Dose distributions registered in water equivalent, polymer gel dosimeters were used to measure the output factors and off-axis profiles of the radiosurgical photon beams employed for CyberKnife radiosurgery. Corresponding measurements were also performed using a shielded silicon diode commonly employed for CyberKnife commissioning, the PinPoint ion chamber, and Gafchromic EBT films, for reasons of comparison. Polymer gel results of this work for the output factors of the 5, 7.5, and 10 mm diameter beams are (0.702 +/- 0.029), (0.872 +/- 0.039), and (0.929 +/- 0.041), respectively. Comparison of polymer gel and diode measurements shows that the latter overestimate output factors of the two small beams (5% for the 5 mm beam and 3% for the 7.5 mm beams). This is attributed to the nonwater equivalence of the high atomic number silicon material of the diode detector. On the other hand, the PinPoint chamber is found to underestimate output factors up to 10% for the 5 mm beam due to volume averaging effects. Polymer gel and EBT film output factor results are found in close agreement for all beam sizes, emphasizing the importance of water equivalence and fine detector sensitive volume for small field dosimetry. Relative off-axis profile results are in good agreement for all dosimeters used in this work, with noticeable differences observed only in the PinPoint estimate of the 80%-20% penumbra width, which is relatively overestimated.

This work reports the first results obtained using a new 3D radiochromic gel dosimeter. The dosimeter is an aqueous physical gel matrix made of poly(ethylene oxide)-block-poly(propylene oxide)-block-poly(ethylene oxide) (Pluronic F-127, PEO-PPO-PEO) doped with a representative of tetrazolium salts, 2, 3, 5-triphenyltetrazolium chloride (TTC). There were several reasons for the choice of Pluronic as a gel forming substrate: (i) the high degree of transparency and colourlessness; (ii) the possibility of gel dosimeter preparation at both high and low temperatures due to the phase behaviour of Pluronic; (iii) the broad temperature range over which the TTC-Pluronic dosimeter is stable; and (iv) the non-toxicity of Pluronic. A reason for the choice of TTC was its ionising radiation-induced transformation to water-insoluble formazan, which was assumed to impact beneficially on the spatial stability of the dose distribution. If irradiated, the TTC-Pluronic gels become red but transparent in the irradiated part, while the non-irradiated part remains crystal clear. The best obtained composition is characterised by <4 Gy dose threshold, a dose sensitivity of 0.002 31 (Gy  ×  cm), a large linear dose range of >500 Gy and a dynamic dose response much greater than 500 Gy (7.5% TTC, 25% Pluronic F-127, 50 mmol dm tetrakis). Temporal and spatial stability studies revealed that the TTC-Pluronic gels (7.5% TTC, 25% Pluronic F-127) were stable for more than one week. The addition of compounds boosting the gels' dose performance caused deterioration of the gels' temporal stability but did not impact the stability of the 3D dose distribution. The proposed method of preparation allows for the repeatable manufacture of the gels. There were no differences observed between gels irradiated fractionally and non-fractionally. The TTC-Pluronic dose response might be affected by the radiation source dose rate-this, however, requires further examination.

The water equivalence and stable relative energy response of polymer gel dosimeters are usually taken for granted in the relatively high x-ray energy range of external beam radiotherapy based on qualitative indices such as mass and electron density and effective atomic number. However, these favourable dosimetric characteristics are questionable in the energy range of interest to brachytherapy especially in the case of lower energy photon sources such as 103Pd and 125I that are currently utilized. In this work, six representative polymer gel formulations as well as the most commonly used experimental set-up of a LiF TLD detector-solid water phantom are discussed on the basis of mass attenuation and energy absorption coefficients calculated in the energy range of 10 keV-10 MeV with regard to their water equivalence as a phantom and detector material. The discussion is also supported by Monte Carlo simulation results. It is found that water equivalence of polymer gel dosimeters is sustained for photon energies down to about 60 keV and no corrections are needed for polymer gel dosimetry of 169Yb or 192Ir sources. For 125I and 103Pd sources, however, a correction that is source-distance dependent is required. Appropriate Monte Carlo results show that at the dosimetric reference distance of 1 cm from a source, these corrections are of the order of 3% for 125I and 2% for 103Pd. These have to be compared with corresponding corrections of up to 35% for 125I and 103Pd and up to 15% even for the 169Yb energies for the experimental set-up of the LiF TLD detector-solid water phantom.

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This work presents an improvement of the VIPAR ('nd' stands for 'normoxic, double', or VIP) polymer gel dosimeter. The gel composition was altered by increasing the concentration of the monomeric components, N-vinylpyrrolidone (NVP) and N,N'-methylenebisacrylamide (MBA), in co-solvent solutions. The optimal composition (VIPAR, where 'CT' stands for computed tomography, or VIC) comprised: 17% NVP, 8% MBA, 12% t-BuOH, 7.5% gelatine, 0.007% ascorbic acid, 0.0008% CuSO ×  5HO and 0.02% hydroquinone. The following characteristics of VIC were achieved: (i) linear dose range of 0.930 Gy, (ii) saturation for radiation doses of over 50 Gy, (iii) threshold dose of about 0.5 Gy, (iv) dose sensitivity of 0.171 Gy s, which is roughly 2.2 times higher than that of VIP (for nuclear magnetic resonance measurements). It was also found that VIC is dose- rate-independent, and its dose response does not alter if the radiation source is changed from electrons to photons for external beam radiotherapy. The gel responded similarly to irradiation with small changes in radiation energy but was sensitive to larger energy changes. The VIC gel retained temporal stability from 20 h until at least 10 d after irradiation, whereas spatial stability was retained from 20 h until at least 6 d after irradiation. The scheme adopted for VIC manufacturing yields repeatable gels in terms of radiation dose response. The VIC was also shown to perform better than VIP using x-ray computed tomography as a readout method; the dose sensitivity of VIC (0.397 HU Gy) was 1.5 times higher than that of VIP. Also, the dose resolution of VIC was better than that of VIP in the whole dose range examined.

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This work describes an experimental procedure with potential to assess the overall accuracy associated with gamma knife clinical applications, from patient imaging and dosimetry planning to patient positioning and dose delivery using the automated positioning system of a Leksell Gamma Knife model C. The VIPAR polymer gel-MRI dosimetry method is employed due to its inherent three-dimensional feature and linear dose response over the range of gamma knife applications. Different polymer gel vials were irradiated with single shot gamma knife treatment plans using each of the four available collimator helmets to deliver a maximum dose of 30 Gy. Percentage relative dose results are presented not only in the form of one-dimensional profiles but also planar isocontours and isosurfaces in three dimensions. Experimental results are compared with corresponding Gammaplan treatment planning system calculations as well as acceptance test radiochromic film measurements. A good agreement, within the experimental uncertainty, is observed between measured and expected dose distributions. This experimental uncertainty is of the order of one imaging pixel in the MRI gel readout session (<1 mm) and allows for the verification of single shot gamma knife applications in terms of acceptance specifications for precision in beam alignment and accuracy. Averaging net R(2) results in the dose plateau of the 4 mm and 18 mm collimator irradiated gel vials, which were MR scanned in the same session, provides a crude estimate of the 4 mm output factor which agrees within errors with the default value of 0.870.