Table of contents

IC3DDose 2014, the 8th International Conference on 3D Radiation Dosimetry was held in Ystad, Sweden, from 4-7 September 2014. This grew out of the DosGel series, which began as DosGel99, the 1st International Workshop on Radiation Therapy Gel Dosimetry in Lexington, Kentucky. Since 1999 subsequent DoSGel conferences were held in Brisbane, Australia (2001), Ghent, Belgium (2004), Sherbrooke, Canada (2006) and Crete, Greece (2008). In 2010 the conference was held on Hilton Head Island, South Carolina and underwent a name-change to IC3DDose. The 7th and last meeting was held in Sydney, Australia from 4–8 November 2012.

It is worth remembering that the conference series started at the very beginning of the intensity modulated radiotherapy era and that the dosimeters being developed then were, to some extent, ahead of the clinical need of radiotherapy. However, since then the technical developments in radiation therapy have been dramatic, with dynamic treatments, including tracking, gating and volumetric modulated arc therapy, widely introduced in the clinic with the need for 3D dosimetry thus endless. This was also reflected by the contributions at the meeting in Ystad.

Accordingly the scope of the meeting has also broadened to IC3DDOSE - I See Three-Dimensional Dose. A multitude of dosimetry techniques and radiation detectors are now represented, all with the common denominator: three-dimensional or 3D. Additionally, quality assurance (QA) procedures and other aspects of clinical dosimetry are represented.

The implementation of new dosimetric techniques in radiotherapy is a process that needs every kind of caution, carefulness and thorough validation. Therefore, the clinical needs, reformulated as the aims for IC3DDOSE - I See Three-Dimensional Dose, are:

• Enhance the quality and accuracy of radiation therapy treatments through improved clinical dosimetry.

• Investigate and understand the dosimetric challenges of modern radiation treatment techniques.

• Provide a forum to discuss the latest research and developments in 3D and advanced radiation dosimetry.

• Energize and diversify dosimetry research and clinical practice by encouraging interaction and synergy between advanced, 3D, and semi-3D dosimetry techniques.

We commend these IC3Dose 2014 conference proceedings to you and strongly believe they include significant contributions to scientific progress in this field.

We would like to express our sincere gratitude to everybody involved in making the conference possible, the Scientific committee for their work on the general planning, paper review and program formulation, the distinguished invited speakers for their contributions and the local organizing committee members for all their hard work on the practical preparation for the meeting.

Lars E. Olsson, Sven Bäck and Sofie Ceberg

Lund University and Skåne University Hospital, Sweden

International Scientific Committee

Sven Bäck, Sweden (chair)

Clive Baldock, Australia

Sam Beddar, USA

Crister Ceberg, Sweden

Yves de Deene, Belgium/Australia

Simon Doran, UK

Geoffrey Ibbott, USA

Andrew Jirasek, Canada

Kevin Jordan, Canada

Martin Lepage, Canada

Daniel Low, USA

Mark Oldham, USA

Tony Popescu, Canada

John Schreiner, Canada

Cheng-Shie Wuu, USA

David Thwaites, Australia

Local Organizing Committee

Sofie Ceberg (chair)

Lars E. Olsson (conference chair)

Fredrik Nordstrom

Anneli Edvardsson

Anna Karlsson Hauer

Anna Bäck

The complete conference programme is available in the pdf available above.

All papers published in this volume of Journal of Physics: Conference Series have been peer reviewed through processes administered by the proceedings Editors. Reviews were conducted by expert referees to the professional and scientific standards expected of a proceedings journal published by IOP Publishing.

The radiotherapy process is reviewed briefly and potential risks or pitfalls are identified. The focus is on modern advanced modalities in radiation therapy such as IMRT, VMAT, gating and tracking and also for the unknown to come. Existing methods, or quality controls (QC), or with better word barriers, are introduced at important steps of process with the purpose of prohibiting errors to continue through the process and thus avoiding an unwanted erroneous irradiation of the patient. The soft branch of quality assurance (QA) such as peer-review is also a major component of today's process and its safety. The importance of knowing your QCs is pointed out. The role of dosimetry method i.e. 3D-dosimetry is reviewed. Staff have to be working with awareness and alertness that can reduce most of the risks. Having comprehensive protocols known by all involved together with well-trained staff at the department with dedicated functions and responsibilities will further reduce the risk for unintended irradiations of patient. Having a well-designed QA system with the appropriate barriers have the possibility of producing high quality radiotherapy, which will also result in better outcome for the patients. The international head and neck trial illustrates very well the importance of accurate radiotherapy.

Radiation therapy has advanced rapidly over the last few decades, progressing from 3D conformal treatment to image-guided intensity modulated therapy of several different flavors, both 3D and 4D and to adaptive radiotherapy. The use of intensity modulation has increased the complexity of quality assurance and essentially eliminated the physicist's ability to judge the validity of a treatment plan, even approximately, on the basis of appearance and experience. Instead, complex QA devices and procedures are required at the institutional level. Similarly, the assessment of treatment quality through remote and on-site audits also requires greater sophistication. The introduction of 3D and 4D dosimetry into external audit systems must follow, to enable quality assurance systems to perform meaningful and thorough audits.

Since the introduction of volumetric chemical dosimetry with Fricke gel dosimeters in the 1980s, three-dimensional (3D) dosimetry has been a promising technique for the clinic, since it provides a unique methodology for 3D dose measurement of the complex conformal dose distributions achieved by modern techniques such as Intensity Modulated and Volumetric Arc Radiation Therapy. In the last decade, the potential for improved clinical applicability has been advanced by the development of improved 3D dosimeters such as normoxic polymer gel systems, radiochromic plastics (such as PRESAGE) and, recently, newer radiochromic gel dosimeters. Some of these new 3D dosimetry systems were enabled by the availability of optical computed tomography imaging systems for fast dose readout. However, despite its promise, true 3D dosimetry is still not widely practiced in the community. Its use has been confined primarily to select centres of expertise and to specialised quality assurance or commissioning roles where other dosimetry techniques are difficult to implement. In this paper I review some of the current 3D chemical dosimeters available, discuss the requirements for their use and briefly review the roles that these systems can provide to complement the other dose delivery validation approaches available in the clinic. I conclude by describing two roles that may be uniquely served by 3D chemical dosimetry in end-to-end process testing and validation in the complex environment coming into play with the development of Image Guided Adaptive Radiation Therapy.

The goal of this review is to outline a solution for patient-specific QA of VMAT, IMRT, and other complex treatment delivery techniques. This solution has been developed in direct response to clinical needs, in order to allow our institution to offer VMAT to all patients who could potentially benefit from this advanced technique. To date, over 2500 VMAT patient plans and approximately 1000 IMRT patient plans have been verified by this method in Vancouver, while 40 other institutions worldwide have expressed interest in, or are already at various stages of implementing, this process. The addition of EPID in vivo dosimetry (i.e. data acquired during the patient treatment) and associated Monte Carlo predictions amounts to introducing a 'measurement component' in this QA process, which is currently mandated by the regulatory framework in some European countries, or for billing purposes in the USA. The fully automated, patient-specific, Monte Carlo based QA process described here is fast, maximally efficient in terms of departmental resources, and capable of simulating any plan in a single run, regardless of its complexity.

The goal of this brief review is to review the current status of real-time 3D scintillation dosimetry and what has been done so far in this area. The basic concept is to use a large volume of a scintillator material (liquid or solid) to measure or image the dose distributions from external radiation therapy (RT) beams in three dimensions. In this configuration, the scintillator material fulfills the dual role of being the detector and the phantom material in which the measurements are being performed. In this case, dose perturbations caused by the introduction of a detector within a phantom will not be at issue. All the detector configurations that have been conceived to date used a Charge-Coupled Device (CCD) camera to measure the light produced within the scintillator. In order to accurately measure the scintillation light, one must correct for various optical artefacts that arise as the light propagates from the scintillating centers through the optical chain to the CCD chip. Quenching, defined in its simplest form as a nonlinear response to high-linear energy transfer (LET) charged particles, is one of the disadvantages when such systems are used to measure the absorbed dose from high-LET particles such protons. However, correction methods that restore the linear dose response through the whole proton range have been proven to be effective for both liquid and plastic scintillators. Volumetric scintillation dosimetry has the potential to provide fast, high-resolution and accurate 3D imaging of RT dose distributions. Further research is warranted to optimize the necessary image reconstruction methods and optical corrections needed to achieve its full potential.

Radiochromic materials exhibit a colour change when exposed to ionising radiation. Radiochromic film has been used for clinical dosimetry for many years and increasingly so recently, as films of higher sensitivities have become available. The two principle advantages of radiochromic dosimetry include greater tissue equivalence (radiologically) and the lack of requirement for development of the colour change. In a radiochromic material, the colour change arises direct from ionising interactions affecting dye molecules, without requiring any latent chemical, optical or thermal development, with important implications for increased accuracy and convenience. It is only relatively recently however, that 3D radiochromic dosimetry has become possible. In this article we review recent developments and the current state-of-the-art of 3D radiochromic dosimetry, and the potential for a more comprehensive solution for the verification of complex radiation therapy treatments, and 3D dose measurement in general.

We have investigated the dosimetric characteristics of the new Octavius1500 array and its associated phantoms (Oct2D and Oct4D) and compared it to the previous systems. In line with the rising amount of publications advocating the retirement of the widely used but overly lenient 3%, 3mm (global dose) gamma analysis criteria, we have also focused on deriving appropriate evaluation criteria to be used with the new measurement systems in clinical routine. Using the Octavius1500 study as an example, we advocate the use of more selective, equipment specific gamma criteria, all starting from the same, very strict acceptance criteria but adding measurement uncertainty to these.

Three-dimensional (3D) gel dosimetry has a unique role to play in safeguarding conformal radiotherapy treatments as the technique can cover the full treatment chain and provides the radiation oncologist with the integrated dose distribution in 3D. It can also be applied to benchmark new treatment strategies such as image guided and tracking radiotherapy techniques. A major obstacle that has hindered the wider dissemination of gel dosimetry in radiotherapy centres is a lack of confidence in the reliability of the measured dose distribution. Uncertainties in 3D dosimeters are attributed to both dosimeter properties and scanning performance. In polymer gel dosimetry with MRI readout, discrepancies in dose response of large polymer gel dosimeters versus small calibration phantoms have been reported which can lead to significant inaccuracies in the dose maps. The sources of error in polymer gel dosimetry with MRI readout are well understood and it has been demonstrated that with a carefully designed scanning protocol, the overall uncertainty in absolute dose that can currently be obtained falls within 5% on an individual voxel basis, for a minimum voxel size of 5 mm³. However, several research groups have chosen to use polymer gel dosimetry in a relative manner by normalizing the dose distribution towards an internal reference dose within the gel dosimeter phantom. 3D dosimetry with optical scanning has also been mostly applied in a relative way, although in principle absolute calibration is possible. As the optical absorption in 3D dosimeters is less dependent on temperature it can be expected that the achievable accuracy is higher with optical CT. The precision in optical scanning of 3D dosimeters depends to a large extend on the performance of the detector. 3D dosimetry with X-ray CT readout is a low contrast imaging modality for polymer gel dosimetry. Sources of error in x-ray CT polymer gel dosimetry (XCT) are currently under investigation and include inherent limitations in dosimeter homogeneity, imaging performance, and errors induced through post-acquisition processing. This overview highlights a number of aspects relating to uncertainties in polymer gel dosimetry.

Radiation therapy has been getting progressively more complex for the past 20 years. Early radiation therapy techniques needed only basic dosimetry equipment; motorized water phantoms, ionization chambers, and basic radiographic film techniques. As intensity modulated radiation therapy and image guided therapy came into widespread practice, medical physicists were challenged with developing effective and efficient dose measurement techniques. The complex 3-dimensional (3D) nature of the dose distributions that were being delivered demanded the development of more quantitative and more thorough methods for dose measurement. The quality assurance vendors developed a wide array of multidetector arrays that have been enormously useful for measuring and characterizing dose distributions, and these have been made especially useful with the advent of 3D dose calculation systems based on the array measurements, as well as measurements made using film and portal imagers. Other vendors have been providing 3D calculations based on data from the linear accelerator or the record and verify system, providing thorough evaluation of the dose but lacking quality assurance (QA) of the dose delivery process, including machine calibration. The current state of 3D dosimetry is one of a state of flux. The vendors and professional associations are trying to determine the optimal balance between thorough QA, labor efficiency, and quantitation. This balance will take some time to reach, but a necessary component will be the 3D measurement and independent calculation of delivered radiation therapy dose distributions.

The purpose of this study was to present a novel optical diagnostic tool that corrects for undesired contribution of multiply scattered light, thus opening up for e.g. quantitative optical CT measurements of opaque samples. The approach is based on a technique called Structured Illumination (SI), which is commonly employed within microscopic imaging to enhance the depth-resolution. The concept of SI applies for many types of source-detector arrangements and the configuration employed in this paper relies on side-scattering detection. A nPAG polymer gel phantom was irradiated using 6 MV beam. Three-dimensional information was obtained by translating the sample perpendicular to the direction of light, thus sequentially probing different sections. These were then stacked together to form a 3D representation of the sample. By altering the polarization of the laser light during the data acquisition it was discovered that the aggregates responsible for the scattering of light followed Rayleigh scattering, implying that their individual sizes are smaller than, or in the order of, 500 nm.

Both 3-D gels and radiochromic plastic dosimeters, in conjunction with dose image readout systems (MRI or optical-CT), have been employed to measure 3-D dose distributions in many clinical applications. The 3-D dose maps obtained from these systems can provide a useful tool for clinical dose verification for complex treatment techniques such as IMRT, SRS/SBRT, brachytherapy, and proton beam therapy. These complex treatments present high dose gradient regions in the boundaries between the target and surrounding critical organs. Dose accuracy in these areas can be critical, and may affect treatment outcome. In this review, applications of 3-D gels and PRESAGE dosimeter are reviewed and evaluated in terms of their performance in providing information on clinical dose verification as well as commissioning of various treatment modalities. Future interests and clinical needs on studies of 3-D dosimetry are also discussed.

Patient specific pretreatment measurement for IMRT and VMAT QA should preferably give information with a high resolution in 3D. The ability to distinguish complex treatment plans, i.e. treatment plans with a difference between measured and calculated dose distributions that exceeds a specified tolerance, puts high demands on the dosimetry system used for the pretreatment measurements and the results of the measurement evaluation needs a clinical interpretation. There are a number of commercial dosimetry systems designed for pretreatment IMRT QA measurements. 2D arrays such as MapCHECK^® (Sun Nuclear), MatriXX^Evolution (IBA Dosimetry) and OCTAVIOUS^® 1500 (PTW), 3D phantoms such as OCTAVIUS^® 4D (PTW), ArcCHECK^® (Sun Nuclear) and Delta⁴ (ScandiDos) and software for EPID dosimetry and 3D reconstruction of the dose in the patient geometry such as EPIDose^TM (Sun Nuclear) and Dosimetry Check^TM (Math Resolutions) are available. None of those dosimetry systems can measure the 3D dose distribution with a high resolution (full 3D dose distribution). Those systems can be called quasi 3D dosimetry systems. To be able to estimate the delivered dose in full 3D the user is dependent on a calculation algorithm in the software of the dosimetry system. All the vendors of the dosimetry systems mentioned above provide calculation algorithms to reconstruct a full 3D dose in the patient geometry. This enables analyzes of the difference between measured and calculated dose distributions in DVHs of the structures of clinical interest which facilitates the clinical interpretation and is a promising tool to be used for pretreatment IMRT QA measurements. However, independent validation studies on the accuracy of those algorithms are scarce. Pretreatment IMRT QA using the quasi 3D dosimetry systems mentioned above rely on both measurement uncertainty and accuracy of calculation algorithms. In this article, these quasi 3D dosimetry systems and their use in patient specific pretreatment IMRT/VMAT QA will be discussed.

This paper presents a survey of three types of imaging of radiation beams in water tanks for comparison to dose maps. The first was simple depth and lateral profile verification, showing excellent agreement between Cherenkov and planned dose, as predicted by the treatment planning system for a square 5cm beam. The second approach was 3D tomography of such beams, using a rotating water tank with camera attached, and using filtered backprojection for the recovery of the 3D volume. The final presentation was real time 2D imaging of IMRT or VMAT treatments in a water tank. In all cases the match to the treatment planning system was within what would be considered acceptable for clinical medical physics acceptance.

3D in vivo dose verification using a-Si EPIDs is performed routinely in our institution for almost all RT treatments. The EPID-based 3D dose distribution is reconstructed using a back-projection algorithm and compared with the planned dose distribution using 3D gamma evaluation. Dose-reconstruction and gamma-evaluation software runs automatically, and deviations outside the alert criteria are immediately available and investigated, in combination with inspection of cone-beam CT scans. The implementation of our 3D EPID- based in vivo dosimetry approach was able to replace pre-treatment verification for more than 90% of the patient treatments. Clinically relevant deviations could be detected for approximately 1 out of 300 patient treatments (IMRT and VMAT). Most of these errors were patient related anatomical changes or deviations from the routine clinical procedure, and would not have been detected by pre-treatment verification. Moreover, 3D EPID-based in vivo dose verification is a fast and accurate tool to assure the safe delivery of RT treatments. It provides clinically more useful information and is less time consuming than pre-treatment verification measurements. Automated 3D in vivo dosimetry is therefore a prerequisite for large-scale implementation of patient-specific quality assurance of RT treatments.

In late 2011 The Swedish Society of Radiation Physics formed a working group to concentrate on the Quality Assurance of modern radiation therapy techniques. The given task was to identify and summarise the different QA strategies in Sweden and also the international recommendations. This was used to formulate recommendations for practical guidelines within Sweden. In this paper a brief summery of the group's work is presented. All the Swedish radiation therapy centres do a pre treatment verification measurement as QA for every new IMRT and VMAT plan. Physicists do it and they believe it to be time consuming. A general standpoint from all the centres was that new guidelines and legislation is needed to allow QA that does not require a measurement. Based on various international publications and recommendations the working group has presented two strategies, one where all new plans are checked through measurement and one where no measurement is needed. The measurement- based strategy is basically the same as the one used today with an extended machine QA part. The other presented strategy is process oriented where all the different parts of the treatment chain are checked separately. The final report can be found in Swedish on http://www.radiofysik.org.

IMRT/VMAT treatment plans contain treatment fields with MLC openings of various size and shape. Clinical dose calculation algorithms show limitations in calculating the correct dose in small and irregular parts of a MLC opening which leads to differences between the planned and delivered dose distributions. The patient-specific IMRT QA is often designed to compare planned and measured dose distributions and is therefore heavily dependent on the measurement equipment and the evaluation method. The purpose of this study is to develop a complexity metric based on shape and size of MLC openings that correlates to the dose differences between planned and delivered 3D dose distributions. Different MLC openings are measured and evaluated and used to determine a penalty function to steer the complexity metric and make the complexity scores correlate to dose difference pass rates. Results of this initial study show that a correlation was found between complexity scores and dose difference pass rates for static fields with varied complexity. Preliminary results also show that the complexity metric can distinguish clinical IMRT fields with higher complexity.

Laser CT scanning of LET-independent BANG3-Pro2^® polymer gel dosimeters has recently shown potential in proton dosimetry. However, raw materials' impurities impart some variability. This study aimed to validate a new method of compensating for this variability, and to validate the suitability of the improved dosimeter for patient-specific QA in pencil beam scanning (PBS) and IMPT. Six modifications of the BANG3-Pro2^® gel dosimeter were analysed for their sensitivity to proton dose and to LET. One formulation was selected for a clinical QA feasibility study, in which one composite IMPT plan, two single-field IMPT plans, and one SFUD plan were delivered to identical gel phantoms. New commercial VOLQA^TM software (beta version) was used for data analysis. Both validations were successful.

When implementing new technology into clinical practice, there will always be a need for large knowledge gain. The aim of this study was twofold, (I) audit the treatment planning and dose delivery of Flattening Filter Free (FFF) beam technology for Stereotactic Body Radiation Therapy (SBRT) of lung tumours across a range of treatment planning systems compared to the conventional Flatting Filter (FF) beams, (II) investigate how sharing knowledge between centres of different experience can improve plan quality. All vendor/treatment planning system (TPS) combinations investigated were able to produce acceptable treatment plans and the dose accuracy was clinically acceptable for all plans. By sharing knowledge between the different centres, the minor protocol violations (MPV) could be significantly reduced, from an average of 1.9 MPV per plan to 0.6 after such sharing of treatment planning knowledge. In particular, for the centres with less SBRT and/or volumetric- modulated arc therapy (VMAT) experience the MPV average per plan improved. All vendor/TPS combinations were also able to successfully deliver the FF and FFF SBRT VMAT plans. The plan quality and dose accuracy were found to be clinically acceptable.

Dosimetric validation of two volumetric modulated arc therapy (VMAT) stereotactic ablative radiotherapy (SABR) plans was completed as part of the commissioning process of this technique in our clinic. Static and dynamic ion chamber, EBT3 film and leuco crystal violet (LCV) micelle gel measurements were acquired using a motion phantom with appropriate inserts for each dosimeter. The results show good agreement between measured and calculated plan dose.

This paper is intended as a preliminary study to demonstrate the quality assurance benefits from polymer gel detectors for proton pencil beam cranio-spinal treatments. A stable gel type was selected for protons to suppress the LET dependence at the end of the Bragg peak. The depth dose distributions in the gels were examined with regard of its dose dependences and compared to baseline measurements. The preliminary experimental results indicate polymer gel detectors may be able to verify dose in three dimensions along match line for proton therapy treatments.

In this paper the sensitivity of an Electronic Portal Imaging Device (EPID) to detecting introduced Volumetric Arc Therapy (VMAT) treatment errors was studied using the Collapsed Arc method. Two clinical Head and Neck (H&N) and Prostate treatment plans had gantry dependent dose and MLC errors introduced to the plans. These plans were then delivered to an Elekta Synergy Linear Accelerator EPID and compared to the original treatment planning system Collapsed Arc dose matrix. With the Collapsed Arc technique the EPID was able to detect MLC errors down to 2mm and dose errors of down to 3% depending on the treatment plan complexity and gamma tolerance used.

Bone, air passages, cavities, and lung are elements present in patients, but challenging to properly correct for in treatment planning dose calculations. Plastic scintillator detectors (PSDs) have proven to be well suited for dosimetry in non-reference conditions such as small fields. The objective of this study was to investigate the performance of a commercial treatment planning system (TPS) using a PSD and a specially designed thorax phantom with lung tumor inserts. 10 treatment plans of different complexity and phantom configurations were evaluated. Although the TPS agreed well with the measurements for the least complex tests, deviations of tumor dose > 4% were observed for some cases. This study underpins the dosimetric challenge in TPS calculations for clinically relevant heterogeneous geometries. The scintillator system, together with the special phantom, provides a promising tool for evaluation of complex radiotherapy dose calculations and delivery.

There are few reported intercomparisons or audits of combinations of advanced radiotherapy methods, particularly for 4D treatments. As part of an evaluation of the implementation of advanced radiotherapy technology, a phantom and associated methods, initially developed for in-house commissioning and QA of 4D lung treatments, has been developed further with the aim of using it for end-to-end dose intercomparison of 4D treatment planning and delivery. The respiratory thorax phantom can house moving inserts with variable speed (breathing rate) and motion amplitude. In one set-up mode it contains a small ion chamber for point dose measurements, or alternatively it can hold strips of radiochromic film to measure dose distributions. Initial pilot and feasibility measurements have been carried out in one hospital to thoroughly test the methods and procedures before using it more widely across a range of hospitals and treatment systems. Overall, the results show good agreement between measured and calculated doses and distributions, supporting the use of the phantom and methodology for multi-centre intercomparisons. However, before wider use, refinements of the method and analysis are currently underway particularly for the film measurements.

Conducting four-dimensional deforming dosimetry with a deformable gel dosimeter presents several challenges for implementation and interpretation of results. In this work, we describe a modification to a respiratory motion phantom to accommodate the DEFGEL dosimeter, and an evaluation of the reproducibility of the setup and deformation cycle. Setup errors are sub-mm while deformation reproducibility is typically less than half the CT voxel size (1 mm AP and LR; 3 mm SI). 4DCT confirms the absence of hysteresis.

A new deformable polydimethylsiloxane (PDMS) based dosimeter is proposed that can be cast in an anthropomorphic shape and that can be used for 3D radiation dosimetry of deformable targets. The new material has additional favorable characteristics as it is tissue equivalent for high-energy photons, easy to make and is non-toxic. In combination with dual wavelength optical scanning, it is a powerful dosimeter for dose verification of image gated or organ tracked radiotherapy with moving and deforming targets.

High Intensity Focused ultrasound (HIFU) is a non-invasive cancer therapy that makes use of the mainly thermal effects of ultrasound to destroy tissue. In order to achieve reliable treatment planning, it is necessary to characterise the ultrasound source (transducer) and to understand how the wave propagates in tissue and the energy deposition in the focal region. This novel exploratory study investigated how HIFU affects PRESAGE^®, an optical phantom used for radiotherapy dosimetry, which is potentially a rapid method of calibrating the transducer. Samples, of two different formulations, were exposed to focused ultrasound and imaged using Optical Computed Tomography. First results showed that, PRESAGE^® changes colour on ultrasound exposure (darker green regions were observed) with the alterations being related to the acoustic power and sample composition. Future work will involve quantification of these alterations and understanding how to relate them to the mechanisms of action of HIFU.

We considered an availability of the polymer gel detector without container but with a plastic wrap under assumption of the low oxygen transmissivity of a sheet of plastic wrap. And a gelatin container was also examined for a gel detector. These samples can be made easily and this containerless polymer gel detector well works without any artifacts by means of wrapping with a thin plastic sheet. Nevertheless, there is still room for improvement on preventing oxygen contamination. Combination with a gelatin container and a polymer gel detector and/or Gafchromic films has a various potential for extension of 3D dosimetry.

Polymer gel dosimeters based on radiation-crosslinked hydroxypropyl cellulose gel were prepared, which comprised 2-hydroxyethyl methacrylate (HEMA) and polyethylene glycol #400 dimethacrylate (9G) as less toxic monomers and tetrakis (hydroxymethyl) phosphonium chloride (THPC) as an antioxidant. The dosimeters exposed to ⁶⁰Co γ-rays became cloudy at only 1 Gy. The irradiated dosimeters were optically analyzed by using a UV- vis spectrophotometer to evaluate dose response. Absorbance of the dosimeters linearly increased in the dose range from 0 to 10 Gy, in which dose sensitivity increased with increasing 9G concentration. The dose sensitivity of the dosimeters with 2 wt% HEMA and 3 wt% 9G was also enhanced by increment in THPC.

To improve the dosimetric accuracy of normoxic polyacrylamide gelatin (PAGAT) gel dosimeters, the addition of saccharides (glucose and sucrose) has been suggested. An increase in R₂-response sensitivity upon irradiation will result in smaller uncertainties in the derived dose if all other uncertainties are conserved. However, temperature variations during the magnetic resonance scanning of polymer gels result in one of the highest contributions to dosimetric uncertainties. The purpose of this project was to study the dose sensitivity against the temperature sensitivity. The overall dose uncertainty of PAGAT gel dosimeters with different concentrations of saccharides (0, 10 and 20%) was investigated. For high concentrations of glucose or sucrose, a clear improvement of the dose sensitivity was observed. For doses up to 6 Gy, the overall dose uncertainty was reduced up to 0.3 Gy for all saccharide loaded gels compared to PAGAT gel. Higher concentrations of glucose and sucrose deteriorate the accuracy of PAGAT dosimeters for doses above 9 Gy.

The initial trial of methylthymol blue (MTB) as a chelator for ferric iron in Fricke gel dosimeters, used for three-dimensional (3D) dosimetry in cancer radiotherapy, is reported. MTB is a structural analogue of the conventionally used xylenol orange (XO); however, the absorbance spectrum of the ferric-MTB complex is shifted to higher wavelengths, which should allow for lower amount of light scattering during gel scanning. In this study, two gelatin substrates, two sources of XO and one source of MTB have been compared. The MTB- containing gels exhibited similar dose response and diffusion coefficient to the XO-containing gels at their wavelengths of maximum absorption (620 and 585 nm, respectively). In addition, the MTB gels gave an excellent dose response at 633 nm, which is an important wavelength that is already used with other 3D dosimeters.

The aim of this study was to investigate the chemistry of the PAGAT dosimeters when doped with saccharides and irradiated' using NMR spectroscopy. Three batches of PAGAT gel dosimeters were manufactured. Two of them were doped with 20 % glucose and sucrose' respectively. For each batch' one sample was left unirradiated while the remaining samples were irradiated to different doses. After irradiation' NMR spectra were obtained which clearly showed the composition of the dosimeter and the change in monomer concentration caused by irradiation. In addition' it revealed that the saccharides did not directly participate in the chemical process before and during irradiation but the addition of saccharides resulted in a higher consumption rate of the monomers.

Optical Computed Tomography (CT) is a promising technique for dosimetry of Microbeam Radiation Therapy (MRT), providing high resolution 3D dose maps. Here different MRT irradiation geometries are visualised showing the potential of Optical CT as a tool for future MRT trials. The Peak-to-Valley dose ratio (PVDR) is calculated to be 7 at a depth of 3mm in the radiochromic dosimeter PRESAGE®. This is significantly lower than predicted values and possible reasons for this are discussed.

The planar diffuser light source for a cone-beam optical CT scanner was replaced with a filtered LED and large Fresnel lens. The source was focused on a camera and convergent cone-beam images were acquired. Images are sensitive to mismatches in the refractive index of vessels, samples and matching liquid. For PETE jars and water solutions, a loss of approximately 30% of the projections was demonstrated. Teflon PFA cylinders provided better refractive index matching and more accurate reconstructions. The convergent cone-beam source dramatically increased imaging efficiency by a factor of 1000 and reduced stray light levels by confining illumination to image forming rays.

Advanced radiotherapy and brachytherapy techniques are raising the bar for detectors with respect to high spatial resolution. Dosimetry based on most point-like dosimeters, e.g. diamond detectors or small volume ionization chambers cannot be used efficiently and accurately for detecting 2 or 3D-dose variations at millimeter scale. Hence radiochromic films and polymer gels with high two/three-dimensional resolution provide a good verification tool for measuring dose distributions of very small collimated beams. In this study the performance of film and gel detectors in detecting the very fine dose distributions generated from collimation holes of four different sizes is investigated. Pencil beams with diameters down to 0.455 mm could be resolved by both detector types comparably.

For the verification of 3D dose distributions in modern radiation therapy, a new inclusion type radiochromic gel detector has been developed. In this gel, a hydrophobic leuco dye (leucomalachite green: LMG) was dissolved in water as an inclusion complex with highly branched cyclic dextrin. The radiation induced radical oxidation property of the LMG gel with various sensitizers was investigated. As a result, the optical dose responses were enhanced by the addition of bromoacetic acid and manganese (II) chloride. Unfavorable auto-oxidation of the gel was reduced when it was stored at 4°C.

The radiation-induced polymerization and fluorescence intensity of a radio- fluorogenic medium consisting of tertiary-butyl acrylate (TBA) with ca 100 ppm maleimido- pyrene (MPy) display a super-linear dependence on dose and a close to inverse square root dependence on dose rate over the range from 2 to 30 Gy/min. In contrast with the fluorescence, the clarity and optical absorption remain unchanged on irradiation up to at least 17% monomer conversion for which the medium is a rigid gel.

The effects of the various components of leuco crystal violet (LCV) micelle gels on dose sensitivity and initial colour are tested. Dose sensitivity and gel turbidity are influenced by tri-chloro acetic acid (TCAA) concentration, with the highest dose sensitivity obtained at ~21.5 mM. Increasing Triton x-100 (Txl00) concentration improved dose sensitivity but, unfortunately, increased initial colour of the gel. Using Cetyl Trimethyl Ammonium Bromide (CTAB) in place of Tx100 produces gels that are nearly colourless prior to irradiation, but reduces the dose sensitivity. The effects of chlorinated species on dose sensitivity are tested using 2,2,2-trichloroethanol (TCE), chloroform, and 1,1,1-trichloro-2-methyl-2-propanol hemihydrate (TCMPH). TCE gives the largest improvement in dose sensitivity and is recommended for use in micelle gel dosimeters because it is less volatile and safer to use than chloroform. A new gel containing CTAB as the surfactant and TCE gives improved dose sensitivity compared to previous LCV micelle gels.

Designed experiments and empirical models are used to optimize a Leuco Crystal Violet (LCV) micelle gel recipe to improve dose sensitivity and initial colour. The optimized recipe contains 0.75 mM LCV, 17.0 mM Cetyl Trimethyl Ammonium Bromide (CTAB), 120 mM 2,2,2-trichloroethanol (TCE), 25.0 mM tri-chloro acetic acid (TCAA), 4 wt% gelatin and ~96 wt% water. Dose sensitivity of the optimized gel is 1.5 times higher than Jordan's standard LCV gel. Spatial integrity of the 3D dose distribution information in 1L jar phantoms made using this recipe is maintained for more than two weeks.

This study investigates a reusable PRESAGE® 3D dosimeter (Presage-RU), which would improve cost-effectiveness and facilitate wider implementation of comprehensive, high resolution 3D dosimetry. Small (1x1x4.5 cm) and large (8 cm diameter, 4.5 cm length) sample dosimeters were irradiated multiple times to characterize dose response (i.e. radiation-induced change in optical density (ΔOD)), optical clearing rate, and dose distribution stability. Presage- RU exhibited an initial dose response sensitivity of 0.0119 ΔOD/(cm-Gy), a reduction in response with subsequent irradiations, and a small, permanent ΔOD (~1-6% of initial signal) following each irradiation. Dosimeters optically cleared at an exponential rate (average T_1/2 = 24.8±3.6 h), and were effectively cleared after ~5-8 days. 3D gamma analysis (3%/3mm, 10% dose threshold) of a 4-field box plan applied to the large dosimeter showed good agreement following initial irradiation (96.6% passing), but a reduction in passing rate (89.1% passing) with subsequent irradiation. Further study is warranted to fully assess and quantify the performance of Presage-RU for repeat irradiations.

A minimum expected gamma (γ) pass rate for VMAT plan verification using ArcCHECK was established based on the RTTQA, TGI 19 test cases and 10 clinical plans with varying levels of complexity. The impact of the 'Measurement Uncertainty' parameter as available in the ArcCHECK software on γ pass rate was studied for both global and local γ analysis. Our results show that excluding measurement uncertainty adds tighter tolerance in local γ comparison. From the verification of our benchmark cases we established minimum expected γ pass rates of 85% and 88% for 2%/2mm global and 3%/3mm local tolerance criteria.

Electronic portal imaging device (EPID) is currently used for dosimetric verification of IMRT fields and linac quality assurance (QA). It is critical to understand the dosimetric response and perform an accurate and robust calibration of EPID. We present the implementation of an efficient method for the calibration and the validation of a Varian EPID, which relies only on data collected with that specific device. The calibration method is based on images obtained with five shifts of EPID panel. With this method, the relative gain (sensitivity) of each element of a detector matrix is calculated and applied on top of the calibration determined with the flood-field procedure. The calibration procedure was verified using a physical wedge inserted in the beam line and the corrected profile shows consistent results with the measurements using a calibrated 2D array. This method does not rely on the beam profile used in the flood-field calibration process, which allows EPID calibration in 10 minutes with no additional equipment compared to at least 2 hours to obtain beam profile and scanning beam equipment requirement with the conventional method.

One challenge in gel dosimetry is the manipulation and analysis of complex data sets from different systems. In this paper, we describe a simple and fast gel dosimetry analysis tool for radiation therapy dose deliveries. Using the open source medical imaging software 3D Slicer, an extension was designed and implemented for the purpose of importing treatment planning system dose, CT imaging from simulation and at treatment, and optical CT gel dosimeter data. The extension also allows for calibration of gel dosimeter data, registration, and comparison of 3D dose distributions. The development of an open source gel dosimetry processing environment may help adoption of gels in the clinic.

Chemical dosimeters, including PRESAGE® as used in optical CT, exhibit significant quenching effects in response to proton irradiation and this may limit their widespread uptake. This study performs careful measurements of the observed quenching of a recently developed variant of PRESAGE® in a 60 MeV proton beam and uses them to attempt an empirical correction of a simple superposition of two unmodulated beams.

The influence of atmospheric oxygen on the efficiency of the PRESAGE^® dosimeter was investigated. Batches of PRESAGE^® and reporting system solution were deoxygenated using nitrogen and compared to similar batches that were exposed to atmospheric oxygen during fabrication. The overall results show little influence of oxygen on the characteristics of PRESAGE^® with the radical initiator oxidizing the leucomalachite green in the presence of oxygen. However, when deoxygenating the reporting system the sensitivity to radiation dose increased by 30% compared to the non-deoxygenated system. A slight improvement in sensitivity (5%) was achieved by deoxygenating the PRESAGE^® precursors prior to casting. The results suggest that the solid polyurethane matrix is not permeable to atmospheric oxygen. In addition, there were no observed changes in the dose linearity, absorption spectrum and post-response photofading characteristics of PRESAGE^® under the conditions investigated.

Sub-millimeter resolution images are required for gel dosimeters to be used in preclinical research, which is challenging for MR probed ferrous xylenol-orange (FXG) dosimeters due to ion diffusion and inadequate SNR. A preclinical 7 T MR, small animal irradiator and FXG dosimeters were used in all experiments. Ion diffusion was analyzed using high resolution (0.2 mm/pixel) T₁ MR images collected every 5 minutes, post-irradiation, for an hour. Using Fick's second law, ion diffusion was approximated for the first hour post-irradiation. SNR, T1 map precision and calibration fit were determined for two MR protocols: (1) 10 minute acquisition, 0.35mm/pixel and 3mm slices, (2) 45 minute acquisition, 0. 25 mm/pixel and 2 mm slices. SNR and T1 map precision were calculated using a Monte Carlo simulation. Calibration curves were determined by plotting R1 relaxation rates versus depth dose data, and fitting a linear trend line. Ion diffusion was estimated as 0.003mm² in the first hour post-irradiation. For protocols (1) and (2) respectively, Monte Carlo simulation predicted T1 precisions of 3% and 5% within individual voxels using experimental SNRs; the corresponding measured T1 precisions were 8% and 12%. The linear trend lines reported slopes of 27 ± 3 Gy*s (R²: 0.80 ± 0.04) and 27 ± 4 Gy*s (R²: 0.90 ± 0.04). Ion diffusion is negligible within the first hour post-irradiation, and an accurate and reproducible calibration can be achieved in a preclinical setting with sub-millimeter resolution.

A modification to the PVA-FX hydrogel whereby the chelating agent, xylenol orange, was partially bonded to the gelling agent, poly-vinyl alcohol, resulted in an 8% reduction in the post irradiation Fe³⁺ diffusion, adding approximately 1 hour to the useful timespan between irradiation and readout. This xylenol orange functionalised poly-vinyl alcohol hydrogel had an OD dose sensitivity of 0.014 Gy⁻¹ and a diffusion rate of 0.133 mm² h⁻¹. As this partial bond yields only incremental improvement, it is proposed that more efficient methods of bonding xylenol orange to poly-vinyl alcohol be investigated to further reduce the diffusion in Fricke gels.

Micro-beam Radiation Therapy (MRT) is an experimental radiation therapy with provocative experimental data indicating potential for improved efficacy in some diseases. Here we demonstrated a comprehensive micro-beam verification method utilizing high resolution (50pm) PRESAGE/Micro-Optical-CT 3D Dosimetry. A small PRESAGE cylindrical dosimeter was irradiated by a novel compact Carbon-Nano-Tube (CNT) field emission based MRT system. The Percentage Depth Dose (PDD), Peak-to-Valley Dose Ratio (PVDR) and beam width (FWHM) data were obtained and analyzed from a three strips radiation experiment. A fast dose drop-off with depth, a preserved beam width with depth (an averaged FWHM across three beams remains constant (405.3um, sigma=13.2um) between depth of 3.0~14.0mm), and a high PVDR value (increases with depth from 6.3 at 3.0mm depth to 8.6 at 14.0mm depth) were discovered during this verification process. Some operating procedures such as precise dosimeter mounting, robust mechanical motions (especially rotation) and stray-light artifact management were optimized and developed to achieve a more accurate and dosimetric verification method.

The purpose of the study was to evaluate how breathing motion during tomotherapy (Accuray, CA, USA) treatment affects the absorbed dose distribution. The experiments were carried out using gel dosimetry and a motion device simulating respiratory-like motion (HexaMotion, ScandiDos, Uppsala, Sweden). Normoxic polyacrylamide gels (nPAG) were irradiated, both during respiratory-like motion and in a static mode. To be able to investigate interplay effects the static absorbed dose distribution was convolved with the motion function and differences between the dynamic and convolved static absorbed dose distributions were interpreted as interplay effects. The expected dose blurring was present and the interplay effects formed a spiral pattern in the lower dose volume. This was expected since the motion induced affects the preset pitch and the theoretically predicted thread effect may emerge. In this study, the motion induced thread effect was experimentally verified for the first time.

The aim of the study was to perform assessment of radiochromic gel dosimeter based on Turnbull blue dye formed by irradiation (TB gel dosimeter) for measurement of ROFs for 4 mm and 8 mm collimators for the Leksell Gamma Knife Perfexion^TM. All measurements have been carried out using home-made spherical Perspex glass phantom of diameter 160 mm. TB gel dosimeters were scanned using homemade optical CT scanner. The results are compared with vendor recommended Monte Carlo calculated ROFs values of 0.814 and 0.900 for 4 mm and 8 mm collimators, respectively. The comparisons between the gel measurements and the treatment planning system (TPS) calculation are presented in the form of 2D isodoses for the central slices and 1D profile. Measured ROF 0.746 and 0.874 for 4 mm and 8 mm collimators respectively are in a reasonable agreement with vendor recommended values and measured relative dose distribution in a central slice and measured profiles of all shots show excellent correspondence with TPS.

This work presents an end-to-end test using a composite Gel-Alanine phantom, in order to validate 3-dimensionally the dose distribution delivered by a single isocenter VMAT technique on the simultaneous treatment of multiple brain metastases. The results obtained with the gel and alanine dosimeters are consistent with the expected by the treatment planning system, showing the potential of this multidosimetric approach and validating dosimetrically the multiple brain metastases treatment using VMAT.

In a high resolution image-guided small animal irradiation platform, a cone beam computed tomography (CBCT) is integrated with an irradiation unit for precise targeting. Precise quality assurance is essential for both imaging and irradiation components. The conventional commissioning techniques with films face major challenges due to alignment uncertainty and labour intensive film preparation and scanning. In addition, due to the novel design of this platform the mouse stage rotation for CBCT imaging is perpendicular to the gantry rotation for irradiation. Because these two rotations are associated with different mechanical systems, discrepancy between rotation isocenters exists. In order to deliver x-ray precisely, it is essential to verify coincidence of the imaging and the irradiation isocenters. A 3D PRESAGE dosimeter can provide an excellent tool for checking dosimetry and verifying coincidence of irradiation and imaging coordinates in one system. Dosimetric measurements were performed to obtain beam profiles and percent depth dose (PDD). Isocentricity and coincidence of the mouse stage and gantry rotations were evaluated with starshots acquired using PRESAGE dosimeters. A single PRESAGE dosimeter can provide 3 -D information in both geometric and dosimetric uncertainty, which is crucial for translational studies.

Optical computed tomography (optical-CT) is a method for visualizing 3dimensional dose distributions in radiochromic dosimeters. Projection images are acquired by collimating a visible light point source into parallel-beam geometry and imaging differential absorption through the sample dosimeter. Practical challenges involved in optical-CT imaging were addressed through the investigation of an in-house Fresnel-based optical-CT system with considerably less refractive index-matching fluid. The "DFOS" (Duke Fresnel-based Optical- CT System) system differed from current optical-CT systems by replacing cumbersome convex telecentric lenses with a lighter and much less expensive Fresnel system. A second major modification was the replacement of the refractive index-matching fluid bath with a solid polyurethane tank. PRESAGE radiochromic dosimeters were irradiated with orthogonal parallel-opposed treatments and dose distributions were readout by the DFOS system and compared to both treatment planning software prediction and two other in-house optical-CT systems. Gamma index passing rate at the 3%/3mm threshold in relation to Eclipse treatment planning software for the treatment was 92.2%%, compared to 96.8% and 95.6% for two other systems featuring a traditional setup. The DFOS system showed promise for 3D dosimetry, but the performance is still substantially inferior at present to the gold-standard systems.

The accuracy of 3DVH (Sun Nuclear Corporation, USA) reported DVH metrics for target volumes and Organs at Risk (OARs) for two Prostate Volumetric Modulated Arc Therapy (VMAT) plans was studied. The accuracy of 3DVH estimated DVH metrics in the presence of Multi Leaf Collimator (MLC) systematic errors was also tested with error introduced plans calculated in Pinnacle. The results of the study show that the DVH metrics estimated by 3DVH for error-free plans agree with the TPS calculation within 3%. The D95 to PTV was shown to be sensitive in detecting studied MLC errors. However the accuracy of 3DVH estimated DVH metrics for Target Volumes and OARs in the presence of MLC errors for VMAT prostate plans has limitations with this small data set. Although for most situations values matched within 3% for small MLC errors, there was up to a 9.8% difference between the TPS and 3DVH in the presence of a simulated 5mm MLC positioning error. Further study with more plans including other treatment sites is required to fully assess the performance of 3DVH in detecting potential clinical delivery errors.

3D Gamma index is one of the metrics which have been widely used for clinical routine patient specific quality assurance for IMRT, Tomotherapy and VMAT. The algorithms for calculating the 3D Gamma index using global and local methods implemented in two software tools: PTW- VeriSoft^® as a part of OCTIVIUS 4D dosimeter systems and 3DVH^TM from Sun Nuclear were assessed. The Gamma index calculated by the two systems was compared with manual calculated for one data set. The Gamma pass rate calculated by the two systems was compared using 3%/3mm, 2%/2mm, 3%/2mm and 2%/3mm for two additional data sets. The Gamma indexes calculated by the two systems were accurate, but Gamma pass rates calculated by the two software tools for same data set with the same dose threshold were different due to the different interpolation of raw dose data by the two systems and different implementation of Gamma index calculation and other modules in the two software tools. The mean difference was -1.3%±3.38 (1SD) with a maximum difference of 11.7%.

Gamma index pass rates were evaluated for an anthropomorphic phantom using both 2D and 3D calculations. The phantom was irradiated with the traditional dosimetry insert loaded with radiochromic film and TLD, and then with a 3D dosimetry insert. A comparison with the calculated dose distribution showed that both the PRESAGE^® dosimeter and the film and TLD system agreed with the plan to within 5% using 2D gamma index criteria. The 3D gamma index showed a slightly higher pass rate than the 2D gamma index at 3%/3mm, and comparable pass rates using more generous constraints. The acceptable number of pixels passing the tighter constraints (3%/3mm) might be dependent upon the choice between a 2D calculation versus a 3D calculation.

A new method for estimation of fluence complexity in Intensity Modulated Radiation Therapy (IMRT) fields is proposed. Unlike other previously published works, it is based on portal images calculated by the Portal Dose Calculation algorithm in Eclipse (version 8.6, Varian Medical Systems) in the plane of the EPID aS500 detector (Varian Medical Systems). Fluence complexity is given by the number and the amplitudes of dose gradients in these matrices. Our method is validated using a set of clinical plans where fluence has been smoothed manually so that each plan has a different level of complexity. Fluence complexity calculated with our tool is in accordance with the different levels of smoothing as well as results of gamma analysis, when calculated and measured dose matrices are compared. Thus, it is possible to estimate plan complexity before carrying out the measurement. If appropriate thresholds are determined which would distinguish between acceptably and overly modulated plans, this might save time in the re-planning and re-measuring process.

Net optical attenuation in optical CT scanning is usually determined by pre and postirradiation scans. Replacement of the pre-irradiation scan by a scan of different wavelength, acquired concurrently with the post irradiation scan is proposed. This would result in greater practicality of gel dosimetry and potentially improved image quality. This study indicates that the approach may be viable, however experimental investigation is required for analysis of the prospective benefits of removing inter-scan variations.

To create an optical density map of 3D dosimeter phantoms, the ratio of the transmission profile (either a line or planar) acquired after irradiation of the dosimeter and a pre-irradiation reference scan of the same dosimeter phantom is taken. Any uncertainty in repositioning of the phantom may result in an uncertainty in the optical density map and finally also in the derived dose maps. Correct repositioning is paramount when scanning noncylindrical dosimeter phantoms as any repositioning error will give rise to severe imaging artifacts. We hereby propose a different scanning technique that does not require any repositioning of the dosimeter phantom. In this method, no pre-irradiation san is recorded but the dosimeter phantom is scanned twice with light at two different wavelengths. It is demonstrated that this method is accurate in scanning non-cylindrical anthropomorphic shaped phantoms.

A cone-beam optical computed tomography (CT) scanner was modified by replacing the diffuse planar yellow light emitting diode (LED) source with violet and red LEDs and a large Fresnel lens. The narrow band sources provided transmission images of radiochromic EBT2 film at 420 and 633 nm, with air as a reference. The dose image was not detectable with the violet source. This demonstrated spectral independence of the two images. Assuming attenuation at 420 nm was dominated by absorption from yellow dye in the active film layer allowed a relative thickness image to be calculated. By scaling the 633 nm optical density image for relative thickness, non-uniformities in the recorded dose distribution due to film thickness variations, were removed.

This study reports on the development of CCD-based optical computed tomography (CT) CT-s2. A commercially available 10× fast optical computed tomography scanner (OCTOPUSTM-10X, MGS Research, Inc., Madison, CT, USA) was used for comparison. NIPAM polymer gel dosimeter was used to validate the performance of CT-s2. The gamma pass rate can reach 96.00% when using a 3% dose difference and 3 mm dose-to-agreement criteria. The results of CT-s2 are as good as those of the single-beam optical-CT scanner, but the scanning time of CT-s2 is only one-tenth of that of the single-beam optical-CT scanner.

This work examined the suitability of the PAGAT gel dosimeter for use in dose distribution measurements around high-density implants. An assessment of the gels reactivity with various metals was performed and no corrosive effects were observed. An artefact reduction technique was also investigated in order to minimise scattering of the laser light in the optical CT scans. The potential for attenuation and backscatter measurements using this gel dosimeter were examined for a temporary tissue expander's internal magnetic port.

This study examines the effects of temporary tissue expanders (TTEs) on the dose distributions of photon beams in breast cancer radiotherapy treatments. EBT2 radiochromic film and ion chamber measurements were taken to quantify the attenuation and backscatter effects of the inhomogeneity. Results illustrate that the internal magnetic port present in a tissue expander causes a dose reduction of approximately 25% in photon tangent fields immediately downstream of the implant. It was also shown that the silicone elastomer shell of the tissue expander reduced the dose to the target volume by as much as 8%. This work demonstrates the importance for an accurately modelled high-density implant in the treatment planning system for post-mastectomy breast cancer patients.

Optical CT has been considered as an important and promising readout method for 3D gel dosimetry. However, tomographic image qualities are often corrupted by artifacts such as streaks and rings, which are induced by projection discontinuities and magnified by FBP reconstruction. These artifacts will surely deteriorate the accuracy and precision of dose measurement. In this paper, we performed a preliminary study on our in-house optical CT scanner using an iterative algorithm instead of the commonly used FBP for image reconstruction. Comparative analysis of the results validates the proposed method in artifacts suppression and image quality improvement when the convergent process is properly controlled.

This work represents the response of PAGAT gel dosimeter using UV-Visible Spectrophotometry. The particle size and optimal wavelength of the gel sample were analyzed from the obtained spectrum. In addition, the compressibility was estimated using Ultrasonic Interferometer. The results showed that the particle size of the PAGAT varied appreciably with respect to the dose applied but did not vary significantly with the post irradiation time.

Extract from Green Tea (GTE) acts as an antioxidant in acrylamide based polymer gel dosimeter. In this work, PAGAT gel was used for investigation of antioxidant effect of GTE.PAGAT was called PAGTEG (Polyacrylamide green tea extract gel dosimeter) after adding GTE. Free radicals in water cause pre polymerization of polymer gel before irradiation. Polyphenols from GTE are highly effective to absorb the free radicals in water. THPC is used as an antioxidant in polymer gel dosimeter but here we were replaced it by GTE and investigated its effect by spectrophotometer. GTE added PAGAT samples response was lower compared to THPC added sample. To increase the sensitivity of the PAGTEG, sugar was added. This study confirmed that THPC was a good antioxidant for polymer gel dosimeter. However, GTE also can be used as an antioxidant in polymer gel if use less quantity (GTE) and add sugar as sensitivity enhancer.

The Fricke gel dosimeter has been the widely used dosimeter among the gel dosimeters because of its dose response characteristics and easy preparation. The ferrous to ferric conversion that happens in this gel dosimeter on irradiation, corresponds to the absorbed dose of radiation. Gel dosimetry in India is not moving forward because of the import restrictions on the commercially available high bloom strength gelatin (imported 300 bloom). The feasibility of using Fricke gel dosimeter prepared with the locally available gelatin of 240 bloom and 200 bloom were compared with the 300 bloom gelatin taken as standard. The gel samples were prepared with 5% gelatin by weight and irradiated with ⁶⁰Co gamma radiation for a dose range from 0-3 Gy used clinically. The optical absorption of gel samples were analyzed using spectrophotometer at 585 nm and dose response curves were generated. The results indicate that Fricke gels prepared with 240 bloom have linear dose response and comparable with those prepared with 300 bloom but the use of gels prepared with 200 bloom was found to be limited because of its poor optical transmittance.

We present the characteristics of a new silicone-based radiochromic dosimeter containing the leuco-malachite green (LMG) dye. The dose response as well as the dose-rate and photon-energy dependence of the dosimeter were characterized. To optimise the dose response, different concentrations of the chemical components were investigated. The dose response was found to decrease exponentially as a function of time after irradiation. A cylindrical dosimeter was produced and irradiated with a volumetric modulated arc therapy plan; the standard deviation between measured and calculated dose was 5% of the total dose.

This study aimed to investigate whether gel dosimetry could be used to measure neutron beams. We irradiated a BANG3-type polymer gel dosimeter using neutron beams in the Neutron exposure Accelerator System for Biological Effect Experiments (NASBEE) at the National Institute of Radiological Sciences (NIRS) in Japan. First, the polymer gels were irradiated from 0 to 7.0 Gy to investigate the dose-R₂ responses. Irradiated gels were evaluated using 1.5-T magnetic resonance R₂ images. Second, the polymer gels were irradiated to 1.0, 3.0, and 5.0 Gy to acquire a depth-R₂ response curve. The dose-R₂ response curve was linear up to approximately 7 Gy, with a slope of 1.25 Gy⁻¹·s⁻¹. Additionally, compared with the photon- irradiated gels, the neutron-irradiated gels had lower R₂ values. The acquired depth-R₂ curves of the central axis from the 3.0- and 5.0-Gy neutron dose-irradiated gels exhibited an initial build-up. Although, a detailed investigation is needed, polymer gel dosimetry is effective for measuring the dose-related R₂ linearity and depth-R₂ relationships of neutron beams.

The paper describes the energy dependence of two types of radiochromic gels, a Fricke-xylenol orange gel (FX gel) and a gel based on Turnbull blue (TB gel), on low energy photons between 14 and 145 keV. Gel samples were irradiated at reference photon fields at the Czech Metrology Institute and evaluated by two independent optical methods. Measurements revealed that the response of the TB gel is independent on photon energy down to at least 14 keV photons, while the FX gel is energy dependent for photons below roughly 50 keV.

The polyGeVero^® software package was elaborated for calculations of 3D dosimetry data such as the polymer gel dosimetry. It comprises four workspaces designed for: i) calculating calibrations, ii) storing calibrations in a database, iii) calculating dose distribution 3D cubes, iv) comparing two datasets e.g. a measured one with a 3D dosimetry with a calculated one with the aid of a treatment planning system. To accomplish calculations the software was equipped with a number of tools such as the brachytherapy isotopes database, brachytherapy dose versus distance calculation based on the line approximation approach, automatic spatial alignment of two 3D dose cubes for comparison purposes, 3D gamma index, 3D gamma angle, 3D dose difference, Pearson's coefficient, histograms calculations, isodoses superimposition for two datasets, and profiles calculations in any desired direction. This communication is to briefly present the main functions of the software and report on the speed of calculations performed by polyGeVero^®.

A feasibility study is considered using PRESAGE® dosimeters as a direct dosimetry comparison tool to correlate proton activation to dose in a clinical beam. Proton activation measured by PET/CT has been studied as a future tool method for in vivo dosimetry. PRESAGE® is a 3D offline dosimeter that has a material composition giving it a longer activation decay time than similar dosimeters allowing easier measurements. In this study, the PRESAGE® positron emissions were measured by PET and directly compared to dose measurements made by optical-CT to make spatial comparisons of dose and proton activation. Profiles along the central axis of the beam found a shift in the distal-80% resulting in the proton activation profile being 1 cm shallower than the dose profile. Cross beam profiles demonstrated little discrepancy between long (3 hour) and short (30 minute) PET scan times.

Strontium-90 eye applicators are a beta-ray emitter with a relatively high-energy (maximum energy about 2.28 MeV and average energy about 0.9 MeV). These applicators come in different shapes and dimensions; they are used for the treatment of eye diseases. Whenever, radiation is used in treatment, dosimetry is essential. However, knowledge of the exact dose distribution is a critical decision-making to the outcome of the treatment. The main aim of our study is to simulate the dosimetry of the SIA.20 eye applicator with Monte Carlo GATE 6.1 platform and to compare the calculated results with those measured with EBT2 films. This means that GATE and EBT2 were used to quantify the surface and depths dose- rate, the relative dose profile and the dosimetric parameters in according to international recommendations. Calculated and measured results are in good agreement and they are consistent with the ICRU and NCS recommendations.

Measurements of half-field beam penumbra were taken using EBT2 film for a variety of blocking techniques. It was shown that minimizing the SSD reduces the penumbra as the effects of beam divergence are diminished. The addition of a lead block directly on the surface provides optimal results with a 10-90% penumbra of 0.53 ± 0.02 cm. To resolve the uncertainties encountered in film measurements, future Monte Carlo measurements of halffield penumbras are to be conducted.

MAGAT gel dosimeter with boron is irradiated in Heavy Water Neutron Irradiation Facility (HWNIF) of Kyoto University Research Reactor (KUR). The cylindrical gel phantoms are exposed to neutron beams of three different energy spectra (thermal neutron rich, epithermal and fast neutron rich and the mixed modes) in air. Preliminary results corresponding to depth-dose responses are obtained as the transverse relaxation rate (R₂=1/T₂) from magnetic resonance imaging data. As the results MAGAT gel dosimeter has the higher sensitivity on thermal neutron than on epi-thermal and fast neutron, and the gel with boron showed an enhancement and a change in the depth-R₂ response explicitly. From these results, it is suggested that MAGAT gel dosimeter can be an effective tool in BNCT dosimetry.

The signal-to-noise ratio achievable in x-ray computed tomography (CT) images of polymer gels can be increased by averaging over multiple scans of each sample. However, repeated scanning delivers a small additional dose to the gel which may compromise the accuracy of the dose measurement. In this study, a NIPAM-based polymer gel was irradiated and then CT scanned 25 times, with the resulting data used to derive an averaged image and a "zero-scan" image of the gel. Comparison between these two results and the first scan of the gel showed that the averaged and zero-scan images provided better contrast, higher contrast-to- noise and higher signal-to-noise than the initial scan. The pixel values (Hounsfield units, HU) in the averaged image were not noticeably elevated, compared to the zero-scan result and the gradients used in the linear extrapolation of the zero-scan images were small and symmetrically distributed around zero. These results indicate that the averaged image was not artificially lightened by the small, additional dose delivered during CT scanning. This work demonstrates the broader usefulness of the zero-scan method as a means to verify the dosimetric accuracy of gel images derived from averaged x-ray CT data.

In 3D radiation dosimetry with optical CT scanning readout, projections of transmitted light are recorded in either lines or planar. The projections are then transferred to optical density maps by use of filtered back-projection. Absolute dose maps can be derived from the optical density maps by calibration of the optical absorption coefficient to dose values. The transmission profiles will be subject to a certain level of detector noise and noise arriving from fluctuations in the light source. Different reconstruction filters in the frequency domain can be applied in the image reconstruction procedure. The noise level in the final reconstructed images is determined by the noise in the projections, the spatial resolution and the reconstruction algorithm. The reconstruction filters may also have an effect on the geometrical precision as a spatial frequency filter may also affect the spatial resolution. We here propose an easy method to assess both the noise sensitivity and the performance in terms of mapping dose distributions with various theoretical dose gradients.

Delivery quality assurance (DQA) has been performed for each Tomotherapy patient either using ArcCHECK or MatriXX Evolution in our clinic since 2012. ArcCHECK is a quasi-3D dosimeter whereas MatriXX is a 2D detector. A review of DQA results was performed for all patients in the last three years, a total of 221 DQA plans. These DQA plans came from 215 patients with a variety of treatment sites including head-neck, pelvis, and chest wall. The acceptable Gamma pass rate in our clinic is over 95% using 3mm and 3% of maximum planned dose with 10% dose threshold. The mean value and standard deviation of Gamma pass rates were 98.2% ± 1.98(1SD) for MatriXX and 98.5%±1.88 (1SD) for ArcCHECK. A paired t-test was also performed for the groups of patients whose DQA was performed with both the ArcCHECK and MatriXX. No statistical dependence was found in terms of the Gamma pass rate for ArcCHECK and MatriXX. The considered 3D and 2D dosimeters have achieved similar results in performing routine patient-specific DQA for patients treated on a TomoTherapy unit.

The successful manufacturing of a modified Fricke gel with increased shelf life in a pilot scale (20-liter) commercial production facility is reported. The gels remained chemically stable and usable for over 30 days. Linear dose dependence was observed for cumulative doses up to 30 Gy. Dose-depth studies showed a good correlation between the experimental data and theoretical expectations, but the dose response appeared to be energy-dependent.

A dynamic ex-vivo porcine lung phantom combined with polymer gel dosimetry is tested as a new tool to validate modern adaptive radiotherapy techniques (e.g. gating or tracking). The gel was inserted into the lung via a latex balloon to simulate a tumor. After irradiation, the location of the dose maximum was verified, however, the dose was higher than planned and a high background signal was seen. Potential reasons for this finding are the nonstandard conditions of gel handling. These conditions were systematically studied. Besides temperature, the material of the balloon seems to be of special importance. The results identify open issues that have to be addressed in future studies.

The chemical oxidative decomposition of leucocrystal violet micelle hydrogel dosimeters was investigated using the reaction of ferrous ions with hydrogen peroxide or sodium bicarbonate with hydrogen peroxide. The second reaction is more effective at dye decomposition in gelatin hydrogels. Additional chemical analysis is required to determine the decomposition products.

The Octavius 4D dosimetric system generates a 3D dose matrix based on a measured planar dose and user supplied Percentage Depth Dose (PDD) data. The accuracy of 3D dose matrices reconstructed by the Octavius 4D dosimetric system was systematically studied for an open static field, an open arc field and clinical VMAT plans. The Octavius reconstructed 3D dose matrices were compared with the Treatment Planning System (TPS) calculated 3D dose matrices using 3D gamma (γ) analysis with 2%/2mm and 3%/3mm tolerance criteria. The larger detector size in the 2D detector array of the Octavius system resulted in failed voxels in the high dose gradient regions. For the open arc fields mean (1σ) γ pass rates of 84.5(8.9) % and 94.2(4.5) % were observed with 2%/2mm and 3%/3mm tolerance criteria respectively and for clinical VMAT plans mean (1σ) γ pass rates of 86.8(3.5) % and 96.7(1.4) % were observed.