Normoxic Polyacrylamide Gel Research Articles

An improved abdominal phantom for intrafraction image guidance validation

A dynamically compressible phantom of the human abdomen that simulates organ motion with breathing is being developed for possible testing of image-gated beam delivery in radiotherapy. The polyvinyl chloride plastisol (PVCP) phantom features a cavity that can contain a deformable normoxic polyacrylamide gel (nPAG) dosimeter that is intended for use with MRI to provide dosimetric data. The phantom has been improved by the inclusion of new components that are more realistic anatomically and exhibit CT values similar to those of the tissues they mimic. Component organs were made from 3D-printed molds developed from CT contours of a real patient and their radiodensities adjusted by varying the mass ratios of the PVCP hardener and softener during manufacture. To make the phantom more compatible with ultrasound imaging a graphite scatterer was mixed into some of the phantom components to produce a background speckle pattern. This provided contrast between the body and a moving anatomical target intended for motion tracking.Phantom insert motion magnitude and repeatibility was assessed using CT by imaging two phantom inserts, one containing fiducial markers and the other containing iodinated gelatin, at the same position after repeated cycles of deformation. The maximum motion of a phantom fiducial at the position of the phantom treatment target was found to be 12.2 mm. The phantom design resulted in dosimeter motion with a point-to-point repatability within 0.3 mm on average and contour repeatability resulting in Dice coefficients exceeding 0.98 on average.

Deformable abdominal phantom for the validation of real-time image guidance and deformable dose accumulation.

PurposeEnd‐to‐end testing with quality assurance (QA) phantoms for deformable dose accumulation and real‐time image‐guided radiotherapy (IGRT) has recently been recommended by American Association of Physicists in Medicine (AAPM) Task Groups 132 and 76. The goal of this work was to develop a deformable abdominal phantom containing a deformable three‐dimensional dosimeter that could provide robust testing of these systems.MethodsThe deformable abdominal phantom was fabricated from polyvinyl chloride plastisol and phantom motion was simulated with a programmable motion stage and plunger. A deformable normoxic polyacrylamide gel (nPAG) dosimeter was incorporated into the phantom apparatus to represent a liver tumor. Dosimeter data were acquired using magnetic resonance imaging (MRI). Static measurements were compared to planned dose distributions. Static and dynamic deformations were used to simulate inter‐ and intrafractional motion in the phantom and measurements were compared to baseline measurements.ResultsThe statically irradiated dosimeters matched the planned dose distribution with an average γ pass rates of 97.0 ± 0.5% and 97.5 ± 0.2% for 3%/5 mm and 5%/5 mm criteria, respectively. Static deformations caused measured dose distribution shifts toward the phantom plunger. During the dynamic deformation experiment, the dosimeter that utilized beam gating showed an improvement in the γ pass rate compared to the dosimeter that did not.ConclusionsA deformable abdominal phantom apparatus which incorporates a deformable nPAG dosimeter was developed to test real‐time IGRT systems and deformable dose accumulation algorithms. This apparatus was used to benchmark simple static irradiations in which it was found that measurements match well to the planned distributions. Deformable dose accumulation could be tested by directly measuring the shifts and blurring of the target dose due to interfractional organ deformation and motion. Dosimetric improvements were achieved from the motion management during intrafractional motion.

Evaluations of N-(Isobutoxymethyl) acrylamide gel dosimeter by NMR technique for radiotherapy and uncertainty in dose measurements

N-(Isobutoxymethyl) acrylamide (NIBMA) monomer in gelatin, named NIBMAGAT gel dosimeter, was prepared and investigated by nuclear magnetic imaging (NMR) for radiotherapy in the dose range of 0–30 Gy. NIBMA monomer polymerizes upon irradiation, increasing spin–spin relaxation rate R2. The addition of glycerol as a co-solvent in the gel matrix improved its radiation sensitivity better than the co-solvents of acetone and methanol. The increase of glycerol content by 1% wt/wt enhanced the sensitivity by ˜ 3.1%. This gel has better radiation sensitivity as compared to the polyacrylamide gel (PAG) dosimeter; the sensitivities of NIBMAGAT gel and normoxic polyacrylamide gel (nPAG) are ≈0.13 and ≈0.1 s−1.Gy−1, respectively. By comparing NIBMAGAT gel dosimeter with PAG, nMAG and nPAG gel dosimeters, NIBMAGAT gel dosimeter is less influenced by scanning temperature than the last three dosimeters. The gel is water equivalent and has an energy-independent response from 80 keV to 20 MeV. The overall uncertainty of dose measurement using NIBMAGAT gel is 5.46% at 2σ. Our findings suggest the applicability of using NIBMAGAT gel dosimeter by NMR technique for dose verification/planning in the practice of clinical radiotherapy.

The effect of THPS concentration on nPAG microstructure

The microstructures formed within a normoxic polyacrylamide gel (nPAG) dosimeter and their correlation to amount of dose received is investigated through the use of two scanning electron microscope modalities. The effect of gold sputtering onto the samples was examined to determine if it impacted the detectable structures. The evolution of polymer structure with increasing dose is shown to progress from long shard like polymer chains to smooth polymer structures coating the gel surface. It is demonstrated that without gold coating the samples, which is a necessity in high vacuum scanning electron microscopy, that an environmental scanning electron microscope can be used for analysis of polymerized structures. The addition of THPS as an antioxidant is shown to not alter the formation of polymer microstructures when compared to other studies involving THPC. It is also proposed that knowledge of these features could be used to manipulate the deformability, stability and polymerized opacity of an nPAG dosimeter.

Dosimetric comparison of DEFGEL and PAGAT formulae paired with an MRI acquisition

Normoxic Polyacrylamide Gels, or nPAGs, are 3D gel dosimeters that measure dose through the process of radiation-induced polymerization. Two nPAG formulae are DEFGEL and PAGAT, which are very similar, but differ mainly due to different weight fractions of monomers. The dosimetric resolutions of the two formulae when paired with a Spin-Echo (SE) MRI sequence and a monoexponential fit were compared over a range of 0-15 Gy. It was found that in the dose range 0-6 Gy the PAGAT formula generally showed a much finer dose resolution, while the DEFGEL formula showed a finer resolution from 8-15 Gy.

Initial characterization of a gel patch dosimeter for in vivo dosimetry

In vivo dosimetry is a greatly underutilized tool for patient safety in clinical external beam radiotherapy treatments, despite being recommended by several national and international organizations (AAPM, ICRU, IAEA, NACP). The reasons for this underutilization mostly relate to the feasibility and cost of in vivo dosimetry methods. Due to the increase in the number of beam angles and dose per fraction in modern treatments, there is a compelling need for a novel dosimeter that is robust and affordable while able to operate properly in these complex conditions. This work presents a gel patch dosimeter as a novel method of in vivo dosimetry. DEFGEL, a 6% T normoxic polyacrylamide gel, was injected into 1 cm thick acrylic molds to create 1 cm thick small cylindrical patch dosimeters. To evaluate the change in optical density due to radiation induced polymerization, dosimeters were scanned before and after irradiation using an in-house developed laser densitometer. The dose–responses of three separate batches of gel were evaluated and compared to check for linearity and repeatability. The response development time was evaluated to ensure that the patch dosimeter could be high throughput. Additionally, the potential of this system to be used as an in vivo dosimeter was tested with a clinically relevant end-to-end in vivo phantom test. All irradiations were performed with a Varian Clinac 21EX at the University of Wisconsin Medical Radiation Research Center (UWMRRC). The dose–response of all three batches of gel was found to be linear within the range of 2–20 Gy. At doses below 0.5 Gy the statistical uncertainties were prohibitively large to make quantitative assessments of the results. The three batches demonstrated good repeatability in the range of 2 Gy to up to 10 Gy, with only slight variations in response at higher doses. For low doses the dosimeter fully developed within an hour while at higher doses they fully developed within four hours. During the in vivo phantom test the predicted patch absorbed dose was 4.23 Gy while the readout dose was evaluated to be 4.37 Gy, which corresponds to a 3.2% discrepancy. The dosimeter and densitometer pairing shows promise as an in vivo dosimetry system, especially for hypofractionated or MRI-guided radiotherapy treatments where higher doses are prescribed.

Verification of motion induced thread effect during tomotherapy using gel dosimetry

The purpose of the study was to evaluate how breathing motion during tomotherapy (Accuray, CA, USA) treatment affects the absorbed dose distribution. The experiments were carried out using gel dosimetry and a motion device simulating respiratory-like motion (HexaMotion, ScandiDos, Uppsala, Sweden). Normoxic polyacrylamide gels (nPAG) were irradiated, both during respiratory-like motion and in a static mode. To be able to investigate interplay effects the static absorbed dose distribution was convolved with the motion function and differences between the dynamic and convolved static absorbed dose distributions were interpreted as interplay effects. The expected dose blurring was present and the interplay effects formed a spiral pattern in the lower dose volume. This was expected since the motion induced affects the preset pitch and the theoretically predicted thread effect may emerge. In this study, the motion induced thread effect was experimentally verified for the first time.

Application of optical methods for dose evaluation in normoxic polyacrylamide gels irradiated at two different geometries

Normoxic gels are frequently used in clinical praxis for dose assessment or 3-D dose imaging in radiotherapy due to their relative simple manufacturing process under normal atmospheric conditions, spatial stability and well expressed modification feature of physical properties which is related to radiation induced polymerization of gels. In this work we have investigated radiation induced modification of the optical properties of home prepared normoxic polyacrylamide gels (nPAG) in relation to polymerization processes that occur in irradiated gels. Two irradiation geometries were used for irradiation of gel samples: broad beam irradiation geometry of teletherapy unit ROKUS-M with a 60Co source and point source irradiation geometry using 192Ir source of high dose rate afterloading brachytherapy unit MicroSelectron v2 which was inserted into gel via 6Fr (2mm thick) catheter. Verification of optical methods: UV–VIS spectrometry, spectrophotometry, Raman spectroscopy for dose assessment in irradiated gels has been performed. Aspects of their application for dose evaluation in gels irradiated using different geometries are discussed. Simple pixel-dose based photometry method also has been proposed and evaluated as a potential method for dose evaluation in catheter based interstitial high dose rate brachytherapy.

SU-C-224-01: 3D Dosimetry with Gels and Optical Tomography of Dynamic MLC Tracking Based on an Electromagnetic Transponder System

Purpose: Complex treatment methods such as rotational intensity modulated radiotherapy (rIMRT) offer highly conformal dose delivery but are at risk of being compromised due to target motion. Dynamic MLC tracking has been developed to compensate for target motion online. Due to the complex 3D patterns of tumour motion, tracking would benefit from a full 3D dosimetric verification. In this study we have therefore investigated the use of 3D dosimetry - with gels and optical tomography - for measuring the effect of tracking on 3D dose distributions with the use of a clinically measured prostate trajectory. Methods: Two normoxic polyacrylamide gel dosimeters were irradiated with the same prostate rIMRT treatment plan, delivered with and without tracking while placed on a motion stage that reproduced a patient measured prostate trajectory. A reference gel dosimeter was irradiated without motion or tracking. Dynamic MLC tracking was performed using an electromagnetic transponder system (RayPilot, MicroPos AB, Gothenburg Sweden). After experiments the 3D dose distributions in the two motion experiments were read-out using an optical CT scanner and compared to the stationary reference dosimeter using 3 %/3 mm gamma analyses. Results: 2D 3%/3mm gamma analyses were performed at equidistant slices separated by 1 cm in the transverse plane and the coronal plane of the 3D dosimeters. The weighted average gamma fail-rate was improved from 37% to 14% (transversal plane) and from 30% to 9% (coronal plane) by tracking compared to treatment without tracking. Conclusions: Optical 3D dosimetry is a valuable tool to quantify the impact of motion and motion compensation on the delivered dose distribution to a moving target. Improved knowledge about the dose distribution is obtained due to (i) the three-dimensional nature of the measurements and (ii) the high resolution compared to competing techniques.

3D geometric gel dosimetry verification of intraprostatic fiducial guided hypofractionated radiotherapy of prostate cancer

This pre-study is aimed to investigate the feasibility of a normoxic polyacrylamide gel (nPAG) dosimeter with implanted gold fiducials to evaluate the geometric precision, including setup correction strategies, in the delivery of hypofractionated treatments. For this purpose a phantom consisting of three parts was constructed: (1) the patient simulating volume, providing realistic scatter conditions and weight, (2) a bottle containing the active dosimetric volume and (3) the gold fiducials and the fiducial support structure. A 6.1 Gy prostate IMRT treatment was delivered to the phantom using the sliding-window technique. The phantom was positioned prior to the treatment using the implanted fiducials and kV on-board imaging. An overlay of the 95% isosurface of the TPS calculated dose distribution and the measured dose distribution using gel showed good agreement. The clinical target volume (CTV) was well centred inside the 95% isodose surface of the measured volume. It was shown for the evaluated case that the use of on-board imaging and integrated setup correction tools could be used to compensate for a deliberately introduced offset in CTV position. The study showed that MRI based nPAG gel dosimetry can be used to verify setup correction procedures using implanted gold fiducials.

Reproducibility study of normoxic polyacrylamide gel (nPAG) dosimeters

In this study, the overall accuracy of normoxic polyacrylamide gel (nPAG) dosimeters is considered. Different badges of nPAG are fabricated, poured in containers of glass and Barex" and irradiated with a 6MV square photon beam. The polymer gel dosimeters were read out using MRI. The overall reproducibility and accuracy of nPAG gel dosimeters was determined by comparison with depth-dose profiles acquired with a Pin Point ionization chamber. Additionally, the effect of the container wall on the depth-dose profile and the effect of temperature changes before and after irradiation on the R2-dose response have been investigated. The average standard deviation and maximum deviation between 8 gel-measured depth-dose profiles and a depth-dose profile measured with an ionization chamber amounted to 0.543 Gy (2.5%) and 2.579 Gy (11.7%) respectively.

Verification of dynamic radiotherapy: the potential for 3D dosimetry under respiratory-like motion using polymer gel

Following the implementation of advanced treatment procedures in radiotherapy, there is a need for dynamic dose verification in 3D. Gel dosimetry could potentially be used for such measurements. However, recently published data show that certain types of gels have a dose rate and fractionation dependence. The aim of this study was to investigate the feasibility of using a polymer gel dosimeter for dose verification of dynamic radiotherapy. To investigate the influence of dose rate dependence during respiratory-like motion in and out of the beam, a respiration robot together with two types of gel systems (normoxic methacrylic acid gel (nMAG) and normoxic polyacrylamide gel (nPAG)) were used. Reference measurements were obtained using a linear diode array (LDA). Expected results, if there was no influence of the dose rate variation, were calculated by convolving the static irradiated gel data with the motion function controlling the robot. To investigate the fractionation dependence, the gels were irradiated using gated and ungated deliveries. Magnetic resonance imaging was used to evaluate the absorbed dose response of the gel. The measured gel data coincided well with the LDA data. Also, the calculated data agreed well with the measured dynamic gel data, i.e. no dose rate dependence due to motion was observed. The difference in the R2 response for the gels receiving ungated and gated, i.e. fractionated, deliveries was less than 1% for the nPAG and 4% for the nMAG, for absorbed doses up to 2 Gy. The maximum difference was 1.2% for the nPAG and 9% for the nMAG, which occurred at the highest given dose (4 Gy). The investigated gels were found to be feasible detectors for dose measurements under respiratory-like motion. For dose verification of dynamic RT involving gated delivery, e.g. breathing-adapted radiotherapy, relative absorbed dose evaluation should be used in order to minimize the effects of fractionated irradiation.

Normoxic polyacrylamide gel doped with iodine: Response versus X-ray energy

The basis of Synchrotron Stereotactic Radio-Therapy (SSRT) is the incorporation of high atomic number atoms (iodine, for example) into the tumour mass followed by an irradiation with a monochromatic, low energy, X-ray beam from a synchrotron source. The purpose of the present study was to determine whether polymer gel dosimetry could be used to measure the enhancement of absorbed energy induced by the iodine in the media. We have used a standard nPAG formulation, loaded with NaI and the irradiations were performed either with monochromatic X-rays at the ESRF medical beamline or with a conventional 6 MV X-ray beam from a linear accelerator at the Grenoble University Hospital. We observed sensitivity increase with iodine loaded gels irradiated at low energies, in good agreement with the theoretical iodine dose-enhancement. As expected, the response of the iodine-doped polymer gel was not increased after irradiation with mega-voltage X-rays. We demonstrate in this study that polymer gel dosimeters can be used for measuring dose-enhancement due to iodine presence in SSR treatment.

X‐ray CT dose in normoxic polyacrylamide gel dosimetry

This study reports on the effects of x-ray CT dose in CT imaged normoxic polyacrylamide (nPAG) gel dosimeters. The investigation is partitioned into three sections. First, the CT dose absorbed in nPAG is quantified under a range of typical gel CT imaging protocols. It is found that the maximum absorbed CT dose occurs for volumetric imaging and is in the range of 4.6 +/- 0.2 cGy/image. This does scales linearly with image averaging. Second, using Raman spectroscopy, the response of nPAG to CT imaging photon energies (i.e., 120-140 kVp) is established and compared to the well known dose response of nPAG exposed to 6 MV photons. It is found that nPAG exhibits a weaker response (per unit dose) to 140-kVp incident photons as compared to 6 MV incident photons (slopes m6 mv = -0.0374 +/- 0.0006 Gy(-1) and m140 kVp = -0.016 +/- 0.001 Gy(-1)). Finally, using the above data, an induced change in CT number (deltaN(CT)) is calculated for nPAG imaged using a range of gel imaging protocols. It is found that under typical imaging protocols (120-140 kVp, 200 mAs, approximately 16-32 image averages) a deltaN(CT) < 0.2 H is induced in active nPAG dosimeters. This deltaN(CT) is below the current limit of detectability of CT nPAG polymer gel dosimetry. Under expanded imaging protocols (e.g., very high number of image averages) an induced deltaN(CT) of approximately 0.5 H is possible. In these situations the additional polymerization occurring in nPAG due to the imaging process may need to be accounted for.

Experimental properties of THPC based normoxic polyacrylamide gels for use in x-ray computed tomography gel dosimetry

The aim of the present study is to investigate the effects of tetrakis(hydroxymethyl)phosphonium chloride (THPC) on the experimental properties of normoxic polyacrylamide gels. Specifically we: (1) assess the use of THPC as an anti-oxidant for x-ray CT PAGAT dosimetry by investigating dose response reproducibility and stability, and optimal THPC concentration for maximum dose sensitivity while ensuring no O2 inhibition; (2) investigate the reactions of THPC with gel constituents; (3) describe the reaction mechanisms of THPC in PAGAT polymer gels; (4) assess the effects of THPC on O2 diffusion through the polymer gel.

Utilization of nPAG dosimeter for synchrotron radiotherapy: first results

The specificity of synchrotron stereotactic radiotherapy requires new developments in dose calculation and appropriate experimental procedures. The medical beamline of the European Synchrotron Radiation Facility allows quantitative synchrotron radiation CT (SRCT) images to be obtained from a monochromatic x-ray beam. This paper investigates initial experimental dosimetry with normoxic polyacrylamide gel dosimeters. MRI and SRCT readouts are compared.

Preliminary study of a normoxic polyacrylamide gel doped with iodine

At the medical beamline of the European Synchrotron Radiation Facility (ESRF), a new radiotherapy technique called synchrotron stereotactic radiotherapy (SSR) is under development. During an SSR treatment, it has been demonstrated that iodine should perfuse the tumour for achieving acceptable dose distributions within a human head (Boudou C, Balosso J, Estève F and Elleaume H 2005 Phys. Med. Biol. 50 4841-4851). The aim of this study was to experimentally assess the dose enhancement due to iodine. We compared the results obtained using a standard polyacrylamide gel in the presence or absence of an iodinated contrast agent.

Polymer gel dosimeters with reduced toxicity: a preliminary investigation of the NMR and optical dose–response using different monomers

In this work, three new polymer gel dosimeter recipes were investigated that may be more suitable for widespread applications than polyacrylamide gel dosimeters, since the extremely toxic acrylamide has been replaced with the less harmful monomers N-isopropylacrylamide (NIPAM), diacetone acrylamide and N-vinylformamide. The new gel dosimeters studied contained gelatin (5 wt%), monomer (3 wt%), N,N′-methylene-bis-acrylamide crosslinker (3 wt%) and tetrakis (hydroxymethyl) phosphonium chloride antioxidant (10 mM). The NMR response (R 2) of the dosimeters was analysed for conditions of varying dose, dose rate, time post-irradiation, and temperature during irradiation and scanning. It was shown that the dose–response behaviour of the NIPAM/Bis gel dosimeter is comparable to that of normoxic polyacrylamide gel (PAGAT) in terms of high dose-sensitivity and low dependence on dose rate and irradiation temperature, within the ranges considered. The dose–response (R 2) of NIPAM/Bis appears to be linear over a greater dose range than the PAGAT gel dosimeter. The effects of time post-irradiation (temporal instability) and temperature during NMR scanning on the R 2 response were more significant for NIPAM/Bis dosimeters. Diacetone acrylamide and N-vinylformamide gel dosimeters possessed considerably lower dose-sensitivities. The optical dose–response, measured in terms of the attenuation coefficient for each polymer gel dosimeter, showed potential for the use of optical imaging techniques in future studies.