A study of GafChromic XR Type R film response with reflective-type densitometers and economical flatbed scanners

Influence of Pitch on Surface Dose Distribution and Image Noise of Computed Tomography Scans

This study evaluated the effect of pitch on 256-slice helical computed tomography (CT) scans. Cylindrical water phantoms (CWP) were measured using axial and helical scans with various pitch values. The surface dose distributions of CWP were measured, and reconstructed images were obtained using filtered back-projection (FBP) and iterative model reconstruction (IMR). The image noise in each reconstructed image was decomposed into a baseline component and another component that varied along the z-axis. The baseline component of the image noise was highest at the center of the reconstructed image and decreased toward the edges. The normalized 2D power spectra for each pitch were almost identically distributed. Furthermore, the ratios of the 2D power spectra for IMR and FBP at different pitch values were obtained. The magnitudes of the components varying along the z-axis were smallest at the center of the reconstructed image and increased toward the edge. The ratios of the 3D power spectra on the f_x axis for IMR and FBP at different pitch values were obtained. The results showed that the effect of the pitch was related to the component that varied along the z-axis. Furthermore, the pitch had a smaller effect on IMR than on FBP.

Comparison of Patient Skin Dose Evaluated Using Radiochromic Film and Dose Calculation Software

PURPOSE

To compare, in an interventional radiology setting, peak skin doses (PSDs) delivered as calculated using a dedicated software tool and as measured using radiochromic film. To assess the utility of this dose calculation software tool in routine clinical practice.

MATERIALS AND METHODS

First, radiochromic films were positioned on the examination table in the back of an adult anthropomorphic phantom to measure PSD, and X-ray examinations were simulated. Then, films were again positioned in the patient's back for 59 thoracic or abdominopelvic endovascular interventions. The results obtained with the radiochromic films were taken as a reference and were statistically compared with those of the software.

RESULTS

With measured PSDs ranging from 100 to 7000 mGy, the median software-film difference was 8.5%. Lin's concordance coefficient was 0.98 [0.97; 0.99] (p < 0.001), meaning that concordance was excellent between the two methods. For the films where PSD exceeded 1000 mGy, the median difference in the measured value was 8.7% [- 1.3; 21.1], with a maximum discrepancy of 34%. Lin's concordance coefficient was 0.98 [0.96; 1] (p < 0.001), meaning that concordance was excellent between the two methods.

CONCLUSION

Comparison between radiochromic films and the software tool showed that the software is a suitable tool for a simple and reliable estimation of PSD. The software seems to be a good alternative to films, whose use remains complex.

Implementation of a program for quality assurance on leaf positioning accuracy using Gafchromic(®) RTQA2 films

In radiotherapy treatments the correct dose delivery to the target volume and the consequent conservation of healthy tissues is affected by multileaf collimator (MLC) leaf positioning accuracy and reproducibility, mostly in intensity-modulated radiation therapy (IMRT): For this reason a quality assurance (QA) program is necessary to ensure the best treatment possible to each patient. The aim of this study is the implementation of a method using Gafchromic(®) RTQA 2 films to perform routine QA on the MLC, both for qualitative and quantitative analysis. A flatbed document scanner (Epson 10000XL) was used in conjunction with radiochromic detector; a scanning protocol was firstly defined to improve readout accuracy. RTQA2 films were irradiated with 6 MV X-rays at different dose levels to obtain calibration curve. To evaluate the leaf positioning accuracy in different conditions, a rhomboidal shape and a field consisting in three rectangular segments were selected. The images quantitative analysis was handled with a program developed in MATLAB to evaluate the differences between expected and measured leaves positions. The reproducibility and global uncertainty of the method were estimated to be equal to 0.5% and 0.6 mm, respectively. Moreover, a qualitative test was performed: A garden picket fence field, consisting in multiple segments 2 × 22 cm(2), was realized setting known leaves shifts to test the method sensitivity. The picket fence test shows that the method is able to detect displacements equal to 1 mm. The results suggest that Gafchromic(®) RTQA2 films represent a reliable tool to perform MLC routine QA.

Using GafChromic film to estimate the effective dose from dental cone beam CT and panoramic radiography

OBJECTIVES

To demonstrate the feasibility of GafChromic(®) XR-QA2 (ISP Corp., Wayne, NJ) as a dosemeter when performing measurements of the effective dose from three cone beam CT (CBCT) units and to compare the doses from examinations of three common dental clinical situations. A second aim was to compare the radiation doses for three digital panoramic units with the doses for the CBCT units.

METHODS

The CBCT units used were Veraviewepocs 3De(®) (J Morita MFG Corp., Kyoto, Japan), ProMax(®) 3D (Planmeca, Helsinki, Finland) and NewTom VGi(®) (Quantitative Radiology, Verona, Italy). GafChromic XR-QA2 films were placed between the selected layers of the head and neck of a tissue-equivalent human skull (RANDO(®) phantom; The Phantom Laboratory, Salem, NY). The exposure parameters were set using the automatic exposure control function of the units. Depending on the availability, medium and smaller field of view (FOV) scanning modes were used. The effective dose was estimated using the 2007 International Commission on Radiological Protection formalism.

RESULTS

The lowest effective dose of a CBCT unit was observed for ProMax 3D, FOV 4 × 5 cm (10 μSv), the highest for NewTom VGi, FOV 8 × 8 cm-high resolution (129 μSv). The range of effective doses for digital panoramic machines measured was 8-14 μSv.

CONCLUSIONS

This study demonstrates the feasibility of using radiochromic films for dental CBCT and panoramic dosimetry.

Evaluation of the absorbed dose to the breast using radiochromic film in a dedicated CT mammotomography system employing a quasi-monochromatic x-ray beam

PURPOSE

A dual modality SPECT-CT prototype system dedicated to uncompressed breast imaging (mammotomography) has been developed. The computed tomography subsystem incorporates an ultrathick K-edge filtration technique producing a quasi-monochromatic x-ray cone beam that optimizes the dose efficiency of the system for lesion imaging in an uncompressed breast. Here, the absorbed dose in various geometric phantoms and in an uncompressed and pendant cadaveric breast using a normal tomographic cone beam imaging protocol is characterized using both thermoluminescent dosimeter (TLD) measurements and ionization chamber-calibrated radiochromic film.

METHODS

Initially, two geometric phantoms and an anthropomorphic breast phantom are filled in turn with oil and water to simulate the dose to objects that mimic various breast shapes having effective density bounds of 100% fatty and glandular breast compositions, respectively. Ultimately, an excised human cadaver breast is tomographically scanned using the normal tomographic imaging protocol, and the dose to the breast tissue is evaluated and compared to the earlier phantom-based measurements.

RESULTS

Measured trends in dose distribution across all breast geometric and anthropomorphic phantom volumes indicate lower doses in the medial breast and more proximal to the chest wall, with consequently higher doses near the lateral peripheries and nipple regions. Measured doses to the oil-filled phantoms are consistently lower across all volume shapes due to the reduced mass energy-absorption coefficient of oil relative to water. The mean measured dose to the breast cadaver, composed of adipose and glandular tissues, was measured to be 4.2 mGy compared to a mean whole-breast dose of 3.8 and 4.5 mGy for the oil- and water-filled anthropomorphic breast phantoms, respectively.

CONCLUSIONS

Assuming rotational symmetry due to the tomographic acquisition exposures, these results characterize the 3D dose distributions in an uncompressed human breast tissue volume for this dedicated breast imaging device and illustrate advantages of using the novel ultrathick K-edge filtered beam to minimize the dose to the breast during fully-3D imaging.

Calibration of GafChromic XR-RV3 radiochromic film for skin dose measurement using standardized x-ray spectra and a commercial flatbed scanner

PURPOSE

In this study, newly formulated XR-RV3 GafChromic film was calibrated with National Institute of Standards and Technology (NIST) traceability for measurement of patient skin dose during fluoroscopically guided interventional procedures.

METHODS

The film was calibrated free-in-air to air kerma levels between 15 and 1100 cGy using four moderately filtered x-ray beam qualities (60, 80, 100, and 120 kVp). The calibration films were scanned with a commercial flatbed document scanner. Film reflective density-to-air kerma calibration curves were constructed for each beam quality, with both the orange and white sides facing the x-ray source. A method to correct for nonuniformity in scanner response (up to 25% depending on position) was developed to enable dose measurement with large films. The response of XR-RV3 film under patient backscattering conditions was examined using on-phantom film exposures and Monte Carlo simulations.

RESULTS

The response of XR-RV3 film to a given air kerma depended on kVp and film orientation. For a 200 cGy air kerma exposure with the orange side of the film facing the source, the film response increased by 20% from 60 to 120 kVp. At 500 cGy, the increase was 12%. When 500 cGy exposures were performed with the white side facing the x-ray source, the film response increased by 4.0% (60 kVp) to 9.9% (120 kVp) compared to the orange-facing orientation. On-phantom film measurements and Monte Carlo simulations show that using a NIST-traceable free-in-air calibration curve to determine air kerma in the presence of backscatter results in an error from 2% up to 8% depending on beam quality. The combined uncertainty in the air kerma measurement from the calibration curves and scanner nonuniformity correction was +/- 7.1% (95% C.I.). The film showed notable stability. Calibrations of film and scanner separated by 1 yr differed by 1.0%.

CONCLUSIONS

XR-RV3 radiochromic film response to a given air kerma shows dependence on beam quality and film orientation. The presence of backscatter slightly modifies the x-ray energy spectrum; however, the increase in film response can be attributed primarily to the increase in total photon fluence at the sensitive layer. Film calibration curves created under free-in-air conditions may be used to measure dose from fluoroscopic quality x-ray beams, including patient backscatter with an error less than the uncertainty of the calibration in most cases.

Evaluation of the calibration parameters of radiochromic films for patient dosimetry in interventional radiology

The study aims to analyse the effects of beam energy, dose fractionation, response homogeneity, long-term fading and response sensitivity of radiochromic films. It also investigates the effect of the scanner, ambient temperature and storage conditions on the response of the films. The radiochromic films were irradiated at various air kerma from 20 mGy to about 8 Gy. Results showed that the response of the films is not energy dependent for low doses ranging from 300 to 700 mGy (coefficient of variation = 5-12%) but starts to show a slight dependence for high doses above 2 Gy (coefficient of variation = 20%). There is no significant difference (4%) in optical densities (OD) and pixel values when doses were fractionated and when using scanner with and without warm-up lamp. The curve fitting of OD and pixel values for the sensitivity test at different kilovolt potential gave an r(2) value of 0.99.

A feasibility study using radiochromic films for fast neutron 2D passive dosimetry

The objective of this paper is threefold: (1) to establish sensitivity of XRQA and EBT radiochromic films to fast neutron exposure; (2) to develop a film response to radiation dose calibration curve and (3) to investigate a two-dimensional (2D) film dosimetry technique for use in establishing an experimental setup for a radiobiological irradiation of mice and to assess the dose to the mice in this setup. The films were exposed to a 10 MeV neutron beam via the (2)H(d,n)(3)He reaction. The XRQA film response was a factor of 1.39 greater than EBT film response to the 10 MeV neutron beam when exposed to a neutron dose of 165 cGy. A film response-to-soft tissue dose calibration function was established over a range of 0-10 Gy and had a goodness of fit of 0.9926 with the calibration data. The 2D film dosimetry technique estimated the neutron dose to the mice by measuring the dose using a mouse phantom and by placing a piece of film on the exterior of the experimental mouse setup. The film results were benchmarked using Monte Carlo and aluminum (Al) foil activation measurements. The radiochromic film, Monte Carlo and Al foil dose measurements were strongly correlated, and the film within the mouse phantom agreed to better than 7% of the externally mounted films. These results demonstrated the potential application of radiochromic films for passive 2D neutron dosimetry.

Implementation of radiochromic film dosimetry protocol for volumetric dose assessments to various organs during diagnostic CT procedures

PURPOSE

The authors present a means to measure high-resolution, two-dimensional organ dose distributions in an anthropomorphic phantom of heterogeneous tissue composition using XRQA radiochromic film. Dose distributions are presented for the lungs, liver, and kidneys to demonstrate the organ volume dosimetry technique. XRQA film response accuracy was validated using thermoluminescent dosimeters (TLDs).

METHODS

XRQA film and TLDs were first exposed at the center of two CTDI head phantoms placed end-to-end, allowing for a simple cylindrical phantom of uniform scatter material for verification of film response accuracy and sensitivity in a computed tomography (CT) exposure geometry; the TLD and film dosimeters were exposed separately. In a similar manner, TLDs and films were placed between cross-sectional slabs of a 5 yr old anthropomorphic phantom's thorax and abdomen regions. The anthropomorphic phantom was used to emulate real pediatric patient geometry and scatter conditions. The phantom consisted of five different tissue types manufactured to attenuate the x-ray beam within 1%-3% of normal tissues at CT beam energies. Software was written to individually calibrate TLD and film dosimeter responses for different tissue attenuation factors, to spatially register dosimeters, and to extract dose responses from film for TLD comparison. TLDs were compared to film regions of interest extracted at spatial locations corresponding to the TLD locations.

RESULTS

For the CTDI phantom exposure, the film and TLDs measured an average difference in dose response of 45% (SD +/- 2%). Similar comparisons within the anthropomorphic phantom also indicated a consistent difference, tracking along the low and high dose regions, for the lung (28%) (SD +/- 8%) and liver and kidneys (15%) (SD +/- 4%). The difference between the measured film and TLD dose values was due to the lower response sensitivity of the film that arose when the film was oriented with its large surface area parallel to the main axis of the CT beam. The consistency in dose response difference allowed for a tissue specific correction to be applied. Once corrected, the average film response agreed to better than 3% (SD +/- 2%) for the CTDI scans, and for the anthropomorphic phantom scans: 3% (SD +/- 3%) for the lungs, 5% (SD +/- 3%) for the liver, and 4% (SD +/- 3%) for the kidneys. Additionally, XRQA film measured a heterogeneous dose distribution within the organ volumes. The extent of the dose distribution heterogeneity was not measurable with the TLDs due to the limitation on the number of TLDs loadable in the regions of the phantom organs. In this regard, XRQA film demonstrated an advantage over the TLD method by discovering a 15% greater maximum dose to lung in a region unmeasured by TLDs.

CONCLUSIONS

The films demonstrated a lower sensitivity to absorbed dose measurements due to the geometric inefficiency of measuring dose from a beam situated end-on to the film. Once corrected, the film demonstrated equivalent dose measurement accuracy as TLD detectors with the added advantage of relatively simple measurement of high-resolution dose distributions throughout organ volumes.

Characterization of a 137Cs irradiator from a new perspective with modern dosimetric tools

To provide for accurate dosimetry in a 137Cs irradiator, the following were investigated: (1) correct mapping of the irradiator cavity's dose distribution, (2) rotated versus stationary dose rate measurements, (3) exposure-to-dose calibration selection for exposure time calculation, and (4) irradiator-timer error correction. This work introduces techniques to map dose distributions and measure dose rates with new high-sensitivity radiochromic films and a small-volume ion chamber constructed for in-beam, high-intensity gamma irradiation. Measured film distributions were compared to manufacturer-provided data and independent measurements from an ion chamber and TLD-100 chips. Measured film distributions agreed with the manufacturer-provided data in the central-vertical region, but disagreed by as much as 95% in surrounding regions. The independent measurements agreed within 96% with the measured dose distribution. Dose rates varied by approximately 11% for a rotational versus stationary setup, by approximately 10% for the dose-to-medium correction between air and soft tissue, and by approximately 4-12% for irradiation times from 0.2-0.7 min due to timer error. In conclusion, a critical irradiator characterization should be performed, initially, as a part of the acceptance testing of a newly installed irradiator, and periodically as an ongoing quality assurance protocol. We investigated, and recommend as part of a comprehensive irradiator verification protocol, the inclusion of radiochromic film-measured dose distributions, dose rates measured during rotation when samples are likewise rotated for exposure, timer error corrections for short-time irradiation, and exposure-to-dose corrections that reflect typical sample compositions, e.g., soft tissue or air.

An evaluation of fluoroscopic times and peak skin doses during radiofrequency catheter ablation and biventricular internal cardioverter defibrillator implant procedures

Fluoroscopy-guided medical procedures are generally diagnostic in nature and involve low dose and minimal risk to the patient. However, an increasingly larger percentage of procedures offer a therapeutic benefit to the patient. Such interventional procedures are very often technically difficult, but offer a less-invasive alternative to higher-risk surgical procedures. Although infrequent, severe skin injury can result from these procedures that involve total fluoroscopy time in excess of 1 h. The purpose of this study was to evaluate fluoroscopy time and peak skin dose (PSD) for lengthy fluoroscopy procedures, and to determine the variables that may best predict PSD.

Dose indices of radiation to skin in fluoroscopically guided invasive cardiology procedures

Tissue injury depends on the extent as well as the intensity of the assault. It would be helpful to develop skin dose indices that are more descriptive of the skin area receiving radiation above a threshold value of potential injury. For monitoring radiation exposure to patients, radiochromic film was placed close to the skin of a patient undergoing cardiac catheterization procedures. With the approval of the Institutional Review Board, films from 36 patients were scanned. Contours were drawn at the increment of 100 cGy in air kerma. Using each contour value as a threshold, the area exceeding this threshold and the average dose within this area were computed. For the four patients who had skin doses exceeding the 200 cGy threshold, the peak entrance doses have a range from 230 cGy to 409 cGy. However, these high radiation exposures were confined to limited skin areas and support the absence of any significant skin injury in these patients. The area exceeding a chosen threshold value and the average dose within the area circumscribed might therefore serve as helpful measures of the assault to the skin. This investigation has demonstrated the technical feasibility of providing such dose indices.

GafChromic XR-QA film in testing panoramic dental radiography

The location and field size of the incident X-ray beam in panoramic dental radiography cannot be ascertained visually most of the time. However, these parameters are needed for quality control and dosimetry determination. To alleviate this problem, we tested GafChromic XR-QA film on two panoramic systems. For each system, we used the length of a cross-sectional image of the incident beam and the exposure measurement with a pencil ion chamber to compute the dose-area product. The result was confirmed by direct analysis of a dose distribution on a film. Placement of the ion chamber was determined by the latter images. The GafChromic XR-QA version of radiochromic film has thus been demonstrated to usefully complement a pencil ion chamber in the testing of a panoramic radiography system.

Clinical use of EBT model Gafchromic™ film in radiotherapy

The Gafchromic EBT was recently introduced in film dosimetry for external beam therapy (EBT). The high spatial resolution, weak energy dependence, and near-tissue equivalence of EBT films make them suitable for measurement of dose distributions in radiotherapy, especially intensity-modulated radiation therapy (IMRT). Starting with a sensitometric curve and dose uncertainty relative to the flatbed scanner, the goal of this study was to find an efficient method of correcting for light scattering, and to compare dose distribution supplied by Gafchromic EBT with the distribution obtained with a 2D ion-chamber detector system. Light scattering was analyzed for different levels of dose, and was found to depend on the red-scale value as well as the position of the pixel on the scanner. Many "uniform" films were exposed at different levels of dose to create a two-dimensional matrix correction to take this effect into account. The dose distribution obtained for three clinical beams (10 x 10, 15 x 15 cm open fields and 12 x 12 cm wedge 60 degrees field) were in agreement with those supplied by the 2D array. Gamma index <1 (using 5 mm distance and 5% dose as constraints) for the three fields considered was reached in an average of 98% of the points.

Sensitivity of linear CCD array based film scanners used for film dosimetry

Film dosimetry is commonly performed by using linear CCD array transmission optical densitometers. However, these devices suffer from a variation in response along the detector array. If not properly corrected for, this nonuniformity may lead to significant overestimations of the measured dose as one approaches regions close to the edges of the scanning region. In this note, we present measurements of the spatial response of an AGFA Arcus II document scanner used for radiochromic film dosimetry. Results and methods presented in this work can be generalized to other CCD based transmission scanners used for film dosimetry employing either radiochromic or radiographic films.

Skin entrance radiation dose in an interventional radiology procedure

Monitoring of skin entrance radiation exposure in lengthy interventional procedures has been recommended because of the potential for skin injury. Fluoroscopy duration and dose-area product (DAP) are readily available real-time measurements. It would be of interest to study the correlation of these parameters and skin entrance radiation. Twenty neurological interventional procedures performed through the aortic arch were monitored. Two pieces of GafChromic XR Type R film were placed between the patient and the examination table. An observer recorded the fluoroscopy duration and DAP for each phase of the procedure. Each film was scanned post-procedure in RBG mode, and then the image was analyzed for peak skin entrance radiation dose (in air kerma). All DAP values were corrected according to a calibration with an ion chamber. With the DAP values for the respective phases of a procedure, the effective dose in a Reference Man was calculated. For these twenty cases, the means and standard deviations were 17.2+/-6.4 min for x ray on-time, 256+/-65 Gy cm (-2) for DAP, 94+/-34 cGy for peak skin entrance dose in air kerma, and 19.2+/-5.0 mSv for effective dose, respectively. The peak skin entrance dose was correlated to fluoroscopy duration, DAP, and effective dose with the r(2)-values of 0.48, 0.46, and 0.09, respectively. The correlation with DAP or fluoroscopy duration was not sufficiently strong to infer skin entrance dose from either of these parameters. Therefore, skin entrance dose should be determined directly.

Measurement of dose-area product with GafChromic XR Type R film

Many of the newer X‐ray machines are equipped with electronic means to provide dose–area product (DAP) information. For machines without that ability, an alternative method is to record radiation on a film that can handle a large amount of cumulative exposure. The use of GafChromic XR Type R film was investigated for this purpose by placing it at the X‐ray tube assembly to record the radiation in interventional radiological procedures. Dose‐area product was determined with a reflective densitometer and then with a flatbed scanner. Precisions were demonstrated to be 5% and 2%, respectively. In a comparison with the machine‐recorded DAP, a regression analysis showed the validity of both techniques for values less than 1200 Gy‐cm².

PACS numbers: 87.52.Df, 87.66.Cd

Dosimetric evaluation of GAFCHROMIC XR type T and XR type R films

The high spatial resolution of radiochromic film makes it ideal for dosimetric measurements and dose distributions in regions of high dose gradient. Intensity‐modulated radiation therapy, intravascular brachytherapy, and eye‐plaque radiation therapy demand precise spatial dosimetric calculations. Such precision is not possible with conventional dosimeters, such as thermoluminescent dosimeters and ionization chambers. Recently, new GAFCHROMIC® XR type T and type R films have been developed for radiation dosimetry, specifically in interventional radiology procedures. Dosimetric characteristics (i.e., linearity, post‐exposure density growth, energy dependence, dose‐rate dependence, and UV light sensitivity) of these new films were investigated. To evaluate the clinical applications of these films, their characteristics were compared with other commercially available film models. GAFCHROMIC® XR type T and type R films were found to be more sensitive to low‐energy doses as compared with GAFCHROMIC® MD‐55 films.

PACS numbers: 87.66‐a, 87.53‐j