Browsing by Subject "3D dosimetry"

Purpose: The purpose of this work is to characterize three novel formulations of a radiochromic material Presage and identify optimal imaging procedures for accurate 3D dosimetry. The dosimetric qualities of interest were studied for each formulation of Presage dosimeter in the context of accurate 3D dosimetry. The formulation of Presage showing the most promise is compared to a clinical 3D quality assurance device to investigate the accuracy of a complex state-of-the-art brain IMRT treatment.

Methods and Materials: Three novel formulations of Presage were studied for their temporal stability, sensitivity, linearity of dose response, and feasibility of absolute dose calibration in large volume dosimeters (1 kg) with small volume cuvettes (4g). Large cylindrical dosimeters with 11 cm diameter and 10 cm height were irradiated with 5 2x2 cm fields on the upper flat surface with 3 distinct dose levels (3, 6 and 9.5 Gy, representing low, medium and high). This irradiation pattern is used to determine the dosimetric characteristics mentioned above and was chosen because of its repeatability and it lends to simple measurements of linearity and sensitivity. Measurements were taken at various time points from 0 hours to 24 hours post-irradiation using the high resolution (6.45 m pixels) Duke Medium-Sized Optical-CT Scanner (DMOS) and reconstructed with a Matlab-based reconstruction GUI created in-house. Analysis of the pertinent dosimetric characteristics was performed in the GUI. A comprehensive end-to-end QA test was performed on the optimal formulation using optimal scan timing determined from the formulation studies described above. A 5-field IMRT plan was created for head treatment. The plan was delivered both to a head phantom containing a Presage insert, and to the Delta4 QA device. Comparison of both delivered distributions together with the Eclipse predicted dose distribution enabled investigation of the accuracy of the delivery, and the consistency of independent measurement devices.

Results: The DEA-1 formulation showed up to 10% variation from 0-2 hours post-irradiation, but showed excellent temporal stability (<2% variation) between 3-7 hours post irradiation, and maintained good stability until 24 hours post-irradiation (up to 3% variation). The DEA-2 also showed up to 10% variation from 0-2 hours post-irradiation. The DEA-2 formulation then showed good stability (up to 2.1% variation) from 3-7 hours, but optical density values dropped by up to 11% after 24 hours. The DX formulation did not maintain stability of optical density for any significant time with values decreasing by ~20% by the 24-hour time point and optical density decreasing at different rates for different dose levels. Linearity of dose response was good for all formulations with an R2 value > 0.99. Gamma analysis with criteria of 3%/2mm was performed on two irradiations of the 5-field pattern on DEA-1 formulation. Voxel passing rates were 96.68% and 97.96%. Comparison of the DEA-1 formulation large dosimeter was done with small volume cuvettes of the same formulation and batch. Sensitivity of the large dosimeter was less than half the sensitivity of the cuvettes. For clinical 3D QA comparison, the DEA-1 formulation was used because it had optimal performance showed the most promise for accurate 3D dosimetry. Line dose profiles showed that Presage compared very well with the Eclipse calculation and had a much better 3D gamma passing rate for 3%/3mm criteria than the Delta4 (>99% vs 75%).

Conclusions: The DEA-1 formulation shows the most promise because of its temporal stability and linearity of dose response. The optimal imaging window for this formulation was determined to be 3-24 hours post-irradiation. The DEA-2 and DX formulation also showed potential for accurate dosimetry. The optimal imaging window for the DEA-2 formulation was determined to be 2-6 hours post-irradiation. The optimal scan time for the DX formulation was determined to be immediately post-irradiation. The amount of accuracy loss depending on the scan time is dependent on the formulation and when the dosimeter is scanned. Line dose profiles and gamma analysis results from the comparison of Presage and Eclipse calculation provide strong validation of the accuracy of the IMRT treatment delivery. Comparison of Presage to the Delta4 show the Delta4 to be somewhat lacking in its ability to calculate 3D dose in the phantom/Presage geometry.

As complex radiotherapy techniques become more readily-practiced, comprehensive 3D dosimetry is a growing necessity for advanced quality assurance. However, clinical implementation has been impeded by a wide variety of factors, including the expense of dedicated optical dosimeter readout tools, high operational costs, and the overall difficulty of use. To address these issues, a novel dry-tank optical CT scanner was designed for PRESAGE 3D dosimeter readout, relying on 3D printed components and omitting costly parts from preceding optical scanners. This work details the design, prototyping, and basic commissioning of the Duke Integrated-lens Optical Scanner (DIOS).

The convex scanning geometry was designed in ScanSim, an in-house Monte Carlo optical ray-tracing simulation. ScanSim parameters were used to build a 3D rendering of a convex ‘solid tank’ for optical-CT, which is capable of collimating a point light source into telecentric geometry without significant quantities of refractive-index matched fluid. The model was 3D printed, processed, and converted into a negative mold via rubber casting to produce a transparent polyurethane scanning tank. The DIOS was assembled with the solid tank, a 3W red LED light source, a computer-controlled rotation stage, and a 12-bit CCD camera. Initial optical phantom studies show negligible spatial inaccuracies in 2D projection images and 3D tomographic reconstructions. A PRESAGE 3D dose measurement for a 4-field box treatment plan from Eclipse shows 95% of voxels passing gamma analysis at 3%/3mm criteria. Gamma analysis between tomographic images of the same dosimeter in the DIOS and DLOS systems show 93.1% agreement at 5%/1mm criteria. From this initial study, the DIOS has demonstrated promise as an economically-viable optical-CT scanner. However, further improvements will be necessary to fully develop this system into an accurate and reliable tool for advanced QA.

Pre-clinical animal studies are used as a conventional means of translational research, as a midpoint between in-vitro cell studies and clinical implementation. However, modern small animal radiotherapy platforms are primitive in comparison with conventional linear accelerators. This work also investigates a series of 3D printed tools to expand the treatment capabilities of the X-RAD 225Cx orthovoltage irradiator, and applies them to a feasibility study of hippocampal avoidance in rodent whole-brain radiotherapy.

As an alternative material to lead, a novel 3D-printable tungsten-composite ABS plastic, GMASS, was tested to create precisely-shaped blocks. Film studies show virtually all primary radiation at 225 kVp can be attenuated by GMASS blocks of 0.5cm thickness. A state-of-the-art software, BlockGen, was used to create custom hippocampus-shaped blocks from medical image data, for any possible axial treatment field arrangement. A custom 3D printed bite block was developed to immobilize and position a supine rat for optimal hippocampal conformity. An immobilized rat CT with digitally-inserted blocks was imported into the SmART-Plan Monte-Carlo simulation software to determine the optimal beam arrangement. Protocols with 4 and 7 equally-spaced fields were considered as viable treatment options, featuring improved hippocampal conformity and whole-brain coverage when compared to prior lateral-opposed protocols. Custom rodent-morphic PRESAGE dosimeters were developed to accurately reflect these treatment scenarios, and a 3D dosimetry study was performed to confirm the SmART-Plan simulations. Measured doses indicate significant hippocampal sparing and moderate whole-brain coverage.

Purpose:

The feasibility of MRT has recently been demonstrated utilizing a new technology of Carbon-Nano-Tube (CNT) field emission x-ray sources. This approach can deliver very high dose (10's of Gy) in narrow stripes (sub-mm) of radiation, which enables the study of novel radiation treatment approaches. Here we investigate the application of high- resolution (50𝑢𝑚 isotropic) PRESAGE®/Optical-CT 3D dosimetry techniques to characterize the radiation delivered in this extremely dosimetrically challenging scenario.

Methods:

The CNT field emission x-ray source irradiator comprises of a linear cathode array and a novel collimating system. The device delivers small `stripe' beams of approximately X long and Y wide, at an energy of 160 kVp. To characterize the MRT beams, an ultra-high-resolution prototype 3D dosimetry system was constructed and optimized, consisting of two parts: a radiochromic 3D dosimetry material PRESAGE, and a high resolution small field-of-view optical-CT imaging system for dose-readout (DMicrOS - Duke Micro Optical-CT Scanner). Small PRESAGE cylindrical dosimeters (~2.2cm in height and ~2.5cm in diameter) were irradiated by CNT MRT delivering 3 stripes of radiation with a nominal entrance dose of 32 Gy (16Gy for the second batch). PRESGAE dosimeters (with same dimensions) were also irradiated with at 32 Gy entrance dose, with a regular x-ray irradiator collimated to microscopical stripe- beams using a customized cerrobend material collimator. 50𝑢𝑚 (isotropic) 3D dosimetry was performed on all dosimeters using an in-house optical-CT system designed and optimized for high-resolution imaging (including a stray light deconvolution correction). The Percentage Depth Dose (PDD), Peak-to-Valley Dose Ratio (PVR) and beam width (FWHM) data were obtained and analyzed in both cases. Independent verification against EBT2 radiochromic film is ongoing.

Results:

Basic testing of the DMicrOS system indicated the following performance: Modulated-Transfer-Function (MTF), dynamic range, resolution, largest Field-Of-View (FOV), Point-Spread-Function (PSF) were performed. When applied to the PRESAGE dosimeters irradiated with MRT stripe beams, high-resolution 3D images were successfully achieved with the prototype system, enabling extraction of dose profiles. The PDDs for the CNT irradiation showed pronounced attenuation in UNC_A and UNC_C (little attenuation in UNC_F), but less build-up effect than that from the multibeam irradiation. The beam spacing between the three strips has an average value of 0.9mm while that for the 13 strips is 1.5 mm at a depth of 16.5 mm. The spacing between the three strips' barely varies with depth, while the 13 beams exhibit clear divergence. The three stripes show consistent PVR values (the average value is 18 at all depth). The stray light corrected image shows line profiles with reduced noise and consistent PVR values.

Conclusion:

MRT dosimetry is extremely challenging mostly due to little beam divergence tolerance and high dose rate required associated with the ultra small geometry. As a result, various artifacts (ring, donut, "dirty" fluid, imperfection removing the were observed and cannot be removed easily) present in the data. This preliminary application of a novel, ultra-high resolution, optical-CT 3D dosimetry system showed promise (reduced dose diverging, more accurate dose delivery), but suggested extremely careful techniques (flood matching, mounting, rotation stability). Further work is required to further validate the accuracy of dose distribution and investigate the causes of the artifacts as well as their removal methods. Especially, the stray light correction is believed to have a substantial impact in this extreme geometry, further optimizing the correcting methods is necessary to be explored.

Purpose: To develop, evaluate and apply a novel high-resolution 3D remote dosimetry protocol for validation of MRI guided radiation therapy treatments (MRIdian® by ViewRay®). We demonstrate the first application of the protocol (including two small but required new correction terms) utilizing radiochromic 3D plastic PRESAGE® with optical-CT readout.

Methods: A detailed study of PRESAGE® dosimeters (2kg) was conducted to investigate the temporal and spatial stability of radiation induced optical density change (ΔOD) over 8 days. Temporal stability was investigated on 3 dosimeters irradiated with four equally-spaced square 6MV fields delivering doses between 10cGy and 300cGy. Doses were imaged (read-out) by optical-CT at multiple intervals. Spatial stability of ΔOD response was investigated on 3 other dosimeters irradiated uniformly with 15MV extended-SSD fields with doses of 15cGy, 30cGy and 60cGy. Temporal and spatial (radial) changes were investigated using CERR and MATLAB’s Curve Fitting Tool-box. A protocol was developed to extrapolate measured ΔOD readings at t=48hr (the typical shipment time in remote dosimetry) to time t=1hr.

Results: All dosimeters were observed to gradually darken with time (<5% per day). Consistent intra-batch sensitivity (0.0930±0.002 ΔOD/cm/Gy) and linearity (R2=0.9996) was observed at t=1hr. A small radial effect (<3%) was observed, attributed to curing thermodynamics during manufacture. The refined remote dosimetry protocol (including polynomial correction terms for temporal and spatial effects, CT and CR) was then applied to independent dosimeters irradiated with MR-IGRT treatments. Excellent line profile agreement and 3D-gamma results for 3%/3mm, 10% threshold were observed, with an average passing rate 96.5%± 3.43%.

Conclusion: A novel 3D remote dosimetry protocol is presented capable of validation of advanced radiation treatments (including MR-IGRT). The protocol uses 2kg radiochromic plastic dosimeters read-out by optical-CT within a week of treatment. The protocol requires small corrections for temporal and spatially-dependent behaviors observed between irradiation and readout.

Optical-CT has been shown to be a potentially useful imaging tool for for the two very different spheres of biologists and radiation therapy physicists, but it has yet to live up to that potential. In radiation therapy, researchers have used optical-CT for the readout of 3D dosimeters, but it is yet to be a clinically relevant tool as the technology is too slow to be considered practical. Biologists have used the technique for structural imaging, but have struggled with emission tomography as the reality of photon attenuation for both excitation and emission have made the images quantitatively irrelevant.

Dosimetry. The DLOS (Duke Large field of view Optical-CT Scanner) was designed and constructed to make 3D dosimetry utilizing optical-CT a fast and practical tool while maintaining the accuracy of readout of the previous, slower readout technologies. Upon construction/optimization/implementation of several components including a diffuser, band pass filter, registration mount & fluid filtration system the dosimetry system provides high quality data comparable to or exceeding that of commercial products. In addition, a stray light correction algorithm was tested and implemented. The DLOS in combination with the 3D dosimeter it was designed for, PREAGETM, then underwent rigorous commissioning and benchmarking tests validating its performance against gold standard data including a set of 6 irradiations.

DLOS commissioning tests resulted in sub-mm isotropic spatial resolution (MTF >0.5 for frequencies of 1.5lp/mm) and a dynamic range of ~60dB . Flood field uniformity was 10% and stable after 45minutes. Stray light proved to be small, due to telecentricity, but even the residual can be removed through deconvolution. Benchmarking tests showed the mean 3D passing gamma rate (3%, 3mm, 5% dose threshold) over the 6 benchmark data sets was 97.3% ± 0.6% (range 96%-98%) scans totaling ~10 minutes, indicating excellent ability to perform 3D dosimetry while improving the speed of readout. Noise was low at ~2% for 2mm reconstructions. The DLOS/PRESAGE® benchmark tests show consistently excellent performance, with very good agreement to simple known distributions. The telecentric design was critical to enabling fast (~15mins) imaging with minimal stray light artifacts. The system produces accurate isotropic 2mm3 dose data over clinical volumes (e.g. 16cm diameter phantoms, 12 cm height), and represents a uniquely useful and versatile new tool for commissioning complex radiotherapy techniques. The system also has wide versatility, and has successfully been used in preliminary tests with protons and with kV irradiations.

Biology. Attenuation corrections for optical-emission-CT were done by modeling physical parameters in the imaging setup within the framework of an ordered subset expectation maximum (OSEM) iterative reconstruction algorithm. This process has a well documented history in single photon emission computed tomography (SPECT), but is inherently simpler due to the lack of excitation photons to account for. Excitation source strength distribution, excitation and emission attenuation were modeled. The accuracy of the correction was investigated by imaging phantoms containing known distributions of attenuation and fluorophores. The correction was validated on a manufactured phantom designed to give uniform emission in a central cuboidal region and later applied to a cleared mouse brain with GFP (green-fluorescent-protein) labeled vasculature and a cleared 4T1 xenograft flank tumor with constitutive RFP (red-fluorescent-protein). Reconstructions were compared to corresponding slices imaged with a fluorescent dissection microscope.

Significant optical-ECT attenuation artifacts were observed in the uncorrected phantom images and appeared up to 80% less intense than the verification image in the central region. The corrected phantom images showed excellent agreement with the verification image with only slight variations. The corrected tissue sample reconstructions showed general agreement between the verification images. Comprehensive modeling in optical-ECT imaging was successfully implemented, creating quantitatively accurate 3D fluorophore distributions. This work represents the 1st successful attempt encompassing such a complete set of corrections. This method provides a means to accurately obtain 3D fluorophore distributions with the potential to better understand tumor biology and treatment responses.

The need for clinically intuitive quality assurance procedures has been well-documented; current QA methods such as 2D gamma analysis have been shown (Nelms, Zhen et al. 2011) to be inadequate in predicting clinically relevant errors. This thesis investigates the accuracy of a novel "transform method" (Oldham, Thomas et al. 2012) which claims to create "measured" patient dose-volume histograms (DVHs) through the use of 3D dosimetry techniques; a measured 3D phantom dose distribution is "transformed" back onto the patient geometry, enabling a clinically relevant analysis through the DVHs. The transform method was tested by inducing a series of known mechanical and delivery errors onto simulated measurements of six different head-and-neck treatment plans; the accuracy of this method was then examined through the comparison of the transformed patient dose distributions and the known actual patient dose distributions through dose-volume histogram metrics and normalized dose difference analysis (Jiang, Sharp et al. 2006). Through these metrics, the transform method was found to be highly accurate in predicting measured patient dose distributions for these types of errors. Further work is needed to investigate other types of errors, such as beam model errors and treatment sites of great inhomogeneity, such as the lung.