Natalka Suchowerska

In vivo dosimeters for HDR brachytherapy: A comparison of a diamond detector, MOSFET, TLD, and scintillation detector

The large dose gradients in brachytherapy necessitate a detector with a small active volume for accurate dosimetry. The dosimetric performance of a novel scintillation detector (BrachyFOD) is evaluated and compared to three commercially available detectors, a diamond detector, a MOSFET, and LiF TLDs. An 192Ir HDR brachytherapy source is used to measure the depth dependence, angular dependence, and temperature dependence of the detectors. Of the commercially available detectors, the diamond detector was found to be the most accurate, but has a large physical size. The TLDs cannot provide real time readings and have depth dependent sensitivity. The MOSFET used in this study was accurate to within 5% for distances of 20 to 50 mm from the 192Ir source in water but gave errors of 30%-40% for distances greater than 50 mm from the source. The BrachyFOD was found to be accurate to within 3% for distances of 10 to 100 mm from an HDR 192Ir brachytherapy source in water. It has an angular dependence of less than 2% and the background signal created by Cerenkov radiation and fluorescence of the plastic optical fiber is insignificant compared to the signal generated in the scintillator. Of the four detectors compared in this study the BrachyFOD has the most favorable combination of characteristics for dosimetry in HDR brachytherapy.

A plastic scintillation dosimeter for high dose rate brachytherapy.

In vivo dose verification in brachytherapy requires a small insertable dosimeter with a real-time readout capability. Fibre optic scintillation dosimeters, consisting of a plastic scintillator coupled to an optical fibre, are one of the most promising dosimeters for this application. We have developed two sizes of the BrachyFOD scintillation dosimeter which have external diameters of 2.2 mm and 1 mm and have determined their important dosimetric characteristics (depth dose relation, angular dependence, temperature dependence, energy dependence). We have shown that the background signal created by Cerenkov and fibre fluorescence does not significantly affect the performance in most clinical geometries using an (192)Ir source from an HDR brachytherapy unit. The dosimeter design enables readout at less than 0.5 s intervals. The BrachyFOD satisfies the need for a real-time in vivo brachytherapy dosimeter.

Directional dependence in film dosimetry: radiographic and radiochromic film

The trend towards conformal, intensity modulated radiotherapy treatments has established the need for a true integrating dosimeter. In traditional radiotherapy, radiographic film dosimetry is commonly used. The accuracy and reproducibility of film optical density as an indicator of dose is influenced by several variables, including the chemical processing conditions. As a result radiochromic film, with all the advantages of radiographic film but without the need for chemical processing, has increased in popularity, although the low-dose sensitivity of radiochromic film does remain a disadvantage for some experiments. Several studies have investigated the reproducibility of radiochromic film results, but none have specifically addressed the well-known directional dependence seen with traditional radiographic film. In this study, the directional dependence of radiographic (Kodak X-omat V) and radiochromic (Gafchromic) films were measured. It was found that both films over responded when exposed parallel to the central axis of the beam as opposed to perpendicular exposure. An attempt is made to explain the reason for the responses of both films in terms of spectral effects and the air gap between the phantom segments. Although radiographic film exposed parallel rather than perpendicular to the central axis of the beam exhibits a measured difference in film response at depth, this over response does not occur when the extent of the film is restricted to a small region at the centre of the phantom (in this case an air gap is not introduced across the phantom). This suggests that it is the air gap rather than the orientation of the film that is the cause of the over response. Furthermore, when film occupies a slice through the entire phantom an over response occurs for both radiographic and radiochromic film, indicating that spectral effects are not the cause.

Small field diode correction factors derived using an air core fibre optic scintillation dosimeter and EBT2 film

There is no commercially available real-time dosimeter that can accurately measure output factors for field sizes down to 4 mm without the use of correction factors. Silicon diode detectors are commonly used but are not dosimetrically water equivalent, resulting in energy dependence and fluence perturbation. In contrast, plastic scintillators are nearly dosimetrically water equivalent. A fibre optic dosimeter (FOD) with a 0.8 mm(3) plastic scintillator coupled to an air core light guide was used to measure the output factors for Novalis/BrainLab stereotactic cones of diameter 4-30 mm and Novalis MLC fields of width 5-100 mm. The FOD data matched the output factors measured by a 0.125 cm(3) Semiflex ion chamber for the MLC fields above 30 mm and those measured with the EBT2 radiochromic film for the cones and MLC fields below 30 mm. Relative detector readings were obtained with four diode types (IBA SFD, EFD, PFD, PTW 60012) for the same fields. Empirical diode correction factors were determined by taking the ratio of FOD output factors to diode relative detector readings. The diodes were found to over-respond by 3%-16% for the smallest field. There was good agreement between different diodes of the same model number.

Cerenkov-free scintillation dosimetry in external beam radiotherapy with an air core light guide

Plastic scintillators have many advantages for dosimetry in external beam radiotherapy. The current method of transmitting the scintillation light to a remote detector is through a solid core optical fibre. When exposed in a high energy therapeutic radiotherapy beam this fibre is subject to an unwanted background signal from Cerenkov light which can exceed the scintillation signal at characteristic angles. We have constructed a plastic scintillation dosimeter that uses an air core light guide to transport the light from the scintillator to the light detector. We show that there is sufficient signal propagation in the air core light guide to allow the scintillator signal to be carried outside the primary beam of a radiotherapy linear accelerator and for a dosimeter to be constructed using a scintillator inserted into the end of the light guide. Studies of the background light generated in the air core light guide, as a function of the angle between the beam and the fibre axis, show that there is no characteristic Cerenkov peak generated in the air core. Depth dose measurements using the air core scintillation dosimeter with no correction for Cerenkov are compared to ionization chamber measurements for a 6 MV photon beam and a 9 MeV electron beam.

Irradiation Enhances the Efficiency of Testicular Germ Cell Transplantation in Sheep

Testis germ cell transplantation in livestock has the potential for production of transgenic genotypes and for use as an alternative to artificial insemination in animal breeding systems. In a pilot experiment, we investigated a workable protocol for testis germ cell transplantation in sheep, including donor cell isolation, rete testis injection, and microsatellite detection of donor spermatozoa in recipient semen. In a second experiment, the effect of depletion of endogenous stem cells with a single irradiation dose of 9 Gy (n = 5) or 15 Gy (n = 5) on the outcome of germ cell transplantation was investigated. Irradiation of recipient testes with a single dose of 15 Gy, followed by transplantation 6 wk after depletion, may be most advantageous because it resulted in all recipients (five of five) producing donor-derived spermatozoa, while the 9-Gy and control groups had limited success rates (two of five and one of three, respectively). Using microsatellite markers to detect the presence of donor DNA, 10 rams were identified that produced spermatozoa of donor origin. The proportion of donor DNA was between 1% and 30% of total ejaculate DNA. When three of these positive rams were used in breeding experiments, four donor-derived offspring (four of 50 [8% of progeny])resulted from a recipient in Merino to Merino transplantation. Six lambs (six of 41 [15% of progeny]) were sired by donor-derived Border Leicester sperm produced in a Merino recipient ram; however, no donor-derived offspring were detected among 34 progeny from a second Border Leicester to Merino combination. These results confirm that preparation of recipient animals with a correct dose of irradiation not only enhances the success rate of the transplantation procedure but also increases the proportion of donor spermatozoa in recipient semen. This study represents the first report of the production of live progeny following testis germ cell transplantation using irradiated recipients in a livestock species.

Intrafractional motion during proton beam scanning

Patient and internal organ motion during treatment with a scanned proton beam can introduce unplanned heterogeneities in the dose distribution throughout the irradiated volume. With static beam techniques, a margin around the target volume is added to compensate for patient and organ motion. This margin may not provide the solution with dynamic beam scanning. Intrafractional motion parallel and perpendicular to the beam axis is studied using two different scanning methods on a cubic water phantom. The direction of motion relative to the beam scanning direction as well as the method of scanning the proton beam across the target has a significant effect on the resulting dose distribution within the target volume. In the extreme cases studied here up to 100% of the target receives a dose outside the recommended limits, with a minimum dose as low as 34% of the prescribed dose.

Plastic scintillation dosimetry: optimization of light collection efficiency

Practical contemporary radiotherapy dosimetry systems used for dose measurement and verification are ionization chambers (which typically have at least a 0.1 cm3 air cavity volume), thermoluminescent dosimeters (TLDs) and silicon diodes. However, during the last decade, there has been an increased interest in scintillation dosimetry using small water-equivalent plastic scintillators, due to their favourable characteristics when compared with other more commonly used detector systems. Although plastic scintillators have been shown to have many desirable dosimetric properties, as yet there is no successful commercial detector system of this type available for routine clinical use in radiation oncology. The objectives of this study are to identify the factors preventing this new technology from realizing its full potential in commercial applications. A definition of signal to noise ratio (S/N) will be proposed for this category of detectors. In doing so the S/N ratio for an early prototype design has been calculated and/or measured. Criteria to optimize the response and sensitivity of this category of detectors are presented.

The radiobiological effect of intra-fraction dose-rate modulation in intensity modulated radiation therapy (IMRT)

Intensity-modulated radiation therapy (IMRT) achieves optimal dose conformity to the tumor through the use of spatially and temporally modulated radiation fields. In particular, average dose rate and instantaneous dose rate (pulse amplitude) are highly variable within a single IMRT fraction. In this study we isolate these variables and determine their impact on cell survival. Survival was assessed using a clonogenic assay. Two cell lines of differing radiosensitivity were examined: melanoma (MM576) and non-small cell lung cancer (NCI-H460). The survival fraction was observed to be independent of instantaneous dose rate. A statistically significant trend to increased survival was observed as the average dose rate was decreased, for a constant total dose. The results are relevant to IMRT practice, where average treatment times can be significantly extended to allow for movement of the multi-leaf collimator (MLC). Our in vitro study adds to the pool of theoretical evidence for the consequences of protracted treatments. We find that extended delivery times can substantially increase the cell survival. This also suggests that regional variation in the dose-rate history across a tumor, which is inherent to IMRT, will affect radiation dose efficacy.

Plastic scintillation dosimetry for radiation therapy: minimizing capture of Cerenkov radiation noise

Over the last decade, there has been an increased interest in scintillation dosimetry using small water-equivalent plastic scintillators, because of their favourable characteristics when compared with other more commonly used detector systems. Although plastic scintillators have been shown to have many desirable dosimetric properties, as yet there is no successful commercial detector system of this type available for routine clinical use in radiation oncology. The main factor preventing this new technology from realizing its full potential in commercial applications is the maximization of signal coupling efficiency and the minimization of noise capture. A principal constituent of noise is Cerenkov radiation. This study reports the calculated capture of Cerenkov radiation by an optical fibre in the special case where the radiation is generated by a relativistic particle on the fibre axis and the fibre axis is parallel to the Cerenkov cone. The fraction of radiation captured is calculated as a function of the fibre core refractive index and the refractive index difference between the core and the cladding of the fibre for relativistic particles. This is then used to deduce the relative intensity captured for a range of fibre core refractive indices and fibre core-cladding refractive index differences. It is shown that the core refractive index has little effect on the amount of radiation captured compared to the refractive index difference. The implications of this result for the design of radiation therapy plastic scintillation dosimeters are considered.