Sunil Dutt Sharma

Radiochromic film dosimetry of rectal inhomogeneity and applicator attenuation in high dose rate brachytherapy of uterine cervix

Heterogeneities existing in the patient during treatment are neglected, as the treated subject is considered homogeneous in most of the commercially‐available treatment planning systems (TPSs) used for high dose rate (HDR) brachytherapy. The choice of a suitable dosimeter for experimental dosimetry near the HDR source is crucial, mainly due to existence of steep dose gradients. The present work aimed to assess the effect of rectal air heterogeneity and applicator attenuation in the HDR Ir‐192 brachytherapy treatment of carcinoma uterine cervix by utilizing GAFCHROMIC EBT2 film dosimetry. The dose to rectal walls under the condition of rectal air heterogeneity was measured experimentally using EBT2 film in a rectal phantom, and the measurements were validated by the Monte Carlo (MC) simulations. The applicator attenuation was measured by EBT2 film for a commonly used stainless steel uterine tube in a homogeneous water equivalent phantom. The measured doses were compared with the TPS calculated values. In case of the air cavity, the measured dose at the closest rectal surface was 12.8% less than the TPS calculated value due to lack of back scattering, whereas at the farthest rectal surface, it was higher by 24.5% due to no attenuation. The magnitude of attenuation due to the metal applicator was measured as high as 2% when compared with the TPS calculation. The dose reduction at the nearest rectal surface due to the effect of rectal air has indicated a clinically favorable dose distribution within the rectum, whereas the shielding effect posed by the metallic applicator was found to be less significant. Mutual agreement of the measured doses with the MC calculated dose values confirmed the suitability of EBT2 film for clinical dosimetry in HDR brachytherapy. PACS numbers: 87.53.Bn, 87.53.Jw, 87.56.bg, 87.55.Qr

Dose enhancement in gold nanoparticle-aided radiotherapy for the therapeutic photon beams using Monte Carlo technique

BACKGROUND Gold nanoparticle (GNP)-aided radiation therapy (RT) is useful to make the tumor more sensitive to radiation damage because of the enhancement in the dose inside the tumor region. Polymer gel dosimeter (PGD) can be a good choice for the physical measurement of dose enhancement produced by GNP inside the gel. MATERIALS AND METHODS The present study uses EGSnrc Monte Carlo code to estimate dose enhancement factor (DEF) due to the introduction of GNPs inside the PGD at different concentrations (7 and 18 mg Au/g of gel) when irradiated by therapeutic X-rays of energy 100 kVp, 150 kVp, 6 MV, and 15 MV. The simulation was also carried out to quantify the dose enhancement in PAGAT gel and tumor for 100 kVp X-rays. RESULTS For 100 kVp X-rays, average DEF of 1.86 and 2.91 is observed in the PAGAT gel dosimeter with 7 and 18 mg Au/g of gel, respectively. Average DEF of 1.69 and 2.61 is recorded for 150 kVp X-rays with 7 and 18 mg Au/g of gel, respectively. No clinically meaningful DEF was observed for 6 and 15 MV photon beams. Furthermore, the dose enhancement within the PAGAT gel dosimeter and tumor closely matches with each other. CONCLUSION The polymer gel dosimetry can be a suitable method of dose estimation and verification for clinical implementation of GNP-aided RT. GNP-aided RT has the potential of delivering high localized tumoricidal dose with significant sparing of normal structures when the treatment is delivered with low energy X-rays.

Dosimetric comparison of linear accelerator-based stereotactic radiosurgery systems.

Stereotactic radiosurgery (SRS) is a special radiotherapy technique used to irradiate intracranial lesions by 3-D arrangements of narrow photon beams eliminating the needs of invasive surgery. Three different tertiary collimators, namely BrainLab and Radionics circular cones and BrainLab micro multileaf collimator (mMLC), are used for linear accelerator-based SRS systems (X-Knife). Output factor (St), tissue maximum ratio (TMR) and off axis ratio (OAR) of these three SRS systems were measured using CC01 (Scanditronix/ Welhofer) and Pinpoint (PTW) cylindrical and Markus plane parallel ionization chambers as well as TLD and radiochromic film. Measurement results of CC01 and Pinpoint chambers were very close to each other which indicate that further reduction in volume and physical dimensions of cylindrical ionization chamber is not necessary for SRS/SRT dosimetry. Output factors of BrainLab and Radionics SRS cones were very close to each other while output factors of equivalent diameter mMLC field were different from SRS circular cones. TMR of the three SRS systems compared were very close to one another. OAR of Radionics cone and BrainLab mMLC were very close to each other, within 2%. However, OARs of BrainLab cone were found comparable to OARs of Radionics cone and BrainLab mMLC within maximum variation of 4%. In addition, user-measured similar data of other three mMLC X-Knives were compared with the mMLC X-Knife data measured in this work and found comparable. The concept of switching over to mMLC-based SRS/SRT is thus validated from dosimetric characteristics as well.

Dosimetry Parameters of BARC Ocuprosta I-125 Seed Source

A new model of125I seed source, named OcuProsta seed, was designed and fabricated by Radiopharmaceuticals Division of Bhabha Atomic Research Centre for ophthalmic and interstitial applications. AAPM TG 43 recommended dosimetry parameters for this seed source were determined experimentally using TLD as well as by Monte Carlo (MC) simulation. Measured and MC calculated values of the dose rate constant (DRC) are 0.95±0.065 cGyh−1U−1 and 0.972±0.005 cGyh−1U−1, respectively. The mean of measured and calculated DRC (Λ=0.96 cGyh−1U−1) was recommended for the clinical dosimetry of OcuProsta seed. Measured and MC calculated radial dose function, g(r), anisotropy function, F(r,θ), anisotropy factor and anisotropy constants are also found to be in good agreement to each other. Dosimetry parameters of OcuProsta seed were compared with the published values of similar in-design125I seed sources. The DRC of BARC OcuProsta seed is very close to Amersham 6711 seed and is also comparable to the DRC of Best model 2301, Syncor PharmaSeed and Isotron selectSeed within the uncertainty of measurement/calculation. The g(r) of OcuProsta seed shows a difference of up to 10% in comparison to the g(r) values of the similar in-design seed sources. The values of anisotropy function of OcuProsta are 7 – 13% different from the anisotropy function of Amersham 6711 and Syncor PharmaSeed. The anisotropy constant of OcuProsta is close to Amersham 6711 seed while it is about 9% smaller than the anisotropy constant of Best model 2301 and Synchor PharmaSeed.

Monte Carlo simulation based study of a proposed multileaf collimator for a telecobalt machine.

PURPOSE The objective of the present work was to propose a design of a secondary multileaf collimator (MLC) for a telecobalt machine and optimize its design features through Monte Carlo simulation. METHODS The proposed MLC design consists of 72 leaves (36 leaf pairs) with additional jaws perpendicular to leaf motion having the capability of shaping a maximum square field size of 35 × 35 cm(2). The projected widths at isocenter of each of the central 34 leaf pairs and 2 peripheral leaf pairs are 10 and 5 mm, respectively. The ends of the leaves and the x-jaws were optimized to obtain acceptable values of dosimetric and leakage parameters. Monte Carlo N-Particle code was used for generating beam profiles and depth dose curves and estimating the leakage radiation through the MLC. A water phantom of dimension 50 × 50 × 40 cm(3) with an array of voxels (4 × 0.3 × 0.6 cm(3) = 0.72 cm(3)) was used for the study of dosimetric and leakage characteristics of the MLC. Output files generated for beam profiles were exported to the PTW radiation field analyzer software through locally developed software for analysis of beam profiles in order to evaluate radiation field width, beam flatness, symmetry, and beam penumbra. RESULTS The optimized version of the MLC can define radiation fields of up to 35 × 35 cm(2) within the prescribed tolerance values of 2 mm. The flatness and symmetry were found to be well within the acceptable tolerance value of 3%. The penumbra for a 10 × 10 cm(2) field size is 10.7 mm which is less than the generally acceptable value of 12 mm for a telecobalt machine. The maximum and average radiation leakage through the MLC were found to be 0.74% and 0.41% which are well below the International Electrotechnical Commission recommended tolerance values of 2% and 0.75%, respectively. The maximum leakage through the leaf ends in closed condition was observed to be 8.6% which is less than the values reported for other MLCs designed for medical linear accelerators. CONCLUSIONS It is concluded that dosimetric parameters and the leakage radiation of the optimized secondary MLC design are well below their recommended tolerance values. The optimized design of the proposed MLC can be integrated into a telecobalt machine by replacing the existing adjustable secondary collimator for conformal radiotherapy treatment of cancer patients.

A survey on performance status of mammography machines: image quality and dosimetry studies using a standard mammography imaging phantom

It is essential to perform quality control (QC) tests on mammography equipment in order to produce an appropriate image quality at a lower radiation dose to patients. Imaging and dosimetric measurements on 15 mammography machines located at the busiest radiology centres of Mumbai, India were carried out using a standard CIRS breast imaging phantom in order to see the level of image quality and breast doses. The QC tests include evaluations of image quality and the mean glandular doses (MGD), which is derived from the breast entrance exposure, half-value layer (HVL), compressed breast thickness (CBT) and breast tissue compositions. At the majority of the centres, film-processing and darkroom conditions were not found to be maintained, which is required to meet the technical development specifications for the mammography film in use as recommended by the American College of Radiology (ACR). In most of the surveyed centres, the viewbox luminance and room illuminance conditions were not found to be in line with the mammography requirements recommended by the ACR. The measured HVL values of the machines were in the range of 0.27-0.39 mm aluminium (Al) with a mean value of 0.33±0.04 mm Al at 28 kV(p) following the recommendation provided by ACR. The measured MGDs were in the range of 0.14-3.80 mGy with a mean value of 1.34 mGy. The measured MGDs vary between centre to centre by a factor of 27.14. Referring to patient doses and image quality, it was observed that only one mammography centre has exceeded the recommended MGD, i.e. 3.0 mGy per view with the value of 3.80 mGy and at eight mammography centres the measured central background density (CBD) values for mammography phantom image are found to be less than the recommended CBD limit value of 1.2-2.0 optical density.

Evaluation of Gafchromic EBT2 film for the measurement of anisotropy function for high-dose-rate 192Ir brachytherapy source with respect to thermoluminescent dosimetry

AIM The aim of this work was to assess the suitability of the use of a Gafchromic EBT2 film for the measurement of anisotropy function for microSelectron HDR (192)Ir (classic) source with a comparative dosimetry method using a Gafchromic EBT2 film and thermoluminescence dosimeters (TLDs). BACKGROUND Sealed linear radiation sources are commonly used for high dose rate (HDR) brachytherapy treatments. Due to self-absorption and oblique filtration of radiation in the source capsule material, an inherent anisotropy is present in the dose distribution around the source which can be described by a measurable two-dimensional anisotropy function, F(r, θ). MATERIALS AND METHODS Measurements were carried out in a specially designed and locally fabricated PMMA phantom with provisions to accommodate miniature LiF TLD rods and EBT2 film dosimeters at identical radial distances with respect to the (192)Ir source. RESULTS The data of anisotropy function generated by the use of the Gafchromic EBT2 film method are in agreement with their TLD measured values within 4%. The produced data are also consistent with their experimental and Monte Carlo calculated results for this source available in the literature. CONCLUSION Gafchromic EBT2 film was found to be a feasible dosimeter in determining anisotropy in the dose distribution of (192)Ir source. It offers high resolution and is a viable alternative to TLD dosimetry at discrete points. The method described in this paper is useful for comparing the performances of detectors and can be applied for other brachytherapy sources as well.

PATIENT DOSIMETRY DURING INTERVENTIONAL CARDIAC PROCEDURES IN A DEDICATED CATHETERIZATION LABORATORY

Cardiac interventions often result in high radiation dose to patients skin, so a reliable indicator in terms of a commonly used dose descriptor is required to monitor skin exposures. In the present study, Gafchromic XR-RV3 film was used to measure the peak skin dose (PSD) during 40 coronary angiography (CA) and 50 percutaneous transluminal coronary angioplasty (PTCA) procedures. Corresponding values of kerma-area product (PKA), fluoroscopy time (FT) and reference air-kerma (Ka,r) were recorded and correlated with PSD. Doses to patients eyes and thyroid were also measured by using thermoluminescent dosimeters (TLDs) during PTCA procedures. The average dose to thyroid was about six times higher than the average dose to eyes. The mean values of PSD, PKA and FT were 1140 mGy, 97 Gy cm2 and 15.7 min for PTCA and 290 mGy, 21.1 Gy cm2 and 2.4 min for CA procedures, respectively. One in seven patients of PTCA procedure received PSD >2 Gy. With respect to FT, PKA may be used as a better predictor of skin exposures because the correlation of PSD with PKA was found better than with FT for both CA and PTCA procedures.

Effect of low-density heterogeneities in telecobalt therapy and validation of dose calculation algorithm of a treatment planning system

Telecobalt machines are still prominently used for the treatment of a variety of cancer cases in developing countries. The human body is a heterogeneous composition of variety of tissues and cavities which vary widely in their physical and radiological properties. The presence of heterogeneities in the path of telecobalt beam presents an altered dose distribution in the region of clinical interests. A computerized treatment planning system (TPS) is generally used for calculating the dose distribution in the patient. Experimental measurements were carried out in a telecobalt beam with the objectives to study the effects of low-density heterogeneities and to verify the ability of the ASHA radiotherapy TPS in predicting the altered dose distribution along the central axis and off-axis of the beam. Locally available kailwood was tested for its lung equivalence and measurements were carried out in a polymethyl methacrylate phantom by introducing lung equivalent and air gap heterogeneities. A comparison of experimentally measured and TPS calculated dose values indicates that the TPS overestimates the dose by 11.6% in lung equivalent (kailwood) heterogeneity along the central axis. Similarly, it was found that the TPS overestimates the dose by 3.9% and 5.9%, respectively, with air heterogeneity of 1.0 and 2.0 cm. While testing the adequacy of TPS in off-axis region, it was found that the TPS calculation does not indicate the widening of the beam profile in the low-density heterogeneity region. This study suggests that the effective path length based algorithm of the ASHA radiotherapy TPS is unable to achieve the recommended 3% accuracy of clinical dose calculation in heterogeneous media.

Radiation dose to patients from X-ray radiographic examinations using computed radiography imaging system

The screen-film system is replaced by computed radiography system for recording the images of the patients during X-ray radiography examinations. The change in imaging system requires the re-establishment of the institutional diagnostic reference levels (DRLs) for different types of X-ray examinations conducted at the hospital. For this purpose, patient specific parameters [age, height, weight, body mass index (BMI), object to image distance (OID)] and machine specific parameters (kVp, mAs, distance and field sizes) of 1875 patients during 21 different types of X-ray examinations were recorded for estimating the entrance skin dose (ESD). The ESD for each of these patients were estimated using measured X-ray beam output and the standard value of the back scatter factor. Five number summary was calculated for all the data for their presentation in the Box-Whisker plot, which provides the statistical distribution of the data. The data collected indicates that majorly performed examinations are cervical spine AP, Chest PA and Knee Lat with percentage contributions of 16.05, 16 and 8.27% respectively. The lowest contribution comes from Hip Lat which is about 1.01%. The ratio of measured ESD (maximum to minimum) for these examinations is found to be highest for the cervical spine AP with a value of 50 followed by Thoracic spine AP of 32.36. The ESD ratio for Chest PA, Knee Lat and Lumbar Spine AP are 30.75, 30.4 and 30.2 respectively. The lowest ESD ratio is for Hip Lat which is 2.68. The third quartile values of ESDs are established as the institutional DRLs. The ESD values obtained for 21 different X-ray projections are either comparable or lesser than the reported national/international values.