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To assess visibility and artifact characteristics of polymer fiducials compared to standard gold fiducials for radiotherapy CT and MRI simulation. Three gold and three polymer fiducials were inserted into a CT and MRI tissue-equivalent phantom that approximated the prostate cancer radiotherapy configuration. The phantom and fiducials were imaged on CT and MRI. Images were assessed in terms of fiducial visibility and artifact. ImageJ was employed to quantify the pixel gray-scale of each fiducial and artifact. Fiducial gray-scale histograms and profiles were generated for analysis. Objective measurements of the contrast-to-noise ratio (CNR), signal-to-noise ratio (SNR), and artifact index (AI) were calculated. The CT images showed that the gold fiducials are visually brighter, with greater contrast than the polymer. The higher peak values illustrate this in the line profiles. However, they produce bright radiating and dark shadowing artifacts. This is depicted by the greater width of line profiles and the disruption of phantom area profiles. Quantitatively this results in greater percentile ranges of the histograms. Furthermore, for CT, gold had a higher CNR than polymer, relative to the phantom. However, the gold CNR and SNR were degraded by the greater artifact and thus AI. Both fiducials were visible on MRI and had similar histograms and profiles that were also reflected in comparable CNR, SNR and AI. Polymer fiducials were well visualized in a phantom on CT and MR and produce less artifact than the gold fiducials. Polymer markers could enhance the quality and accuracy of radiotherapy co-registration and planning but require clinical confirmation.

One feature of the dynamic wedge is the improved flatness of the beam profile in the nonwedged direction when compared to fixed wedges. Profiles in the nonwedged direction for fixed wedges show a fall-off in dose away from the central axis when compared to the open field profile. This study will show that there is no significant difference between open field profiles and nonwedged direction profiles for dynamically wedged beams. The implications are that the dynamic wedge offers an improved dose distribution in the nonwedged direction that can be modelled by approximating the dynamically wedged field to an open field. This is possible as both the profiles and depth doses of the dynamically wedged fields match those of the open fields, if normalized to dmax of the same field size. For treatment planning purposes the effective wedge factor (EWF) provides a normalization factor for the open field depth dose data set. Data will be presented to demonstrate that the EWF shows relatively little variation with depth and can be treated as being independent of field size in the nonwedged direction.

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