Helen Gustavsson

MAGIC-type polymer gel for three-dimensional dosimetry: Intensity-modulated radiation therapy verification

A new type of polymer gel dosimeter, which responds well to absorbed dose even when manufactured in the presence of normal levels of oxygen, was recently described by Fong et al. [Phys. Med. Biol. 46, 3105-3113 (2001)] and referred to by the acronym MAGIC. The aim of this study was to investigate the feasibility of using this new type of gel for intensity-modulated radiation therapy (IMRT) verification. Gel manufacturing was carried out in room atmosphere under normal levels of oxygen. IMRT inverse treatment planning was performed using the Helios software. The gel was irradiated using a linear accelerator equipped with a dynamic multileaf collimator, and intensity modulation was achieved using sliding window technique. The response to absorbed dose was evaluated using magnetic resonance imaging. Measured and calculated dose distributions were compared with regard to in-plane isodoses and dose volume histograms. In addition, the spatial and dosimetric accuracy was evaluated using the gamma formalism. Good agreement between calculated and measured data was obtained. In the isocenter plane, the 70% and 90% isodoses acquired using the different methods are mostly within 2 mm, with up to 3 mm disagreement at isolated points. For the planning target volume (PTV), the calculated mean relative dose was 96.8 +/- 2.5% (1 SD) and the measured relative mean dose was 98.6 +/- 2.2%. Corresponding data for an organ at risk was 34.4 +/- 0.9% and 32.7 +/- 0.7%, respectively. The gamma criterion (3 mm spatial/3% dose deviation) was fulfilled for 94% of the pixels in the target region. Discrepancies were found in hot spots the upper and lower parts of the PTV, where the measured dose was up to 11% higher than calculated. This was attributed to sub optimal scatter kernels used in the treatment planning system dose calculations. Our results indicate great potential for IMRT verification using MAGIC-type polymer gel.

Linear energy transfer dependence of a normoxic polymer gel dosimeter investigated using proton beam absorbed dose measurements

Three-dimensional dosimetry with good spatial resolution can be performed using polymer gel dosimetry, which has been investigated for dosimetry of different types of particles. However, there are only sparse data concerning the influence of the linear energy transfer (LET) properties of the radiation on the gel absorbed dose response. The purpose of this study was to investigate possible LET dependence for a polymer gel dosimeter using proton beam absorbed dose measurements. Polymer gel containing the antioxidant tetrakis(hydroxymethyl)phosphonium (THP) was irradiated with 133 MeV monoenergetic protons, and the gel absorbed dose response was evaluated using MRI. The LET distribution for a monoenergetic proton beam was calculated as a function of depth using the Monte Carlo code PETRA. There was a steep increase in the Monte Carlo calculated LET starting at the depth corresponding to the front edge of the Bragg peak. This increase was closely followed by a decrease in the relative detector sensitivity (Srel = Dgel/Ddiode), indicating that the response of the polymer gel detector was dependent on LET. The relative sensitivity was 0.8 at the Bragg peak, and reached its minimum value at the end of the proton range. No significant effects in the detector response were observed for LET < 4.9 keV microm(-1), thus indicating that the behaviour of the polymer gel dosimeter would not be altered for the range of LET values expected in the case of photons or electrons in a clinical range of energies.

Dosimetric verification of breathing adapted radiotherapy using polymer gel

In radiation therapy patient movement caused by respiration can be a major challenge to the ambition to deliver a high absorbed dose to the target volume while minimizing the dose to normal tissues. Large respiratory motion requires increased margins, which implies an increased risk of morbidity from late toxicity. It is therefore important to take respiratory motion into account when treating targets in the thorax region. The aim of this study was to investigate the feasibility of using a 3D gel dosimeter for dose verification of breathing adapted radiotherapy

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.

Dose response evaluation of a low-density normoxic polymer gel dosimeter using MRI.

A low-density (approximately 0.6 g cm(-3)) normoxic polymer gel, containing the antioxidant tetrakis (hydroxymethyl) phosponium (THP), has been investigated with respect to basic absorbed dose response characteristics. The low density was obtained by mixing the gel with expanded polystyrene spheres. The depth dose data for 6 and 18 MV photons were compared with Monte Carlo calculations. A large volume phantom was irradiated in order to study the 3D dose distribution from a 6 MV field. Evaluation of the gel was carried out using magnetic resonance imaging. An approximately linear response was obtained for 1/T2 versus dose in the dose range of 2 to 8 Gy. A small decrease in the dose response was observed for increasing concentrations of THP. A good agreement between measured and Monte Carlo calculated data was obtained, both for test tubes and the larger 3D phantom. It was shown that a normoxic polymer gel with a reduced density could be obtained by adding expanded polystyrene spheres. In order to get reliable results, it is very important to have a uniform distribution of the gel and expanded polystyrene spheres in the phantom volume.

Liquid ionization chamber calibrated gel dosimetry in conformal stereotactic radiotherapy of brain lesions

Hypofractionated conformal stereotactic radiotherapy (HCSRT) is an established method of treating brain lesions such as arteriovenous malformations (AVMs) and brain metastases. The aim of this study was to investigate the reliability of treatment plans in the terms of dose distribution and absorbed dose for HCSRT. Methods and materials. Treatment plans for three different clinical intracerebral targets, AVMs, were transferred to a CT study of a spherical water filled phantom simulating the human head and recalculated for the phantom geometry using a standard treatment planning system utilizing a pencil beam algorithm for dose calculation. The calculated absorbed dose, relative three dimensional (3D) dose distribution and dose conformity were investigated using gel dosimetry normalized to liquid ionization chamber (LIC) measurements. Results. The measured absorbed dose to the dose reference point was found to be within 2% of the calculated dose for all three targets. The measured dose distribution was found to be within 3% and 2 mm of the calculated dose for more than 93% of all points in the target volume for all three targets. Conclusions. The results show that the investigated standard treatment planning system can correctly predict the absorbed dose and dose distribution in different types of intracerebral targets and that the treatment can be delivered according to the plan.

IMRT prostate dosimetry using a normoxic polymer gel and MRI

Conventional dosimeters such as ionization chambers, thermoluminescent dosimeters and diodes are point dose measuring devices and therefore difficult to use for spatial evaluation of dose distributions. The film dosimeter is limited to 2D measurements, and the response is dependent of radiation direction. However, using gel dosimetry, dose information can be obtained in 3D with high spatial resolution. Intensity modulated radiation therapy (IMRT) usually involves steep dose gradients in all directions. For verification of this type of treatments gel dosimetry has shown to be suitable. The aim of this study was to investigate the feasibility of using a new type of normoxic polymer gel dosimeter and a water filled homogenous pelvis phantom with a gel insert for verification of IMRT prostate dose distributions.

Sequential beam integration characteristics of a methacrylic acid based normoxic polymer gel dosimeter

Polymer gel dosimetry offers great potential for volumetric measurements of dose distributions from complex radiotherapy treatment modalities. In order to assess the quality of a gel dosimeter to be used for radiotherapy dosimetry, a number of properties, such as dose resolution, temporal and spatial stability, beam quality dependence, dose rate dependence, and temperature dependence during manufacturing, irradiation and read out should be characterized. The aim of this study was to investigate the dose integration properties for a methacrylic acid based normoxic polymer gel dosimeter. The effect of sequential irradiation was investigated for different fractionation schemes and varying amounts of methacrylic acid (MAA).