L. John Schreiner

Cone beam optical computed tomography for gel dosimetry I: scanner characterization

The ongoing development of easily accessible, fast optical readout tools promises to remove one of the barriers to acceptance of gel dosimetry as a viable tool in cancer clinics. This paper describes the characterization of a number of basic properties of the Vista cone beam CCD-based optical scanner, which can obtain high resolution reconstructed data in less than 20 min total imaging and reconstruction time. The suitability of a filtered back projection cone beam reconstruction algorithm is established for optically absorbing dosimeters using this scanner configuration. The system was then shown to be capable of imaging an optically absorbing media-filled 1 L polyethylene terephthalate (PETE) jar dosimeter to a reconstructed voxel resolution of 0.5 x 0.5 x 0.5 mm(3). At this resolution, more than 60% of the imaged volume in the dosimeter exhibits minimal spatial distortion, a measurement accuracy of 3-4% and the mean to standard deviation signal-to-noise ratio greater than 100 over an optical absorption range of 0.06-0.18 cm(-1). An inter-day scan precision of 1% was demonstrated near the upper end of this range. Absorption measurements show evidence of stray light perturbation causing artifacts in the data, which if better managed would improve the accuracy of optical readout. Cone beam optical attenuation measurements of scattering dosimeters, on the other hand, are nonlinearly affected by angled scatter stray light. Scatter perturbation leads to significant cupping artifacts and other inaccuracies that greatly limit the readout of scattering polymer gel dosimeters with cone beam optical CT.

Temperature increases associated with polymerization of irradiated PAG dosimeters

Polyacrylamide gel (PAG) dosimeters show considerable promise as three-dimensional dosimeters for the verification of complex dose distributions associated with conformal therapy. However, the potential of PAG dosimeters has not yet been borne out in clinical practice and it is apparent that basic investigations of these dosimeters are still required. The polymerization reactions in PAG dosimeters are exothermic and the heat given off by the reactions may influence polymerization reaction kinetics. We report the results of in situ measurements of local temperature increases in irradiated PAG resulting from heat generated by the radiation-induced exothermic polymerization reactions. Temperature changes proportional to the absorbed dose were observed in the irradiated gels, reaching a maximum of 12 degrees C under high-dose conditions, depending on the thermal boundary conditions. This has practical implications, for example, using small vials of PAG to calibrate large phantoms may not be appropriate since temperature differences during irradiation between the calibration vials and phantom may alter the morphology and quantity of the polymer formed, even when irradiated to the same dose. The inhibition of radiation-induced polymerization associated with low-level oxygen contamination is manifested by a delay in the onset of temperature rise during irradiation. The observed temperature changes are used to estimate the percentage conversion of double bonds from the bis/acrylamide monomers by polymerization reactions.

Cone-beam optical computed tomography for gel dosimetry II: imaging protocols.

This work develops imaging protocols for improved dose readout of a Fricke-xylenol orange-gelatin (FXG) gel-filled 1 L polyethylene terephthalate (PETE) jar dosimeter using a commercial Vista(TM) cone-beam optical computed tomography (CT) scanner from Modus Medical Devices Inc. (London, ON, Canada). To ensure good management of light source-detector stability, it was determined that (a) a minimum of 2 h warm-up time is necessary prior to dosimeter scanning, (b) the light source should be kept on until the completion of the last data scan except for the minimum amount of time required to acquire dark field images, and (c) the optional Vista software projection image normalization routine should be used in image reconstruction. The institution of dosimeter scan time and temperature control was strongly indicated from the experiments. A standard post-irradiation wait time of 30 min measured to within ±30 s was established to minimize the measurement uncertainties due to dosimeter development and diffusion. To alleviate thermochromic behavior leading to inaccurate dose readout, holding bath warm up and pre-scan temperature adjustment procedures were developed to control dosimeter temperature to within ±0.2 °C. The possibility of stray light minimizing protocols was also investigated and deemed to be unnecessary. The largest significant sources of stray light in the system were identified as being due to angled scatter from the dosimeter gelatin matrix and refraction from the jar wall interfaces. It was concluded that these phenomena would be better addressed through dosimeter modification and an inter-jar dose-to-attenuation calibration methodology, rather than by setting additional imaging protocols.

Initial experience with a commercial cone beam optical CT unit for polymer gel dosimetry II: Clinical potential

Gel dosimetry has been shown to have a great potential for 3D dosimetry for treatment delivery validation of conformal plans, particularly after the development of more spatially stable polymer-based dosimeters. However, despite its promise, gel dosimetry has not come into widespread clinical use, in part because of limited access to imaging modalities (particularly MRI) for dose readout. In this paper we present some initial investigations of the clinical potential of a Vista cone beam optical CT unit (Modus Medical, London, Canada) in conjunction with various polymer gel dosimeters.

Investigation of an efficient source design for Cobalt-60-based tomotherapy using EGSnrc Monte Carlo simulations

Recent investigations demonstrate a strong potential for Cobalt-60 (Co-60)-based tomotherapy. Reported work suggests that Co-60-based tomotherapy offers a clinically and commercially viable alternative to megavoltage x-ray-based tomotherapy. Tomotherapy applications use a combination of intensity-modulated fan beams to deliver highly conformal radiotherapy. However, conventional Co-60 units are designed to give large uniform rectangular fields using an isotropic radioactive source in a cylindrical geometry. Such cylindrical source geometry likely provides a sub-optimal use of the radioactivity within the source volume for tomotherapy applications due to a significant loss of radiated energy outside the fan beam collimation system. To investigate a more efficient source geometry suitable for Co-60 tomotherapy applications, a computer code was written to model an isotropic source in a 6-faced polyhedron geometry such as cube, parallelepiped, prism and truncated pyramid. This code was integrated with the existing EGSnrc/BEAMnrc Monte Carlo (MC) code. The integrated source code was thoroughly tested, validated and used to investigate the energy spectra, radiation output and self-shielding properties of various rectangular-shaped (RS) Co-60 sources. Fan beam dose profiles were calculated for various cylindrical and RS Co-60 sources for a range of source-to-axis distances (SAD), multi-leaf collimator-to-isocentre distances (CID) and modified collimator systems. Fringe and penumbra distances were analysed for the simulated dose profiles. Our results demonstrate that clinically acceptable fringe and penumbra distances can be achieved by a careful selection of SAD, CID, source shape and dimensions and modified collimator system. Significant overall gain in radiation output of the 20 x 1 cm(2) fan beams can be achieved by an optimal selection of the source geometry for a given active volume of Co-60. The overall gain includes the effects of change in packing density (accounting for self-absorption) and change in source shape.

Dosimetry in modern radiation therapy: limitations and needs

This paper extends the motivation for gel dosimetry beyond the discussion of solely radiation measurement and presents a broad review of the developments in modern conformal radiation therapy using intensity modulation, image guidance and adaptive processes.

The Potential for Image Guided Radiation Therapy with Cobalt-60 Tomotherapy

Helical tomotherapy, a new approach for Intensity Modulated Radiation Therapy, employs a fan-beam of radiation from a source mounted in a CT-like ring gantry. Complex conformal dose delivery is achieved by modulating the intensity of the radiation beam as the source revolves about the patient. A particular benefit of helical tomotherapy is the ability to perform in-situ CT imaging to confirm patient set-up, and to reconstruct the dynamically delivered dose distributions. In this paper we present the results of ongoing work to establish the potential for tomotherapy using a Cobalt-60 radioactive source. Both dose delivery and megavoltage CT imaging data confirm the feasibility of image guided radiation therapy using Cobalt-60 tomotherapy.

Initial experience with a commercial cone beam optical CT unit for polymer gel dosimetry I: Optical dosimetry issues

Treatment validation of conformal plans is becoming a very important part of radiation therapy. Soon after its inception, gel dosimetry was shown to have a great potential for 3D dosimetry, particularly after the development of more spatially stable polymer-based dosimeters. However, despite its promise, gel dosimetry has not come into widespread clinical use, in part because of limited access to imaging modalities (particularly MRI) for dose readout. In this paper we present some initial investigations of the use of a Vista cone beam optical CT unit (Modus Medical Devices Inc., London, Canada) in conjunction with various polymer gel dosimeters.

Production, review, and impact of technical quality control guidelines in a national context

A close partnership between the Canadian Partnership for Quality Radiotherapy (CPQR) and the Canadian Organization of Medical Physicists (COMP) Quality Assurance and Radiation Safety Advisory Committee (QARSAC) has resulted in the development of a suite of Technical Quality Control (TQC) guidelines for radiation treatment equipment; they outline specific performance objectives and criteria that equipment should meet in order to assure an acceptable level of radiation treatment quality. The adopted framework for the development and maintenance of the TQCs ensures the guidelines incorporate input from the medical physics community during development, measures the workload required to perform the QC tests outlined in each TQC, and remain relevant (i.e., “living documents”) through subsequent planned reviews and updates. The framework includes consolidation of existing guidelines and/or literature by expert reviewers, structured stages of public review, external field‐testing, and ratification by COMP. This TQC development framework is a cross‐country initiative that allows for rapid development of robust, community‐driven living guideline documents that are owned by the community and reviewed to keep relevant in a rapidly evolving technical environment. Community engagement and uptake survey data shows 70% of Canadian centers are part of this process and that the data in the guideline documents reflect, and are influencing, the way Canadian radiation treatment centers run their technical quality control programs. For a medium‐sized center comprising six linear accelerators and a comprehensive brachytherapy program, we evaluate the physics workload to 1.5 full‐time equivalent physicists per year to complete all QC tests listed in this suite. PACS number(s): 87.55.Qr, 87.56.Fc, 87.56.‐v

Medical physics staffing for radiation oncology: a decade of experience in Ontario, Canada

The January 2010 articles in The New York Times generated intense focus on patient safety in radiation treatment, with physics staffing identified frequently as a critical factor for consistent quality assurance. The purpose of this work is to review our experience with medical physics staffing, and to propose a transparent and flexible staffing algorithm for general use. Guided by documented times required per routine procedure, we have developed a robust algorithm to estimate physics staffing needs according to center‐specific workload for medical physicists and associated support staff, in a manner we believe is adaptable to an evolving radiotherapy practice. We calculate requirements for each staffing type based on caseload, equipment inventory, quality assurance, educational programs, and administration. Average per‐case staffing ratios were also determined for larger‐scale human resource planning and used to model staffing needs for Ontario, Canada over the next 10 years. The workload specific algorithm was tested through a survey of Canadian cancer centers. For center‐specific human resource planning, we propose a grid of coefficients addressing specific workload factors for each staff group. For larger scale forecasting of human resource requirements, values of 260, 700, 300, 600, 1200, and 2000 treated cases per full‐time equivalent (FTE) were determined for medical physicists, physics assistants, dosimetrists, electronics technologists, mechanical technologists, and information technology specialists, respectively. PACS numbers: 87.55.N‐, 87.55.Qr