X-ray CT Polymer Gel Dosimetry Research Articles

Linac-integrated kV-cone beam CT polymer gel dosimetry

X-ray CT polymer gel dosimetry (PGD) remains a promising tool for three dimensional verification of high-dose treatment deliveries such as non-coplanar stereotactic irradiations. Recent demonstrations have shown a proof-of-principle application of linac-integrated cone beam CT-imaged (LI-CBCT) PGDs for 3D dose verification. LI-CBCT offers advantages over previous CT based PGD, including close to real-time imaging of the irradiated dosimeter, as well as the ability to maintain the dosimeter in the same physical location for irradiation and imaging, thereby eliminating spatial errors due to dosimeter re-positioning for read-out that may occur for other systems. However the dosimetric characteristics of a LI-CBCT PGD system remain to be established. The work herein determines the dosimetric properties and critical parameters needed to perform cone beam PGD. In particular, we show that imaging the dosimeter 20–30 min post irradiation offers excellent recovery of maximum polymerization yield (90%), averaging with as few as 10 image averages can provide ∼90% gamma pass rates (3%, 3 mm) as compared to treatment planning, and that eliminating outlier averaging points can improve the precision and signal to noise ratio of resultant images. In summary, with appropriate methodology LI-CBCT PGD can provide dosimetric data capable of verification of complex high dose radiation deliveries in three dimensions and may find use in commissioning and validation of novel complex treatments.

Evaluation of an x-ray CT polymer gel dosimetry system in the measurement of deformed dose

This study is an evaluation of the use of a N-isopropylacrylamide (NIPAM)-based x-ray CT polymer gel dosimetry (PGD) system in the measurement of deformed dose. This work also compares dose that is measured by the gel dosimetry system to dose calculated by a novel deformable dose accumulation algorithm, defDOSXYZnrc, that uses direct voxel tracking. Deformable gels were first irradiated using a single 3.5 × 5 cm2 open field and the static dose was compared to defDOSXYZnrc as a control measurement. Gel measurement was found to be in excellent agreement with defDOSXYZnrc in the static case with gamma passing rates of 94.5% using a 3%/3 mm criterion and 93.3% using a 3%/2 mm criterion. Following the static measurements, a deformable gel was irradiated with the same single field under an external compression of 25 mm and then released from this compression for dosimetric read out. The measured deformed dose was then compared to deformed dose calculated by defDOSXYZnrc based on deformation vectors produced by the Velocity AI deformable image registration (DIR) algorithm. In the deformed dose distribution there were differences in the measured and calculated field position of up to 0.8 mm and differences in the measured in calculated field size of up to 11.9 mm. Gamma pass rates were 60.0% using a 3%/3 mm criterion and 56.8% using a 3%/2 mm criterion for the deforming measurements representing a decrease in agreement compared to the control measurements. Further analysis showed that passing rates increased to 86.5% using a 3%/3 mm criterion and 70.5% using a 3%/2 mm criterion in voxels within 5 mm of fiducial markers used to guide the deformable image registration. This work represents the first measurement of deformed dose using x-ray CT polymer gel dosimetry. Overall these results highlight some of the challenges in the calculation and measurement of deforming dose and provide insight into possible strategies for improvement.

Uncertainty in 3D gel dosimetry

Three-dimensional (3D) gel dosimetry has a unique role to play in safeguarding conformal radiotherapy treatments as the technique can cover the full treatment chain and provides the radiation oncologist with the integrated dose distribution in 3D. It can also be applied to benchmark new treatment strategies such as image guided and tracking radiotherapy techniques. A major obstacle that has hindered the wider dissemination of gel dosimetry in radiotherapy centres is a lack of confidence in the reliability of the measured dose distribution. Uncertainties in 3D dosimeters are attributed to both dosimeter properties and scanning performance. In polymer gel dosimetry with MRI readout, discrepancies in dose response of large polymer gel dosimeters versus small calibration phantoms have been reported which can lead to significant inaccuracies in the dose maps. The sources of error in polymer gel dosimetry with MRI readout are well understood and it has been demonstrated that with a carefully designed scanning protocol, the overall uncertainty in absolute dose that can currently be obtained falls within 5% on an individual voxel basis, for a minimum voxel size of 5 mm3. However, several research groups have chosen to use polymer gel dosimetry in a relative manner by normalizing the dose distribution towards an internal reference dose within the gel dosimeter phantom. 3D dosimetry with optical scanning has also been mostly applied in a relative way, although in principle absolute calibration is possible. As the optical absorption in 3D dosimeters is less dependent on temperature it can be expected that the achievable accuracy is higher with optical CT. The precision in optical scanning of 3D dosimeters depends to a large extend on the performance of the detector. 3D dosimetry with X-ray CT readout is a low contrast imaging modality for polymer gel dosimetry. Sources of error in x-ray CT polymer gel dosimetry (XCT) are currently under investigation and include inherent limitations in dosimeter homogeneity, imaging performance, and errors induced through post-acquisition processing. This overview highlights a number of aspects relating to uncertainties in polymer gel dosimetry.

Dose calibration optimization and error propagation in polymer gel dosimetry

This study reports on the relative precision, relative error, and dose differences observed when using a new full-image calibration technique in NIPAM-based x-ray CT polymer gel dosimetry. The effects of calibration parameters (e.g. gradient thresholding, dose bin size, calibration fit function, and spatial remeshing) on subsequent errors in calibrated gel images are reported. It is found that gradient thresholding, dose bin size, and fit function all play a primary role in affecting errors in calibrated images. Spatial remeshing induces minimal reductions or increases in errors in calibrated images. This study also reports on a full error propagation throughout the CT gel image pre-processing and calibration procedure thus giving, for the first time, a realistic view of the errors incurred in calibrated CT polymer gel dosimetry. While the work is based on CT polymer gel dosimetry, the formalism is valid for and easily extended to MRI or optical CT dosimetry protocols. Hence, the procedures developed within the work are generally applicable to calibration of polymer gel dosimeters.

Considerations for x-ray CT polymer gel dosimetry

This review paper addresses the basic considerations required when performing x-ray CT polymer gel dosimetry. The review focuses on recent developments pertaining to these basic considerations.

An x-ray CT polymer gel dosimetry prototype: I. Remnant artefact removal

In this study a new x-ray CT polymer gel dosimetry (PGD) filtering technique is presented for the removal of (i) remnant ring and streak artefacts, and (ii) ‘structured’ noise in the form of minute, intrinsic gel density fluctuations. It is shown that the noise present within x-ray CT PGD images is not purely stochastic (pixel by pixel) in nature, but rather is ‘structured’, and hence purely stochastic-based noise-removal filters fail in removing this significant, unwanted noise component. The remnant artefact removal (RAR) technique is based on a class of signal stripping (i.e. baseline-estimation) algorithms typically used in the estimation of unwanted non-uniform baselines underlying spectral data. Here the traditional signal removal algorithm is recast, whereby the ‘signal’ that is removed is the structured noise and remnant artefacts, leaving the desired polymer gel dose distribution. The algorithm is extended to 2D and input parameters are optimized for PGD images. RAR filter results are tested on (i) synthetic images with measured gel background images added, in order to accurately represent actual noise present in PGD images, and (ii) PGD images of a three-field gel irradiation. RAR results are compared to a top-performing noise filter (adaptive mean, AM), used in previous x-ray CT PGD studies. It is shown that, in all cases, the RAR filter outperforms the AM filter, particularly in cases where either (i) a low-dose gel image has been acquired or (ii) the signal-to-noise ratio of the PG image is low, as in the case when a low number of image averages are acquired within a given experiment. Guidelines for the implementation of the RAR filter are given.

SU-E-T-93: A CT Polymer Gel Dosimetry System for End-To-End Dosimetry

Purpose: To design and test an x-ray CT polymer gel dosimetry system for 3D end-to-end dosimetry of brain and head and neck radiotherapy Methods: A head and neck phantom has been designed to undergo the entire RT process from immobilization and planning CT through to treatment. The phantom houses a 1L polymer gel in one of two locations: cranial and inferiorly in the neck region allowing for quality assurance of both brain and head and neck treatment processes. The gel dosimeter measures the delivered radiation dose in 3D, and following CT read-out, provides a dose record of the entire treatment process, i.e. “end-to-end” dosimetry. Enhanced dose-sensitivity N-isopropylacrylamide (NIPAM) based gels along with an optimized CT protocol were used to minimize uncertainty in image CT numbers (H). Tests of phantom set-up were performed to quantify image noise, uniformity and positioning reproducibility using locking bar (ideal conditions) and aquaplast mask (clinical conditions). The end-to-end dosimetry capability was tested by undertaking the full RT process (immobilization, planning CT, treatment planning, treatment set-up and delivery) and comparing delivered and planned doses for a simple “star-pattern” irradiation. Results: Removing the phantom head for gel read-out minimized noise and artifacts (63% noise reduction), produced uniform images and has minimal impact on phantom re-positioning (less than 0.5mm). Full phantom re-positioning reproducibility was also excellent: less than 0.9 mm for both locking bar and mask immobilization. Initial end-to-end dosimetry tests indicate accurate localization of treatment dose to within 1 mm. Conclusions: An x-ray CT polymer gel dosimetry system for performing 3D end-to-end dosimetry has been designed, tested and is demonstrated to provide accurate 3D localization of delivered radiation dose. Future work will assess clinical processes as undertaken by appropriate RT staff and look at other treatment sites.

Polymer gel dosimeters with enhanced sensitivity for use in x-ray CT polymer gel dosimetry

A primary limitation of current x-ray CT polymer gel dosimetry is the low contrast, and hence poor dose resolution, of dose images produced by the system. The low contrast is largely due to the low-dose sensitivity of current formulations of polymer gel for x-ray CT imaging. This study reports on the investigation of new dosimeter formulations with improved dose sensitivity for x-ray CT polymer gel dosimetry. We incorporate an isopropanol co-solvent into an N-isopropylacrylamide-based gel formulation in order to increase the total monomer/crosslinker concentration (%T) within the formulation. It is shown that gels of high %T exhibit enhanced dose sensitivity and dose resolutions over traditional formulations. The gels are shown to be temporally stable and reproducible. A single formulation (16%T) is used to demonstrate the capabilities of the x-ray CT polymer gel dosimetry system in measuring known dose distributions. A 1 L gel volume is exposed to three separate irradiations: a single-field percent depth dose, a two-field ‘cross’ and a three-field ‘test case’. The first two irradiations are used to generate a dose calibration curve by which images are calibrated. The calibrated images are compared with treatment planning predictions and it is shown that the x-ray CT polymer gel dosimetry system is capable of capturing spatial and dose information accurately. The proposed new gel formulation is shown to be sensitive, stable and to improve the dose resolution over current formulations so as to provide a feasible gel for clinical applications of x-ray CT polymer gel dosimetry.

Effects of glycerol co-solvent on the rate and form of polymer gel dose response

A factor currently limiting the clinical utility of x-ray CT polymer gel dosimetry is the overall low dose sensitivity (and hence low dose resolution) of the system. Hence, active research remains in the investigation of polymer gel formulations with increased CT dose response. An ideal polymer gel dosimeter will exhibit a sensitive CT response which is linear over a suitable dose range, making clinical implementation reasonably straightforward. This study reports on the variations in rate and form of the CT dose response of irradiated polymer gels manufactured with glycerol, which is a co-solvent that permits dissolution of additional bisacrylamide above its water solubility limit (3% by weight). This study focuses on situations where the concentration of bisacrylamide is kept at or below its water solubility limit so that the influence of the co-solvent on the dose response can be explored separately from the effects of increased cross-linker concentration. CT imaging and Raman spectroscopy are used to construct dose–response curves for irradiated gels varying in (i) initial total monomer (%T) and (ii) initial co-solvent concentration. Results indicate that: (i) for a fixed glycerol concentration, gel response increases linearly with %T. Furthermore, the functional form of the dose response remains constant, in agreement with a previous model of polymer formation. (ii) Polymer gels with constant %T and increasing co-solvent concentrations also show enhanced CT response. In addition, the functional form of the response is altered in these gels as co-solvent concentration is increased. Raman data indicate that the fraction of bis-acrylamide incorporated into polymerization, as opposed to cyclization, increases as co-solvent concentration increases. The changes in functional form indicate varying polymer yields (per unit dose), akin to relative fractional monomer/cross-linker (i.e. %C) changes in earlier studies. These results are put into context of the model of polymer formation. The implications of these results on the clinical utility of polymer gels with co-solvent are highlighted.

Investigation of optimal scanning protocol for X-ray computed tomography polymer gel dosimetry

X-ray computed tomography is one of the potential tool used to evaluate the polymer gel dosimeters in three dimensions. The purpose of this study is to investigate the factors which affect the image noise for X-ray CT polymer gel dosimetry. A cylindrical water filled phantom was imaged with single slice Siemens Somatom Emotion CT scanner. The imaging parameters like tube voltage, tube current, slice scan time, slice thickness and reconstruction algorithm were varied independently to study the dependence of noise on each other. Reductions of noise with number of images to be averaged and spatial uniformity of the image were also investigated. Normoxic polymer gel PAGAT was manufactured and irradiated using Siemens Primus linear accelerator. The radiation induced change in CT number was evaluated using X-ray CT scanner. From this study it is clear that image noise is reduced with increase in tube voltage, tube current, slice scan time, slice thickness and also reduced with increasing the number of images averaged. However to reduce the tube load and total scan time, it was concluded that tube voltage of 130 kV, tube current of 200 mA, scan time of 1.5 s, slice thickness of 3 mm for high dose gradient and 5 mm for low dose gradient were optimal scanning protocols for this scanner. Optimum number of images to be averaged was concluded to be 25 for X-ray CT polymer gel dosimetry. Choice of reconstruction algorithm was also critical. From the study it is also clear that CT number increase with imaging tube voltage and shows the energy dependency of polymer gel dosimeter. Hence for evaluation of polymer gel dosimeters with X-ray CT scanner needs the optimization of scanning protocols to reduce the image noise.

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.