera to collect a color background image. Following a process developed with phantom studies, the two images are co-registered together in post-processing, RGB values are extracted from the skin over the treatment regions to calculate the relative skin luminance, L, and this value is compared to the optical emission from the corresponding Cherenkov image. A linear regression model is then used to assess the proportionality between L and Cherenkov emission intensity. <h3>Results</h3> The Cherenkov imaging system is being deployed in a clinic with a catchment area demographic of 67.4% Non-Hispanic White, an increase in diversity from 89.4% at the home institution. A clear relationship exists between skin color information and Cherenkov intensity, which cannot be determined like the bulk tissue properties from the CT scan alone. We found that L, derived from a wide range of melanin concentrations, is linearly proportional to Cherenkov intensity (R² = 0.98). Each Cherenkov image can be corrected based on skin luminance to improve the Cherenkov-dose relationship across various skin types. <h3>Conclusion</h3> The effect of both inter- and intra-patient skin color variations on the Cherenkov intensity can be corrected by using a linear regression model to increase the linearity between Cherenkov and deposited dose. This work will be used to improve our current CT-correction algorithm for all skin types and presents a major step towards expanding the inclusivity of Cherenkov imaging as a dosimetric tool for every patient.

Preliminary Study on the Use of Fricke Gel Dosimeter for Verification of IMRT Beam Delivery

The goal of intensity-modulated radiation therapy (IMRT) is to deliver a uniform dose to the tumor with minimal margins around the target, in order to increase local control of the disease while reducing secondary effects. The research performed in this work has shown the potential usefulness of the Fricke-gel dosimeter as a quality assurance (QA) tool to verify IMRT treatments produced by inverse treatment planning. First, the 3D integrating Fricke-gel dosimeter was successfully compared to an accepted dosimetric tool. It was then used to measure relative 3D dose distributions of simple treatment plans with multiple square or rectangular fields and specific inverse-planned IMRT treatment plans. By combining the CT anatomical information and the plan contours with the gel-measured data, it was possible to display the contours on the measured dose and the measured isodose lines on the CT, in addition to measuring dose-volume histograms (DVH) for the plans. This demonstrated the usefulness of the gel dosimeter as a QA tool for IMRT and inverse planning.

Characterization of an Innovative Detector Based on Scintillating Fiber for Personalized Computed Tomography Dosimetry.

For technical and radioprotection reasons, it has become essential to develop new dosimetric tools adapted to the specificities of computed tomography (CT) to ensure precise and efficient dosimetry since the current standards are not suitable for clinical use and for new CT technological evolution. Thanks to its many advantages, plastic scintillating fibers (PSF) is a good candidate for more accurate and personalized real-time dosimetry in computed tomography, and the company Fibermetrix has developed a new device named IVISCAN® based on this technology. In this study, we evaluated performances of IVISCAN® and associated uncertainties in terms of dose-rate dependence, angular dependence, stability with cumulative dose, repeatability, energy dependence, length dependence, and special uniformity in reference and clinical computed tomography beam qualities. For repeatability, the standard deviation is less than 0.039%, and the absolute uncertainty of repeatability lies between 0.017% and 0.025%. The deviation between IVISCAN® and the reference regarding energy dependence is less than 1.88% in clinical use. Dose rate dependence results show a maximum deviation under ±2%. Angular dependence standard deviation σ is 0.8%, and the absolute uncertainty was 1.6%. We observed 1% of variation every 50 Gy steps up to a cumulative dose of 500 Gy. Probe response was found to be independent of the PSF length with a maximum deviation < 2.7% between the IVISCAN® probe and the 1 cm PSF probe. The presented results demonstrated that IVISCAN® performances are in accordance with metrology references and the international standard IEC61674 relative to dosemeters used in X-ray diagnostic imaging and then make it an ideal candidate for real-time dosimetry in CT applications.

Comparison between different Dosimetric Tools based on Intensity-modulated Radiotherapy (IMRT): A Phantom Study

This study examined the gamma passing rate (GPR) consistency during applying different kinds of gamma analyses and dosimeters to IMRT. Methods: Import treatment protocols for QA phantom irradiation have been recalculated. A gamma analysis was used for comparing the measured and calculated dose distribution of IMRT for different gamma criteria (2%/2mm, 3%/3mm, 4%/4mm, 3%/5mm, 3%/5mm). These criteria are evaluated when 5%, 10%, or 15% of the dose distribution is suppressed. Measured and calculated dose distribution was evaluated with gamma analysis to dose difference (DD) with DTA criteria (distance to agreement). IMRT QA plans to 25 patients from various sites were formed with the Varian Eclipse treatment planning system. Results: Results indicate different diverse hardware and software combinations show varied levels of agreement with expected analysis for the same pass-rate criterion. For a dosimetry audit of the IMRT technique, an EPID detector is superior to conventional methods comparable to Gafchromic EPT3 film and 2D array due to cost, time-consuming, and set up error to get result analysis. The gamma passing rate (GPR) average is increased by increasing the low-dose threshold for different dosimetric tools. For EPID, regardless of the gamma criterion employed, the %GP does not appear to be dependent on the low-dose threshold values (5%-15%) because it indicates that fulfilment the low-dose threshold to global normalization has little effect on patient-specific QA outcomes. Conclusions: It is concluded that GPRs differ depending on gamma, dosimetric tools, and the suppressing dose ratio. To get the best results of quality assurance, each institution should thus carefully develop its procedure for gamma analysis by defining the gamma index analysis and gamma criterion using its dosimetric tools.

Deep learning-enabled EPID-based 3D dosimetry for dose verification of step-and-shoot radiotherapy.

The study aims at a novel dosimetry methodology to reconstruct a 3D dose distribution as imparted to a virtual cylindrical phantom using an electronic portal imaging device (EPID). A deep learning-based signal processing strategy, referred to as 3DosiNet, is utilized to learn a mapping from an EPID image to planar dose distributions at given depths. The network was trained with the volumetric dose exported from the clinical treatment planning system (TPS). Given the latent inconsistency between measurements and corresponding TPS calculations, unsupervised learning is formulated in 3DosiNet to capture abstractive image features that are less sensitive to the potential variations. Validation experiments were performed using five regular fields and three clinical intensity-modulated radiation therapy (IMRT) cases. The measured dose profiles and percentage depth dose (PDD) curves were compared with those measured using standard tools in terms of the 1D gamma index. The mean gamma pass rates (2%/2mm) over the regular fields are 100% and 97.3% for the dose profile and PDD measurements, respectively. The measured volumetric dose was compared to the corresponding TPS calculation in terms of the 3D gamma index. The mean 2%/2mm gamma pass rates are 97.9% for square fields and 94.9% for the IMRT fields. The system promises to be a practical 3D dosimetric tool for pre-treatment patient-specific quality assurance and further developed for in-treatment patient dose monitoring.

A simulation study of ionizing radiation acoustic imaging (iRAI) as a real-time dosimetric technique for ultra-high dose rate radiotherapy (UHDR-RT).

Electron-based ultra-high dose rate radiation therapy (UHDR-RT), also known as Flash-RT, has shown the ability to improve the therapeutic index in comparison to conventional radiotherapy (CONV-RT) through increased sparing of normal tissue. However, the extremely high dose rates in UHDR-RT have raised the need for accurate real-time dosimetry tools. This work aims to demonstrate the potential of the emerging technology of Ionized Radiation Acoustic Imaging (iRAI) through simulation studies and investigate its characteristics as a promising relative in vivo dosimetric tool for UHDR-RT. The detection of induced acoustic waves following a single UHDR pulse of a modified 6 MeV 21EX Varian Clinac in a uniform porcine gelatin phantom that is brain-tissue equivalent was simulated for an ideal ultrasound transducer. The full 3D dose distributions in the phantom for a 1×1 cm2 field were simulated using EGSnrc (BEAMnrc∖DOSXYZnrc) Monte Carlo (MC) codes. The relative dosimetry simulations were verified with dose experimental measurements using Gafchromic films. The spatial dose distribution was converted into an initial pressure source spatial distribution using the medium-dependent dose-pressure relation. The MATLAB-based toolbox k-Wave was then used to model the propagation of acoustic waves through the phantom and perform time-reversal (TR)-based imaging reconstruction. The effect of the various linear accelerator (linac) operating parameters, including linac pulse duration and pulse repetition rate (frequency), were investigated as well. The MC dose simulation results agreed with the film measurement results, specifically at the central beam region up to 80% dose within approximately 5% relative error for the central profile region and a local relative error of<6% for percentage dose depth. IRAI-based FWHM of the radiation beam was within approximately 3mm relative to the MC-simulated beam FWHM at the beam entrance. The real-time pressure signal change agreed with the dose changes proving the capability of the iRAI for predicting the beam position. IRAI was tested through 3D simulations of its response to be based on the temporal changes in the linac operating parameters on a dose per pulse basis as expected theoretically from the pressure-dose proportionality. The pressure signal amplitude obtained through 2D simulations was proportional to the dose per pulse. The instantaneous pressure signal amplitude decreases as the linac pulse duration increases, as predicted from the pressure wave generation equations, such that the shorter the linac pulse the higher the signal and the better the temporal (spatial) resolutions of iRAI. The effect of the longer linac pulse duration on the spatial resolution of the 3D constructed iRAI images was corrected for linac pulse deconvolution. This correction has improved the passing rate of the 1%/1mm gamma test criteria, between the pressure-constructed and dosimetric beam characteristics, to as high as 98%. A full simulation workflow was developed for testing the effectiveness of iRAI as a promising relative dosimetry tool for UHDR-RT radiation therapy. IRAI has shown the advantage of 3D dose mapping through the dose signal linearity and, hence, has the potential to be a useful dosimeter at depth dose measurement and beam localization and, hence, potentially for in vivo dosimetry in UHDR-RT.

OC-0305 Acceptance procedure of a novel Flash irradiation system with standard dosimetric tools

OC-0305 Acceptance procedure of a novel Flash irradiation system with standard dosimetric tools

124I-PET/CT-Guided Diagnosis and Personalized Treatment of Metastatic Papillary Thyroid Cancer to the Pancreas.

Metastasis to the pancreas from differentiated thyroid carcinoma is rare. A new pancreatic lesion was identified on surveillance imaging of a man with metastatic papillary thyroid carcinoma 7 years after initial diagnosis. Imaging with 124I-PET/CT was performed to noninvasively confirm metastatic thyroid cancer and provide prospective dosimetry to guide selection of a safe and effective administered activity of 131I. This case demonstrates the emerging role of 124I-PET/CT as a useful diagnostic scan, pretherapy scan, and dosimetric tool to deliver personalized therapy for patients with metastatic thyroid cancer.

Investigation of Verification Methods of Field Matching Using Polymer Gel Dosimeter in Proton Therapy

In our proton beam therapy center, we use imaging plates (IP) for dose verification of field matching in irradiation (called patch-field technique). In this study, a polymer gel dosimeter, which can perform three- dimensional dose distribution measurement, was used as a new tool for the verification of the patch field irradiation method corresponding to the rectangular irradiation. The results of measurements of the PAGAT gel dosimeter to irradiate to two rectangular fields called as patch irradiation fields, which were created using the treatment planning system, were evaluated and compared to the results of IP and plan in profiles near the boundary of two fields. In the case of no gap between the two fields, the relative dose using the gel dosimeter was 10.1% higher compared to that measured with the IP in the midpoint of two fields. In case of overlap (called hot region), the result of gels was 6.3% higher than that of IP. In the case of space (called cold region), the result of gels was 14.9% higher than that of IP. The results of the difference between gel and plan in the midpoint of two fields were 14.2% (no gap), -5.0% (hot), and 10.5% (cold). We found that the gel dosimeter was a 3-D dosimetric tool and possibility method for dose verification of patch fields. In this study, the results were preliminary and included several error factors. In the future, it is necessary to develop a dosimeter with improved and more precise measurements.