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Purpose: To test the use of a three-dimensional (3D) optical cone beam computed tomography reconstruction algorithm, for estimation of the imparted 3D dose distribution from megavoltage photon beams in a water tank for quality assurance, by imaging the induced Cherenkov-excited fluorescence (CEF). Methods: An intensified charge-coupled device coupled to a standard nontelecentric camera lens was used to tomographically acquire two-dimensional (2D) projection images of CEF from a complex multileaf collimator (MLC) shaped 6 MV linear accelerator x-ray photon beam operating at a dose rate of 600 MU/min. The resulting projections were used to reconstruct the 3D CEF light distribution, a potential surrogate of imparted dose, using a Feldkamp–Davis–Kress cone beam back reconstruction algorithm. Finally, the reconstructed light distributions were compared to the expected dose values from one-dimensional diode scans, 2D film measurements, and the 3D distribution generated from the clinical Varian ECLIPSE treatment planning system using a gamma index analysis. A Monte Carlo derived correction was applied to the Cherenkov reconstructions to account for beam hardening artifacts. Results: 3D light volumes were successfully reconstructed over a 400 × 400 × 350 mm3 volume at a resolution of 1 mm. The Cherenkov reconstructions showed agreement with all comparative methods and were also able to recover both inter- and intra-MLC leaf leakage. Based upon a 3%/3 mm criterion, the experimental Cherenkov light measurements showed an 83%–99% pass fraction depending on the chosen threshold dose. Conclusions: The results from this study demonstrate the use of optical cone beam computed tomography using CEF for the profiling of the imparted dose distribution from large area megavoltage photon beams in water.

Purpose: To identify achievable camera performance and hardware needs in a clinical Cherenkov imaging system for real-time, in vivo monitoring of the surface beam profile on patients, as novel visual information, documentation, and possible treatment verification for clinicians. Methods: Complementary metal-oxide-semiconductor (CMOS), charge-coupled device (CCD), intensified charge-coupled device (ICCD), and electron multiplying-intensified charge coupled device (EM-ICCD) cameras were investigated to determine Cherenkov imaging performance in a clinical radiotherapy setting, with one emphasis on the maximum supportable frame rate. Where possible, the image intensifier was synchronized using a pulse signal from the Linac in order to image with room lighting conditions comparable to patient treatment scenarios. A solid water phantom irradiated with a 6 MV photon beam was imaged by the cameras to evaluate the maximum frame rate for adequate Cherenkov detection. Adequate detection was defined as an average electron count in the background-subtracted Cherenkov image region of interest in excess of 0.5% (327 counts) of the 16-bit maximum electron count value. Additionally, an ICCD and an EM-ICCD were each used clinically to image two patients undergoing whole-breast radiotherapy to compare clinical advantages and limitations of each system. Results: Intensifier-coupled cameras were required for imaging Cherenkov emission on the phantom surface with ambient room lighting; standalone CMOS and CCD cameras were not viable. The EM-ICCD was able to collect images from a single Linac pulse delivering less than 0.05 cGy of dose at 30 frames/s (fps) and pixel resolution of 512 × 512, compared to an ICCD which was limited to 4.7 fps at 1024 × 1024 resolution. An intensifier with higher quantum efficiency at the entrance photocathode in the red wavelengths [30% quantum efficiency (QE) vs previous 19%] promises at least 8.6 fps at a resolution of 1024 × 1024 and lower monetary cost than the EM-ICCD. Conclusions: The ICCD with an intensifier better optimized for red wavelengths was found to provide the best potential for real-time display (at least 8.6 fps) of radiation dose on the skin during treatment at a resolution of 1024 × 1024.

A method was developed utilizing Cherenkov imaging for rapid and thorough determination of the two gantry angles that produce the most uniform treatment plane during dual-field total skin electron beam therapy (TSET).Cherenkov imaging was implemented to gather 2D measurements of relative surface dose from 6 MeV electron beams on a white polyethylene sheet. An intensified charge-coupled device camera time-gated to the Linac was used for Cherenkov emission imaging at sixty-two different gantry angles (1° increments, from 239.5° to 300.5°). Following a modified Stanford TSET technique, which uses two fields per patient position for full body coverage, composite images were created as the sum of two beam images on the sheet; each angle pair was evaluated for minimum variation across the patient region of interest. Cherenkov versus dose correlation was verified with ionization chamber measurements. The process was repeated at source to surface distance (SSD) = 441, 370.5, and 300 cm to determine optimal angle spread for varying room geometries. In addition, three patients receiving TSET using a modified Stanford six-dual field technique with 6 MeV electron beams at SSD = 441 cm were imaged during treatment.As in previous studies, Cherenkov intensity was shown to directly correlate with dose for homogenous flat phantoms (R(2) = 0.93), making Cherenkov imaging an appropriate candidate to assess and optimize TSET setup geometry. This method provided dense 2D images allowing 1891 possible treatment geometries to be comprehensively analyzed from one data set of 62 single images. Gantry angles historically used for TSET at their institution were 255.5° and 284.5° at SSD = 441 cm; however, the angles optimized for maximum homogeneity were found to be 252.5° and 287.5° (+6° increase in angle spread). Ionization chamber measurements confirmed improvement in dose homogeneity across the treatment field from a range of 24.4% at the initial angles, to only 9.8% with the angles optimized. A linear relationship between angle spread and SSD was observed, ranging from 35° at 441 cm, to 39° at 300 cm, with no significant variation in percent-depth dose at midline (R(2) = 0.998). For patient studies, factors influencing in vivo correlation between Cherenkov intensity and measured surface dose are still being investigated.Cherenkov intensity correlates to relative dose measured at depth of maximum dose in a uniform, flat phantom. Imaging of phantoms can thus be used to analyze and optimize TSET treatment geometry more extensively and rapidly than thermoluminescent dosimeters or ionization chambers. This work suggests that there could be an expanded role for Cherenkov imaging as a tool to efficiently improve treatment protocols and as a potential verification tool for routine monitoring of unique patient treatments.

To identify achievable camera performance and hardware needs in a clinical Cherenkov imaging system for real-time, in vivo monitoring of the surface beam profile on patients, as novel visual information, documentation, and possible treatment verification for clinicians.Complementary metal-oxide-semiconductor (CMOS), charge-coupled device (CCD), intensified charge-coupled device (ICCD), and electron multiplying-intensified charge coupled device (EM-ICCD) cameras were investigated to determine Cherenkov imaging performance in a clinical radiotherapy setting, with one emphasis on the maximum supportable frame rate. Where possible, the image intensifier was synchronized using a pulse signal from the Linac in order to image with room lighting conditions comparable to patient treatment scenarios. A solid water phantom irradiated with a 6 MV photon beam was imaged by the cameras to evaluate the maximum frame rate for adequate Cherenkov detection. Adequate detection was defined as an average electron count in the background-subtracted Cherenkov image region of interest in excess of 0.5% (327 counts) of the 16-bit maximum electron count value. Additionally, an ICCD and an EM-ICCD were each used clinically to image two patients undergoing whole-breast radiotherapy to compare clinical advantages and limitations of each system.Intensifier-coupled cameras were required for imaging Cherenkov emission on the phantom surface with ambient room lighting; standalone CMOS and CCD cameras were not viable. The EM-ICCD was able to collect images from a single Linac pulse delivering less than 0.05 cGy of dose at 30 frames/s (fps) and pixel resolution of 512 × 512, compared to an ICCD which was limited to 4.7 fps at 1024 × 1024 resolution. An intensifier with higher quantum efficiency at the entrance photocathode in the red wavelengths [30% quantum efficiency (QE) vs previous 19%] promises at least 8.6 fps at a resolution of 1024 × 1024 and lower monetary cost than the EM-ICCD.The ICCD with an intensifier better optimized for red wavelengths was found to provide the best potential for real-time display (at least 8.6 fps) of radiation dose on the skin during treatment at a resolution of 1024 × 1024.

A novel technique for optical dosimetry of dynamic intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) plans was investigated for the first time by capturing images of the induced Cherenkov radiation in water.A high-sensitivity, intensified CCD camera (ICCD) was configured to acquire a two-dimensional (2D) projection image of the Cherenkov radiation induced by IMRT and VMAT plans, based on the Task Group 119 (TG-119) C-Shape geometry. Plans were generated using the Varian Eclipse treatment planning system (TPS) and delivered using 6 MV x-rays from a Varian TrueBeam Linear Accelerator (Linac) incident on a water tank doped with the fluorophore quinine sulfate. The ICCD acquisition was gated to the Linac target trigger pulse to reduce background light artifacts, read out for a single radiation pulse, and binned to a resolution of 512 × 512 pixels. The resulting videos were analyzed temporally for various regions of interest (ROI) covering the planning target volume (PTV) and organ at risk (OAR), and summed to obtain an overall light intensity distribution, which was compared to the expected dose distribution from the TPS using a gamma-index analysis.The chosen camera settings resulted in 23.5 frames per second dosimetry videos. Temporal intensity plots of the PTV and OAR ROIs confirmed the preferential delivery of dose to the PTV versus the OAR, and the gamma analysis yielded 95.9% and 96.2% agreement between the experimentally captured Cherenkov light distribution and expected TPS dose distribution based upon a 3%/3 mm dose difference and distance-to-agreement criterion for the IMRT and VMAT plans, respectively.The results from this initial study demonstrate the first documented use of Cherenkov radiation for video-rate optical dosimetry of dynamic IMRT and VMAT treatment plans. The proposed modality has several potential advantages over alternative methods including the real-time nature of the acquisition, and upon future refinement may prove to be a robust and novel dosimetry method with both research and clinical applications.

Purpose: To determine the feasibility of using real-time imaging of Cherenkov light emission from an object’s surface for the qualitative identification of radiation ‘mistakes’. Methods: A highly sensitive camera was used to image the Cherenkov light emitted for a solid water phantom. A Varian 2100CD was used to deliver 500 MU for a 6 MV photon beam operating a dose rate of 600 MU/min, and the chosen imaging system and geometry provided data with a field of view of 30×30 cm, at 10 FPS, at a resolution of approximately 0.6 mm. Three mistake scenarios were imaged, two static errors (1) incorrect jaw size for stereotactic delivery using a 20 mm cone, (2) incorrect wedge angle applicator for a 10×10 cm field, and a dynamic errors (3) MLC leaf error and (4) incorrect collimator or gantry angle for IMRT delivery. Results: Using the real-time results of Cherenkov light emission imaging, the incorrect jaw size setting for SRS or SRT and incorrect wedge angle applicator were clearly identified in the first captured image. For the detection of a MLC leaf error, the proposed method was able to provide 4 frames per field, and detect leaf errors down to 1 mm and collimator and gantry errors down to 1 deg. Discussion and Conclusions: While the results in this feasibility study were performed using a solid water phantom, the technique could be readily applied in-vivo, as Cherenkov light emission imaging is completely non-invasive and requires no external materials to be introduced into the Linac or radiation beam path. For the detection of static errors, by providing real-time information after a single MU of delivery, further incorrect radiation field delivery could be avoided. Furthermore, dynamic errors in leaf positioning collimator or gantry angle could be detected in real-time down to 1 mm or 1 deg.

Purpose: To evaluate treatment field heterogeneity resulting from gantry angle choice in total skin electron beam therapy (TSEBT) following a modified Stanford dual-field technique, and determine a relationship between source to surface distance (SSD) and optimized gantry angle spread. Methods: Cherenkov imaging was used to image 62 treatment fields on a sheet of 1.2m x 2.2m x 1.2cm polyethylene following standard TSEBT setup at our institution (6 MeV, 888 MU/min, no spoiler, SSD=441cm), where gantry angles spanned from 239.5° to 300.5° at 1° increments. Average Cherenkov intensity and coefficient of variation in the region of interest were compared for the set of composite Cherenkov images created by summing all unique combinations of angle pairs to simulate dual-field treatment. The angle pair which produced the lowest coefficient of variation was further studied using an ionization chamber. The experiment was repeated at SSD=300cm, and SSD=370.5cm. Cherenkov imaging was also implemented during TSEBT of three patients. Results: The most uniform treatment region from a symmetric angle spread was achieved using gantry angles +/−17.5° about the horizontal axis at SSD=441cm, +/−18.5° at SSD=370.5cm, and +/−19.5° at SSD=300cm. Ionization chamber measurements comparing the original treatment spread (+/−14.5°) and the optimized angle pair (+/−17.5°) at SSD=441cm showed no significant deviation (r=0.999) in percent depth dose curves, and chamber measurements from nine locations within the field showed an improvement in dose uniformity from 24.41% to 9.75%. Ionization chamber measurements correlated strongly (r=0.981) with Cherenkov intensity measured concurrently on the flat Plastic Water phantom. Patient images and TLD results also showed modest uniformity improvements. Conclusion: A decreasing linear relationship between optimal angle spread and SSD was observed. Cherenkov imaging offers a new method of rapidly analyzing and optimizing TSEBT setup geometry by providing a 2D image of the treatment plane as a sum of the two fields. This study has been funded by NIH grants R21EB17559 and R01CA109558 as well as Norris Cotton Cancer Center Pilot funding.

Purpose: A new imaging modality Cherenkov-excited luminescence scanned imaging (CELSI) is demonstrated illustrating that LINAC beams induce Cherenkov emission within tissue, and that in-turn can excite luminescence of optical probes. This is achieved in a highly spatially confined fashion thereby allowing scanned imaging of distributions of luminescent sources. Methods: A 5 mm thick line-excitation megavoltage X-ray beam (6 MV) was collimated and moved by the multi-leaf collimator (MLC) of a linear accelerator (LINAC), to scan in 3 orthogonal directions. The scan in this demonstration was through a rat abdomen for lymph node imaging. The node was injected with oxygen-sensitive phosphor (Oxyphor PtG4), having strong luminescence lifetime, which is sensitive to the local oxygen concentration. During the scanning, Cherenkov-excited luminescence was continuously integrated by an intensified charge-coupled device (ICCD) synchronized to radiation pulses, and the position of the total signal was back-projected to the position of the scanning beam. Results: The lymph node was accurately located in the axillary region by CELSI imaging. Through lifetime measurement of the luminescence signal from within the lymph node, the pO2 was found to be reporting the true oxygenation level. Phantom studies validated that an inclusion with size below 1 mm could be reconstructed through a layer of 20 mm thick tissue equivalent phantom material. Concentrations of PtG4 down to 100 nM were detectable and capillary tubes containing the probe with diameters down to 200 µm could be resolved by CELSI, at 5 mm depth in tissue equivalent phantoms. Conclusion: CELSI is reported here for the first time, as an innovative optical molecular imaging technique by utilizing the LINAC as an optical scanning and excitation device. Potential applications of CELSI include reconstructions of interested optical probes and recoveries of local physiological information with relatively high spatial resolution.

Čerenkov radiation emission occurs in all tissue, when charged particles (either primary or secondary) travel at velocity above the threshold for the Čerenkov effect (about 220 KeV in tissue for electrons). This study presents the first examination of optical Čerenkov emission as a surrogate for the absorbed superficial dose for MV x-ray beams.In this study, Monte Carlo simulations of flat and curved surfaces were studied to analyze the energy spectra of charged particles produced in different regions near the surfaces when irradiated by MV x-ray beams. Čerenkov emission intensity and radiation dose were directly simulated in voxelized flat and cylindrical phantoms. The sampling region of superficial dosimetry based on Čerenkov radiation was simulated in layered skin models. Angular distributions of optical emission from the surfaces were investigated. Tissue mimicking phantoms with flat and curved surfaces were imaged with a time domain gating system. The beam field sizes (50 × 50-200 × 200 mm(2)), incident angles (0°-70°) and imaging regions were all varied.The entrance or exit region of the tissue has nearly homogeneous energy spectra across the beam, such that their Čerenkov emission is proportional to dose. Directly simulated local intensity of Čerenkov and radiation dose in voxelized flat and cylindrical phantoms further validate that this signal is proportional to radiation dose with absolute average discrepancy within 2%, and the largest within 5% typically at the beam edges. The effective sampling depth could be tuned from near 0 up to 6 mm by spectral filtering. The angular profiles near the theoretical Lambertian emission distribution for a perfect diffusive medium, suggesting that angular correction of Čerenkov images may not be required even for curved surface. The acquisition speed and signal to noise ratio of the time domain gating system were investigated for different acquisition procedures, and the results show there is good potential for real-time superficial dose monitoring. Dose imaging under normal ambient room lighting was validated, using gated detection and a breast phantom.This study indicates that Čerenkov emission imaging might provide a valuable way to superficial dosimetry imaging in real time for external beam radiotherapy with megavoltage x-ray beams.

A novel technique for beam profiling of megavoltage photon beams was investigated for the first time by capturing images of the induced Čerenkov emission in water, as a potential surrogate for the imparted dose in irradiated media.A high-sensitivity, intensified CCD camera (ICCD) was configured to acquire 2D projection images of Čerenkov emission from a 4 × 4 cm(2) 6 MV linear accelerator (LINAC) x-ray photon beam operating at a dose rate of 400 MU∕min incident on a water tank with transparent walls. The ICCD acquisition was gated to the LINAC sync pulse to reduce background light artifacts, and the measurement quality was investigated by evaluating the signal to noise ratio and measurement repeatability as a function of delivered dose. Monte Carlo simulations were used to derive a calibration factor for differences between the optical images and deposited dose arising from the anisotropic angular dependence of Čerenkov emission. Finally, Čerenkov-based beam profiles were compared to a percent depth dose (PDD) and lateral dose profile at a depth of d(max) from a reference dose distribution generated from the clinical Varian ECLIPSE treatment planning system (TPS).The signal to noise ratio was found to be 20 at a delivered dose of 66.6 cGy, and proportional to the square root of the delivered dose as expected from Poisson photon counting statistics. A 2.1% mean standard deviation and 5.6% maximum variation in successive measurements were observed, and the Monte Carlo derived calibration factor resulted in Čerenkov emission images which were directly correlated to deposited dose, with some spatial issues. The dose difference between the TPS and PDD predicted by Čerenkov measurements was within 20% in the buildup region with a distance to agreement (DTA) of 1.5-2 mm and ±3% at depths beyond d(max). In the lateral profile, the dose difference at the beam penumbra was within ±13% with a DTA of 0-2 mm, ±5% in the central beam region, and 2%-3% in the beam umbra.The results from this initial study demonstrate the first documented use of Čerenkov emission imaging to profile x-ray photon LINAC beams in water. The proposed modality has several potential advantages over alternative methods, and upon future refinement may prove to be a robust and novel dosimetry method.

Purpose: To identify the optimum imaging sensor for a clinical system that would provide real-time imaging of the surface beam profile on patients as novel visual information to radiation therapy technologists, and more rapidly collect clinical data for large-scale studies of Cherenkov applications in radiotherapy. Methods: Four camera types, CMOS, CCD, ICCD and EMICCD, were tested to determine proficiency in the detection of Cherenkov signal in the clinical radiotherapy setting, and subsequent maximum supportable frame rate. Where possible, time-gating between the trigger signal from the LINAC and the intensifiers was implemented to detect signal with room lighting conditions comparable to patient treatment scenarios. A solid water phantom was imaged by the EM-ICCD and ICCD to evaluate the minimum number of accumulations-on-chip required for adequate Cherenkov detection, defined as >200% electron counts per pixel over background signal. Additionally, an ICCD and EM-ICCD were used clinically to image patients undergoing whole-breast radiation therapy, to understand the impact of the resolution limitation of the EM-ICCD. Results: The intensifier-coupled cameras performed best at imaging Cherenkov signal, even with room lights on, which is essential for patient comfort. The tested EM-ICCD was able to support single-shot imaging and frame rates of 30 fps, however, themore » current maximum resolution of 512 × 512 pixels was restricting. The ICCD used in current clinical trials was limited to 4.7 fps at a 1024 × 1024 resolution. An intensifier with higher quantum efficiency at the entrance photocathode in the red wavelengths (30% QE vs current 7%) promises 16 fps at the same resolution at lower cost than the EM-ICCD. Conclusion: The ICCD with the better red wavelength QE intensifier was determined to be the best suited commercial-off-the-shelf camera to detect real-time Cherenkov signal and provide the best potential for real-time display of radiation dose on the skin during treatment. Funding is from grants from the NIH numbers R01CA109558 and R21EB017559.« less

Purpose: Through Monte Carlo simulations and phantom studies, the dominant factors affecting the calibration of superficial Cherenkov intensity to absolute surface dose was investigated, including tissue optical properties, curvatures, beam properties and imaging angle. Methods: The phasespace files for the TrueBeam system from Varian were used in GAMOS (a GEANT4 based Monte Carlo simulation toolkit) to simulate surface emission Cherenkov signals and the correlated deposited dose. The parameters examined were: i) different tissue optical properties (skin color from light to dark), ii) beam types (X-ray and electron beam), iii) beam energies, iv) thickness of tissues (2.5 cm to 20 cm), v) SSD (80 cm to 120 cm), vi) field sizes (0.5×0.5 cm2 to 20×20 cm2), vii) entrance/exit sides, viii) curvatures (cylinders with diameters from 2.5 cm to 20cm) and ix) imaging angles (0 to 90 degrees). In a specific case, for any Cherenkov photon emitted from the surface, the original position and direction, final position and direction and energy were recorded. Similar experimental measurements were taken in a range of the most pertinent parameters using tissue phantoms. Results: Combining the dose distribution and sampling sensitivity of Cherenkov emission, quantitatively accurate calibration factors (the amount of radiation dose represented by amore » single Cherenkov photon) were calculated. The data showed relatively large dependence upon different optical properties, curvature, entrance/exit and beam types. For a diffusive surface, the calibration factor was insensitive to imaging angles smaller than 60 degrees. Normalization with the reflectance image was experimentally validated as a simple and accurate method for calibrations of different optical properties. Conclusion: This study sheds light on how and to what extent different conditions affect the calibration from Cherenkov intensity to absolute superficial dose and provides practical solutions to allow quantitative Cherenkov imaging to be used as a dose surrogate for imaging.« less

Purpose: To investigate the positional accuracy possible with real time Cherenkov video imaging based patient positioning and movement tracking during EBRT. Methods: In a phase 1 clinical trial, including 12 patients undergoing post-lumpectomy whole breast irradiation, Cherenkov emission was imaged with a time-gated ICCD camera synchronized to the LINAC pulse output, during different fractions of the treatment. Patients were positioned with the aid of the AlignRT system. Inter-fraction setup variation was studied by rigid image registrations between images acquired at individual treatments to the average image from all imaged treatment fractions. The amplitude of respiratory motion was calculated from the registration of each frame of Cherenkov images to the reference. A Canny edge detection algorithm was utilized to highlight the beam field edges and biological features provided by major blood vessels apparent in the images. Results: Real-time Cherenkoscopy could monitor the treatment delivery, patient motion and alignment of the beam edge to the treatment region simultaneously. For all the imaged fractions, the patient positioning errors were within our clinical tolerances (3 mm in shifts and 3 degree in pitch angle rotation), with 4.60% exceeding no more than 1 mm in shifts. The averaged error of repetitive patient positioning was 1.2 mm in linear shift and 0.34 degrees in rotational pitch, consistent with the accuracy reported by the AlignRT system. The edge detection algorithm enhanced features such as field edges and blood vessels. Patient positioning errors and respiratory motion retrieved from rigid image registration were consistent with the edge enhanced images. Besides positioning errors caused by global inaccurate setups, edge enhanced blood vessels indicate the existence of deformations Conclusion: Real-time Cherenkoscopy imaging during EBRT is a novel imaging tool that can be used for treatment monitoring, patient positioning and motion tracking with approximately 1.2mm displacement and 0.34 degree rotational accuracy.

Purpose: A novel optical dosimetry technique for the QA and verification of intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) radiotherapy plans was investigated for the first time by capturing images of the induced Cherenkov radiation in water. Methods: An intensified CCD camera (ICCD) was used to acquire a two-dimensional (2D) projection image of the Cherenkov radiation induced by IMRT and VMAT plans, based on the Task Group 119 C-Shape geometry. Plans were generated using the Varian Eclipse treatment planning system (TPS) and delivered using 6 MV x-rays from a Varian TrueBeam Linear Accelerator (Linac) incident on a water tank. The ICCD acquisition was gated to the Linac, operated for single pulse imaging, and binned to a resolution of 512×512 pixels. The resulting videos were analyzed temporally for regions of interest (ROI) covering the planning target volume (PTV) and organ at risk (OAR) and summed to obtain an overall light distribution, which was compared to the expected dose distribution from the TPS using a gammaindex analysis. Results: The chosen camera settings resulted in data at 23.5 frames per second. Temporal intensity plots of the PTV and OAR ROIs confirmed the preferential delivery of dose to the PTV versus the OAR, and the gamma analysis yielded 95.2% and 95.6% agreement between the light distribution and expected TPS dose distribution based upon a 3% / 3 mm dose difference and distance-to-agreement criterion for the IMRT and VMAT plans respectively. Conclusion: The results from this initial study demonstrate the first documented use of Cherenkov radiation for optical dosimetry of dynamic IMRT and VMAT treatment plans. The proposed modality has several potential advantages over alternative methods including the real-time nature of the acquisition, and upon future refinement may prove to be a robust and novel dosimetry method with both research and clinical applications. NIH R01CA109558 and R21EB017559.

Purpose: A number of recent studies have proposed that light emitted by the Cherenkov effect may be used for a number of radiation therapy dosimetry applications. Here we investigate the fundamental nature and accuracy of the technique for the first time by using a theoretical and Monte Carlo based analysis. Methods: Using the GEANT4 architecture for medically-oriented simulations (GAMOS) and BEAMnrc for phase space file generation, the light yield, material variability, field size and energy dependence, and overall agreement between the Cherenkov light emission and dose deposition for electron, proton, and flattened, unflattened, and parallel opposed x-ray photon beams was explored. Results: Due to the exponential attenuation of x-ray photons, Cherenkov light emission and dose deposition were identical for monoenergetic pencil beams. However, polyenergetic beams exhibited errors with depth due to beam hardening, with the error being inversely related to beam energy. For finite field sizes, the error with depth was inversely proportional to field size, and lateral errors in the umbra were greater for larger field sizes. For opposed beams, the technique was most accurate due to an averaging out of beam hardening in a single beam. The technique was found to be not suitable for measuring electron beams, except for relative dosimetry of a plane at a single depth. Due to a lack of light emission, the technique was found to be unsuitable for proton beams. Conclusions: The results from this exploratory study suggest that optical dosimetry by the Cherenkov effect may be most applicable to near monoenergetic x-ray photon beams (e.g. Co-60), dynamic IMRT and VMAT plans, as well as narrow beams used for SRT and SRS. For electron beams, the technique would be best suited for superficial dosimetry, and for protons the technique is not applicable due to a lack of light emission. NIH R01CA109558 and R21EB017559.

Purpose: A novel technique for optical dosimetry of dynamic intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) plans was investigated for the first time by capturing images of the induced Cherenkov radiation in water. Methods: A high-sensitivity, intensified CCD camera (ICCD) was configured to acquire a two-dimensional (2D) projection image of the Cherenkov radiation induced by IMRT and VMAT plans, based on the Task Group 119 (TG-119) C-Shape geometry. Plans were generated using the Varian Eclipse treatment planning system (TPS) and delivered using 6 MV x-rays from a Varian TrueBeam Linear Accelerator (Linac) incident on a water tank doped with the fluorophore quinine sulfate. The ICCD acquisition was gated to the Linac target trigger pulse to reduce background light artifacts, read out for a single radiation pulse, and binned to a resolution of 512 × 512 pixels. The resulting videos were analyzed temporally for various regions of interest (ROI) covering the planning target volume (PTV) and organ at risk (OAR), and summed to obtain an overall light intensity distribution, which was compared to the expected dose distribution from the TPS using a gamma-index analysis. Results: The chosen camera settings resulted in 23.5 frames per second dosimetry videos. Temporal intensity plots of the PTV and OAR ROIs confirmed the preferential delivery of dose to the PTV versus the OAR, and the gamma analysis yielded 95.9% and 96.2% agreement between the experimentally captured Cherenkov light distribution and expected TPS dose distribution based upon a 3%/3 mm dose difference and distance-to-agreement criterion for the IMRT and VMAT plans, respectively. Conclusions: The results from this initial study demonstrate the first documented use of Cherenkov radiation for video-rate optical dosimetry of dynamic IMRT and VMAT treatment plans. The proposed modality has several potential advantages over alternative methods including the real-time nature of the acquisition, and upon future refinement may prove to be a robust and novel dosimetry method with both research and clinical applications.

Purpose: Cerenkov radiation emission occurs in all tissue, when charged particles (either primary or secondary) travel at velocity above the threshold for the Cerenkov effect (about 220 KeV in tissue for electrons). This study presents the first examination of optical Cerenkov emission as a surrogate for the absorbed superficial dose for MV x-ray beams. Methods: In this study, Monte Carlo simulations of flat and curved surfaces were studied to analyze the energy spectra of charged particles produced in different regions near the surfaces when irradiated by MV x-ray beams. Cerenkov emission intensity and radiation dose were directly simulated in voxelized flat and cylindrical phantoms. The sampling region of superficial dosimetry based on Cerenkov radiation was simulated in layered skin models. Angular distributions of optical emission from the surfaces were investigated. Tissue mimicking phantoms with flat and curved surfaces were imaged with a time domain gating system. The beam field sizes (50 × 50–200 × 200 mm2), incident angles (0°–70°) and imaging regions were all varied. Results: The entrance or exit region of the tissue has nearly homogeneous energy spectra across the beam, such that their Cerenkov emission is proportional to dose. Directly simulated local intensity of Cerenkov and radiation dose in voxelized flat and cylindrical phantoms further validate that this signal is proportional to radiation dose with absolute average discrepancy within 2%, and the largest within 5% typically at the beam edges. The effective sampling depth could be tuned from near 0 up to 6 mm by spectral filtering. The angular profiles near the theoretical Lambertian emission distribution for a perfect diffusive medium, suggesting that angular correction of Cerenkov images may not be required even for curved surface. The acquisition speed and signal to noise ratio of the time domain gating system were investigated for different acquisition procedures, and the results show there is good potential for real-time superficial dose monitoring. Dose imaging under normal ambient room lighting was validated, using gated detection and a breast phantom. Conclusions: This study indicates that Cerenkov emission imaging might provide a valuable way to superficial dosimetry imaging in real time for external beam radiotherapy with megavoltage x-ray beams.

Purpose: To show that Cherenkov emission generated by megavoltage X‐ray beams could be imaged in real time during external beam radiotherapy. Images of Cherenkov emission could be applied for quality assurance (QA) and estimate the superficial dose distribution for complex surface profiles. Methods: Cherenkov radiation has been documented to be generated by MeV external beam radiotherapy in both water and tissue. A typical breast cancer treatment plan was adopted to irradiate the breast and torso region of an anthropometric phantom. Images of Cherenkov emission have been taken by using a scientific‐grade time‐gated ICCD camera, synchronized to the LINAC pulse output, during treatment. Sampling depth depending on wavelength and angular distribution of Cherenkov photons (similar to Lambertian distribution) emitted from the surface have been investigated for different optical properties by Monte Carlo simulations in GAMOS and corresponding angular emission corrections have been applied. Registration of the 2‐D Cherenkov emission images to 3‐D surface profiles measured by motion monitoring system (Catalyst™, C‐RAD) has been investigated. Results: The images show that superficial dose varies dramatically with complex surface profiles. Imaging of this can be done, with a typical acquisition time of 2 sec, based upon Signal to noise ratio of SNR=30 for a 10 MeV beam, suggesting that near real time surface dosimetry is possible during the treatment time. The spatial resolution achieved here was approximately 1mm. Conclusion: Superficial dose can be imaged in realtime directly with a camera, capturing the Cherenkov emitted from the surface of the treatment region during external beam radiotherapy, and these surface dose images could potentially allow real time monitoring, quality assurance and decisions to be made about dose errors in complex treatment areas.

Purpose: Here, we explore a novel medical physics application of the Cerenkov effect for the dosimetric profiling of megavoltage beams used in radiation therapy. The technology to achieve these images has recently progressed from capturing single 2D projections with an intensified charge‐coupled device, to full 3D optical tomography using parallel beam back projection and a telecentric lens. In the current study, the method is extended to 3D imaging with a standard CMOS commercial camera and lens, using cone beam tomography algorithms for the reconstruction. Methods: Projection images of the induced Cerenkov light from a 20×20 cm2 6 MV beam operating at a dose rate of 600 MU/min incident on a water tank with a 1.0 g/L concentration of Quinine Sulfate were captured from 0–360° with a 3° angular resolution and 5.0 second exposure time, resulting in a total scan time of 10 minutes. The resulting projection images were used in a Feldkamp‐Davis‐Kress (FDK) cone beam tomography algorithm to reconstruct the imparted 3D dose distribution. An accuracy analysis was performed by comparing the reconstructed lateral profile at a depth of 10 cm and a percent depth dose curve to a reference dose distribution from the treatment planning system (TPS). Results: A 3D dose distribution was successfully reconstructed from the captured projections yielding results which were within +/− 8% of the TPS dose distribution. Conclusion: Optical cone beam 3D tomography of radiation beams using Cerenkov‐excited fluorescence has been demonstrated for the first time. The proposed technique has several advantages over alternative methods (e.g., ionization chambers, scintillation, and gel dosimetry) including speed, flexibility, and necessitates only water, which serves as a cheap, abundant, and easily standardized tissue equivalent medium. Upon future refinement and improved accuracy the proposed modality may prove to be an important dosimetric tool with both clinical and research applications.

Purpose: A novel technique for beam profiling of megavoltage photon beams was investigated for the first time by capturing images of the induced Cerenkov emission in water, as a potential surrogate for the imparted dose in irradiated media. Methods: A high-sensitivity, intensified CCD camera (ICCD) was configured to acquire 2D projection images of Cerenkov emission from a 4 × 4 cm2 6 MV linear accelerator (LINAC) x-ray photon beam operating at a dose rate of 400 MU/min incident on a water tank with transparent walls. The ICCD acquisition was gated to the LINAC sync pulse to reduce background light artifacts, and the measurement quality was investigated by evaluating the signal to noise ratio and measurement repeatability as a function of delivered dose. Monte Carlo simulations were used to derive a calibration factor for differences between the optical images and deposited dose arising from the anisotropic angular dependence of Cerenkov emission. Finally, Cerenkov-based beam profiles were compared to a percent depth dose (PDD) and lateral dose profile at a depth of d max from a reference dose distribution generated from the clinical Varian ECLIPSE treatment planning system (TPS). Results: The signal to noise ratio was found to be 20 at a delivered dose of 66.6 cGy, and proportional to the square root of the delivered dose as expected from Poisson photon counting statistics. A 2.1% mean standard deviation and 5.6% maximum variation in successive measurements were observed, and the Monte Carlo derived calibration factor resulted in Cerenkov emission images which were directly correlated to deposited dose, with some spatial issues. The dose difference between the TPS and PDD predicted by Cerenkov measurements was within 20% in the buildup region with a distance to agreement (DTA) of 1.5–2 mm and ±3% at depths beyondd max . In the lateral profile, the dose difference at the beam penumbra was within ±13% with a DTA of 0–2 mm, ±5% in the central beam region, and 2%–3% in the beam umbra. Conclusions: The results from this initial study demonstrate the first documented use of Cerenkov emission imaging to profile x-ray photon LINAC beams in water. The proposed modality has several potential advantages over alternative methods, and upon future refinement may prove to be a robust and novel dosimetry method.

Purpose: To demonstrate the potential for fast 3D dose profile imaging of a LINAC beam using images of the induced Cherenkov radiation in a water tank. A specialized time‐gated imaging system was developed as a prototype to quantify and compare with Monte Carlo, to illustrate the concept. Methods: Images were acquired from a water tank during irradiation from a 6 MV Varian‐2100C linear accelerator beam using a time‐gated CCD‐based imaging system. The camera was placed normal to the tank wall to minimize parallax reflections, and resultant images were produced by evaluating the median of each pixel in a stack of 2000 images taken at a rate of 60 Hz with an exposure time of 10 ms. Experimental data was compared to images obtained from GEANT4 simulations of the optical setup. Results: Examination of the scored quantities for dose and generated Cherenkov photons indicates that there is a strong similarity, which can be explained by considering the electron energy losses per unit path length. However, due to the complex convolution of the Cherenkov emission directionality and camera lens angular field of view, this relationship is distorted. These errors can be calibrated using the GEANT4 simulations to more accurately reflect the intrinsic dose in the water volume. Conclusions: This work demonstrates dose profiling using the induced Cherenkov radiation signal for the first time. These preliminary results serve as a proof of concept of imaging at one azimuthal angle. Analogous to SPECT, the technique could easily be translated to multiple angles yielding full dose reconstructions following filtered back projection. Further refinement of this technology could be the first step in a paradigm shift towards an alternative method for fast radiation field analysis. Advantages would include increased speed, as well as the ability to profile dynamic beam shapes within transparent solid anthropomorphic phantoms. This work has been financially supported by NIH grant R01CA109558.