High Dose Rate vaginal brachytherapy for endometrial cancer has evolved from simple single-channel (i.e. cylindrical applicator) deliveries to treatments involving several channels (i.e. multichannel ...applicator) for the radiotherapy source to dwell, increasing the complexity of the dose distribution, and allowing more space for potential errors. For this reason real-time treatment verification has gained a greater importance than ever before, and more methods need to be developed in order to provide assurance that the dose delivery has been carried out as intended by the hospital staff. P-type silicon epi diodes have been designed at the Centre for Medical Radiation Physics (CMRP) in Australia to suit the specific needs of HDR BT, and characterized in the clinical BT facility of the Fondazione IRCCS (INT) in Italy. They have shown great potential for BT treatment verification in real time due to their radiation hardness, dose rate independence, flexibility in physical design, and ability to monitor the treatment at a 1-kHz readout frequency. Their dynamic range has been determined as ±17 to ±20 mm and dwell time calculation accuracy of > 0.1 s has been shown. If placed on the same longitudinal plane of a treatment accessory, these detectors would enable coverage of about 40 mm for source position and dwell time tracking. Respective detector positioning at (0, +3, −3 mm) would extend this range to 45-50 mm, depending on the catheter location, proving to be sufficient for the majority of treatment cases. Further studies are encouraged to develop diodes with a wider dynamic range.
•The BrachyView system displays a detection rate of 100•Seed positions for CT and the BrachyView system were fused with the 3D volume, reconstructed from TRUS images.•An 11.5% reduction in positon ...accuracy was noted without baseline subtraction application.•Without baseline subtraction a 7.6% and 2.1% reduction in the D90 and V100, respectively, were noted.
BrachyView is a novel in-body imaging system developed with the objective to provide real-time intraoperative dosimetry for low dose rate (LDR) prostate brachytherapy treatments. The BrachyView coordinates combined with conventional transrectal ultrasound (TRUS) imaging, provides the possibility to localise the effective position of the implanted seeds inside the prostate volume, providing a unique tool for intra-operative verification of the quality of the implantation. This research presents the first complete LDR brachytherapy plan reconstructed by the BrachyView system and is used to evaluate the effectiveness of an imaging algorithm with baseline subtraction.
A plan featuring 98 I-125 brachytherapy seeds, with an average activity of 0.248 mCi, were implanted into a prostate gel phantom under TRUS guidance. Images of implanted seeds were obtained by the BrachyView after the implantation of seeds. The baseline subtraction algorithm is applied as a pixel-to-pixel counts subtraction and is applied to every second projection obtained after the implantation of each needle. Seed positions and effectiveness of the baseline reconstruction in the identification of seeds were verified by a high-resolution post-implant CT scan.
A complete brachytherapy plan has been reconstructed with a 100% detection rate. This is possible due to the effectiveness of the baseline subtraction, with its application an overall increase of 11.3% in position accuracy and 8.2% increase in detection rate was noted.
It has been demonstrated that the BrachyView system shows the potential to be a solution to providing clinics with the means for intraoperative dosimetry for LDR prostate brachytherapy treatments.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Due to the ever-increasing complexity of treatment modalities in radiation therapy, there has been a greater need for detectors to perform quality assurance to ensure patients are treated correctly ...and safely. Modern radiation therapy techniques involve small field sizes, high dose gradients, and varying intensity of energy and rate. The ideal dosimeter for this treatment should display high spatial resolution, high linearity, accuracy, and radiation hardness. Silicon detectors have been widely used for radiotherapy measurements and have many attractive qualities as a dosimeter; weaknesses of silicon detectors are, however, decreases in sensitivity with accumulated dose. The Centre for Medical Radiation Physics has developed a new technology with an unusual charge collection efficiency variation with accumulated dose which stabilizes the response of the detector within ±5% after 120 kGy photon irradiation. The sensor has been also characterized by irradiation by an 18 MV medical LINAC with sensitivity to a photoneutron-induced damage of less than 0.5%/100 Gy. The radiation damage mechanism has been validated by TCAD simulations which confirmed the mechanism behind the CCE increase as a function of the accumulated dose.
Microbeam Radiation Therapy (MRT) involves the use of a spatially fractionated beam of synchrotron generated X-rays to treat tumours. MRT treatment is delivered via an array of high dose 'peaks' ...separated by low dose 'valleys'. A good Peak to Valley Dose Ratio (PVDR) is an important indicator of successful treatment outcomes. MRT dosimetry requires a radiation hard detector with high spatial resolution, large dynamic range, which is ideally real-time and tissue equivalent. We have developed a Silicon Strip Detector (SSD) and very recently, a new 3D MESA SSD to meet the very stringent requirements of MRT dosimetry. We have compared these detectors through the characterisation of the MRT radiation field at the Australian Synchrotron Imaging and Medical Beamline. The EPI SSD was able to measure the microbeam profiles and PVDRs, however the effective spatial resolution was limited by the detector alignment options available at the time. The geometry of the new 3D MESA SSD is less sensitive to this alignment restriction was able to measure the microbeam profiles within 2 μm of that expected. The 3D MESA SSD measured PVDRs were possibly affected by undesired and slow charge collection outside the sensitive volume and additional scattering from the device substrate.
The increasing complexity and high amount of dose per fraction delivered in prostate high dose rate (HDR) brachytherapy treatments call for the implementation of accurate and effective methods for ...the systematic and independent quality control of the overall treatment procedure. In this study, MOSkin detectors were placed on a trans-rectal ultrasound (TRUS) probe with the aim of performing both imaging and real time rectal wall in vivo dosimetry with the use of just one single instrument. After an adequate calibration of the detectors, which was carried out in a solid water phantom, the use of MOSkins integrated to the TRUS probe was studied in a gel phantom with a typical (simplified) prostate implant. Measured and calculated doses from the treatment planning system were compared, with a resulting very low average discrepancy of −0.6 ± 2.6%. The results are very promising and of particular clinical importance, however, further in vivo investigation is planned to validate the proposed method.
•MOSkins were placed on a TRUS probe to perform rectal wall in vivo dosimetry.•Their response was studied in a gel phantom including a typical prostate implant.•The average discrepancy between calculated and measured dose was −0.6 ± 2.6%.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
The purpose of this study is to investigate the directional dependence of a two dimensional monolithic detector array (M512) under 6 MV photon irradiation and to evaluate the effect of field size on ...angular dependence. Square fields of sizes: 3x3 cm2 and 10x10 cm2 were measured at the iso-centre of a cylindrical phantom. Beam angles with incidences from 00- 1800 in increments of 150 were used to investigate the central pixel angular response of M512, normalized to the pixel response for normal (0°) beam incidence. The angular response of the detector was compared to the response of EBT3 radiochromic film in the identical geometric orientation. The maximum angular dependence was observed at the angle 90°±15° to be -18.62% and -17.70% for the field sizes 3x3 cm2 and 10x10 cm2, respectively. The angular dependence of M512 showed no significant difference between field sizes of 3x3 cm2 and 10x10 cm2 (p>0.05). The maximum dose difference measured by the central pixel of M512 and EBT3 for all angles are -20% for 3x3 cm2 field size and -18.58% for the 10x10 cm2 field. The diode array's size and packaging effects the angular response of the detector. The angular correction factor is necessary to apply to increase accuracy in dosimetry for arc treatment delivery.
In this work, a dual detector system for simultaneous in-vivo dosimetry and MV imaging was investigated. The ability to measure real-time water equivalent dose post transit for a heterogeneous ...phantom was demonstrated, illustrating its advantage over non-water equivalent EPID dosimetry. Identification of incorrect MU delivery as well as patient misalignment can be identified in the dose profiles and confirmed through co-registration with EPID images. The dual detector comprising of a silicon array detector “Magic Plate” (MP) and an EPID was positioned beneath the patient couch at a source to detector distance of 150 cm. Two pseudo lung phantoms were utilised in this study; identical, except for the inclusion of a water equivalent hidden target mimicking a tumour. The dosimetric accuracy of the MP was evaluated with EBT3 film and TPS calculations. The presence and position of the hidden target was detected and accurately co-registered between the dose profiles measured with MP and the EPID image. The system measured a difference in post transit doses through the two phantoms of (5.0 ±1.6) cGy due to the presence of the target, in agreement with the TPS calculation of 5.16 cGy. The capability of the system for error detection was confirmed when a deliberate 7 mm lateral shift of the phantom was observed in both the dose profiles measured with MP and the EPID images. The MP as a dosimetric real time detector is lucent in MV photon fields and does not obstruct the EPID field of view.
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