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Purpose: To introduce a model that reproducibly linearizes the response from radiochromic film (RCF) dosimetry systems at extended dose range. To introduce a correction method, generated from the same scanned images, which corrects for scanner temporal response variation and scanner bed inhomogeneity. Methods: Six calibration curves were established for different lot numbers of EBT3 GAFCHROMIC™ film model based on four EPSON scanners [10000XL (2 units), 11000XL, 12000XL] at three different centers. These films were calibrated in terms of absorbed dose to water based on TG51 protocol or TRS398 with dose ranges up to 40 Gy. The film response was defined in terms of a proposed normalized pixel value (nPVRGB) as a summation of first‐order equations based on information from red, green, and blue channels. The fitting parameters of these equations are chosen in a way that makes the film response equal to dose at the time of calibration. An integrated set of correction factors (one per color channel) was also introduced. These factors account for the spatial and temporal changes in scanning states during calibration and measurements. The combination of nPVRGB and this "fingerprint" correction formed the basis of this new protocol and it was tested against net optical density (netODX=R,G,B) single‐channel dosimetry in terms of accuracy, precision, scanner response variability, scanner bed inhomogeneity, noise, and long‐term stability. Results: Incorporating multichannel features (RGB) into the normalized pixel value produced linear response to absorbed dose (slope of 1) in all six RCF dosimetry systems considered in this study. The "fingerprint" correction factors of each of these six systems displayed unique patterns at the time of calibration. The application of nPVRGB to all of these six systems could achieve a level of accuracy of ± 2.0% in the dose range of interest within modeled uncertainty level of 2.0%–3.0% depending on the dose level. Consistent positioning of control and measurement film pieces and integrating the multichannel correction into the response function formalism mitigated possible scanner response variations of as much as ± 10% at lower doses and scanner bed inhomogeneity of ± 8% to the established level of uncertainty at the time of calibration. The system was also able to maintain the same level of accuracy after 3 and 6 months post calibration. Conclusions: Combining response linearity with the integrated correction for scanner response variation lead to a sustainable and practical RCF dosimetry system that mitigated systematic response shifts and it has the potential to reduce errors in reporting relative information from the film response. [ABSTRACT FROM AUTHOR]

Purpose Radiochromic films change their color upon irradiation due to polymerization of the sensitive component embedded within the sensitive layer. However, agents, other than monitored radiation, can lead to a change in the color of the sensitive layer (temperature, humidity, UV light) that can be considered as a background signal and can be removed from the actual measurement by using a control film piece. In this work, we investigate the impact of the use of control film pieces on both accuracy and uncertainty of dose measured using radiochromic film based reference dosimetry protocol. Methods We irradiated “control” film pieces (EBT3 GafChromic TM film model) to known doses in a range of 0.05–1 Gy, and five film pieces of the same size to 2, 5, 10, 15 and 20 Gy, considered to be “unknown” doses. Depending on a dose range, two approaches to incorporating control film piece were investigated: signal and dose corrected method. Results For dose values greater than 10 Gy, the increase in accuracy of 3% led to uncertainty loss of 5% by using dose corrected approach. At lower doses and signals of the order of 5%, we observed an increase in accuracy of 10% with a loss of uncertainty lower than 1% by using the corrected signal approach. Conclusions Incorporation of the signal registered by the control film piece into dose measurement analysis should be a judgment call of the user based on a tradeoff between deemed accuracy and acceptable uncertainty for a given dose measurement. [ABSTRACT FROM AUTHOR]

Purpose: In radiochromic film dosimetry systems, measurements are usually obtained from film images acquired on a CCD-based flatbed scanner. The authors investigated factors affecting scan-to-scan response variability leading to increased dose measurement uncertainty. Methods: The authors used flatbed document scanners to repetitively scan EBT3 radiochromic films exposed to doses 0-1000 cGy, together with three neutral density filters and three blue optical filters. Scanning was performed under two conditions: scanner lid closed and scanner lid opened/closed between scans. The authors also placed a scanner in a cold room at 9 ?C and later in a room at 22 ?C and scanned EBT3 films to explore temperature effects. Finally, the authors investigated the effect of altering the distance between the film and the scanner's light source. Results: Using a measurement protocol to isolate the contribution of the CCD and electronic circuitry of the scanners, the authors found that the standard deviation of response measurements for the EBT3 film model was about 0.17% for one scanner and 0.09% for the second. When the lid of the first scanner was opened and closed between scans, the average scan-to-scan difference of responses increased from 0.12% to 0.27%. Increasing the sample temperature during scanning changed the RGB response values by about -0.17, -0.14, and -0.05%/?C, respectively. Reducing the film-to-light source distance increased the RBG response values about 1.1, 1.3, and 1.4%/mm, respectively. The authors observed that films and film samples were often not flat with some areas up to 8 mm away from the scanner's glass window. Conclusions: In the absence of measures to deal with the response irregularities, each factor the authors investigated could lead to dose uncertainty >2%. Those factors related to the film-to-light source distance could be particularly impactful since the authors observed many instances where the curl of film samples had the potential to cause dose uncertainty in excess of 5%. Two expedients will eliminate the uncertainties: a transparent sheet (preferably glass) placed over the scanned film keeps the film-to-light source distance constant, and an EBT3 reference film included in all scans provides correction factors for measured response values. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the performance of the EBT3 radiochromic film dosimetry system using reflection measurements and to suggest a calibration protocol for precise and accurate reflection film dosimetry. Methods: A set of 14 Gafchromic EBT3 film pieces were irradiated to various doses ranging from 0 to 8 Gy and subsequently scanned using both the reflection and transmission mode. Scanning resolution varied from 50 to 508 dpi (0.5-0.05 mm/pixel). Both the red and green color channels of scanned images were used to relate the film response to the dose. A sensitivity, uncertainty, and accuracy analysis was performed for all scanning modes and color channels. The total uncertainty, along with the fitting and experimental uncertainty components, was identified and analyzed. A microscope resolution target was used to evaluate possible resolution losses under reflection scanning. The calibration range was optimized for reflection scanning in the low (<2 Gy) and high (>2 Gy) dose regions based on the reported results. Results: Reflection scanning using the red channel exhibited the highest sensitivity among all modes, being up to 150% higher than transmission mode in the red channel for the lowest dose level. Furthermore, there was no apparent loss in resolution between the two modes. However, higher uncertainties and reduced accuracy were observed for the red channel under reflection mode, especially at dose levels higher than 2 Gy. These uncertainties were mainly attributed to saturation effects which were translated in poor fitting results. By restricting the calibration to the 0-2 Gy dose range, the situation is reversed and the red reflection mode was superior to the transmission mode. For higher doses, the green channel in reflection mode presented comparable results to the red transmission. Conclusions: A two-color reflection scanning protocol can be suggested for EBT3 radiochromic film dosimetry using the red channel for doses less than 2 Gy and the green channel for higher doses. The precision and accuracy are significantly improved in the low dose region following such a protocol. [ABSTRACT FROM AUTHOR]

Purpose: The authors investigated the energy response of XR-QA2 GafChromicTM film over a broad energy range used in diagnostic radiology examinations. The authors also made an assessment of the most suitable functions for both reference and relative dose measurements. Methods: Pieces of XR-QA2 film were irradiated to nine different values of air kerma in air, following reference calibration of a number of beam qualities ranging in HVLs from 0.16 to 8.25 mm Al, which corresponds to effective energy range from 12.7 keV to 56.3 keV. For each beam quality, the authors tested three functional forms (rational, linear exponential, and power) to assess the most suitable function by fitting the delivered air kerma in air as a function of film response in terms of reflectance change. The authors also introduced and tested a new parameter ? = netΔR · em netΔR that linearizes the inherently nonlinear response of the film. Results: The authors have found that in the energy range investigated, the response of the XR-QA2 based radiochromic film dosimetry system ranges from 0.222 to 0.420 in terms of netΔR at Kair air = 8 cGy. For beam qualities commonly used in CT scanners (4.03-8.25 mm Al), the variation in film response (netΔR at Kair air film is accompanied by a rather pronounced energy dependent response for beam qualities used for x-ray based diagnostic imaging purposes. The authors also found that the most appropriate function for the reference radiochromic film dosimetry would be the power function, while for the relative dosimetry one may use the exponential response function that can be easily linearized. [ABSTRACT FROM AUTHOR]TM film is accompanied by a rather pronounced energy dependent response for beam qualities used for x-ray based diagnostic imaging purposes. The authors also found that the most appropriate function for the reference radiochromic film dosimetry would be the power function, while for the relative dosimetry one may use the exponential response function that can be easily linearized. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this work was to design a novel high-dose rate (HDR) (192Ir) brachytherapy applicator for treatment of rectal carcinomas that uses tungsten shielding for possibly improved dosimetric results over commercial brachytherapy applicator(s). Methods: A set of 15 single-depth applicators and one dual-depth applicator were designed and simulated using Monte Carlo (MCNPX). All applicators simulated were high-density tungsten alloy cylinders, 16-mm in diameter, and 60-mm long, with longitudinal grooves within which an 192Ir source can be placed. The single-depth designs varied regarding the number and depth of these grooves, ranging from 8 to 16 and 1-mm to 3-mm, respectively. The dual-depth design had ten channels, each of which had two depths at which the source could be placed. Optimized treatment plans were generated for each design on data from 13 treated patients (36 fractions) with asymmetrical clinical target volumes (CTVs). All results were compared against the clinically treated plans which used intracavitary mold applicator (ICMA), as well as a recently designed, highly automated, and collimated intensity modulation device named dynamic modulated brachytherapy (DMBT) device. Results: All applicator designs outperformed the ICMA in every calculated dosimetric criteria, except the total dwell times (∼30% increase). There were clear, but relative, tradeoffs regarding both the number of channels and the depth of each channel. Overall, the 12-channel, 1-mm depth, and 14-channel 2-mm depth designs had the best results of the simpler designs, sparing the healthy rectal tissues the most while achieving comparable CTV coverage with the dose heterogeneity index and lateral spill doses improving by over 10% and the contralateral healthy rectum dose dropping over 30% compared to ICMA. The ten-channel dual-depth design outperformed each single-depth design, yielding the best coverage and sparing. Conclusions: New grooved tungsten HDR-brachytherapy devices have been designed and simulated. The results of this work attest to the capability of these new, highly anisotropic, intelligently shielded applicators to limit dose to healthy tissues while maintaining a conformal prescription dose to the CTV. [ABSTRACT FROM AUTHOR]

Purpose: All forms of past and current high-dose-rate brachytherapy utilize immobile applicators during treatment delivery. The only moving part is the source itself. This paradigm misses an important degree of freedom that, if explored, can in some instances produce previously unachievable dose conformality; that is, the dynamic motion of the applicator itself during treatment delivery. Monte Carlo and treatment planning simulations were used to illustrate the potential benefits of moving applicators for rectal cancer applications in particular. This concept is termed dynamic modulated brachytherapy (DMBT). Methods: The DMBT system uses a high-density, 18.0 g/cm3, 45 mm long tungsten alloy shield, cylindrical in shape, with a small window on one side to encapsulate a 192Ir source, to create collimation that results in a highly directional beam profile. This shield can be dynamically translated and rotated, using an attached robotic arm, during treatment to create a volumetric modulated arc therapy-type delivery, but from inside the rectal cavity. Monte Carlo simulations and planning optimization algorithms were developed inhouse to evaluate the effectiveness of this new approach using 36 clinical treatment plans comprised of 13 patients each treated using the intracavitary mold applicator (ICMA, Nucletron, The Netherlands) to quantify the potential clinical benefit. The prescription dose was 10 Gy/fx and the group had an average clinical target volume of 9.0 ± 3.5 cm3. Ideal phantom geometries were used to evaluate the impact of various shield dimensions and designs on the resulting plan quality. Results: Simulations of ideal phantom geometries found that shields as small as 10 mm in diameter can produce high quality plans. For the clinical patient cases, compared to the ICMA, for equal prescription tumor coverage, the DMBT plans provided >30% decrease in D5 (high dose volume) resulting in a ∼40% decrease in dose heterogeneity index. In addition, mean dose and D98 showed a reduction (typically 40%-60%) on all critical structures evaluated. However, for a 10 Gy prescribed dose there was an increase in total treatment time on average from 7.6 to 20.8 min for a source with an air-kerma strength of 40.25 kU (10 Ci). Conclusions: Dosimetric properties of a novel DMBT system have been described and evaluated. Comparison with the ICMA commercial applicator has shown it to be a prospective step forward in high-dose-rate brachytherapy 192Ir technology. Dynamic motion of an applicator during treatment, for any applicator and site in general, can provide additional degrees of freedom that, if properly considered, can potentially increase the plan quality significantly. [ABSTRACT FROM AUTHOR]