C. Wojnecki

Small SRS photon field profile dosimetry performed using a PinPoint air ion chamber, a diamond detector, a novel silicon-diode array "DOSI…, and polymer gel dosimetry. Analysis and intercomparison

Small photon fields are increasingly used in modern radiotherapy and especially in IMRT and SRS/SRT treatments. The uncertainties related to small field profile measurements can introduce significant systematic errors to the overall treatment process. These measurements are challenging mainly due to the absence of charged particle equilibrium conditions, detector size and composition effects, and positioning problems. In this work four different dosimetric methods have been used to measure the profiles of three small 6 MV circular fields having diameters of 7.5, 15.0, and 30.0 mm: a small sensitive volume air ion chamber, a diamond detector, a novel silicon-diode array (DOSI), and vinyl-pyrrolidone based polymer gel dosimeter. The results of this work support the validity of previous findings, suggesting that (a) air ion chambers are not suitable for small field dosimetry since they result in penumbra broadening and require significant corrections due to severe charged particle transport alterations; (b) diamond detectors provide high resolution and rather accurate small field profile measurements, as long as positioning problems can be addressed and the necessary dose rate corrections are correctly applied; and (c) the novel silicon-diode array (DOSI) used in this study seems to be adequate for small field profile measurements overcoming positioning problems. Polymer gel data were assumed as reference data to which the other measurement data were compared both qualitatively and quantitatively using the gamma-index concept. Polymer gels are both phantom and dosimeter, hence there are no beam perturbation effects. In addition, polymer gels are tissue equivalent and can provide high-spatial density and high-spatial resolution measurements without positioning problems, which makes them useful for small field dosimetry measurements. This work emphasizes the need to perform beam profile measurements of small fields (for acceptance, commissioning, treatment planning systems data feed, and periodic quality assurance purposes) using more than one dosimetric method. The authors believe this to be a safe way towards the reduction of the overall uncertainty related to SRS/SRT treatments.

LET dependence of GafChromic films and an ion chamber in low-energy proton dosimetry

Dosimetry using a PMMA phantom was performed in 15 and 29 MeV proton beams from the Birmingham cyclotron, with a Markus parallel-plate ionization chamber and GafChromic EBT and MD-V2-55 film. Simulations of the depth-dose curves were performed with FLUKA 2008.3 and MCNPX 2.5.0, which agreed almost perfectly with each other in range and only differed by 2% in the Bragg peak (BP) region. FLUKA was also used to calculate k(Q) factors for Markus chamber measurements as an improvement to the IAEA TRS-398 values in low-energy beams. FLUKA depth-dose simulations overestimate the BP height measured by ion chamber by about 10%, where the initial proton energy spread was estimated by fitting to the slope of the measured BP distal edge. Both GafChromic films showed an under-response in the BP compared to ion chamber; however, EBT exhibits this effect at lower energies than MD-V2-55. A possible reason for this is attributed to the shape and arrangement of the monomer particles being different in the active components of EBT and MD-V2-55. Relative effectiveness (RE) of both films is presented as functions of residual range R(res) in water and peak proton energy determined by FLUKA, with considerations for the spatial separation of the two active layers in each film. The proton energies at which RE reduces to 90% of maximum film response are 6.7 and 3.2 MeV for MD-V2-55 and EBT, respectively. Additionally, a beam quality correction factor (g(Q,Q0)) is suggested for both GafChromic films, involving water-to-film stopping power ratios evaluated using ICRU recommendations, and a polymer yield factor G(Q0)/G(Q). RE in this work is equated to the reciprocal of the polymer yield factor. The calculated values of (S(w,film))Q/(S(w,film))Q0 are constant within 2.1% and 1.2% across the proton energy range of 1-300 MeV for EBT and MD-V2-55, respectively, so it is concluded that the polymer yield factor is the dominant factor causing the LET quenching effect.

A preliminary comparative study of two treatment planning systems developed for boron neutron capture therapy: MacNCTPlan and SERA.

Two treatment planning systems have been specifically developed for BNCT: MacNCTPlan by the Harvard-MIT group and the SERA system developed by the INEEL/Montana State University group. In order to compare the dose components computed by the treatment planning systems, and therefore the clinical results available, it is important to first compare the basic features of the codes. This study investigated the effect of the reconstruction techniques and the form of the cross-section libraries used by the two treatment planning systems on the thermal neutron fluence distributions. Six mono-directional neutron sources of 0.0253 eV, 1 keV, 5 keV, 10 keV, 100 keV, and 1 MeV were directed onto simple geometric phantoms filled with water. The general-purpose Monte Carlo radiation transport code MCNP was used as a reference tool in this study. For the examples studied, it is found that the methods used for geometry representation (in MacNCTPlan) and for cross-section representation (in SERA) were found to impact directly on the accuracy of the calculated results.

A cancer research UK pharmacokinetic study of BPA-mannitol in patients with high grade glioma to optimise uptake parameters for clinical trials of BNCT

This paper describes results to-date from a human pharmacokinetic study which began recruitment in December 2007. Results are presented for a single patient recruited in December 2007. A second patient was recruited in July 2008 but detailed data are not available at the time of writing. The trial is an open-label, non-comparative, non-therapeutic study of BPA-mannitol in patients with high-grade glioma, who will be undergoing stereotactic brain biopsy as part of the diagnostic process before definitive treatment. The study investigates the route of infusion (intra-venous (IV) or intra-carotid artery) and in each case will assess the effect of administration of mannitol as a blood-brain barrier disrupter. All cohorts will receive a 2 h infusion of BPA-mannitol, and for some cohorts an additional mannitol bolus will be administered at the beginning of this infusion. Measurements are made by inductively coupled plasma mass spectrometry (ICP-MS) of (10)B concentration in samples of blood, urine, extra-cellular fluid in normal brain (via a dialysis probe), brain tissue around tumour and tumour tissue. Additional analysis of the tumour tissue is performed using secondary ion mass spectrometry (SIMS). The first patient was part of the cohort having intra-venous infusion without mannitol bolus. No serious clinical problems were experienced and the assay results can be compared with available patient data from other BNCT centres. In particular we note that the peak (10)B concentration in blood was 28.1 mg/ml for a total BPA administration of 350 mg/kg which is very consistent with the previous experience with BPA-fructose reported by the Helsinki group.

Experimental feasibility studies on a SPECT tomograph for BNCT dosimetry.

This article reports on the development of a prototype of a SPECT tomograph system for online dosimetry in BNCT based on LaBr(3)(Ce) scintillation detectors. The setup shielding was optimized to be used in the accelerator based BNCT facility of the University of Birmingham. The system was designed and built. An image of a (241)Am point source was reconstructed. A projection of a phantom with two tumors with 400 microg/g of (10)B was measured at the BNCT facility.

A computational study into the use of polyacrylamide gel and A-150 plastic as brain tissue substitutes for boron neutron capture therapy

A precise evaluation of the dosimetric performance of epithermal neutron beams designed for boron neutron capture theory of brain tumours requires the use of a phantom material that closely matches brain tissue. The aim of this study was to investigate how well polyacrylamide gel (or PAG) and A- 150 plastic performed as substitutes for brain tissue compared with standard phantom materials such as water and polymethyl-methacrylate (or PMMA). Thermal neutron fluence, photon dose and epithermal neutron dose distributions were calculated for the epithermal neutron beam available at the University of Birmingham. The results presented in this paper show that the PAG provides a good simulation of radiation transport in the brain with differences from the real brain of +9.4%, - 10.8% and +5.1% at a depth of 50 mm for thermal neutron fluence, gamma dose and epithermal neutron dose distributions respectively. The polyacrylamide gel presented is therefore a promising substitute for brain tissue that can, as a dosimeter, provide a three-dimensional map of the absorbed dose delivered by the epithermal neutron beam. However, this study does not investigate the agreement between doses derived from magnetic resonance and physical doses for such gels. A- 150 plastic was shown to be a better substitute for brain tissue than PMMA, with differences from brain of -1.9%, -12.4% and - 13.2% at a depth of 50 mm for thermal neutron fluence, gamma dose and epithermal neutron dose distributions respectively, against +21.1%, -16.2% and +19.2% for PMMA. A-150 plastic should therefore be the material of choice for solid phantoms.

Small field measurements with a novel silicon position sensitive diode array

DOSI, a novel dosimeter based on position sensitive detectors for particle physics experiments, was used for relative clinical dosimetry measurements in small radiotherapy fields. The device is capable of dynamic measurements in real time and provides sub-millimetre spatial resolution. The basic beam data for a stereotactic radiotherapy collimator system (BrainLAB) using 6 MV photons were measured and compared with the corresponding data acquired with a small diamond detector and a PinPoint ionization chamber. All measurements showed an excellent agreement between DOSI and the diamond detector. There was an increasing discrepancy between the relative output factors (ROF) measured with DOSI and those measured with the ionization chamber with decreasing field size, specifically for collimators with a diameter smaller than 15 mm. The percentage depth doses (PDD) were in agreement to better than 1% for all depths. The agreement on off-axis ratios (OAR) was better than 3% for all collimators, whereas the agreement on relative output factors (ROF) was at the 1% level. DOSIs fast read-out electronics made it possible for all measurements to be recorded within 45 min including time to change collimators. This should reduce the overall time for commissioning and QA measurements, an important factor especially for busy radiotherapy departments.

Treatment planning for a synchrotron-based radiotherapy modality

Contrast enhanced radiotherapy (CERT) achieves biologically localised dose enhancement through the preferential uptake of high-Z media by the tumour cells. A treatment planning software originally developed for boron neutron capture therapy (BNCT) has been developed to evaluate treatment plans for CERT. A realistic test case of a brain tumour based on actual CT scans was used to calculate dose distributions with and without the presence of an iodinated contrast medium. An enhancement of dose was observed at all depths with the introduction of iodine and the corresponding dose enhancement factors were calculated for various concentrations.

Determination of an RBE for an Epithermal Neutron Beam for BNCT from Microdosimetric Measurements

As the field of BNCT matures, one key element must be the development of a mechanism which allows the clinical experience gained on the beams at the pioneering centres, to be transferred to newer centres. In this way, new centres will have the potential to begin therapy immediately at the optimum dose level, and dose escalation studies may not be necessary. A greater role for microdosimetry in the specification of neutron beam quality for fast neutron therapy has been suggested.1 This paper explores a formalism through which measurements based on the proportional counter techniques can provide RBE data for epithermal neutron beams.

A Preliminary Inter-centre Comparison Study for Photon, Thermal Neutron and Epithermal Neutron Responses of Two Pairs of Ionisation Chambers Used for BNCT

The dual ionisation chamber technique is the recommended method for mixed field dosimetry of epithermal neutron beams. This paper presents initial data from an ongoing inter-comparison study involving two identical pairs of ionisation chambers used at the BNCT facilities of Petten, NL and of the University of Birmingham, UK. The goal of this study is to evaluate the photon, thermal neutron and epithermal neutron responses of both pairs of TE(TE) (Exradin T2 type) and Mg(Ar) (Exradin M2 type) ionisation chambers in similar experimental conditions. At this stage, the work has been completed for the M2 type chambers and is intended to be completed for the T2 type chambers in the near future.