Review on the characteristics of radiation detectors for dosimetry and imaging

Introduction of a hybrid approach based on statistical shape model and Adaptive Neural Fuzzy Inference System (ANFIS) to assess dosimetry uncertainty: A Monte Carlo study

The increasing use of ionizing radiation has raised concerns about adverse and long-term health risks for individuals. Therefore, to evaluate the range of risks and protection against ionizing radiation, it is necessary to assess the dosimetry calculation uncertainty of the absorbed dose of organs and tissues in the body. On the other hand, absorbed dose calculation with low computational load plays a noted role in dosimetry studies. Considering the Monte Carlo simulation's time-consuming and high computational cost, we present a novel model-based organ dosimetry for uncertainty evaluation. We attempt to model and estimate the organ-absorbed dose for lung organ size by combining computational phantoms and ANFIS. Two input variables were used, including variations in lung size and photon energy. The results showed that the proposed hybrid approach increased the speed of evaluation of the uncertainty of dosimetry calculations. The promising results of the hybrid approach demonstrate that it can be a suitable alternative to the time-consuming conventional methods of dosimetry calculations in dosimetry calculations, which will lead to the development of a rapid and reliable tool for organ dose estimation in dosimetry applications in the future.

Optimizing the feasibility of polyvinyl alcohol-potassium iodine gel for medical dosimeter

This work aims to improve the post stabilty of reusable potassium iodide hydrogel dosimter. A reusable and low-cost radiochromic dosimeter containing a gel matrix of polyvinyl alcohol, potassium iodide dye, froctose as reducing agent and glutaraldehyde as cross-linking agent was developed for dose calibration in radiotherapy. The gel samples were exposed to different absorbed doses using a medical linear acceleration. UV-vis Spectrophotometry was utilized to investigate the changes in optical-properties of irradiated gels with regard to peak wavelength of 353 nm. The stability of the gel (one of the most limitation of using this dosimeter) was improved significantly by the addition of certain concentrations of dimethyl sulfoxide. The two-dimensional optical imaging system of charge-coupled-device (CCD) camera with a uniform RGB light-emitting-diode (LED) array source was used for diffusion coefficient purpose using two dimensional gel template. The value of diffusion coefficient reported is significant and highly reduced compared with other dosimeters reported in the literatures. Moreover, heating the improved gels to certain temperatures results in resetting their optical properties, which makes it possible to reuse for multiple times.

Real-time single-proton counting with transmissive perovskite nanocrystal scintillators

High-sensitivity radiation detectors for energetic particles are essential for advanced applications in particle physics, astronomy and cancer therapy. Current particle detectors use bulk crystals, and thin-film organic scintillators have low light yields and limited radiation tolerance. Here we present transmissive thin scintillators made from CsPbBr3 nanocrystals, designed for real-time single-proton counting. These perovskite scintillators exhibit exceptional sensitivity, with a high light yield (~100,000 photons per MeV) when subjected to proton beams. This enhanced sensitivity is attributed to radiative emission from biexcitons generated through proton-induced upconversion and impact ionization. These scintillators can detect as few as seven protons per second, a sensitivity level far below the rates encountered in clinical settings. The combination of rapid response (~336 ps) and pronounced ionostability enables diverse applications, including single-proton tracing, patterned irradiation and super-resolution proton imaging. These advancements have the potential to improve proton dosimetry in proton therapy and radiography.

The first probe of a FLASH proton beam by PET

The recently observed FLASH effect related to high doses delivered with high rates has the potential to revolutionize radiation cancer therapy if promising results are confirmed and an underlying mechanism understood. Comprehensive measurements are essential to elucidate the phenomenon. We report the first-ever demonstration of measurements of successive in-spill and post-spill emissions of gammas arising from irradiations by a FLASH proton beam. A small positron emission tomography (PET) system was exposed in an ocular beam of the Proton Therapy Center at MD Anderson Cancer Center to view phantoms irradiated by 3.5 × 1010protons with a kinetic energy of 75.8 MeV delivered in 101.5 ms-long spills yielding a dose rate of 164 Gy s-1. Most in-spill events were due to prompt gammas. Reconstructed post-spill tomographic events, recorded for up to 20 min, yielded quantitative imaging and dosimetric information. These findings open a new and novel modality for imaging and monitoring of FLASH proton therapy exploiting in-spill prompt gamma imaging followed by post-spill PET imaging.

Inorganic Nanoparticles as Radiosensitizers for Cancer Treatment

Nanotechnology has expanded what can be achieved in our approach to cancer treatment. The ability to produce and engineer functional nanoparticle formulations to elicit higher incidences of tumor cell radiolysis has resulted in substantial improvements in cancer cell eradication while also permitting multi-modal biomedical functionalities. These radiosensitive nanomaterials utilize material characteristics, such as radio-blocking/absorbing high-Z atomic number elements, to mediate localized effects from therapeutic irradiation. These materials thereby allow subsequent scattered or emitted radiation to produce direct (e.g., damage to genetic materials) or indirect (e.g., protein oxidation, reactive oxygen species formation) damage to tumor cells. Using nanomaterials that activate under certain physiologic conditions, such as the tumor microenvironment, can selectively target tumor cells. These characteristics, combined with biological interactions that can target the tumor environment, allow for localized radio-sensitization while mitigating damage to healthy cells. This review explores the various nanomaterial formulations utilized in cancer radiosensitivity research. Emphasis on inorganic nanomaterials showcases the specific material characteristics that enable higher incidences of radiation while ensuring localized cancer targeting based on tumor microenvironment activation. The aim of this review is to guide future research in cancer radiosensitization using nanomaterial formulations and to detail common approaches to its treatment, as well as their relations to commonly implemented radiotherapy techniques.

A phantom based evaluation of the clinical imaging performance of electronic portal imaging devices

Purpose

In this study an evaluation of the imaging performance of an electronic portal imaging device (EPID) is presented. The evaluation performed employing the QC-3V image quality phantom.

Methods

An EPID system of a 6 MV LINAC, was used to obtain images of a QC-3V EPID phantom. The X-ray source to phantom distance was 100 cm and the field size was 15x15 cm2. The irradiation conditions comprised Dose Rates (DR) of 200, 400 and 600 for a 2 MU-100 MU range. The Contrast Transfer Function (CTF), the Noise Power Spectrum (NPS), the Normalized Noise Power Spectrum (NNPS) and the Contrast-to-Noise Ratio (CNR) were studied. In addition, an alternative factor showing a frequency related output signal-to-noise ratio (SNR), the Signal-to-Noise-Frequency Response (SNFR), has been introduced. SNFR is a comprehensive quality index, easily determined in clinical environment.

Results

The CTF curves were found comparable to each other. The lowest values were measured at 2 MU and 200 MU/min. Concerning the NPS and NNPS graphs it was found that the values decrease up to approximately 0.3 lp/mm and demonstrate a white noise shape afterwards. SNFR values were found reducing with spatial frequency. Highest CNR were found between the region 7 and 11 of the phantom.

Conclusions

The influence of MU and DR on EPID performance were investigated. Image quality was assessed using the QC-3V phantom. The presented results can lead to image quality amelioration and act supportively to current image quality control routine protocols.

Improvement of neutron sensitivity for lithium formate EPR dosemeters: a Monte Carlo analysis

This work presents the computational analysis of the sensitivity improvements that could be achieved in lithium formate monohydrate (LFM) electron paramagnetic resonance (EPR) dosemeters exposed to neutron beams. Monte Carlo (MC) simulations were performed on LFM pellets exposed to neutron beams with different energy spectra at various depths inside a water phantom. Various computations were carried out by considering different enrichments of 6Li inside the LFM matrix as well as addition of different amounts of gadolinium oxide inside the pellet blend. The energy released per unit mass was calculated with the aim of predicting the increase in dose achievable by the addition of sensitizers inside the pellets. As expected, a larger amount of 6Li induces an increase of energy released because of the charged secondary particles (i.e. 3H ions and α-particles) produced after neutron capture. For small depths in water phantom and low-energy neutron spectra the dose increase due to 6Li enrichment is high (more than three orders of magnitude with respect to the case of with 7Li). In case of epithermal neutron beams the energy released in 6Li-enriched LFM compound is smaller but larger than in the case of fast neutron beams. On the other hand, the computational analysis evidenced that gadolinium is less effective than 6Li in improving neutron sensitivity of the LFM pellets. Discussion based on the features of MC transport code is provided. This result suggests that 6Li enrichment of LFM dosemeters would be more effective for neutron sensitivity improvement and these EPR dosemeters could be tested for dosimetric applications in Neutron Capture Therapy.

Performance Evaluation of Radiation-Shielding Materials and Process Technology for Manufacturing Skin Protection Cream

Personnel using X-ray devices, the main source of radiation in medical institutions, are primarily affected by scattered rays. When interventionists use radiation for examinations/treatments, their hands may enter the radiation-generating area. The shielding gloves used for protection against these rays restrict movement and cause discomfort. Here, a shielding cream that directly adheres to the skin was developed and examined as a personal protective device; further, its shielding performance was verified. Bismuth oxide and barium sulfate were selected as shielding materials and comparatively evaluated in terms of thickness, concentration, and energy. With increasing wt% of the shielding material, the protective cream became thicker, resulting in improved protection. Furthermore, the shielding performance improved with increasing mixing temperature. Because the shielding cream is applied to the skin and has a protective effect, it must be stable on the skin and easy to remove. During manufacturing, the bubbles were removed, and the dispersion improved by 5% with increasing stirring speed. During mixing, the temperature increased as the shielding performance increased by 5% in the low-energy region. In terms of the shielding performance, bismuth oxide was superior to barium sulfate by approximately 10%. This study is expected to facilitate the mass production of cream in the future.

Towards high sensitivity and high-resolution PET scanners: imaging-guided proton therapy and total body imaging

Quantitative imaging (i.e., providing not just an image but also the related data) guidance in proton radiation therapy to achieve and monitor the precision of planned radiation energy deposition field in-vivo (a.k.a. proton range verification) is one of the most under-invested aspects of radiation cancer treatment despite that it may dramatically enhance the treatment accuracy and lower the exposure related toxicity improving the entire outcome of cancer therapy. In this article, we briefly describe the effort of the TPPT Consortium (a collaborative effort of groups from the University of Texas and Portugal) on building a time-of-flight positron-emission-tomography (PET) scanner to be used in pre-clinical studies for proton therapy at MD Anderson Proton Center in Houston. We also discuss some related ideas towards improving and expanding the use of PET detectors, including the total body imaging.

Gold-Nanoparticle-Enhanced Radio-Fluorogenic Hydrogel Sensor for Low Radiation Doses in Clinical Radiotherapy

Radio-fluorogenic hydrogel dosimeters are urgently needed in radiotherapy for 3D dose verification. However, few hydrogel sensors have been reported at low absorbed doses under 2 Gy which meets the requirements of clinical practice. Here, we report a new type of gold-nanoparticle-enhanced radio-fluorogenic agarose hydrogel with coumarin as the dose-responsive material. An optimal composition of 3 wt% of agarose, 0.1 mM of gold nanoparticles, and 0.5 mM coumarin was selected. The addition of gold nanoparticles enhanced the hydroxyl radicals generated from the radiolysis of water, which can react with coumarin and generate fluorescent 7-hydroxy-coumarin and, eventually, achieve low-dose verification of 0-2.4 Gy with a high linear correlation coefficient. These findings provide an effective method for 3D dose verification, and will inspire the development of other radio-fluorogenic sensing hydrogels as well.

Resistive electrode array (REA) for radiotherapy beam monitoring and quality assurance

We have developed a new type of detector array for monitoring of radiation beams in radiotherapy. The detector has parallel-plane architecture with multiple large-area uniform thin-film electrodes. At least one of the electrodes is resistive and has multiple signal readouts spread out along its perimeter. The integral dose deposited in the detector gives rise to multiple signals that depend on the distribution of radiation with respect to resistive electrode array (REA) geometry. The purpose of the present study was to experimentally determine basic detector response to MLC collimated x-ray fields. Two detector arrays have been characterized: circular and rectangular. The current and electrostatic potential distribution within the resistive electrode are governed by the Laplace and continuity equations with boundary conditions at the border with the readouts. Measurements for pencil beams showed that signal strength depends primarily on the distances between the location of the pencil beam and the readouts. Measurements for larger irregular MLC showed that signals as a function of time are quasi-linear with respect to MLC position and are proportional to the MLC area. Derivation of clinically relevant radiation beam parameters from REA signals, such as MLC position, MLC gap size and monitor unit per MLC segment relies on the detector response model with empirical model parameters. An approximate analytical detector response model was proposed and used to fit experiment data.

Efficient dose-rate correction of silicon diode relative dose measurements

PURPOSE

Silicon diodes are often the detector of choice for relative dose measurements, particularly in the context of radiotherapy involving small photon beams. However, a major drawback lies in their dose-rate dependency. Although ionization chambers are often too large for small field output factor measurements, they are valuable instruments to provide reliable percent-depth dose curves in reference beams. The aim of this work is to propose a practical and accurate method for the characterization of silicon diode dose-rate dependence correction factors using ionization chamber measurements as a reference.

METHODS

The robustness of ionization chambers for percent-depth dose measurements is used to quantify the dose-rate dependency of a diode detector. A mathematical formalism, which exploits the error induced in percent-depth ionization curves for diodes by their dose-rate dependency, is developed to derive a dose-rate correction factor applicable to diode relative measurements. The method is based on the definition of the recombination correction factor given in the addendum to TG 51 and is applied to experimental measurements performed on a CyberKnife M6 radiotherapy unit using a PTW 60012 diode detector. A measurement-based validation is provided by comparing corrected percent-depth ionization curves to measurements performed with a PTW 60019 diamond detector which does not exhibit dose-rate dependence.

RESULTS

Results of dose-rate correction factors for percent-depth ionization curves, off-axis ratios, tissue-phantom ratios and small field output factors are coherent with the expected behavior of silicon diode detectors. For all considered setups and field sizes, the maximum correction and the maximum impact of the uncertainties induced by the correction are obtained for off-axis ratios for the 60 mm collimator, with a correction of 2.5% and an uncertainty of 0.34%. For output factors, corrections range from 0.33% to 0.82% for all field sizes considered, and increase with the reduction of the field size. Comparison of percent-depth ionization curves corrected for dose-rate and for in-depth beam quality variations illustrate excellent agreement with measurements performed using the diamond detector.

CONCLUSIONS

The proposed method allows the efficient and precise correction of the dose-rate dependence of silicon diode detectors in the context of clinical relative dosimetry. This article is protected by copyright. All rights reserved.

Correlation between X-ray tube current exposure time and X-ray photon number in GATE

BACKGROUND

X-ray image quality relies heavily on the emitted X-ray photon number which depends on X-ray tube current and exposure time. To accurately estimate the absorbed dose in an imaging protocol, it is better to simulate the X-ray imaging with a Monte Carlo platform such as GATE (Geant4 Application for Tomographic Emission). Although input of GATE is the X-ray photon number of the simulated X-ray tube, it lacks a good way to setup the photon number for a desired X-ray tube current setting.

OBJECTIVE

To provide a method to correlate the experimental X-ray tube current exposure time and the X-ray photon number in GATE.

METHODS

The accumulated radiation dose of a micro-computed tomography (CT) X-ray tube was recorded at different current exposure times with a general-purpose ion chamber. GATE was used to model the experimental microCT imaging system and calculate the total absorbed dose (cGy) in the sensitive volume of the ion chamber with different X-ray photon numbers. Linear regression models are used to establish a correlation between the estimated X-ray photon number and the X-ray tube settings. At first, one model establishes the relationship between the experimentally measured dose and the X-ray tube setting. Then, another model establishes a relationship between the simulated dose and the X-ray number in GATE. At last, by correlating these two models, a regression model to estimate the X-ray output number from an experimental X-ray tube setting (mAs) is obtained.

RESULTS

For a typical micro-CT scan, the X-ray tube is operated at 50 kVp and 0.5 mA for a 500 ms exposure time per projection (0.25 mAs). For these X-ray imaging parameters, the X-ray number per projection is estimated to be 3.613×106 with 1.0 mm Al filter.

CONCLUSION

The findings of this work provide an approach to correlate the experimental X-ray tube current exposure time to the X-ray photon number in the GATE simulation of the X-ray tube to more accurately determine radiation dose for an imaging protocol.

SABR pre-treatment checks using alanine and nanoDot dosimeters

Stereotactic Ablative Radiotherapy (SABR) remains one of the preferred treatment techniques for early-stage cancer. It can be extended to more treatment locales involving the sternum, scapula and spine. This work investigates SABR checks using Alanine and nanoDot dosimeter for three treatment sites, including sternum, spine and scapula. Alanine and nanoDot dosimeters' performances were verified using a 6 MV photon beam before SABR pretreatment verifications. Each dosimeter was placed inside customized designed inserts into a Rod Phantom (in-house phantom) made of Perspex that mimics the human body for a SABR check. Electron Paramagnetic Resonance (EPR) spectrometer, Bruker EleXsys E500 (9.5 GHz) and Microstar (Landauer Inc.) Reader was employed to acquire the irradiated alanine and nanoDot dosimeters' signal, respectively. Both dosimeters treatment sites are expressed as mean ± standard deviation (SD) of the measured and Eclipse calculated dose Alanine (19.59 ± 0.24, 17.98 ± 0.15, 17.95 ± 0.18) and nanoDot (19.70 ± 0.43, 17.05 ± 0.08, 17.95 ± 0.98) for spine, scapula and sternum, respectively. The percentage difference between alanine and nanoDot dosimeters was within 2% for sternum and scapula but 2.4% for spine cases. These results demonstrate Alanine and nanoDot dosimeters' potential usefulness for SABR pretreatment quality assurance (QA).

Quaternary Semiconductor Cd1−xZnxTe1−ySey for High-Resolution, Room-Temperature Gamma-Ray Detection

The application of Cd0.9Zn0.1Te (CZT) single crystals, the primary choice for high-resolution, room-temperature compact gamma-ray detectors in the field of medical imaging and homeland security for the past three decades, is limited by the high cost of production and maintenance due to low detector grade crystal growth yield. The recent advent of its quaternary successor, Cd0.9Zn0.1Te1−ySey (CZTS), has exhibited remarkable crystal growth yield above 90% compared to that of ~33% for CZT. The inclusion of Se in appropriate stoichiometry in the CZT matrix is responsible for reducing the concentration of sub-grain boundary (SGB) networks which greatly enhances the compositional homogeneity and growth yield. SGB networks also host defect centers responsible for charge trapping, hence their reduced concentration ensures minimized charge trapping. Indeed, CZTS single crystals have shown remarkable improvement in electron charge transport properties and energy resolution over CZT detectors. However, our studies have found that the overall charge transport in CZTS is still limited by the hole trapping. In this article, we systematically review the advances in the CZTS growth techniques, its performance as room-temperature radiation detector, and the role of defects and their passivation studies needed to improve the performance of CZTS detectors further.

Dosimetry with gafchromic films based on a new micro-opto-electro-mechanical system

This work presents the first tests performed with radiochromic films and a new Micro‒Opto‒Electro-Mechanical system (MOEMS) for in situ dosimetry evaluation in radiotherapy in real time. We present a new device and methodology that overcomes the traditional limitation of time-delay in radiochromic film analysis by turning a passive detector into an active sensor. The proposed system consists mainly of an optical sensor based on light emitting diodes and photodetectors controlled by both customized electronic circuit and graphical user interface, which enables optical measurements directly. We show the first trials performed in a low‒energy proton cyclotron with this MOEMS by using gafchromic EBT3 films. Results show the feasibility of using this system for in situ dose evaluations. Further adaptation is ongoing to develop a full real‒time active detector by integrating MOEM multi‒arrays and films in flexible printed circuits. Hence, we point to improve the clinical application of radiochromic films with the aim to optimize radiotherapy treatment verifications.

Preliminary investigation on performance of photodiode sensor as a dosimeter

Radiation dosimetry in the health and medicine field is crucial to ensure there is no unnecessary ionizing radiation exposure to patients and personnel. While various types of semiconductor dosimeters are available, photodiode sensors are seen as a reliable and cost-effective immediate dosimeter. This study investigates the capabilities of a monolithic photodiode with an on-chip trans-impedance amplifier as a dosimeter in diagnostic radiology. A photodiode sensor covered with black insulation tape is irradiated with the diagnostic x-ray of potential in range between 40 to 90 kV with constant tube current-time product of 50 mAs at 60 cm source-to-detector distance (SDD). Exposures of different tube current at the range of 10 to 250 mA with a constant tube voltage of 70 kVp at the same setup are made. The photodiode sensor connected to the electrometer gives out readings in the millivolt (mV), and the output of the photodiode and semiconductor detector is recorded. The photodiode’s energy dependency, reproducibility, dose response, and distance dependency were evaluated as the capabilities of the photodiode to be used as a dosimeter. For energy dependency, it shows a linearity of 0.9458, while the response to increasing tube current with a constant tube voltage shows the R2 of 0.912. The photodiode shows good dependency on the tube voltage and tube current. Other than that, it also showed a linear coefficient of 0.5138 for distance dependence which is considered as a good linearity fit value for a photodiode as initial performance. However, its reproducibility is poor due to its large capacitance. This monolithic photodiode with an on-chip trans-impedance amplifier has demonstrated good results for energy dependency but poor results for reproducibility. However, the photodiode can be improvised in the future to ensure it is suitable as a dosimeter.

Direct detection of 5-MeV protons by flexible organic thin-film devices

The direct detection of 5-MeV protons by flexible organic detectors based on thin films is here demonstrated. The organic devices act as a solid-state detector, in which the energy released by the protons within the active layer of the sensor is converted into an electrical current. These sensors can quantitatively and reliably measure the dose of protons impinging on the sensor both in real time and in integration mode. This study shows how to detect and exploit the energy absorbed both by the organic semiconducting layer and by the plastic substrate, allowing to extrapolate information on the present and past irradiation of the detector. The measured sensitivity, S = (5.15 ± 0.13) pC Gy^-1, and limit of detection, LOD = (30 ± 6) cGy s^-1, of the here proposed detectors assess their efficacy and their potential as proton dosimeters in several fields of application, such as in medical proton therapy.

Application of Bpw34 photodiode and cold white LED as diagnostic X-ray detectors: A comparative analysis

This study compares the real-time dosimetric performance of a bpw34 photodiode (PD) and cold white light-emitting diodes (LEDs) based on diagnostic X-ray-induced signals. Signals were extracted when both the transducers were under identical exposure settings, including source-to-detector distance (SDD), tube voltage (kVp), and current-time product (mAs). The transducers were in a photovoltaic configuration, and black vinyl tape was applied on transducer active areas as a form of optical shielding. X-ray beam spectra and energies were simulated using Matlab-based Spektr functions. Transducer performance analysis was based on signal linearity to mAs and air kerma, and sensitivity dependence on absorbed dose, energy, and dose rate. Bpw34 PD and cold white LED output signals were 84.8% and 85.5% precise, respectively. PD signals were 94.7% linear to mAs, whereas LED signals were 91.9%. PD and LED signal linearity to dose coefficients were 0.9397 and 0.9128, respectively. Both transducers exhibited similar dose and energy dependence. However, cold white LEDs were 0.73% less dose rate dependent than the bpw34 PD. Cold white LEDs demonstrated potential in detecting diagnostic X-rays because their performance was similar to that of the bpw34 PD. Moreover, the cold white LED array's dosimetric response was independent of the heel effect. Although cold white LED signals were lower than bpw34 PD signals, they were quantifiable and electronically amplifiable.

Reconstruction of dose distributions for fine carbon-ion beams using iterative approximation toward carbon-knife

For the practical application of carbon-knife with fine carbon-ion beams, the quantification of the dose distribution is essential and requires a high spatial resolution. We propose a novel method to quantify dose distributions with a spatial resolution smaller than the dosimeter size. The proposed method innovates the iterative reconstruction technique. Using a diode dosimeter with a sensitive area of 1 mm², two-dimensional dose-area-product (DAP) distributions were measured at a 0.1 mm step at the surface and near the Bragg peak depths for fine carbon-ion beams of ∼1 mm size at the full width at half maximum (FWHM). Then, the dose distributions were reconstructed with a spatial resolution of 0.1 × 0.1 mm² from the measured DAP distributions. However, an unnaturally high noise was observed in the reconstructed dose distributions, which were considered to originate from the measurement reproducibility errors of the DAP distributions estimated to be 2.5%-3%. Therefore, a low-pass filtering process was implemented to reduce the errors on the reconstructed dose distributions. The optimum cut-off frequencies of the low-pass filter were estimated depending on the amplitude of the induced noise. Using the filtering process with the obtained optimum cut-off frequency, the dose distribution was quantified with an average error of approximately 3% or less with respect to the peak value, when the actual measurement had an error of 3%. In the reconstructed dose rate distributions, a steep penumbra P_80-20 ∼ 0.2 mm was observed at the surface, and a dose rate at the center axis of ∼90 Gy s^-1 and a beam size of ∼1.1 mm at FWHM near the Bragg peak were obtained. The proposed method is expected to be useful for the measurement-based determination of microbeam models for commissioning and dose distribution calculations toward carbon-knife applications.

Clinical commissioning of intensity-modulated proton therapy systems: Report of AAPM Task Group 185

Proton therapy is an expanding radiotherapy modality in the United States and worldwide. With the number of proton therapy centers treating patients increasing, so does the need for consistent, high-quality clinical commissioning practices. Clinical commissioning encompasses the entire proton therapy system's multiple components, including the treatment delivery system, the patient positioning system, and the image-guided radiotherapy components. Also included in the commissioning process are the x-ray computed tomography scanner calibration for proton stopping power, the radiotherapy treatment planning system, and corresponding portions of the treatment management system. This commissioning report focuses exclusively on intensity-modulated scanning systems, presenting details of how to perform the commissioning of the proton therapy and ancillary systems, including the required proton beam measurements, treatment planning system dose modeling, and the equipment needed.

The 20th Gray lecture 2019: health and heavy ions

OBJECTIVE

Particle radiobiology has contributed new understanding of radiation safety and underlying mechanisms of action to radiation oncology for the treatment of cancer, and to planning of radiation protection for space travel. This manuscript will highlight the significance of precise physical and biologically effective dosimetry to this translational research for the benefit of human health.This review provides a brief snapshot of the evolving scientific basis for, and the complex current global status, and remaining challenges of hadron therapy for the treatment of cancer. The need for particle radiobiology for risk planning in return missions to the Moon, and exploratory deep-space missions to Mars and beyond are also discussed.

METHODS

Key lessons learned are summarized from an impressive collective literature published by an international cadre of multidisciplinary experts in particle physics, radiation chemistry, medical physics of imaging and treatment planning, molecular, cellular, tissue radiobiology, biology of microgravity and other stressors, theoretical modeling of biophysical data, and clinical results with accelerator-produced particle beams.

RESULTS

Research pioneers, many of whom were Nobel laureates, led the world in the discovery of ionizing radiations originating from the Earth and the Cosmos. Six radiation pioneers led the way to hadron therapy and the study of charged particles encountered in outer space travel. Worldwide about 250,000 patients have been treated for cancer, or other lesions such as arteriovenous malformations in the brain between 1954 and 2019 with charged particle radiotherapy, also known as hadron therapy. The majority of these patients (213,000) were treated with proton beams, but approximately 32,000 were treated with carbon ion radiotherapy. There are 3500 patients who have been treated with helium, pions, neon or other ions. There are currently 82 facilities operating to provide ion beam clinical treatments. Of these, only 13 facilities located in Asia and Europe are providing carbon ion beams for preclinical, clinical, and space research. There are also numerous particle physics accelerators worldwide capable of producing ion beams for research, but not currently focused on treating patients with ion beam therapy but are potentially available for preclinical and space research. Approximately, more than 550 individuals have traveled into Lower Earth Orbit (LEO) and beyond and returned to Earth.

CONCLUSION

Charged particle therapy with controlled beams of protons and carbon ions have significantly impacted targeted cancer therapy, eradicated tumors while sparing normal tissue toxicities, and reduced human suffering. These modalities still require further optimization and technical refinements to reduce cost but should be made available to everyone in need worldwide. The exploration of our Universe in space travel poses the potential risk of exposure to uncontrolled charged particles. However, approaches to shield and provide countermeasures to these potential radiation hazards in LEO have allowed an amazing number of discoveries currently without significant life-threatening medical consequences. More basic research with components of the Galactic Cosmic Radiation field are still required to assure safety involving space radiations and combined stressors with microgravity for exploratory deep space travel.

ADVANCES IN KNOWLEDGE

The collective knowledge garnered from the wealth of available published evidence obtained prior to particle radiation therapy, or to space flight, and the additional data gleaned from implementing both endeavors has provided many opportunities for heavy ions to promote human health.

X-Ray Beam Segment Size and Entrance Location Effects on the Integral Quality Monitor (IQM®) Signal and Usefulness in Predicting Complex Segment Output Signals

Background:

The Integral Quality Monitor (IQM®) is an independent online dosimetry device attached to the treatment machine to monitor the accuracy of radiation delivery.

Objective:

This study investigates the influence of beam segment size and displacement as projected onto the IQM chamber on the signals and determine how individual signals can be added to get a combined segment signal made up of smaller segments.

Material and Methods:

This is an experimental original research type of study. IQM response maps were generated by irradiating the IQM sensitive area with small elementary segments and measuring their corresponding signals per monitor unit (MU). The output signal/MU was measured for regular and irregular fields and compared with the predicted signal/MU obtained from decomposing the open segment into a set of smaller regular segments and summing their signals from their respective response maps. The dependence of signals on segment size, shape, location and combination was investigated.

Results:

Predicted signals were calculated within 95-98 % accuracy for regular fields and 90-98% for irregular fields. More uniform fluence contain distribution for larger segments was observed. Response maps were consistent with the geometrical symmetry in the chamber’s wedge shape and the symmetry in the linac fluence.

Conclusion:

The field decomposition method allows the pre-calculation of known segment output signals per MU within 2% error, although the accuracy drops significantly for smaller, irregular fields. A method of correcting predicted signals in smaller segments needs to be laid down to get a better match with measured signals.

Sensitivity enhancement of DHR123 radio-fluorogenic nanoclay gel dosimeter by incorporating surfactants and halogenides

Dosimetry of spatial dose distribution of ionizing radiation in tissue equivalent materials is particularly important for cancer radiotherapy. Here, we describe a radio-fluorogenic gel-based dosimeter that has achieved 16 times higher sensitivity by incorporating surfactants and halogenides. The gel dosimeters were prepared from dihydrorhodamine 123 (DHR123) and small amounts of nano-sized clay and a radiosensitizer. By comprehensively changing the type of additives for the sensitizer (three surfactants: Triton X-100, sodium dodecyl sulfate (SDS) and cetyltrimethylammonium bromide, and three halogenides: trichloroacetic acid, tribromoacetic acid and 2,2,2-trichloroethanol), the increase in sensitivity can be explained by an increase in relative fluorescence quantum yield and an increase in radiation chemical yield. These highly sensitive gel dosimeters also show dose rate independent sensitivity under irradiation at 0.64 and 0.77 Gy min⁻¹ using a 6 MV X-ray therapeutic beam from the medical linac.

Dosimetry of spatial dose distribution of ionizing radiation in tissue equivalent materials using high sensitive radio-fluorogenic gel dosimeter using DHR123 with sensitizer. (Radiation therapy planning image courtesy of Varian Medical Systems, Inc. All rights reserved.)

Technical Note: Nuclear imaging with an x-ray flat panel detector: A proof-of-concept study

PURPOSE

Interventional procedures involving radionuclides (e.g., radioembolization) would benefit from single-photon emission computed tomography (SPECT) performed in the intervention room because the activity distribution could be immediately visualized. We believe it might be possible to perform SPECT with the C-arm cone beam computed tomography (CBCT) scanner present in the intervention room by equipping the x-ray flat panel detector with a collimator. The purpose of this study is to demonstrate the approach and to investigate the achievable SPECT reconstruction quality.

METHODS

A proof-of-concept experiment was performed to evaluate the possibility of nuclear imaging with an x-ray flat panel detector. The experiment was digitally replicated to study the accuracy of the simulations. Three flat panel configurations (with standard hardware and reconstruction methodology, with sophisticated reconstruction methodology, and with expected future hardware) and a conventional gamma camera were evaluated. The Jaszczak and the NEMA IQ phantom (filled with ^99m Tc) were simulated and assessed on resolution and contrast-to-noise ratio (CNR).

RESULTS

The proof-of-concept experiment demonstrated that nuclear images could be obtained from the flat panel detector. The simulation of the same configuration demonstrated that simulations could accurately predict the flat panel detector response. The CNR of the 37 mm sphere in the NEMA IQ phantom was 22.8 ± 1.2 for the gamma camera reconstructions, while it was 11.3 ± 0.7 for the standard flat panel detector. With sophisticated reconstruction methodology, the CNR improved to 13.5 ± 1.4. The CNR can be expected to advance to 18.1 ± 1.3 for future flat panel detectors.

CONCLUSIONS

The x-ray flat panel detector of a CBCT scanner might be used to perform nuclear imaging. The SPECT reconstruction quality will be lower than that achieved by a conventional gamma camera. The flat panel detector approach could, however, be useful in providing a cost-effective alternative to the purchase of a mobile SPECT scanner for enabling interventional scanning.

DNA dosimeter measurements of beam profile using a novel simultaneous processing technique

A DNA dosimeter (DNAd) was previously developed that uses double-strand breaks (DSB) to measure dose. This dosimeter has been tested to measure dose in scenarios where transient-charged particle equilibrium (TCPE) has been established. The probability of double strand break (PDSB_o), which is the ratio of broken double-stranded DNA (dsDNA) to the initial unbroken dsDNA in the dosimeter, was used to quantify DSBs and related to dose. The goal of this work is to produce a new technique to process and analyze the DNAd and quantify DNA-DSBs. This technique included simultaneously processing multiple DNAds and also establishing a new form to the probability of double strand break (PDSB_n), which was then used to test the DNAd in a non-TCPE condition by taking beam penumbra measurements. The technique utilized a 384-well plate, and the measurements were made at the edge of a 10 × 10 cm field and compared to film measurements. During these penumbra measurements, while observing the positional differences in the higher gradient region at 4.1 and 4.55 cm from the center of the radiation field, the distance to agreement of PDSB_o to film were 0.38 cm and 0.26 cm while the distance to agreement of PDSB_n to film were 0.11 cm and 0.06 cm, respectively. Finally, the developed new separation technique reduced the time needed for the analysis of 25 samples from 200 min to 30 min.

External beam patient dose verification based on the integral quality monitor (IQM®) output signals

BACKGROUND

The Integral Quality Monitor (IQM^®) can essentially measure the integral fluence through a segment and provide real-time information about the accuracy of radiation delivery based on comparisons of measured segment signals and pre-calculated reference values. However, the present IQM chamber cannot calculate the dose in the patient.

AIM

This study aims to make use of IQM field output signals to calculate the number of monitor units (MUs) delivered through an arbitrary treatment field in order to convert Monte Carlo (MC)-generated dose distributions in a patient model into absolute dose.

METHODS

XiO and Monaco treatment planning systems (TPSs) were used to define treatment beam portals for cervix and esophagus conformal radiotherapy as well as prostate intensity-modulated radiotherapy for the translation of patient and beam setup information from DICOM to DOSXYZnrc. The planned beams were simulated in a patient model built from actual patient CT images and each simulated integral field/segment was weighted with its MUs before summation to get the total dose in the plan. The segment beam weights (MUs) were calculated as the ratio of the open-field IQM measured signal and the calculated signal per MU extracted from chamber sensitivity maps. These are the actual MUs delivered not just MUs set. The beam weighting method was evaluated by comparing weighted MC doses with original planned doses using profile and isodose comparisons, dose difference maps, γ analysis and dose-volume histogram (DVH) data.

RESULTS

γ pass rates of up to 98% were found, except for the esophagus plan where the γ pass rate was below 45%. DVH comparisons showed good agreement for most organs, with the largest differences observed in low-density lung. However, these discrepancies can result from differences in dose calculation algorithms or differences in MUs used for dose weighting planned by the TPS and MUs calculated using IQM field output signals. To test this, a 4-field box DOSXYZnrc MC simulation weighted with planned (XiO) MUs was compared with the same simulation weighted with IQM-based MUs. Dose differences of up to 5% were found on the isocentre slice. For XiO versus MC, up to 7% dose differences were found, indicating additional error due to limitations of XiO's superposition algorithm. Dose differences between MC Monaco and MC EGSnrc were less than 3%.

CONCLUSIONS

The most valuable comparison was MC versus MC as it eliminated algorithm discrepancies and evaluated dose differences precisely according to beam weighting. For XiO TPS, care must be taken as dose differences may also arise due to limitations in XiO's planning software, not merely due to differences in MUs. Overall, the IQM was successfully used to compute beam dose weights to accurately reconstruct the patient dose using unweighted MC beams. Our technique can be used for pre-treatment QA provided each segment output is known and an accurate linac source model is available.

Light-Dependent Resistors as Dosimetric Sensors in Radiotherapy

Safe quality control of radiotherapy treatments lies in reliable dosimetric sensors. Currently, ionization chambers and solid-state diodes along with electrometers as readout systems are accomplishing this task. In this work, we present a well-known and low-cost semiconductor sensor, the light-dependent resistor (LDR), as an alternative to the existing sensing devices for dosimetry. To demonstrate this, a complete characterization of the response to radiation of commercial LDRs has been conducted in terms of sensitivity, reproducibility and thermal correction under different bias voltages. Irradiation sessions have been applied under the common conditions in radiotherapy treatments using a hospital linear accelerator. Moreover, the same electrometer used for the ionization chamber has also been successfully used for LDRs. In comparison with the sensitivity achieved for the ionization chamber (0.2 nC/cGy at 400 V bias voltage), higher sensitivities have been measured for the proposed LDRs, ranging from 0.24 to 1.04 nC/cGy at bias voltages from 30 to 150 V, with a reproducibility uncertainty among samples of around 10%. In addition, LDR temperature dependence has been properly modeled using the simple thermistor model so that an easy thermal drift correction of dose measurements can be applied. Therefore, experimental results show that LDRs can be a reliable alternative to dosimetric sensors with the advantages of low size, affordable cost and the fact that it could be adopted with minimal changes in routine dosimetry quality control since the same readout system is fully compatible.

Polyphenolic extracts from the xerophyte Rhamnus lycioides as a radiation biodosimeter

The majority of dosimeters currently in use are synthetic and very expensive. Therefore, the study of the dosimetric characteristics of polyphenolic extracts of xerophytes is useful because drought stress causes an increase in the production of these cheap and natural compounds containing benzene rings. Here, the polyphenolic compounds were extracted from Rhamnus lycioides which was collected from Bou-Hedma National Park in Tunisia and identified using liquid chromatography-mass spectrometry (LC-MS). We investigated the impact of cobalt-60 (⁶⁰Co) irradiation (0-30 kilogray (kGy)) on the color parameters of polyphenolic extracts of R. lycioides using the Konica Minolta CR 300 portable colorimeter and UV-Visible spectroscopy. The structural and morphological characteristics of the irradiated extracts were assessed using Fourier transform infrared (FT-IR) spectroscopy, X-ray diffraction (XRD) technique and scanning electron microscopy (SEM). Overall, our results suggest that exposure to ionizing radiation (IR) of the polyphenolic components of the xerophyte R. lycioides has produced significant dose-dependent changes in their optical and morphological properties. Thus, these extracts can be valorized as biodosimeters in the dose range from 5 to 25 kGy.

MOSFET dosimeter characterization in MR-guided radiation therapy (MRgRT) Linac

PURPOSE

With the increasing use of MR-guided radiation therapy (MRgRT), it becomes important to understand and explore accuracy of medical dosimeters in the presence of magnetic field. The purpose of this work is to characterize metal-oxide-semiconductor field-effect transistors (MOSFETs) in MRgRT systems at 0.345 T magnetic field strength.

METHODS

A MOSFET dosimetry system, developed by Best Medical Canada for in-vivo patient dosimetry, was used to study various commissioning tests performed on a MRgRT system, MRIdian^® Linac. We characterized the MOSFET dosimeter with different cable lengths by determining its calibration factor, monitor unit linearity, angular dependence, field size dependence, percentage depth dose (PDD) variation, output factor change, and intensity modulated radiation therapy quality assurance (IMRT QA) verification for several plans. MOSFET results were analyzed and compared with commissioning data and Monte Carlo calculations.

RESULTS

MOSFET measurements were not found to be affected by the presence of 0.345 T magnetic field. Calibration factors were similar for different cable length dosimeters either placed at the parallel or perpendicular direction to the magnetic field, with variations of less than 2%. The detector showed good linearity (R²  = 0.999) for 100-600 MUs range. Output factor measurements were consistent with ionization chamber data within 2.2%. MOSFET PDD measurements were found to be within 1% for 1-15 cm depth range in comparison to ionization chamber. MOSFET normalized angular response matched thermoluminescent detector (TLD) response within 5.5%. The IMRT QA verification data for the MRgRT linac showed that the percentage difference between ionization chamber and MOSFET was 0.91%, 2.05%, and 2.63%, respectively for liver, spine, and mediastinum.

CONCLUSION

MOSFET dosimeters are not affected by the 0.345 T magnetic field in MRgRT system. They showed physics parameters and performance comparable to TLD and ionization chamber; thus, they constitute an alternative to TLD for real-time in-vivo dosimetry in MRgRT procedures.

Nuclear magnetic resonance analysis of a chemically cross-linked ferrous-methylthymol blue-polyvinyl alcohol radiochromic gel dosimeter

A new formulation of hydrogel dosimeter consisting of ferrous-methylthymol blue (MTB)-polyvinyl alcohol (PVA) cross-linked chemically with glutaraldehyde (GTA) was studied and evaluated by nuclear magnetic resonance analysis by means of the R₂ spin-spin relaxation rate. Previous optical studies of this transparent solid chemically cross-linked gel showed important dosimetric features in terms of sensitivity, auto-oxidation rate, and diffusion. This study shows that the MTB-PVA-GTA dosimeter has a reproducible linear dose response up to 40 Gy. For the optimum formulation of 0.1 mM MTB, 2.5% PVA, and 26.6 mM GTA, the measured R₂ sensitivity was higher than that of traditional natural matrix-containing gels (MTB-gelatin) and all other reported PVA gel-based radiochromic dosimeters with MTB, xylenol orange (XO), or GTA (MTB-PVA, XO-PVA, XO-PVA-GTA). Additionally, the auto-oxidation rate was approximately ten times lower than that of the Fricke-MTB-gelatin system, which is consistent with the spectrophotometry results. The results of the independent experimental spectrophotometry and nuclear magnetic resonance analyses indicate that the transparent cross-linked dosimeter has good and consistent dosimetric features.

Optimizing the response, precision, and cost of a DNA double-strand break dosimeter

We developed a dosimeter that measures biological damage following delivery of therapeutic beams in the form of double-strand breaks (DSBs) to DNA. The dosimeter contains DNA strands that are labeled on one end with biotin and on the other with fluorescein and attached to magnetic microbeads. Following irradiation, a magnet is used to separate broken from unbroken DNA strands. Then, fluorescence is utilized to measure the relative amount of broken DNA and determine the probability for DSB. The long-term goal for this research is to evaluate whether this type of biologically based dosimeter holds any advantages over the conventional techniques. The purpose of this work was to optimize the dosimeter fabrication and usage to enable higher precision for the long-term research goal. More specifically, the goal was to optimize the DNA dosimeter using three metrics: the response, precision, and cost per dosimeter. Six aspects of the dosimeter fabrication and usage were varied and evaluated for their effect on the metrics: (1) the type of magnetic microbeads, (2) the microbead to DNA mass ratio at attachment, (3) the type of suspension buffer used during irradiation, (4) the concentration of the DNA dosimeter during irradiation, (5) the time waited between fabrication and irradiation of the dosimeter, and (6) the time waited between irradiation and read out of the response. In brief, the best results were achieved with the dosimeter when attaching 4.2 µg of DNA with 1 mg of MyOne T1 microbeads and by suspending the microbead-connected DNA strands with 200 µl of phosphate-buffered saline for irradiation. Also, better results were achieved when waiting a day after fabrication before irradiating the dosimeter and also waiting an hour after irradiation to measure the response. This manuscript is meant to serve as guide for others who would like to replicate this DNA dose measurement technique.

Parameter estimation and mathematical modeling of the diffusion process of a benzoic acid infused Fricke gel dosimeter

This work presents a mathematical model implementation for studying the diffusion process of ferric ions in post-irradiated Fricke gel dosimeters. Fricke gel samples were manufactured in layers for their analysis by optical transmission imaging and benzoic acid was incorporated to improve their radiosensitivity. The developed method consists on designing the dosimeters with a suitable composition for their optical analysis which allows accurate measurements in a wide dose range with noticeable linear responses with an average linear correlation coefficient of r²=0.993. The developed algorithm calculates the diffusion coefficient by means of an inverse problem formulation. Moreover, the proposed method is capable of modeling time-dependent physical properties and evolution over time of the irradiated dosimeters accurately and comparable with experimentally measured data. The obtained results evince the complexity of the diffusion phenomena in this type of materials and the capacity of the proposed method to provide a reliable quantification of the diffusion coefficient as a scalar approximation of the diffusion tensor. The obtained diffusion coefficient varies from 1.21 to 1.61 mm²/h with uncertainties lower than 2%. The model is also transferable to other diffusion driven systems and the numerical solving method can also be adapted to solve diffusion calculation based on other theoretical approaches.

Evaluations of N-(Isobutoxymethyl) acrylamide gel dosimeter by NMR technique for radiotherapy and uncertainty in dose measurements

N-(Isobutoxymethyl) acrylamide (NIBMA) monomer in gelatin, named NIBMAGAT gel dosimeter, was prepared and investigated by nuclear magnetic imaging (NMR) for radiotherapy in the dose range of 0-30 Gy. NIBMA monomer polymerizes upon irradiation, increasing spin-spin relaxation rate R₂. The addition of glycerol as a co-solvent in the gel matrix improved its radiation sensitivity better than the co-solvents of acetone and methanol. The increase of glycerol content by 1% wt/wt enhanced the sensitivity by ˜ 3.1%. This gel has better radiation sensitivity as compared to the polyacrylamide gel (PAG) dosimeter; the sensitivities of NIBMAGAT gel and normoxic polyacrylamide gel (nPAG) are ≈0.13 and ≈0.1 s^-1.Gy^-1, respectively. By comparing NIBMAGAT gel dosimeter with PAG, nMAG and nPAG gel dosimeters, NIBMAGAT gel dosimeter is less influenced by scanning temperature than the last three dosimeters. The gel is water equivalent and has an energy-independent response from 80 keV to 20 MeV. The overall uncertainty of dose measurement using NIBMAGAT gel is 5.46% at 2σ. Our findings suggest the applicability of using NIBMAGAT gel dosimeter by NMR technique for dose verification/planning in the practice of clinical radiotherapy.

A nanogel sensor for colorimetric fluorescence measurement of ionizing radiation doses

A polyacrylamide-based nanogel sensor was constructed for spectral and visual colorimetric fluorescence measurement of ionizing radiation doses.