A solid water phantom material for radiotherapy x-ray and gamma-ray beam calibrations

Thermoplastic polymers as water substitutes

Background. New applications of 3D printing have recently appeared in the fields of radiotherapy and radiology, but the knowledge of many radiological characteristics of the compounds involved is still limited. Therefore, studies are needed to improve our understanding about the transport and interaction of ionizing radiation in these materials.Purpose. The purpose of this study is to perform an analysis of the most important radiation interaction parameters in thermoplastic materials used in Fused Deposition Modeling 3D printing. Additionally, we propose improvements to bring their characteristics closer to those of water and use them as water substitutes in applications such as radiodiagnosis, external radiotherapy, and brachytherapy.Methods. We have calculated different magnitudes as mass linear attenuation, mass energy absorption coefficients, as well as stopping power and electronic density of several thermoplastic materials along with various compounds that have been used as water substitutes and in a new proposed blend. To perform these computations, we have used the XCOM and ESTAR databases from NIST and the EGSnrc code for Montecarlo simulations.Results. From the representation of the calculated interaction parameters, we have been able to establish relationships between their properties and the proportion of certain chemical elements. In addition, studying these same characteristics in different commercial solutions used as substitutes for water phantoms allows us to extrapolate improvements for these polymers.Conclusion. The radiological characteristics of the analyzed thermoplastic materials can be improved by adding some chemical elements with atomic numbers higher than oxygen and by using polyethylene in new blends.

Low-cost chest paediatric phantom for dose optimisation: construction and validation

INTRODUCTION AND OBJECTIVES

In order to perform chest dose optimisation studies, the imaging phantom should be adequate for image quality evaluation. Since high-end phantoms are cost prohibitive, there is a need for a low-cost construction method with fairly available tissue substitutes.

MATERIALS AND METHODS

Theoretical calculations of radiological characteristics were performed for each of lung, cortical bone and soft tissues in order to choose appropriate substitute, then, cork, P.V.C. (Polyvinyl chloride) and water were chosen, respectively. Validation included, firstly, measuring CT Hounsfield Units (HU) of a real patient's tissues then compared against their corresponding anatomies in the constructed phantom. Secondly, Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) values were acquired in this study to evaluate the quality of images generated from the constructed phantom, then, compare their trends with a valid phantom under different exposure parameters (kVp and mAs).

RESULTS

From theoretical calculations, the percentage differences showed high accuracy of tissue substitutes when simulating real patient tissues; P.V.C. was ≥5.78%, cork was ≥4.46% and water ≥5%. The percentage difference (CT HU) between lung and cortical bone and their equivalent tissue substitutes were 10.44% and 0.53%-3.17%, respectively. Strong positive correlations were found for SNR when changing both kVp (0.79) and mAs (0.65). While the correlation strength of CNR values were found to be moderate when changing both kVp (0.58) and mAs (0.53).

CONCLUSIONS

Our low-cost phantom approved through CT HU that their materials replicate the radiological characteristics of real one-year-old child while SNR and SNR correlations confirmed its applicability in imaging and optimisation studies.

Performance of natural product-based materials as adhesives in the fabrication of mangrove wood composites

Biodegradable adhesives prepared using three different forms of soy protein-based products (defatted soy flour/soy protein concentrate/soy protein isolate), sodium hydroxide, and itaconic acid polyamidoamine-epichlorohydrin (IA-PAE) with 0 wt%-20 wt% substitution rates were utilized to enhance the production of mangrove wood composites. ¹H nuclear magnetic resonance, differential scanning calorimetry, and ultra-high-resolution field emission scanning electron microscopy were employed to characterize the composite samples. Other measurements involved the determination of viscosity, pH, physical, mechanical, dimensional stability, CT numbers, and relative electron density parameters. The ideal curing conditions for the composite bio-adhesives were found to be 15 wt% IA-PAE, 602.50 ± 172.21-391.11 ± 105.82 mPa s, pH 11.0, 180 °C, and 18 min, respectively. The improved physiochemical characteristics of DSF, SPC, and SPI confirmed that NaOH/IA-PAE was integrated into the adhesive system and ameliorated the overall performance of the resulting composites. The results showed that all composite samples, except for those bonded with 0 wt% and 5 wt% IA-PAE, matched up with the quality specification stated in the JIS A-5908 and ASTM D1037. Samples D1, D2, and D3 exhibited optimum characteristics, demonstrating their uses in the development of low-toxicity and sustainable reference tissue substitute phantom in radiological areas.

Prediction of proton beam range in phantom with metals based on monochromatic energy CT images

The purpose of the study was to evaluate the accuracy of monochromatic energy (MonoE) computed tomography (CT) images reconstructed by spectral CT in predicting the stopping power ratio $( SP{R}_w)$ of materials in the presence of metal. The CIRS062 phantom was scanned three times using spectral CT. In the first scan, a solid water insert was placed at the center of the phantom $(C{T}_{no\ metal})$. In the second scan, the solid water insert was replaced with a titanium alloy femoral head $(C{T}_{metal})$. The metal artifact reduction (MAR) algorithm was used in the last scan $(C{T}_{metal+ MAR})$. The MonoE-CT images of 40 keV and 80 keV were reconstructed. Finally, the single-energy CT method (SECT) and the dual-energy CT method (DECT) were used to calculate the $SP{R}_w$. The mean absolute error (MAE) of the $SP{R}_w$ of the inner layer inserts calculated by the SECT method were 3.19%, 13.88% and 2.71%, corresponding to $C{T}_{no\ metal}$, $C{T}_{metal}$ and $C{T}_{metal+ MAR}$, respectively. For the outer layer inserts, the MAE of $SP{R}_w$ were 3.43%, 5.42% and 2.99%, respectively. Using the DECT method, the MAE of the $SP{R}_w$ of the inner layer inserts was 1.30%, 3.69% and 1.46% and the MAE of the outer layer inserts- was 1.34%, 1.36% and 1.05%. The studies shows that, compared with the SECT method, the accuracy of the DECT method in predicting the $SP{R}_w$ of a material is more robust to the presence of metal. Using the MAR algorithm when performing CT scans can further improve the accuracy of predicting the SPR of materials in the presence of metal.

Characterization of GafChromic EBT2 film dose measurements using a tissue-equivalent water phantom for a Theratron® Equinox Cobalt-60 teletherapy machine

Purpose

In vivo dosimetry is a quality assurance tool that provides post-treatment measurement of the absorbed dose as delivered to the patient. This dosimetry compares the prescribed and measured dose delivered to the target volume. In this study, a tissue-equivalent water phantom provided the simulation of the human environment. The skin and entrance doses were measured using GafChromic EBT2 film for a Theratron® Equinox Cobalt-60 teletherapy machine.

Methods

We examined the behaviors of unencapsulated films and custom-made film encapsulation. Films were cut to 1 cm × 1 cm, calibrated, and used to assess skin dose depositions and entrance dose. We examined the response of the film for variations in field size, source to skin distance (SSD), gantry angle and wedge angle.

Results

The estimated uncertainty in EBT2 film for absorbed dose measurement in phantom was ±1.72%. Comparison of the measurements of the two film configurations for the various irradiation parameters were field size (p = 0.0193, α = 0.05, n = 11), gantry angle (p = 0.0018, α = 0.05, n = 24), SSD (p = 0.1802, α = 0.05, n = 11) and wedge angle (p = 0.6834, α = 0.05, n = 4). For a prescribed dose of 200 cGy and at reference conditions (open field 10 cm x 10 cm, SSD = 100 cm, and gantry angle = 0º), the measured skin dose using the encapsulation material was 70% while that measured with the unencapsulated film was 24%. At reference irradiation conditions, the measured skin dose using the unencapsulated film was higher for open field configurations (24%) than wedged field configurations (19%). Estimation of the entrance dose using the unencapsulated film was within 3% of the prescribed dose.

Conclusions

GafChromic EBT2 film measurements were significantly affected at larger field sizes and gantry angles. Furthermore, we determined a high accuracy in entrance dose estimations using the film.

Technical Note: Bremsstrahlung dose in the electron beam at extended distances in total skin electron therapy

PURPOSE

Electron beam from a linear accelerator is commonly used in total skin electron Therapy (TSET) at extended distances. Since Das et al (Med Phys 21, p.1733, 1994) reported 5% bremsstrahlung dose for a 6 MeV electron beam at extended distance of 500 cm it has been accepted as common knowledge. However, measurements by Chen et al (Int J. Rad Onc Biol Phys 59 p.872, 2004) and Monte Carlo simulations by Ding et al (Phys. Med. Biol. 66, 075010, 2021) were unable to reproduce such high bremsstrahlung dose. As bremsstrahlung dose contributes to whole-body dose which could produce bone marrow toxicity with serious complications for the outcome of the TSET, it is important to re-evaluate the magnitude of bremsstrahlung dose accurately.

METHODS

The EGSnrc Monte Carlo system is used to investigate bremsstrahlung doses from 6 MeV high dose rate total skin electron (HDTSe) beams from Varian TrueBeam and Clinac Accelerators. The measurements were carried out at depth of d_max and 5 cm in solid water and Acrylic phantoms at extended distances using a parallel-plate chamber and a cylindrical ion chamber.

RESULTS

We were able to reproduce previously reported high bremsstrahlung dose at extended distances by using a parallel plate ionization chamber. However, both the measurements by using a cylindrical chamber and Monte Carlo simulations showed an insignificant bremsstrahlung dose (∼1%) even at SSD = 500 cm.

CONCLUSION

The bremsstrahlung doses of a 6 MeV electron beam are 0.5% to 1% for SSD from 100 to 700 cm, although it increases with the increasing extended distance. The common belief of up to 5% bremsstrahlung dose at large extended distances is incorrect. Previously reported high bremsstrahlung doses might be due to poor signal-to-noise ratio of using parallel plate chamber for measuring very low dose or particular set-up. This article is protected by copyright. All rights reserved.

The feasibility of an approximate irregular field dose distribution simulation program applied to a respiratory motion compensation system

PURPOSE

This study optimized our previously proposed simulation program for the approximate irregular field dose distribution (SPAD) and applied it to a respiratory motion compensation system (RMCS) and respiratory motion simulation system (RMSS). The main purpose was to rapidly analyze the two-dimensional dose distribution and evaluate the compensation effect of the RMCS during radiotherapy.

METHODS

This study modified the SPAD to improve the rapid analysis of the dose distribution. In the experimental setup, four different respiratory signal patterns were input to the RMSS for actuation, and an ultrasound image tracking algorithm was used to capture the real-time respiratory displacement, which was input to the RMCS for actuation. A linear accelerator simultaneously irradiated the EBT3 film. The gamma passing rate was used to verify the dose similarity between the EBT3 film and the SPAD, and conformity index (CI) and compensation rate (CR) were used to quantify the compensation effect.

RESULTS

The Gamma passing rates were 70.48-81.39% (2%/2mm) and 88.23-96.23% (5%/3mm) for various collimator opening patterns. However, the passing rates of the SPAD and EBT3 film ranged from 61.85% to 99.85% at each treatment time point. Under the four different respiratory signal patterns, CR ranged between 21% and 75%. After compensation, the CI for 85%, 90%, and 95% isodose constraints were 0.78, 0.57, and 0.12, respectively.

CONCLUSIONS

This study has demonstrated that the dose change during each stage of the treatment process can be analyzed rapidly using the improved SPAD. After compensation, applying the RMCS can reduce the treatment errors caused by respiratory movements.

Comparison of the RayStation photon Monte Carlo dose calculation algorithm against measured data under homogeneous and heterogeneous irradiation geometries

PURPOSE

This work compares Monte Carlo dose calculations performed using the RayStation treatment planning system against data measured on a Varian Truebeam linear accelerator with 6 MV and 10 MV FFF photon beams.

METHODS

The dosimetric performance of the RayStation Monte Carlo calculations was evaluated in a variety of irradiation geometries employing homogeneous and heterogeneous phantoms. Profile and depth dose comparisons against measurement were carried out in relative mode using the gamma index as a quantitative measure of similarity within the central high dose regions.

RESULTS

The results demonstrate that the treatment planning system dose calculation engine agrees with measurement to within 2%/1 mm for more than 95% of the data points in the high dose regions for all test cases. A systematic underestimation was observed at the tail of the profile penumbra and out of field, with mean differences generally <0.5 mm or 1% of curve dose maximum respectively. Out of field agreement varied between evaluated beam models.

CONCLUSIONS

The RayStation implementation of photon Monte Carlo dose calculations show good agreement with measured data for the range of scenarios considered in this work and is deemed sufficiently accurate for introduction into clinical use.

Design, Fabrication, and Validation of a Polymethyl Methacrylate Head Phantom for Dosimetric Verification of Cranial Radiotherapy Treatment Plans

Purpose:

The present study aims to design and fabricate a novel, versatile, and cost-effective Polymethyl Methacrylate (PMMA) head phantom for the dosimetric pretreatment verification of radiotherapy (RT) treatment plans.

Materials and Methods:

The head phantom designing involves slice-wise modeling of an adult head using PMMA. The phantom has provisions to hold detectors such as ionization chambers of different sizes, Gafchromic films, gel dosimeter, and optically stimulated luminescence dosimeter. For the point dose verification purpose, 15 volumetric modulated arc therapy patient plans were selected, and doses were measured using a CC13 ionization chamber. The percentage gamma passing rate was calculated for acceptance criteria 3%/3 mm and 2%/2 mm using OmniPro I’mRT film QA software, and Gafchromic EBT3 films were used for 2D planar dose verification.

Results:

Treatment planning system calculated, and the measured point doses showed a percentage deviation ranged from 0.26 to 1.92. The planar dose fluence measurements, for set acceptance criteria of 3%/3 mm and 2%/2 mm, percentages of points having gamma value <1 were in the range of 99.17 ± 0.25 to 99.88 ± 0.15 and 93.16 ± 0.38 to 98.89 ± 0.23, respectively. Measured dose verification indices were within the acceptable limit.

Conclusions:

The dosimetric study reveals that head phantom can be used for routine pretreatment verification for the cranial RT, especially for stereotactic radiosurgery/RT as a part of patient-specific quality assurance. The presently fabricated and validated phantom is novel, versatile, and cost-effective, and many institutes can afford it.

Evolution of radiation protection for medical workers

Within a few months of discovery, X-rays were being used worldwide for diagnosis and within a year or two for therapy. It became clear very quickly that while there were immense benefits, there were significant associated hazards, not only for the patients, but also for the operators of the equipment. Simple radiation protection measures were implemented within a decade or two and radiation protection for physicians and other operators has continued to evolve over the last century driven by cycles of widening uses, new technologies, realization of previously unidentified effects, development of recommendations and regulations, along with the rise of related societies and professional organizations. Today, the continue acceleration of medical radiation uses in diagnostic imaging and in therapeutic modalities not imagined at the turn of this century, such as positron emission tomography, calls for constant vigilance and flexibility to provide adequate protection for the growing numbers of medical radiation workers.

Evaluation of the water-equivalence of plastic materials in low- and high-energy clinical proton beams

The aim of this work was to evaluate the water-equivalence of new trial plastics designed specifically for light-ion beam dosimetry as well as commercially available plastics in clinical proton beams. The water-equivalence of materials was tested by computing a plastic-to-water conversion factor, [Formula: see text]. Trial materials were characterized experimentally in 60 MeV and 226 MeV un-modulated proton beams and the results were compared with Monte Carlo simulations using the FLUKA code. For the high-energy beam, a comparison between the trial plastics and various commercial plastics was also performed using FLUKA and Geant4 Monte Carlo codes. Experimental information was obtained from laterally integrated depth-dose ionization chamber measurements in water, with and without plastic slabs with variable thicknesses in front of the water phantom. Fluence correction factors, [Formula: see text], between water and various materials were also derived using the Monte Carlo method. For the 60 MeV proton beam, [Formula: see text] and [Formula: see text] factors were within 1% from unity for all trial plastics. For the 226 MeV proton beam, experimental [Formula: see text] values deviated from unity by a maximum of about 1% for the three trial plastics and experimental results showed no advantage regarding which of the plastics was the most equivalent to water. Different magnitudes of corrections were found between Geant4 and FLUKA for the various materials due mainly to the use of different nonelastic nuclear data. Nevertheless, for the 226 MeV proton beam, [Formula: see text] correction factors were within 2% from unity for all the materials. Considering the results from the two Monte Carlo codes, PMMA and trial plastic #3 had the smallest [Formula: see text] values, where maximum deviations from unity were 1%, however, PMMA range differed by 16% from that of water. Overall, [Formula: see text] factors were deviating more from unity than [Formula: see text] factors and could amount to a few percent for some materials.

Initial experiments with gel-water: towards MRI-linac dosimetry and imaging

Tracking the position of a moving radiation detector in time and space during data acquisition can replicate 4D image-guided radiotherapy (4DIGRT). Magnetic resonance imaging (MRI)-linacs need MRI-visible detectors to achieve this, however, imaging solid phantoms is an issue. Hence, gel-water, a material that provides signal for MRI-visibility, and which will in future work, replace solid water for an MRI-linac 4DIGRT quality assurance tool, is discussed. MR and CT images of gel-water were acquired for visualisation and electron density verification. Characterisation of gel-water at 0 T was compared to Gammex-RMI solid water, using MagicPlate-512 (M512) and RMI Attix chamber; this included percentage depth dose, tissue-phantom ratio (TPR_20/10), tissue-maximum ratio (TMR), profiles, output factors, and a gamma analysis to investigate field penumbral differences. MR images of a non-powered detector in gel-water demonstrated detector visualisation. The CT-determined gel-water electron density agreed with the calculated value of 1.01. Gel-water depth dose data demonstrated a maximum deviation of 0.7% from solid water for M512 and 2.4% for the Attix chamber, and by 2.1% for TPR_20/10 and 1.0% for TMR. FWHM and output factor differences between materials were ≤0.3 and ≤1.4%. M512 data passed gamma analysis with 100% within 2%, 2 mm tolerance for multileaf collimator defined fields. Gel-water was shown to be tissue-equivalent for dosimetry and a feasible option to replace solid water.

Spaceflight-Relevant Challenges of Radiation and/or Reduced Weight Bearing Cause Arthritic Responses in Knee Articular Cartilage

There is little known about the effect of both reduced weight bearing and exposure to radiation during spaceflight on the mechanically-sensitive cartilage lining the knee joint. In this study, we characterized cartilage damage in rat knees after periods of reduced weight bearing with/without exposure to solar-flare-relevant radiation, then cartilage recovery after return to weight bearing. Male Sprague Dawley rats (n = 120) were either hindlimb unloaded (HLU) via tail suspension or remained weight bearing in cages (GROUND). On day 5, half of the HLU and GROUND rats were 1 Gy total-body X-ray irradiated during HLU, and half were sham irradiated (SHAM), yielding 4 groups: GROUND-SHAM; GROUND-IR; HLU-SHAM; and HLU-IR. Hindlimbs were collected from half of each group of rats on day 13. The remaining rats were then removed from HLU or remained weight bearing, and hindlimbs from these rats were collected on day 62. On day 13, glycosaminoglycan (GAG) content in cartilage lining the tibial plateau and femoral condyles of HLU rats was lower than that of the GROUND animals. Likewise, on day 13, immunoreactivity of the collagen type II-degrading matrix metalloproteinase-13 (MMP-13) and of a resultant metalloproteinase-generated neoepitope VDIPEN was increased in all groups versus GROUND-SHAM. Clustering of chondrocytes indicating cartilage damage was present in all HLU and IR groups versus GROUND-SHAM on day 13. On day 62, after 49 days of reloading, the loss of GAG content was attenuated in the HLU-SHAM and HLU-IR groups, and the increased VDIPEN staining in all treatment groups was attenuated. However, the increased chondrocyte clustering remained in all treatment groups on day 62. MMP-13 activity also remained elevated in the GROUND-IR and HLU-IR groups. Increased T2 relaxation times, measured on day 62 using 7T MRI, were greater in GROUND-IR and HLU-IR knees, indicating persistent cartilage damage in the irradiated groups. Both HLU and total-body irradiation resulted in acute degenerative and pre-arthritic changes in the knee articular cartilage of rats. A return to normal weight bearing resulted in some recovery from cartilage degradation. However, radiation delivered as both a single challenge and when combined with HLU resulted in chronic cartilage damage. These findings suggest that radiation exposure during spaceflight leads to and/or impairs recovery of cartilage upon return to reloading, generating long-term joint problems for astronauts.

Effect of inorganic salts and glucose additives on dose-response, melting point and mass density of genipin gel dosimeters

Genipin gel dosimeters are hydrogels infused with a radiation-sensitive material which yield dosimetric information in three dimensions (3D). The effect of inorganic salts and glucose on the visible absorption dose-response, melting points and mass density of genipin gel dosimeters has been experimentally evaluated using 6-MV LINAC photons. As a result, the addition of glucose with optimum concentration of 10% (w/w) was found to improve the thermal stability of the genipin gel and increase its melting point (Tm) by 6 °C accompanied by a slight decrease of dose-response. Furthermore, glucose helps to adjust the gel mass density to obtain the desired tissue-equivalent properties. A drop of Tm was observed when salts were used as additives. As the salt concentration increased, gel Tm decreased. The mass density and melting point of the genipin gel could be adjusted using different amounts of glucose that improved the genipin gel suitability for 3D dose measurements without introducing additional toxicity to the final gel.

A reproducible radiation delivery method for unanesthetized rodents during periods of hind limb unloading

Exposure to the spaceflight environment has long been known to be a health challenge concerning many body systems. Both microgravity and/or ionizing radiation can cause acute and chronic effects in multiple body systems. The hind limb unloaded (HLU) rodent model is a ground-based analogue for microgravity that can be used to simulate and study the combined biologic effects of reduced loading with spaceflight radiation exposure. However, studies delivering radiation to rodents during periods of HLU are rare. Herein we report the development of an irradiation protocol using a clinical linear accelerator that can be used with hind limb unloaded, unanesthetized rodents that is capable of being performed at most academic medical centers. A 30.5 cm×30.5 cm×40.6 cm30.5 cm×30.5 cm×40.6 cm rectangular chamber was constructed out of polymethyl methacrylate (PMMA) sheets (0.64 cm thickness). Five centimeters of water-equivalent material were placed outside of two PMMA inserts on either side of the rodent that permitted the desired radiation dose buildup (electronic equilibrium) and helped to achieve a flatter dose profile. Perforated aluminum strips permitted the suspension dowel to be placed at varying heights depending on the rodent size. Radiation was delivered using a medical linear accelerator at an accelerating potential of 10 MV. A calibrated PTW Farmer ionization chamber, wrapped in appropriately thick tissue-equivalent bolus material to simulate the volume of the rodent, was used to verify a uniform dose distribution at various regions of the chamber. The dosimetry measurements confirmed variances typically within 3%, with maximum variance <10% indicated through optically stimulated luminescent dosimeter (OSLD) measurements, thus delivering reliable spaceflight-relevant total body doses and ensuring a uniform dose regardless of its location within the chamber. Due to the relative abundance of LINACs at academic medical centers and the reliability of their dosimetry properties, this method may find great utility in the implementation of future ground-based studies that examine the combined spaceflight challenges of reduced loading and radiation while using the HLU rodent model.

Skin dose measurements using radiochromic films, TLDS and ionisation chamber and comparison with Monte Carlo simulation

Estimation of the surface dose is very important for patients undergoing radiation therapy. The purpose of this study is to investigate the dose at the surface of a water phantom at a depth of 0.007 cm as recommended by the International Commission on Radiological Protection and International Commission on Radiation Units and Measurement with radiochromic films (RFs), thermoluminescent dosemeters and an ionisation chamber in a 6-MV photon beam. The results were compared with the theoretical calculation using Monte Carlo (MC) simulation software (MCNP5, BEAMnrc and DOSXYZnrc). The RF was calibrated by placing the films at a depth of maximum dose (d(max)) in a solid water phantom and exposing it to doses from 0 to 500 cGy. The films were scanned using a transmission high-resolution HP scanner. The optical density of the film was obtained from the red component of the RGB images using ImageJ software. The per cent surface dose (PSD) and percentage depth dose (PDD) curve were obtained by placing film pieces at the surface and at different depths in the solid water phantom. TLDs were placed at a depth of 10 cm in a solid water phantom for calibration. Then the TLDs were placed at different depths in the water phantom and were exposed to obtain the PDD. The obtained PSD and PDD values were compared with those obtained using a cylindrical ionisation chamber. The PSD was also determined using Monte Carlo simulation of a LINAC 6-MV photon beam. The extrapolation method was used to determine the PSD for all measurements. The PSD was 15.0±3.6% for RF. The TLD measurement of the PSD was 16.0±5.0%. The (0.6 cm(3)) cylindrical ionisation chamber measurement of the PSD was 50.0±3.0%. The theoretical calculation using MCNP5 and DOSXYZnrc yielded a PSD of 15.0±2.0% and 15.7±2.2%. In this study, good agreement between PSD measurements was observed using RF and TLDs with the Monte Carlo calculation. However, the cylindrical chamber measurement yielded an overestimate of the PSD. This is probably due to the ionisation chamber calibration factor that is only valid in charged particle equilibrium condition, which is not achieved at the surface in the build-up region.

The effect of metallic tracheal stents on radiation dose in the airway and surrounding tissues

BACKGROUND

Metallic airway stents are often used in the management of central airway malignancies. The presence of a metallic foreign body may affect radiation dose in tissue. We studied the effect of a metallic airway stent on radiation dose delivery in a phantom and an in vivo porcine model.

METHODS

A metallic tracheal stent was fitted onto a support in a water phantom. Point dosimeters were positioned in the phantom around the support and the stent. Irradiation was then performed on a linear accelerator with and without the stent. Metallic tracheal stents were deployed in the trachea of three pigs. Dosimeters were implanted in the tissues near (Group 1) and away (Group 2) from the stent. The pigs were then irradiated, and the dose perturbation factor was calculated by comparing the actual dose detected by the dosimeters versus the planned dose.

RESULTS

The difference in the dose detected by the dosimeters and the planned dose ranged from 1.8% to 6.1% for the phantom with the stent and 0%-5.3% for the phantom without the stent. These values were largely within the manufacturer's specified error of 5%. No significant difference was observed in the dose perturbation factor for Group 1 and Group 2 dosimeters (0.836 ± 0.058 versus 0.877 ± 0.088, P = 0.220) in all the three pigs.

CONCLUSIONS

Metallic airway stents do not significantly affect radiation dose in the airway and surrounding tissues in a phantom and porcine model. Radiation treatment planning systems can account for the presence of the stent. External beam radiation can be delivered without concern for significant dose perturbation.

Monte Carlo-based investigation of water-equivalence of solid phantoms at (137)Cs energy

Investigation of solid phantom materials such as solid water, virtual water, plastic water, RW1, polystyrene, and polymethylmethacrylate (PMMA) for their equivalence to liquid water at (137)Cs energy (photon energy of 662 keV) under full scatter conditions is carried out using the EGSnrc Monte Carlo code system. Monte Carlo-based EGSnrc code system was used in the work to calculate distance-dependent phantom scatter corrections. The study also includes separation of primary and scattered dose components. Monte Carlo simulations are carried out using primary particle histories up to 5 × 10(9) to attain less than 0.3% statistical uncertainties in the estimation of dose. Water equivalence of various solid phantoms such as solid water, virtual water, RW1, PMMA, polystyrene, and plastic water materials are investigated at (137)Cs energy under full scatter conditions. The investigation reveals that solid water, virtual water, and RW1 phantoms are water equivalent up to 15 cm from the source. Phantom materials such as plastic water, PMMA, and polystyrene phantom materials are water equivalent up to 10 cm. At 15 cm from the source, the phantom scatter corrections are 1.035, 1.050, and 0.949 for the phantoms PMMA, plastic water, and polystyrene, respectively.

X-ray phase contrast imaging of the breast: analysis of tissue simulating materials

PURPOSE

Phase contrast imaging, particularly of the breast, is being actively investigated. The purpose of this work is to investigate the x-ray phase contrast properties of breast tissues and commonly used breast tissue substitutes or phantom materials with an aim of determining the phantom materials best representative of breast tissues.

METHODS

Elemental compositions of breast tissues including adipose, fibroglandular, and skin were used to determine the refractive index, n = 1 - δ + i β. The real part of the refractive index, specifically the refractive index decrement (δ), over the energy range of 5-50 keV were determined using XOP software (version 2.3, European Synchrotron Radiation Facility, France). Calcium oxalate and calcium hydroxyapatite were considered to represent the material compositions of microcalcifications in vivo. Nineteen tissue substitutes were considered as possible candidates to represent adipose tissue, fibroglandular tissue and skin, and four phantom materials were considered as possible candidates to represent microcalcifications. For each material, either the molecular formula, if available, or the elemental composition based on weight fraction, was used to determine δ. At each x-ray photon energy, the absolute percent difference in δ between the breast tissue and the substitute material was determined, from which three candidates were selected. From these candidate tissue substitutes, the material that minimized the absolute percent difference in linear attenuation coefficient μ, and hence β, was considered to be best representative of that breast tissue.

RESULTS

Over the energy range of 5-50 keV, while the δ of CB3 and fibroglandular tissue-equivalent material were within 1% of that of fibroglandular tissue, the μ of fibroglandular tissue-equivalent material better approximated the fibroglandular tissue. While the δ of BR10 and adipose tissue-equivalent material were within 1% of that of adipose tissue, the tissue-equivalent material better approximated the adipose tissue in terms of μ. Polymethyl methacrylate, a commonly used tissue substitute, exhibited δ greater than fibroglandular tissue by ≈ 12%. The A-150 plastic closely approximated the skin. Several materials exhibited δ between that of adipose and fibroglandular tissue. However, there was an energy-dependent mismatch in terms of equivalent fibroglandular weight fraction between δ and μ for these materials. For microcalcifications, aluminum and calcium carbonate were observed to straddle the δ and μ of calcium oxalate and calcium hydroxyapatite. Aluminum oxide, commonly used to represent microcalcifications in the American College of Radiology recommended phantoms for accreditation exhibited δ greater than calcium hydroxyapatite by ≈ 23%.

CONCLUSIONS

A breast phantom comprising A-150 plastic to represent the skin, commercially available adipose and fibroglandular tissue-equivalent formulations to represent adipose and fibroglandular tissue, respectively, was found to be best suited for x-ray phase-sensitive imaging of the breast. Calcium carbonate or aluminum can be used to represent microcalcifications.

Direct action of radiation on mummified cells: modeling of computed tomography by Monte Carlo algorithms

X-ray imaging is a nondestructive and preferred method in paleopathology to reconstruct the history of ancient diseases. Sophisticated imaging technologies such as computed tomography (CT) have become common for the investigation of skeletal disorders in human remains. Researchers have investigated the impact of ionizing radiation on living cells, but never on ancient cells in dry tissue. The effects of CT exposure on ancient cells have not been examined in the past and may be important for subsequent genetic analysis. To remedy this shortcoming, we developed different Monte Carlo models to simulate X-ray irradiation on ancient cells. Effects of mummification were considered by using two sizes of cells and three different phantom tissues, which enclosed the investigated cell cluster. This cluster was positioned at the isocenter of a CT scanner model, where the cell hit probabilities P(0,1,…, n) were calculated according to the Poisson distribution. To study the impact of the dominant physics process, CT scans for X-ray spectra of 80 and 120 kVp were simulated. Comparison between normal and dry tissue phantoms revealed that the probability of unaffected cells increased by 21 % following cell shrinkage for 80 kVp, while for 120 kVp, a further increase of unaffected cells of 23 % was observed. Consequently, cell shrinkage caused by dehydration decreased the impact of X-ray radiation on mummified cells significantly. Moreover, backscattered electrons in cortical bone protected deeper-lying ancient cells from radiation damage at 80 kVp X-rays.

Measurement of effects of nasal and facial shields on delivered radiation dose for superficial x-ray treatments

Kilovoltage x-ray beams are used for the treatment of facial cancers when located on the patient's skin or subcutaneous tissue. This is of course due to the sharp depth dose characteristics of these beams delivering much lower doses at depth, than high energy x-ray beams. When treatment is performed, lead shields are often used within the nasal passage, or behind the lips and ears. These shields affect the backscattering patterns of the x-ray beams producing perturbations to upstream dose thus reducing delivered dose to the tumour. Experimental results using radiochromic films have shown that up to 10.5% ± 1.9% reduction in tumour dose can occur for field sizes less than 5 cm circle diameter for x-ray beams of 50 to 150 kVp. These results were confirmed using EGSnrc Monte Carlo techniques. Clinically more than 70% of treatments used fields of diameters less than 3 cm where the reductions were up to 6% ± 1.3%. Using a 1 cm diameter field, which can be used for skin cancer treatment on the nose, reductions up to 2.5% ± 1.3% were seen. Thus corrections need to be applied for dose calculations when underlying lead shields are used clinically in kilovoltage x-rays. The size of the reduction was also found to be dependent on the depth of the shield which will normally clinically vary from approximately 0.5 cm for nasal shields or behind eye lobes and up to approximately 1 cm for lips or cheek areas. We recommend that clinics utilize data for corrections to delivered dose in kilovoltage x-ray beams when lead shields are used in nasal passages, behind lips or behind ears for dose reduction. This can be easily and accurately measured with EBT2 Gafchromic film.

Measurement and effects of MOSKIN detectors on skin dose during high energy radiotherapy treatment

During in vivo dosimetry for megavoltage X-ray beams, detectors such as diodes, Thermo luminescent dosimeters (TLD's) and MOSFET devices are placed on the patient's skin. This of course will affect the skin dose delivered during that fraction of the treatment. Whilst the overall impact on increasing skin dose would be minimal, little has been quantified concerning the level of increase in absorbed dose, in vivo dosimeters produce when placed in the beams path. To this extent, measurements have been made and analysis performed on dose changes caused by MOSKIN, MOSFET, skin dose detectors. Maximum increases in skin dose were measured as 15 % for 6 MV X-rays and 10 % for 10 MV X-rays at the active crystal of the MOSKIN device which is the thickest part of the detector. This is compared to 32 and 26 % for a standard 1 mm thick LiF TLD at 10 × 10 cm(2) field size for 6 and 10 MV X-rays respectively. Radiochromic film, EBT2 has been shown to provide a high resolution 2 dimensional map of skin dose from these detectors and measures the effects of in vivo dosimeters used for radiotherapy dose assessment.

Esophageal cancer patients undergoing external beam radiation after placement of self-expandable metal stents: is there a risk of radiation dose enhancement?

BACKGROUND

Self-expandable metal stents (SEMSs) are used for palliation of malignant dysphagia. It is not known whether dose adjustments are required when there is a stent in the radiation field.

OBJECTIVE

To measure the effects of esophageal stents of various designs and materials on radiation dose to the tissue adjacent to the stent in the radiation field to determine whether there should be any dose adjustment.

DESIGN

Simulated clinical protocol.

SETTING

Linear accelerator radiation treatment center.

PATIENTS

Solid Water phantoms were used to mimic the tissue environment of the human esophagus as well as stents of various designs and materials and controls.

INTERVENTIONS

Radiation beams composed of photons (x-rays) delivered in split dosing with energies of 6, 10, and 15 million volts.

MAIN OUTCOME MEASUREMENTS

Film and image-based evidence of dose enhancement; Monte Carlo calculations.

RESULTS

Dose enhancement from single beams was seen only on the anterior surface, particularly in the stainless steel Z-stent (3.5%-7.8%) and the nonmetal Polyflex stent (5.5%-8.8%); less dose enhancement was seen on the anterior surface of the Alimaxx and Ultraflex nitinol stents (2%-2.5%). A negligible dose effect was seen on the posterior wall of all the stents tested. Monte Carlo calculation results were roughly similar to actual dosimeter measurements.

LIMITATIONS

Simulated clinical protocol.

CONCLUSIONS

This tissue-mimicking model reveals that radiation dose enhancement is a function of stent design and material, and the dose reduction is unnecessary as long as multiple fields are used.

Dosimetric impact of density variations in Solid Water 457 water-equivalent slabs

The purpose of this study was to determine the dosimetric impact of density variations observed in water-equivalent solid slabs. Measurements were performed using two 30 cm × 30 cm water-equivalent slabs, one being 4 cm think and the other 5 cm thick. The location and extent of density variations were determined by computed tomography (CT) scans. Additional imaging measurements were made with an amorphous silicon megavoltage portal imaging device and an ultrasound unit. Dosimetric measurements were conducted with a 2D ion chamber array, and a scanned diode in water. Additional measurements and calculations were made of small rectilinear void inhomogeneities formed with water-equivalent slabs, using a 2D ion chamber array and the convolution superposition algorithm. Two general types of density variation features were observed on CT images: 1) regions of many centimeters across, but typically only a few millimeters thick, with electron densities a few percent lower than the bulk material, and 2) cylindrical regions roughly 0.2 cm in diameter and up to 20 cm long with electron densities up to 5% lower than the surrounding material. The density variations were not visible on kilovoltage, megavoltage or ultrasound images. The dosimetric impact of the density variations were not detectable to within 0.1% using the 2D ion chamber array or the scanning photon diode at distances 0.4 cm to 2 cm beyond the features. High-resolution dosimetric calculations using the convolution-superposition algorithm with density corrections enabled on CT-based datasets showed no discernable dosimetric impact. Calculations and measurements on simulated voids place the upper limit on possible dosimetric variations from observed density variations at much less than 0.6%. CT imaging of water-equivalent slabs may reveal density variations which are otherwise unobserved with kV, MV, or ultrasound imaging. No dosimetric impact from these features was measureable with an ion chamber array or scanned photon diode. Consequently, they were determined to be acceptable for all clinical use.

Solid water as phantom material for dosimetry of electron backscatter using low-energy electron beams: a Monte Carlo evaluation

This study evaluated the dosimetry of electron backscatter when Solid Water is used to substitute water as phantom in electron radiotherapy. Monte Carlo simulation (EGSnrc-based code) was employed to predict electron energy spectra and depth doses for the 0.5 and 1 cm of Solid Water and water slabs above 3 mm of lead (Pb) layers using electron beams with energies of 4 and 6 MeV. For comparison, Monte Carlo simulations were repeated with Pb layers taken out from the phantoms using the same experimental configuration. Analyses on electron energy spectra for the 4 and 6 MeV electron beams showed that deviations of electron energy distributions between the Solid Water and water phantom were more significant in the high-energy range (i.e., close to the maximal electron energy) than the lower range corresponding to the electron backscatter. These deviations of electron energy spectra varied with depth and were mainly due to the electron fluence or beam attenuation. Dosimetry results from Monte Carlo simulations showed that the Solid Water phantom had lower depth dose compared to water with the same experimental setup. For the 4 MeV electron beams with 0.5 cm of Solid Water, depth doses were 1.8%-3.9% and 2.3%-4.4% lower than those in water, with and without the Pb layer underneath, respectively. Thicker Solid Water of 1 cm resulted in different decreases in depth doses of 1.8%-4.6% (with Pb) and 2.3%-4.4% (without Pb) compared to water. For higher nominal electron beam energy of 6 MeV with 0.5 cm of Solid Water, depth doses decreased 1.7%-2.9% (with Pb) and 1.6%-2.1% (without Pb) compared to water. These decreases in depth doses changed to 1.7%-3.7% (with Pb) and 1.7%-3% (without Pb) when the thickness of Solid Water was increased to 1 cm. The dosimetry data in this study are useful in determining the correction factor when using Solid Water to substitute water for the electron backscatter measurement in electron radiotherapy.

Cerenkov light spectrum in an optical fiber exposed to a photon or electron radiation therapy beam

A Cerenkov signal is generated when energetic charged particles enter the core of an optical fiber. The Cerenkov intensity can be large enough to interfere with signals transmitted through the fiber. We determine the spectrum of the Cerenkov background signal generated in a poly(methyl methacrylate) optical fiber exposed to photon and electron therapeutic beams from a linear accelerator. This spectral measurement is relevant to discrimination of the signal from the background, as in scintillation dosimetry using optical fiber readouts. We find that the spectrum is approximated by the theoretical curve after correction for the wavelength dependent attenuation of the fiber. The spectrum does not depend significantly on the angle between the radiation beam and the axis of the fiber optic but is dependent on the depth in water at which the fiber is exposed to the beam.