Dosimetry in MRgPT: Impact of magnetic fields on TLD dose response during proton irradiation

BACKGROUND

Proton beam therapy, when integrated with MRI guidance, presents complex dosimetric challenges due to interactions with magnetic fields. Prior research has emphasized the nuanced impact of magnetic fields on dosimetry. For thermoluminescent dosimeters (TLDs) the electron-return effect, alongside small air cavities surrounding the pellets, can lead to nonuniform dose distributions. Future MR-guided proton therapy will require reliable methods for end-to-end tests and dosimetric audits, which so far are often performed using TLDs equipped with phantoms. This implicates the necessity of accounting for these interactions.

PURPOSE

This study investigates the influence of magnetic fields on TLDs at two proton energies, using magnetic field strengths of 0, 0.25, and1 T $1 \,\mathrm{T}$ , aiming to clarify their impact on dose measurement accuracy.

METHODS

The study was conducted at a synchrotron-based ion beam therapy beam line, enhanced by a resistive dipole magnet for creating magnetic fields up to1 T $1 \,\mathrm{T}$ to simulate MR-guided proton therapy. Individual correction factors were applied for TLD measurements. The impact of air gaps on the TLD signal was evaluated using three dedicated TLD holders with air gaps of 0.1, 0.25, and 0.5 mm surrounding the TLD pellets using the highest available proton energy of252.7 M e V $252.7 \,\mathrm{M}\mathrm{e\mathrm{V}}$ . Additionally, the influence of the magnetic field strength on the TLD response was evaluated for two proton energies of97.4 M e V $97.4 \,\mathrm{M}\mathrm{e\mathrm{V}}$ and252.7 M e V $252.7 \,\mathrm{M}\mathrm{e\mathrm{V}}$ .

RESULTS

The study found no statistically significant variation in TLD dose response attributable to changes in the air gap or the presence of magnetic fields. A power analysis indicated an upper limit on a potential change in dose-response as small as 1.5%.

CONCLUSIONS

The findings suggested that the impact of air gap variations and magnetic field strengths on the TLD response was below the detection threshold of TLD sensitivity. This emphasizes the suitability of TLDs for dose measurement in MR-guided proton therapy, indicating that additional correction factors may not be necessary despite the influence of magnetic fields.

Medical physics challenges in clinical MR-guided radiotherapy

The integration of magnetic resonance imaging (MRI) for guidance in external beam radiotherapy has faced significant research and development efforts in recent years. The current availability of linear accelerators with an embedded MRI unit, providing volumetric imaging at excellent soft tissue contrast, is expected to provide novel possibilities in the implementation of image-guided adaptive radiotherapy (IGART) protocols. This study reviews open medical physics issues in MR-guided radiotherapy (MRgRT) implementation, with a focus on current approaches and on the potential for innovation in IGART.Daily imaging in MRgRT provides the ability to visualize the static anatomy, to capture internal tumor motion and to extract quantitative image features for treatment verification and monitoring. Those capabilities enable the use of treatment adaptation, with potential benefits in terms of personalized medicine. The use of online MRI requires dedicated efforts to perform accurate dose measurements and calculations, due to the presence of magnetic fields. Likewise, MRgRT requires dedicated quality assurance (QA) protocols for safe clinical implementation.Reaction to anatomical changes in MRgRT, as visualized on daily images, demands for treatment adaptation concepts, with stringent requirements in terms of fast and accurate validation before the treatment fraction can be delivered. This entails specific challenges in terms of treatment workflow optimization, QA, and verification of the expected delivered dose while the patient is in treatment position. Those challenges require specialized medical physics developments towards the aim of fully exploiting MRI capabilities. Conversely, the use of MRgRT allows for higher confidence in tumor targeting and organs-at-risk (OAR) sparing.The systematic use of MRgRT brings the possibility of leveraging IGART methods for the optimization of tumor targeting and quantitative treatment verification. Although several challenges exist, the intrinsic benefits of MRgRT will provide a deeper understanding of dose delivery effects on an individual basis, with the potential for further treatment personalization.

The Influence of Magnetic Fields (0.05 T ≤ B ≤ 7 T) on the Response of Personal Thermoluminescent Dosimeters to Ionizing Radiation

We investigated the main question of whether thermoluminescent dosimeters indicate the correct dose when exposed to magnetic fields from low stray fields up to high magnetic resonance imaging fields inside human magnetic resonance imaging scanners (0.05 T ≤ B ≤ 7 T) during and after irradiation. Medical personnel working in radiology, oncology, or nuclear medicine are regularly monitored with thermoluminescent dosimeters. They might also enter the magnetic field of a magnetic resonance imaging scanner while supervising patients as well as during positron emission tomography-magnetic resonance imaging and magnetic resonance imaging-linac integrated imaging systems and will therefore be exposed to the magnetic fields of magnetic resonance imaging scanners and low stray fields of several millitesla outside of the magnetic resonance imaging scanner, not only before and after, but also during irradiation. Panasonic thermoluminescent dosimetry badges and ring dosimeters for personal monitoring were exposed to magnetic fields originating from a 7 T and a 3 T magnetic resonance imaging scanner as well as neodymium permanent magnets. Four different sealed Cs sources were used in two sets of experiments: (1) magnetically induced fading: irradiated thermoluminescent dosimeters (D ≈ 100 mSv) were exposed to a strong magnetic field (B = 7 T) of a human high-field magnetic resonance imaging scanner after irradiation; no magnetically induced fading (magnetoluminescence) for LiBO:Cu or CaSO:Tm was observed; (2) magnetically induced attenuation: thermoluminescent dosimeters were placed during irradiation in a magnetic field for about 60 h; a significantly reduced dose response was observed for LiBO:Cu-interestingly not at maximum B ≈ 7 T but at B ≈ 0.2 T. This experimental observation is possibly relevant especially for medical and technical personnel in nuclear medicine before and during a magnetic resonance imaging scanning procedure. Follow-up studies need to be made to clarify the kinetics of this effect.

Investigation of TLD and EBT3 performance under the presence of 1.5T, 0.35T, and 0T magnetic field strengths in MR/CT visible materials

PURPOSE

The aim of this study was to investigate thermoluminescent dosimeters (TLD) and radiochromic EBT3 film inside MR/CT visible geometric head and thorax phantoms in the presence of: 0, 0.35, and 1.5 T magnetic fields.

METHODS

Thermoluminescent Dosimeters reproducibility studies were examined by irradiating IROC-Houston's TLD acrylic block five times under 0 and 1.5 T configurations of Elekta's Unity system and three times under 0 and 0.35 T configurations of ViewRay's MRIdian Cobalt-60 (⁶⁰ Co) system. Both systems were irradiated with an equivalent 10 × 10 cm² field size, and a prescribed dose of 3 Gy to the maximum depth deposition (dmax). EBT3 film and TLDs were investigated using two geometrical Magnetic Resonance (MR)-guided Radiation Therapy (MRgRT) head and thorax phantoms. Each geometrical phantom had eight quadrants that combined to create a centrally located rectangular tumor (3 × 3 × 5 cm³ ) surrounded by tissue to form a 15 × 15 × 15 cm³ cubic phantom. Liquid polyvinyl chloride plastic and Superflab were used to simulate the tumor and surrounding tissue in the head phantom, respectively. Synthetic ballistic gel and a heterogeneous in-house mixture were used to construct the tumor and surrounding tissue in the thorax phantom, respectively. EBT3 and double-loaded TLDs were used in the phantoms to compare beam profiles and point dose measurements with and without magnetic fields. GEANT4 Monte Carlo simulations were performed to validate the detectors for both Unity 0 T/1.5 T and MRIdian 0 T/0.35 T configurations.

RESULTS

Average TLD block measurements which, compared the magnetic field effects (magnetic field vs 0 T) on the Unity and MRIdian systems, were 0.5% and 0.6%, respectively. The average ratios between magnetic field effects for the geometric thorax and head phantoms under the Unity system were -0.2% and 1.6% and for the MRIdian system were 0.2% and -0.3%, respectively. Beam profiles generated with both systems agreed with Monte Carlo measurements and previous literature findings.

CONCLUSIONS

TLDs and EBT3 film dosimeters could potentially be used in MR/CT visible tissue equivalent phantoms that will experience a magnetic field environment.

Investigation of magnetic field effects on the dose-response of 3D dosimeters for magnetic resonance - image guided radiation therapy applications

BACKGROUND AND PURPOSE

The strong magnetic field of integrated magnetic resonance imaging (MRI) and radiation treatment systems influences secondary electrons resulting in changes in dose deposition in three dimensions. To fill the need for volumetric dose quality assurance, we investigated the effects of strong magnetic fields on 3D dosimeters for MR-image-guided radiation therapy (MR-IGRT) applications.

MATERIAL AND METHODS

There are currently three main categories of 3D dosimeters, and the following were used in this study: radiochromic plastic (PRESAGE®), radiochromic gel (FOX), and polymer gel (BANG™). For the purposes of batch consistency, an electromagnet was used for same-day irradiations with and without a strong magnetic field (B₀, 1.5T for PRESAGE® and FOX and 1.0T for BANG™).

RESULTS

For PRESAGE®, the percent difference in optical signal with and without B₀ was 1.5% at the spectral peak of 632nm. For FOX, the optical signal percent difference was 1.6% at 440nm and 0.5% at 585nm. For BANG™, the percent difference in R₂ MR signal was 0.7%.

CONCLUSIONS

The percent differences in responses with and without strong magnetic fields were minimal for all three 3D dosimeter systems. These 3D dosimeters therefore can be applied to MR-IGRT without requiring a correction factor.

MR-safe personal radiation dosimeters

Magnetic resonance imaging (MRI) is being rapidly integrated for cancer treatments—such systems are referred to as MRI‐guided radiation therapy (MRIgRT). As the magnet of an MRI scanner is always on, the presence of a strong static magnetic field from the MRI scanner during radiotherapy delivery presents new challenges. One of the challenges is that a personal radiation dosimeter used to estimate the radiation dose deposited in an individual wearing the device must be MR‐safe. No such devices, however, are currently available. In this work we first modified an existing personal dosimeter (by removing a metal clip) to make it MR‐safe and then investigated potential effects of magnetic field on dosimeter readings, i.e., optically stimulated luminescent dosimeter (OSLD) readings. We found that the effect of magnetic field on OSLD sensitivity was within radiation protection tolerance levels. OSLD personal dosimeters can be directly used in conjunction with MRIgRT radiation protection purposes.