Sarah Alnaghy

Technical Note: Experimental results from a prototype high-field inline MRI-linac

PURPOSE The pursuit of real-time image guided radiotherapy using optimal tissue contrast has seen the development of several hybrid magnetic resonance imaging (MRI)-treatment systems, high field and low field, and inline and perpendicular configurations. As part of a new MRI-linac program, an MRI scanner was integrated with a linear accelerator to enable investigations of a coupled inline MRI-linac system. This work describes results from a prototype experimental system to demonstrate the feasibility of a high field inline MR-linac. METHODS The magnet is a 1.5 T MRI system (Sonata, Siemens Healthcare) was located in a purpose built radiofrequency (RF) cage enabling shielding from and close proximity to a linear accelerator with inline (and future perpendicular) orientation. A portable linear accelerator (Linatron, Varian) was installed together with a multileaf collimator (Millennium, Varian) to provide dynamic field collimation and the whole assembly built onto a stainless-steel rail system. A series of MRI-linac experiments was performed to investigate (1) image quality with beam on measured using a macropodine (kangaroo) ex vivo phantom; (2) the noise as a function of beam state measured using a 6-channel surface coil array; and (3) electron contamination effects measured using Gafchromic film and an electronic portal imaging device (EPID). RESULTS (1) Image quality was unaffected by the radiation beam with the macropodine phantom image with the beam on being almost identical to the image with the beam off. (2) Noise measured with a surface RF coil produced a 25% elevation of background intensity when the radiation beam was on. (3) Film and EPID measurements demonstrated electron focusing occurring along the centerline of the magnet axis. CONCLUSIONS A proof-of-concept high-field MRI-linac has been built and experimentally characterized. This system has allowed us to establish the efficacy of a high field inline MRI-linac and study a number of the technical challenges and solutions.

BrachyView, a novel in-body imaging system for HDR prostate brachytherapy: Experimental evaluation

PURPOSE This paper presents initial experimental results from a prototype of high dose rate (HDR) BrachyView, a novel in-body source tracking system for HDR brachytherapy based on a multipinhole tungsten collimator and a high resolution pixellated silicon detector array. The probe and its associated position estimation algorithms are validated and a comprehensive evaluation of the accuracy of its position estimation capabilities is presented. METHODS The HDR brachytherapy source is moved through a sequence of positions in a prostate phantom, for various displacements in x, y, and z. For each position, multiple image acquisitions are performed, and source positions are reconstructed. Error estimates in each dimension are calculated at each source position and combined to calculate overall positioning errors. Gafchromic film is used to validate the accuracy of source placement within the phantom. RESULTS More than 90% of evaluated source positions were estimated with an error of less than one millimeter, with the worst-case error being 1.3 mm. Experimental results were in close agreement with previously published Monte Carlo simulation results. CONCLUSIONS The prototype of HDR BrachyView demonstrates a satisfactory level of accuracy in its source position estimation, and additional improvements are achievable with further refinement of HDR BrachyViews image processing algorithms.

In vivo endorectal dosimetry of prostate tomotherapy using dual MOSkin detectors

Verification of dose to the anterior rectal wall in helical tomotherapy to the prostate is important due to the close proximity of the rectal wall to the treatment field. The steep dose gradient makes these measurements challenging. A phantom‐based study was completed, aimed at developing a system for measurement of anterior rectal wall doses during hypofractionated prostate stereotactic body radiotherapy (SBRT) utilizing tomotherapy delivery. An array of four dual MOSkin™ dosimeters, spaced 1 cm apart, was placed on a replica Rectafix® immobilization spacer device. This Perspex probe is a more rigid alternative to rectal balloons, to improve geometric reproducibility. The doses at each point were measured in real time and compared to doses calculated by the treatment planning system (TPS). Additionally, distance‐to‐agreement (DTA) measurements were acquired to assist in the comparison of measured and predicted doses. All dual MOSkin detectors measured dose to within ±5% of the TPS at the anterior rectal wall. Whilst several points were outside of experimental error, the largest deviation from the TPS predicted dose represented a DTA of only 1.3 mm, within the acceptable DTA tolerance of 3 mm. Larger deviations of up to −11.9% were observed for the posterior and side walls; however, if acceptable DTA measurements are accounted for, then an agreement of 75% was observed. Although larger differences were observed at the other rectal wall locations, the overall effect of dose at these points was not as significant, given the lower doses. Despite the very high‐dose gradient region, real‐time measurements of the anterior rectal wall doses were within acceptable limits of TPS‐predicted doses. The differences between measured and planned data were due to difficulties in precisely locating each detector on the TPS dose grid, which presented large variations in dose between CT voxels in regions of steep dose gradients. The dual MOSkin system would, therefore, be a useful device for detecting errors in real time, such as patient shifts or incorrect setup, during tomotherapy of the prostate. PACS numbers: 87.53.Ly, 87.55.km, 87.55.N‐

Experimental verification of dose enhancement effects in a lung phantom from inline magnetic fields

BACKGROUND AND PURPOSE To present experimental evidence of lung dose enhancement effects caused by strong inline magnetic fields. MATERIALS AND METHODS A permanent magnet device was utilised to generate 0.95T-1.2T magnetic fields that encompassed two small lung-equivalent phantoms of density 0.3g/cm3. Small 6MV and 10MV photon beams were incident parallel with the magnetic field direction and Gafchromic EBT3 film was placed inside the lung phantoms, perpendicular to the beam (experiment 1) and parallel to the beam (experiment 2). Monte Carlo simulations of experiment 1 were also performed. RESULTS Experiment 1: The 1.2T inline magnetic field induced a 12% (6MV) and 14% (10MV) increase in the dose at the phantom centre. The Monte Carlo modelling matched well (±2%) to the experimentally observed results. Experiment 2: A 0.95T field peaked at the phantom centroid (but not at the phantom entry/exit regions) details a clear dose increase due to the magnetic field of up to 25%. CONCLUSIONS This experimental work has demonstrated how strong inline magnetic fields act to enhance the dose to lower density mediums such as lung tissue. Clinically, such scenarios will arise in inline MRI-linac systems for treatment of small lung tumours.

Technical Note: Penumbral width trimming in solid lung dose profiles for 0.9 and 1.5 T MRI‐Linac prototypes

PURPOSE Longitudinal magnetic fields narrow beam penumbra and tighten lateral spread of secondary electrons in air cavities, including lung tissue. Gafchromic® EBT3 film was used to investigate differences between penumbra in solid water and solid lung, without a magnetic field (0 T) and with two field strengths (0.9 and 1.5 T). METHODS The first prototype of the Australian MRI-linac consisted of a 1.5 T Siemens Sonata MRI and Varian industrial linatron (nominal 4 MV). The second prototype replaced the Sonata with a 1.0 T Agilent split-bore magnet. Measurements were completed at 0.9 T to maintain the same source-to-surface distance between set-ups. Gammex-rmi® solid water with 50 mm of CIRS solid lung inserted as a lung cavity was positioned inside each magnet. This was compared to the same set-up with solid water only, where film measurements were completed at solid water equivalent depths corresponding to entrance interface/mid/exit interface positions of solid lung from the first set-up. Multileaf collimator (MLC)-defined field sizes were set to 3 × 3 cm2 and 10 × 10 cm2 . The 80%-20% penumbral width was determined. RESULTS Under 1.5 T conditions, penumbra narrowing occurred up to 4.4 ± 0.1 mm compared to 0 T. As expected, the effect was less for 0.9 T, which resulted in a maximum narrowing of 2.5 ± 0.1 mm. Exit profile penumbra were more affected than entrance penumbra by up to 2.6 ± 0.2 mm. The 1.5 T field brought the solid water and lung penumbral widths more into alignment by a maximum difference of 0.4 ± 0.1 mm. CONCLUSIONS The trimming of penumbral widths due to magnetic fields in solid water and lung was demonstrated and compared to 0 T. The 0.9 and 1.5 T field trimmed the penumbra by up to 2.5 ± 0.1 mm and 4.4 ± 0.1 mm respectively.

Introducing dynamic dosimaging: Potential applications for MRI-linac

The new era of intra-fraction dose tracking in radiation therapy delivery demands new dosimetry methods, whereby a moving frame of reference as a function of time may be required. This introduces a new paradigm into radiation therapy dose verification. The term we propose to describe this is dynamic dosimaging, which by our definition is tracking the location of a dosimeter array in real time during on-line radiation dose acquisition.

The Australian MRI-Linac Program: measuring profiles and PDD in a horizontal beam

The Australian MRI-Linac consists of a fixed horizontal photon beam combined with a MRI. Commissioning required PDD and profiles measured in a horizontal set-up using a combination of water tank measurements and gafchromic film. To validate the methodology, measurements were performed comparing PDD and profiles measured with the gantry angle set to 0 and 90° on a conventional linac. Results showed agreement to within 2.0% for PDD measured using both film and the water tank at gantry 90° relative to PDD acquired using gantry 0°. Profiles acquired using a water tank at both gantry 0 and 90° showed agreement in FWHM to within 1 mm. The agreement for both PDD and profiles measured at gantry 90° relative to gantry 0° curves indicates that the methodology described can be used to acquire the necessary beam data for horizontal beam lines and in particular, commissioning the Australian MRI-linac.

Progress with MRI-linac image-guided radiation dose imaging

Purpose: To evaluate the significance of fractionated administration of thalidomide combined with γ-ray irradiation in terms of local tumor response and lung metastatic potential, referring to the response of intratumor quiescent (Q) cells. Materials/methods: B16-BL6 melanoma tumor-bearing C57BL/6 mice were continuously given 5-bromo-2’deoxyuridine (BrdU) to label all proliferating (P) cells. The tumor-bearing mice then received γ-ray irradiation after thalidomide treatment through a single or 2 consecutive daily intraperitoneal administrations up to a total dose of 400 mg/kg in combination with an acute hypoxia-releasing agent (nicotinamide, 1,000 mg/kg, intraperitoneally administered) or mild temperature hyperthermia (MTH, 40 centigrade for 60 minutes). Immediately after the irradiation, cells from some tumors were isolated and incubated with a cytokinesis blocker. The responses of the Q and total (= P + Q) cell populations were assessed based on the frequency of micronuclei using immunofluorescence staining for BrdU. In other tumor-bearing mice, 17 days after irradiation, macroscopic lung metastases were enumerated. Results: Thalidomide raised the sensitivity of the total cell population more remarkably than Q cells in both single and daily administrations. Daily administration of thalidomide elevated the sensitivity of both the total and Q cell populations, but especially the total cell population, compared with single administration. Daily administration, especially combined with MTH, decreased the number of lung metastases. Conclusions: Daily fractionated administration of thalidomide in combination with γ-ray irradiation was thought to be more promising than single administration because of its potential to enhance local tumor response and repress lung metastatic potential.

WE‐AB‐BRB‐04: A Novel Monolithic Silicon 2D Detector Array for Use in Stereotactic Applications

Purpose: To assess the capability of a novel 2D monolithic silicon detector array in measuring stereotactic photon fields. Methods: The silicon array detector used in this work, named Magic Plate-512 (MP512), is a thin monolithic silicon wafer (52 × 52 × 0.47 mm3) with 512 ion-implanted diodes (0.5 × 0.5 mm2). Adjacent pixels are spaced evenly with 2 mm pitch, covering a maximum detection area 46 mm wide. Its fast, FPGA based read-out system is synchronised with the linac to allow readout of all pixels pulse-by-pulse. A clinical SABR lung plan (consisting of 9 single segment beams, 6MV) was measured with the array at 1.5 cm depth in a solid water phantom (100 cm SSD). The typical field size was in the range of 3 × 3 cm2 to 4 × 4 cm2. Each beam was delivered at perpendicular incidence to the detector plane so as to avoid the need for angular dependence corrections. The fields were measured under the same conditions using Gafchromic EBT3 film for comparison. The film was scanned at 72 dpi resolution, with the red channel data used for analysis. Results: Average gamma passing rates of (92.3 ± 1.8) % for 2%/2mm criteria, and (86.6 ± 2.3) % for 1%/2mm criteria were achieved for MP512, using EBT3 film as the reference distribution. The detector array was able to accurately measure the full-width-at-half-maximum (FWHM), to within (0.77 ± 0.01) mm accuracy when compared to film. The penumbral widths (80%-20%) were measured to within (0.30 ± 0.01) mm accuracy to film. Conclusion: The MP512 is a feasible option for measurement of stereotactic photon fields, with its high density of detection points making it useful for small field applications. The prototype array has demonstrated merit; in the future the development of a larger array detection area would be beneficial for clinical applications.