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Purpose: To evaluate dosimetric and treatment delivery advantages of aperture-based intensity-modulated radiotherapy (AB-IMRT) for the treatment of patients receiving whole pelvic radiotherapy for gynecologic malignancies., Methods and Materials: Nineteen patients undergoing pelvic radiotherapy after resection of endometrial cancers were selected. A 45-Gy dose was prescribed to the target volume delineated on a planning CT scan. An in-house inverse planning system, Ballista, was used to develop a treatment plan using aperture-based multileaf collimator segments. This approach was compared with conventional four-field, enlarged four-field, and static beamlet-based IMRT (BB-IMRT) techniques in terms of target coverage, dose-volume histogram statistics for surrounding normal tissues, and numbers of segments and monitor units (MU)., Results: Three quarters (76.4%) of the planning target volume received the prescription dose with conventional four-field plans. With adequate target coverage, the Ballista plans significantly reduced the volume of bowel and bladder irradiated at the prescribed dose (p < 0.001), whereas the two approaches provided equivalent results for the rectum (p = 0.5). On the other hand, AB-IMRT and BB-IMRT plans showed only small differences in dose-volume histogram statistics of unknown clinical impact, whereas Ballista plan delivery required on average 73% and 59% fewer segments and MU, respectively., Conclusion: With respect to conventional techniques, AB-IMRT for the treatment of gynecologic malignancies provides dosimetric advantages similar to those with BB-IMRT but with clear treatment delivery improvements.

With the increasing complexity of dose patterns external beam radiotherapy, there is a great need for new types of dosimeters. We studied the first prototype of a new dosimeter array consisting of water-equivalent plastic scintillating fibers for dose measurement in external beam radiotherapy. We found that this array allows precise, rapid dose evaluation of small photon fields. Starting with a dosimeter system constructed with a single scintillating fiber coupled to a clear optical fiber and read using a charge coupled device camera, we looked at the dosimeter's spatial resolution under small radiation fields and angular dependence. Afterward, we analyzed the camera's light collection to determine the maximum array size that could be built. Finally, we developed a prototype made of ten scintillating fiber detectors to study the behavior and precision of this system in simple dosimetric situations. The scintillation detector showed no measurable angular dependence. Comparison of the scintillation detector and a small-volume ion chamber showed agreement except for 1 x 1 and 0.5 x 5.0 cm (2) fields where the output factor measured by the scintillator was higher. The actual field of view of the camera could accept more than 4000 scintillating fiber detectors simultaneously. Evaluation of the dose profile and depth dose curve using a prototype with ten scintillating fiber detectors showed precise, rapid dose evaluation even with placement of more than 75 optical fibers in the field to simulate what would happen in a larger array. We concluded that this scintillating fiber dosimeter array is a valuable tool for dose measurement in external beam radiotherapy. It possesses the qualities necessary to evaluate small and irregular fields with various incident angles such as those encountered in intensity-modulated radiotherapy, radiosurgery, and tomotherapy.

Since metal-oxide-semiconductor field effect transistors (MOSFETs) medical applications in radiotherapy and radiology are gaining popularity, evaluating them under radiation of different energies is of major interest. This study aims at a characterization of MOSFET sensitivity with regard to total integrated dose. Sensitivity is expressed by the water calibration factor (CFw) and allows the user to associate the voltage difference reading displayed by the device to a dose value in water at the MOSFET location. The CFw of seven p-type dual-bias MOSFETs were measured for several accumulated doses. The radiation sources used were a 60Co unit ((E)gamma: 1.25 MeV), an 192Ir high dose rate unit ((E)gamma: 380 keV), and an orthovoltage unit providing two x-ray energy spectra for tube voltages of 30 kV((E)gamma:14.8 KeV) and 150 kV((E)gamma:70.1 keV). The CFw value diminishes with increasing threshold voltage, especially for low-energy radiation. It was stable for 60Co irradiations, while it decreased 6%, 5%, and 15% for beam energies of 192Ir, 150 kV, and 30 kV, respectively. The decrease rate is higher for the first half of the device lifetime. This behavior is explained by an alteration of the effective electric field applied to the MOSFET during irradiation, caused by the accumulation of holes at the Si-SiO2 interface. It is strongly dependent on the nature of the radiation, and particularly affects low x-ray energies. A frequent calibration of the device for this radiation type is essential in order to achieve adequate measurement accuracy, especially in low-energy applications, such as superficial therapy, brachytherapy, and diagnostic and interventional radiology.

One way to improve the performance of scintillation dosimeters is to increase the light-collection efficiency at the coupling interfaces of the detector system. We performed a detailed study of surface preparation of scintillating fibers and their coupling with clear optical fibers to minimize light loss and increase the amount of light collected. We analyzed fiber-surface polishing with aluminum oxide sheets, coating fibers with magnesium oxide, and the use of eight different coupling agents (air, three optical gels, an optical curing agent, ultraviolet light, cyanoacrylate glue, and acetone). We prepared 10 scintillating fiber and clear optical fiber light guide samples to test different coupling methods. To test the coupling, we first cut both the scintillating fiber and the clear optical fiber. Then, we cleaned and polished both ends of both fibers. Finally, we coupled the scintillating fiber with the clear optical fiber in either a polyethylene jacket or a V-grooved support depending on the coupling agent used. To produce more light, we used an ultraviolet lamp to stimulate scintillation. A typical series of similar couplings showed a standard deviation in light-collection efficiency of 10%. This can be explained by differences in the surface preparation quality and alignment of the scintillating fiber with the clear optical fiber. Absence of surface polishing reduced the light collection by approximately 40%, and application of magnesium oxide on the proximal end of the scintillating fiber increased the amount of light collected from the optical fiber by approximately 39%. Of the coupling agents, we obtained the best results using one of the optical gels. Because a large amount of the light produced inside a scintillator is usually lost, better light-collection efficiency will result in improved sensitivity.

With highly conformal radiation therapy techniques such as intensity-modulated radiation therapy, radiosurgery, and tomotherapy becoming more common in clinical practice, the use of these narrow beams requires a higher level of precision in quality assurance and dosimetry. Plastic scintillators with their water equivalence, energy independence, and dose rate linearity have been shown to possess excellent qualities that suit the most complex and demanding radiation therapy treatment plans. The primary disadvantage of plastic scintillators is the presence of Cerenkov radiation generated in the light guide, which results in an undesired stem effect. Several techniques have been proposed to minimize this effect. In this study, we compared three such techniques-background subtraction, simple filtering, and chromatic removal-in terms of reproducibility and dose accuracy as gauges of their ability to remove the Cerenkov stem effect from the dose signal. The dosimeter used in this study comprised a 6-mm(3) plastic scintillating fiber probe, an optical fiber, and a color charge-coupled device camera. The whole system was shown to be linear and the total light collected by the camera was reproducible to within 0.31% for 5-s integration time. Background subtraction and chromatic removal were both found to be suitable for precise dose evaluation, with average absolute dose discrepancies of 0.52% and 0.67%, respectively, from ion chamber values. Background subtraction required two optical fibers, but chromatic removal used only one, thereby preventing possible measurement artifacts when a strong dose gradient was perpendicular to the optical fiber. Our findings showed that a plastic scintillation dosimeter could be made free of the effect of Cerenkov radiation.

Purpose: In this article, an approach to metal artifact reduction is proposed that is practical for clinical use in radiation therapy. It is based on a new interpolation scheme of the projections associated with metal implants in helical computed tomography (CT) scanners., Methods and Materials: A three-step approach was developed consisting of an automatic algorithm for metal implant detection, a correction algorithm for helical projections, and a new, efficient algorithm for projection interpolation. The modified raw projection data are transferred back to the CT scanner device where CT slices are regenerated using the built-in reconstruction operator. The algorithm was tested on a CT calibration phantom in which the density of inserted objects are known and on clinical prostate cases with two hip prostheses. The results are evaluated using the CT number and shape of the objects., Results: The validations on a CT calibration phantom with various inserts of known densities show that the algorithm improved the overall image quality by restoring the shape and the representative CT number of the objects in the image. For the clinical hip replacement cases, a large fraction of the bladder, rectum, and prostate that were not visible on the original CT slices were recovered using the algorithm. Precise contouring of the target volume was thus feasible. Without this enhancement, physicians would have drawn bigger margins to be sure to include the target and, at the same time, could have prescribed a lower dose to keep the same level of normal tissue toxicity., Conclusions: In both phantom experiment and patient studies, the algorithm resulted in significant artifact reduction with increases in the reliability of planning procedure for the case of metallic hip prostheses. This algorithm is now clinically used as a preprocessing before treatment planning for metal artifact reduction.

Scintillation dosimetry is a promising avenue for evaluating dose patterns delivered by intensity-modulated radiation therapy plans or for the small fields involved in stereotactic radiosurgery. However, the increase in signal has been the goal for many authors. In this paper, a comparison is made between plastic scintillating fibers and plastic scintillator. The collection of scintillation light was measured experimentally for four commercial models of scintillating fibers (BCF-12, BCF-60, SCSF-78, SCSF-3HF) and two models of plastic scintillators (BC-400, BC-408). The emission spectra of all six scintillators were obtained by using an optical spectrum analyzer and they were compared with theoretical behavior. For scintillation in the blue region, the signal intensity of a singly clad scintillating fiber (BCF-12) was 120% of that of the plastic scintillator (BC-400). For the multiclad fiber (SCSF-78), the signal reached 144% of that of the plastic scintillator. The intensity of the green scintillating fibers was lower than that of the plastic scintillator: 47% for the singly clad fiber (BCF-60) and 77% for the multiclad fiber (SCSF-3HF). The collected light was studied as a function of the scintillator length and radius for a cylindrical probe. We found that symmetric detectors with nearly the same spatial resolution in each direction (2 mm in diameter by 3 mm in length) could be made with a signal equivalent to those of the more commonly used asymmetric scintillators. With augmentation of the signal-to-noise ratio in consideration, this paper presents a series of comparisons that should provide insight into selection of a scintillator type and volume for development of a medical dosimeter.