title: Comparison of methods for the measurement of radiation dose distributions in high dose rate (HDR) brachytherapy: Ge-doped optical fiber, EBT3 Gafchromic film, and PRESAGE® radiochromic plastic.
abstract: OBJECTIVE
  Dose distribution measurement in clinical high dose rate (HDR) brachytherapy is challenging, because of the high dose gradients, large dose variations, and small scale, but it is essential to verify accurate treatment planning and treatment equipment performance. The authors compare and evaluate three dosimetry systems for potential use in brachytherapy dose distribution measurement: Ge-doped optical fibers, EBT3 Gafchromic film with multichannel analysis, and the radiochromic material PRESAGE(®) with optical-CT readout.
  
  
  METHODS
  Ge-doped SiO2 fibers with 6 μm active core and 5.0 mm length were sensitivity-batched and their thermoluminescent properties used via conventional heating and annealing cycles. EBT3 Gafchromic film of 30 μm active thickness was calibrated in three color channels using a nominal 6 MV linear accelerator. A 48-bit transmission scanner and advanced multichannel analysis method were utilized to derive dose measurements. Samples of the solid radiochromic polymer PRESAGE(®), 60 mm diameter and 100 mm height, were analyzed with a parallel beam optical CT scanner. Each dosimetry system was used to measure the dose as a function of radial distance from a Co-60 HDR source, with results compared to Monte Carlo TG-43 model data. Each system was then used to measure the dose distribution along one or more lines through typical clinical dose distributions for cervix brachytherapy, with results compared to treatment planning system (TPS) calculations. Purpose-designed test objects constructed of Solid Water and held within a full-scatter water tank were utilized.
  
  
  RESULTS
  All three dosimetry systems reproduced the general shape of the isolated source radial dose function and the TPS dose distribution. However, the dynamic range of EBT3 exceeded those of doped optical fibers and PRESAGE(®), and the latter two suffered from unacceptable noise and artifact. For the experimental conditions used in this study, the useful range from an isolated HDR source was 5-40 mm for fibers, 3-50 mm for EBT3, and 4-21 mm for PRESAGE(®). Fibers demonstrated some over-response at very low dose levels, suffered from volume averaging effects in the dose distribution measurement, and exhibited up to 9% repeatability variation over three repeated measurements. EBT3 demonstrated excellent agreement with Monte Carlo and TPS dose distributions, with up to 3% repeatability over three measurements. PRESAGE(®) gave promising results, being the only true 3D dosimeter, but artifacts and noise were apparent.
  
  
  CONCLUSIONS
  The comparative response of three emerging dosimetry systems for clinical brachytherapy dose distribution measurement has been investigated. Ge-doped optical fibers have excellent spatial resolution for single-direction measurement but are currently too large for complex dose distribution assessment. The use of PRESAGE(®) with optical-CT readout gave promising results in the measurement of true 3D dose distributions but further development work is required to reduce noise and improve dynamic range for brachytherapy dose distribution measurements. EBT3 Gafchromic film with multichannel analysis demonstrated accurate and reproducible measurement of dose distributions in HDR brachytherapy. Calibrated dose measurements were possible with agreement within 1.5% of TPS dose calculations. The suitability of EBT3 as a dosimeter for 2D quality control or commissioning work has been demonstrated.
authors.affiliation: Department of Physics, Faculty of Engineering and Physical Science, University of Surrey, Surrey GU2 7JP, United Kingdom. antony.palmer@porthosp.nhs.uk
authors.forename: A L
authors.initials: AL
authors.lastname: Palmer
authors.forename: P
authors.initials: P
authors.lastname: Di Pietro
authors.forename: S
authors.initials: S
authors.lastname: Alobaidli
authors.forename: F
authors.initials: F
authors.lastname: Issa
authors.forename: S
authors.initials: S
authors.lastname: Doran
authors.forename: D
authors.initials: D
authors.lastname: Bradley
authors.forename: A
authors.initials: A
authors.lastname: Nisbet
mesh_terms: D001918:Brachytherapy / Q000295:instrumentation*; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005336:Fiber Optic Technology / Q000295:instrumentation*; D005373:Film Dosimetry / Q000295:instrumentation*; D006801:Humans; D011879:Radiotherapy Dosage; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013819:Thermoluminescent Dosimetry / Q000295:instrumentation*