Studies of magnetization transfer and relaxation in irradiated polymer gels--interpretation of MRI-based dosimetry

Validation of complex radiotherapy techniques using polymer gel dosimetry

Modern radiotherapy delivers highly conformal dose distributions to irregularly shaped target volumes while sparing the surrounding normal tissue. Due to the complex planning and delivery techniques, dose verification and validation of the whole treatment workflow by end-to-end tests became much more important and polymer gel dosimeters are one of the few possibilities to capture the delivered dose distribution in 3D. The basic principles and formulations of gel dosimetry and its evaluation methods are described and the available studies validating device-specific geometrical parameters as well as the dose delivery by advanced radiotherapy techniques, such as 3D-CRT/IMRT and stereotactic radiosurgery treatments, the treatment of moving targets, online-adaptive magnetic resonance-guided radiotherapy as well as proton and ion beam treatments, are reviewed. The present status and limitations as well as future challenges of polymer gel dosimetry for the validation of complex radiotherapy techniques are discussed.

Nonaqueous magnetization following adiabatic and selective pulses in brain: T1 and cross-relaxation dynamics

Inversion pulses are commonly employed in MRI for T 1 $$ {T}_1 $$ -weighted contrast and relaxation measurements. In the brain, it is often assumed that adiabatic pulses saturate the nonaqueous magnetization. We investigated this assumption using solid-state NMR to monitor the nonaqueous signal directly following adiabatic inversion and compared this with signals following hard and soft inversion pulses. The effects of the different preparations on relaxation dynamics were explored. Inversion recovery experiments were performed on ex vivo bovine and porcine brains using 360-MHz (8.4 T) and 200-MHz (4.7 T) NMR spectrometers, respectively, using broadband rectangular, adiabatic, and sinc inversion pulses as well as a long rectangular saturation pulse. Analogous human brain MRI experiments were performed at 3 T using single-slice echo-planar imaging. Relaxation data were fitted by mono- and biexponential decay models. Further fitting analysis was performed using only two inversion delay times. Adiabatic and sinc inversion left much of the nonaqueous magnetization along B 0 $$ {B}_0 $$ and resulted in biexponential relaxation. Saturation of both aqueous and nonaqueous magnetization components led to effectively monoexponential T 1 $$ {T}_1 $$ relaxation. Typical adiabatic inversion pulses do not, as has been widely assumed, saturate the nonaqueous proton magnetization in white matter. Unequal magnetization states in aqueous and nonaqueous ¹ H reservoirs prepared by soft and adiabatic pulses result in biexponential T 1 $$ {T}_1 $$ relaxation. Both pools must be prepared in the same magnetization state (e.g., saturated or inverted) in order to observe consistent monoexponential relaxation.

Radiation Dosimetry by Use of Radiosensitive Hydrogels and Polymers: Mechanisms, State-of-the-Art and Perspective from 3D to 4D

Gel dosimetry was developed in the 1990s in response to a growing need for methods to validate the radiation dose distribution delivered to cancer patients receiving high-precision radiotherapy. Three different classes of gel dosimeters were developed and extensively studied. The first class of gel dosimeters is the Fricke gel dosimeters, which consist of a hydrogel with dissolved ferrous ions that oxidize upon exposure to ionizing radiation. The oxidation results in a change in the nuclear magnetic resonance (NMR) relaxation, which makes it possible to read out Fricke gel dosimeters by use of quantitative magnetic resonance imaging (MRI). The radiation-induced oxidation in Fricke gel dosimeters can also be visualized by adding an indicator such as xylenol orange. The second class of gel dosimeters is the radiochromic gel dosimeters, which also exhibit a color change upon irradiation but do not use a metal ion. These radiochromic gel dosimeters do not demonstrate a significant radiation-induced change in NMR properties. The third class is the polymer gel dosimeters, which contain vinyl monomers that polymerize upon irradiation. Polymer gel dosimeters are predominantly read out by quantitative MRI or X-ray CT. The accuracy of the dosimeters depends on both the physico-chemical properties of the gel dosimeters and on the readout technique. Many different gel formulations have been proposed and discussed in the scientific literature in the last three decades, and scanning methods have been optimized to achieve an acceptable accuracy for clinical dosimetry. More recently, with the introduction of the MR-Linac, which combines an MRI-scanner and a clinical linear accelerator in one, it was shown possible to acquire dose maps during radiation, but new challenges arise.

Improved Dose Response of N-(Hydroxymethyl)acrylamide Gel Dosimeter with Calcium Chloride for Radiotherapy

The impact of calcium chloride (CaCl₂) on the performance of N-(hydroxymethyl)acrylamide (NHMA) polymer gel dosimeter is studied in this article. The dosimeter was exposed to doses of up to 10 Gy with radiation beam-energy of 10 MV and dose-rates of 300 cGy/min. The relaxation rate (R₂) parameter was utilized to explore the performance of irradiated NHMAGAT gels. The dose response in terms of R₂ increased from 0.29 to 0.63 Gy⁻¹·s⁻¹ with increasing calcium chloride concentration from 0 to 1000 mM. The results show no substantial impact of dose-rates as well as radiation energies on NHMAGAT samples. For the steadiness of irradiated NHMAGAT dosimeters, it was found that there is no apparent variation in R₂ (less than ±3%; standard deviation) up to 3 days. The overall uncertainty of the gel dosimeter with calcium chloride is 4.96% (double standard deviation, 95% confidence level).

Polymer gel dosimetry by nuclear Overhauser enhancement (NOE) magnetic resonance imaging

The response to radiation of polymer gel dosimeters has previously been measured by magnetic resonance imaging (MRI) in terms of changes in the water transverse relaxation rate (R _2w) or magnetization transfer (MT) parameters. Here we report a new MRI approach, based on detecting nuclear Overhauser enhancement (NOE) mediated saturation transfer effects, which can also be used to detect radiation and measure dose distributions in MAGIC-f (Methacrylic and Ascorbic Acid and Gelatin Initiated by Copper Solution with formaldehyde) polymer gels. Results show that the NOE effects produced by low powered radiofrequency (RF) irradiation at specific frequencies offset from water may be quantified by appropriate measurements and over a useful range depend linearly on the radiation dose. The NOE effect likely arises from the polymerization of methacrylic acid monomers which become less mobile, facilitating dipolar through-space cross-relaxation and/or relayed magnetization exchange between polymer and water protons. Our study suggests a potential new MRI method for polymer gel dosimetry.

Chemical exchange saturation transfer for predicting response to stereotactic radiosurgery in human brain metastasis

PURPOSE

The purpose of this work was to determine the predictive value of chemical exchange saturation transfer (CEST) metrics in brain metastases treated with stereotactic radiosurgery (SRS).

METHODS

CEST spectra at a radiofrequency power of 0.52 µT were collected on a 3 Tesla (T) magnetic resonance imaging from 25 patients at three time points: pretreatment, 1 week, and 1 month post-treatment. Amide proton transfer-weighted images and maps of the amplitude and width of Lorentzian-shaped CEST peaks and the relaxation-compensated AREX metric were constructed at the offset frequencies of amide, amine, and relayed nuclear Overhauser effect (NOE) from aliphatic groups as well as the broad magnetization transfer effect. Pretreatment CEST metrics, as well as CEST metric changes at 1 week post-treatment, were compared to changes in tumor volume at 1 month.

RESULTS

Significant (P < 0.05) 1-week predictive metrics included NOE peak amplitude (R = 0.69) in normal-appearing white matter (NAWM) and width (R = -0.55) in tumor. Baseline NOE in contralateral NAWM was negatively correlated (R = -0.69) with volume changes at 1 month. Metrics-defined outside tumor margins had higher correlation with volume changes than tumor regions of interest.

CONCLUSION

CEST metrics, in particular, the NOE peak amplitude, can predict volume changes 1 month post-SRS. Magn Reson Med 78:1110-1120, 2017. © 2016 International Society for Magnetic Resonance in Medicine.

A dosimetric study of small photon fields using polymer gel and Gafchromic EBT films

The use of small field sizes is increasingly becoming important in radiotherapy particularly since the introduction of stereotactic radiosurgery and intensity-modulated radiation therapy techniques. The reliable measurement of delivered dose from such fields with conventional dosimeters, such as ionization chambers, is a challenging task. In this work, methacrylic and ascorbic acid in gelatin initiated by copper polymer gel dosimeters are employed to measure dose in 3 dimensions. Field sizes of 5 × 5mm(2), 10 × 10mm(2), 20 × 20mm(2), and 30 × 30mm(2) are investigated for a 6-MV x-rays. The results show an agreement with Gafchromic film, with some variation in measured doses near the edge of the fields, where the film data decrease more rapidly than the other methods. Dose penumbra widths obtained with gel dosimeters and Gafchormic film were generally in agreement with each other. The results of this work indicate that polymer gel dosimetry could be invaluable for the quantification of the 3-dimensional dose distribution in small field size.

Polymer gel dosimetry

Polymer gel dosimeters are fabricated from radiation sensitive chemicals which, upon irradiation, polymerize as a function of the absorbed radiation dose. These gel dosimeters, with the capacity to uniquely record the radiation dose distribution in three-dimensions (3D), have specific advantages when compared to one-dimensional dosimeters, such as ion chambers, and two-dimensional dosimeters, such as film. These advantages are particularly significant in dosimetry situations where steep dose gradients exist such as in intensity-modulated radiation therapy (IMRT) and stereotactic radiosurgery. Polymer gel dosimeters also have specific advantages for brachytherapy dosimetry. Potential dosimetry applications include those for low-energy x-rays, high-linear energy transfer (LET) and proton therapy, radionuclide and boron capture neutron therapy dosimetries. These 3D dosimeters are radiologically soft-tissue equivalent with properties that may be modified depending on the application. The 3D radiation dose distribution in polymer gel dosimeters may be imaged using magnetic resonance imaging (MRI), optical-computerized tomography (optical-CT), x-ray CT or ultrasound. The fundamental science underpinning polymer gel dosimetry is reviewed along with the various evaluation techniques. Clinical dosimetry applications of polymer gel dosimetry are also presented.

Polymer gel dosimetry

Polymer gel dosimeters are fabricated from radiation sensitive chemicals which, upon irradiation, polymerize as a function of the absorbed radiation dose. These gel dosimeters, with the capacity to uniquely record the radiation dose distribution in three-dimensions (3D), have specific advantages when compared to one-dimensional dosimeters, such as ion chambers, and two-dimensional dosimeters, such as film. These advantages are particularly significant in dosimetry situations where steep dose gradients exist such as in intensity-modulated radiation therapy (IMRT) and stereotactic radiosurgery. Polymer gel dosimeters also have specific advantages for brachytherapy dosimetry. Potential dosimetry applications include those for low-energy x-rays, high-linear energy transfer (LET) and proton therapy, radionuclide and boron capture neutron therapy dosimetries. These 3D dosimeters are radiologically soft-tissue equivalent with properties that may be modified depending on the application. The 3D radiation dose distribution in polymer gel dosimeters may be imaged using magnetic resonance imaging (MRI), optical-computerized tomography (optical-CT), x-ray CT or ultrasound. The fundamental science underpinning polymer gel dosimetry is reviewed along with the various evaluation techniques. Clinical dosimetry applications of polymer gel dosimetry are also presented.

Magnetization transfer proportion: a simplified measure of dose response for polymer gel dosimetry

The response to radiation of polymer gel dosimeters has most often been described by measuring the nuclear magnetic resonance transverse relaxation rate as a function of dose. This approach is highly dependent upon the choice of experimental parameters, such as the echo spacing time for Carr-Purcell-Meiboom-Gill-type pulse sequences, and is difficult to optimize in imaging applications where a range of doses are applied to a single gel, as is typical for practical uses of polymer gel dosimetry. Moreover, errors in computing dose can arise when there are substantial variations in the radiofrequency (B1) field or resonant frequency, as may occur for large samples. Here we consider the advantages of using magnetization transfer imaging as an alternative approach and propose the use of a simplified quantity, the magnetization transfer proportion (MTP), to assess doses. This measure can be estimated through two simple acquisitions and is more robust in the presence of some sources of system imperfections. It also has a dependence upon experimental parameters that is independent of dose, allowing simultaneous optimization at all dose levels. The MTP is shown to be less susceptible to B1 errors than are CPMG measurements of R2. The dose response can be optimized through appropriate choices of the power and offset frequency of the pulses used in magnetization transfer imaging.

Three dimensional radiation dosimetry in lung-equivalent regions by use of a radiation sensitive gel foam: Proof of principle

A polymer hydrogel foam is proposed as a potential three dimensional experimental dosimeter for radiation treatment verification in low-density tissue such as the lung. A gel foam is created by beating a radiation sensitive polymer gel mixture in an anoxic atmosphere. The mass density of the gel foam is in the order of 0.25-0.35 kg/dm3. Both nuclear magnetic resonance (NMR) spin-spin relaxation rate (R2) and magnetization transfer ratio (MTR) have been used to map the dose distribution from the gel dosimeter. It is found that MTR has significant advantages compared to R2 for mapping the dose distribution in the polymer gel foam dosimeters. The magnetization transfer ratio is found to be less dependent on the density and microstructure of the gel foam dosimeter while spin-spin relaxation dispersion has been observed making the spin-spin relaxation rate dependent on the interecho time interval. Optical microscopy reveals a microstructure that shows great similarity with human lung tissue. It is also shown how NMR hydrogen proton density measurements can be used to map the density distributions in gel dosimeters.

A quantitative study of magnetization transfer in MAGIC gels

Magnetization transfer (MT) has been measured quantitatively as a function of radiation dose in MAGIC polymer gels. The MT rates between the free and immobile macromolecular proton pools (kmr and kfm), and the ratio of the sizes of these coupled proton pools (Pm/Pf), were measured by analysing the response to an inversion recovery sequence. While pm/pf increases linearly with dose, the fast MT rate kmf also increases with dose, unlike previous measurements in BANG gels. This dependence of kmf on dose suggests there are additional factors that modify spin exchange in MAGIC gels as irradiation occurs.

Ultrasonic absorption in polymer gel dosimeters

Ultrasonic absorption in polymer gel dosimeters was investigated. An ultrasonic interferometer was used to study the frequency (f) dependence of the absorption coefficient (alpha) in a polyacrylamide gel dosimeter (PAG) in the frequency range 5-20 MHz. The frequency dependence of ultrasonic absorption deviated from that of an ideal viscous fluid. The presence of relaxation mechanisms was evidenced by the frequency dependence of alpha/f(2) and the dispersion in ultrasonic velocity. It was concluded that absorption in polymer gel dosimeters is due to a number of relaxation processes which may include polymer-solvent interactions as well as relaxation due to motion of polymer side groups. The dependence of ultrasonic absorption on absorbed dose and formulation was also investigated in polymer gel dosimeters as a function of pH and chemical composition. Changes in dosimeter pH and chemical composition resulted in a variation in ultrasonic dose response curves. The observed dependence on pH was considered to be due to pH induced modifications in the radiation yield while changes in chemical composition resulted in differences in polymerisation kinetics.

Gel dosimetry for the dose verification of intensity modulated radiotherapy treatments

To meet the requirements for 3D dose verification of high-precision radiotherapy treatments (such as in intensity modulated radiotherapy; IMRT), two different kinds of gel dosimeters were developed. In the Fricke gel, an oxidation of ferrous-ions into ferric-ions occurs upon irradiation. As the ferrous and ferric ions possess different magnetic moments, the dose distribution can be read out by use of magnetic resonance imaging (MRI). However, this method is susceptible to spatial instabilities as the ions are able to diffuse through the gel matrix. Attempts have been made to reduce the diffusion by changing the gelling substance. In monomer/polymer gel dosimetry, the spin-spin relaxation rate, R2, is related to the radiation dose that was delivered to the phantom, as ionizing irradiation causes the formation of polymer aggregates. The intended target figure of accuracy in gel dosimetry for IMRT is approximately 3% to 5% of the maximum dose. However, in a conventional MR scanner several imaging artefacts may cause dose inaccuracies. Studies of these different artefacts have resulted in different compensation strategies, otherwise the dose maps will also contain stochastic noise. To minimize the stochastic noise in the images, the imaging sequence parameters should be optimized. Monomer/polymer gels are proven to be valuable dosimeters for IMRT applications. They are able to provide a three-dimensional dose distribution that is integrated over all beams delivered in the treatment. The gels can be molded in humanoid shapes. As a result, gel dosimeters are able to simulate the complete treatment. Gel dosimetry can therefore be regarded as a dosimetric tool to verify dose distributions calculated by the computer planning. Furthermore, gel dosimetry has also been very useful in quality control and investigation of extreme beam configurations possibly occurring in IMRT, in dose verification after implementation of additional devices, and in investigating dose disturbances by low-density structures. The search for new chemical compositions may result in dosimeter gels that are easier to fabricate and possess higher sensitivity. Besides MRI, other imaging techniques are investigated to read out the dosimeters.

Magnetization transfer imaging for polymer gel dosimetry

Off-resonance RF pre-saturation was used to obtain contrast in MRI images of polymer gel dosimeters irradiated to doses up to 50 Gy. Two different polymer gel dosimeters composed of 2-hydroxyethyl-acrylate or methacrylic acid monomers mixed with N, N'-methylene-bisacrylamide (BIS), dispersed in an aqueous gelatin matrix were evaluated. Radiation-induced polymerization of the co-monomers generates a fast-relaxing insoluble polymer. Saturation of the polymer using off-resonance Gaussian RF pulses prior to a spin-echo readout with a short echo time leads to contrast that is dependent on the absorbed dose. This contrast is attributed to magnetization transfer (MT) between free water and the polymer, and direct saturation of water was found to be negligible under the prevailing experimental conditions. The usefulness of MT imaging was assessed by computing the dose resolution obtained with this technique. We found a low value of dose resolution over a wide range of doses could be obtained with a single experiment. This is an advantage over multiple spin echo (MSE) experiments using a single echo spacing where an optimal dose resolution is achieved over only very limited ranges of doses. The results suggest MT imaging protocols may be developed into a useful tool for polymer gel dosimetry.