Eye lens dosimetry and the study on radiation cataract in interventional cardiologists

PurposeTo determine the eye lens dose of the Interventional Cardiology (IC) personnel using optically stimulated luminescent dosimeter (OSLD) and the prevalence and risk of radiation – associated lens opacities in Thailand.Methods and results48 IC staff, with age- and sex- matches 37 unexposed controls obtained eye examines. Posterior lens change was graded using a modified Merriam-Focht technique by two independent ophthalmologists. Occupational exposure (mSv) was measured in 42 IC staff, using 2 OSLD badges place at inside lead apron and at collar. Annual eye lens doses (mSv) were also measured using 4 nanoDots OSL placed outside and inside lead glass eyewear. The prevalence of radiation-associated posterior lens opacities was 28.6% (2/7) for IC, 19.5% (8/41) for nurses, and 2.7% (1/37) for controls. The average and range of annual whole body effective dose, Hp(10), equivalent dose at skin of the neck, Hp(0.07) and equivalent dose at eye lens, Hp(3) were 0.80 (0.05–6.79), 5.88 (0.14–35.28), and 5.73 (0.14–33.20) mSv respectively. The annual average and range of eye lens dose using nano Dots OSL showed the outside lead glass eyewear on left and right sides as 8.06 (0.17–32.45), 3.55(0.06–8.04) mSv and inside left and right sides as 3.91(0.05–14.26) and 2.44(0.06–6.24) mSv respectively.ConclusionEye lens doses measured by OSLD badges and nano Dot dosimeter as Hp(10), Hp(0.07) and Hp(3). The eyes of the IC personnel were examined annually by two ophthalmologists for the prevalence of cataract induced by radiation.     

Characterization of passive dosimeters in proton pencil beam scanning – A EURADOS intercomparison for mailed dosimetry audits in proton therapy centres

The lack of mailed dosimetry audits of proton therapy centres in Europe has encouraged researchers of EURADOS Working Group 9 (WG9) to compare response of several existing passive detector systems in therapeutic pencil beam scanning.Alanine Electron Paramagnetic Resonance dosimetry systems from 3 different institutes (ISS, Italy; UH, Belgium and IFJ PAN, Poland), ^natLiF:Mg, Ti (MTS-N) and ^natLiF:Mg, Cu, P (MCP-N) thermoluminescent dosimeters (TLDs), GD-352M radiophotoluminescent glass dosimeters (RPLGDs) and Al₂O₃:C optically stimulated dosimeters (OSLDs) were evaluate. Dosimeter repeatability, batch reproducibility and response in therapeutic Pencil Beam Scanning were verified for implementation as mail auditing system.Alanine detectors demonstrated the lowest linear energy transfer (LET) dependence with an agreement between measured and treatment planning system (TPS) dose below 1%. The OSLDs measured on average a 6.3% lower dose compared to TPS calculation, with no significant difference between varying modulations and ranges. Both GD-352M and MCP-N measured a lower dose than the TPS and luminescent response was dependent on the LET of the therapeutic proton beam. Thermoluminescent response of MTS-N was also found to be dependent on the LET and a higher dose than TPS was measured with the most pronounced increase of 11%.As alanine detectors are characterized by the lowest energy dependence for different parameters of therapeutic pencil beam scanning they are suitable candidates for mail auditing in proton therapy. The response of luminescence detector systems have shown promises even though more careful calibration and corrections are needed for its implementation as part of a mailed dosimetry audit system.     

An optimized calibration method for surface measurements with MOSFETs in shaped-beam radiosurgery

Nowadays MOSFET dosimeters are widely used for dose verification in radiotherapy procedures. Although their sensitive area satisfies size requirements for small field dosimetry, their use in radiosurgery has rarely been reported. The aim of this study is to propose and optimize a calibration method to perform surface measurements in 6 MV shaped-beam radiosurgery for field sizes down to 18 × 18 mm². The effect of different parameters such as recovery time between 2 readings, batch uniformity and build-up cap attenuation was studied. Batch uniformity was found to be within 2% and isocenter dose attenuation due to the build-up cap over the MOSFET was near 2% irrespective of field size. Two sets of sensitivity coefficients (SC) were determined for TN-502RD MOSFET dosimeters using experimental and calculated calibration; the latter being developed using an inverse square law model. Validation measurements were performed on a realistic head phantom in irregular fields. MOSFET dose values obtained by applying either measured or calculated SC were compared. For calibration, optimal results were obtained for an inter-measurement time lapse of 5 min. We also found that fitting the SC values with the inverse square law reduced the number of measurements required for calibration. The study demonstrated that combining inverse square law and Sterling–Worthley formula resulted in an underestimation of up to 4% of the dose measured by MOSFETs for complex beam geometries. With the inverse square law, it is possible to reduce the number of measurements required for calibration for multiple field–SSD combinations. Our results suggested that MOSFETs are suitable sensors for dosimetry when used at the surface in shaped-beam radiosurgery down to 18 × 18 mm².     

Occupational radiation exposure in vascular interventional radiology: A complete evaluation of different body regions

PurposeTo perform a complete evaluation on radiation doses, received by primary and assistant medical staff, while performing different vascular interventional radiology procedures.Materials and methodsWe evaluated dose received in different body regions during three categories of vascular procedures: lower limb angiography (Angiography), lower limb percutaneous transluminal angioplasty (Angioplasty) and stent graft placement for abdominal aortic aneurysm treatment (A. A. A. Treatment). We positioned the dosimeters near the eye lens, thyroid, chest, abdomen, hands, and feet of the interventional physicians. Equivalent dose was compared with annual dose limits for workers in order to determine the maximum number of procedures per year that each physician could perform. We assessed 90 procedures.ResultsWe found the highest equivalent doses in the A. A. A. Treatment, in which 90% of the evaluations indicated at least one region receiving more than 1 mSv per procedure. Angioplasty was the only procedural modality that provided statistically different doses for different professionals, which is an important aspect on regards to radiological protection strategies. In comparison with the dose limits, the most critical region in all procedures was the eye lens.ConclusionsSince each body region of the interventionist is exposed to different radiation levels, dose distribution measurements are essential for radiological protection strategies. These results indicate that dosimeters placed in abdomen instead of chest may represent more accurately the whole body doses received by the medical staff. Additional dosimeters and a stationary shield for the eye lens are strongly recommended.     

Eye lens dose correlations with personal dose equivalent and patient exposure in paediatric interventional cardiology performed with a fluoroscopic biplane system

PurposeTo analyse the correlations between the eye lens dose estimates performed with dosimeters placed next to the eyes of paediatric interventional cardiologists working with a biplane system, the personal dose equivalent measured on the thorax and the patient dose.MethodsThe eye lens dose was estimated in terms of H_p(0.07) on a monthly basis, placing optically stimulated luminescence dosimeters (OSLDs) on goggles. The H_p(0.07) personal dose equivalent was measured over aprons with whole-body OSLDs. Data on patient dose as recorded by the kerma-area product (P_KA) were collected using an automatic dose management system. The 2 paediatric cardiologists working in the facility were involved in the study, and 222 interventions in a 1-year period were evaluated. The ceiling-suspended screen was often disregarded during interventions.ResultsThe annual eye lens doses estimated on goggles were 4.13 ± 0.93 and 4.98 ± 1.28 mSv. Over the aprons, the doses obtained were 10.83 ± 0.99 and 11.97 ± 1.44 mSv. The correlation between the goggles and the apron dose was R² = 0.89, with a ratio of 0.38. The correlation with the patient dose was R² = 0.40, with a ratio of 1.79 μSv Gy⁻¹ cm⁻². The dose per procedure obtained over the aprons was 102 ± 16 μSv, and on goggles 40 ± 9 μSv. The eye lens dose normalized to P_KA was 2.21 ± 0.58 μSv Gy⁻¹ cm⁻².ConclusionsMeasurements of personal dose equivalent over the paediatric cardiologist’s apron are useful to estimate eye lens dose levels if no radiation protection devices are typically used.     

Addressing the efficiency of X-ray protective eyewear: Proposal for the introduction of a new comprehensive parameter,the Eye Protection Effectiveness (EPE)

Radioprotection of the eye lens of medical staff involved in Surgical procedures is a subject of international debates since ICRP recommended, on 2011, a lower equivalent dose limit for the lens of the eye. In this work we address the effectiveness of different models of X-ray protective eyewear by relating actual dosimetry measurements to an ad hoc developed mathematical model, in order to disentangle the contribution of geometrical factors and shield capabilities. Phantom irradiation was carried out in fixed exposure conditions in angiographic room: we found that measured Dose Reduction Factors (DRF) strongly depend on the ergonomics of the investigated eyewear. Actually a very poor DRF was observed in the case of a glass model in spite of its high nominal attenuation, whereas a protective tool with low shielding capabilities such a visor resulted much more effective as a consequence of is shape (i.e. extended geometric protection of the eye lens). Our work highlights the need of the introduction of a specific parameter to quantify the effectiveness of the protection tools and able to predict their DRF by taking into account the geometry of the clinical condition of exposure. Aiming at making steps forward the standardization of the guidelines concerning the features of eye protective tools, we developed a simple mathematical model describing the eye lens irradiation geometry which allows the introduction, for each eyewear, of a comprehensive parameter, the Eye Protection Effectiveness (EPE), that, for any defined clinical irradiation condition and glass shielding capabilities and shape, defines the overall effective X-ray protection of the eyewear.     

A multicenter study of radiation doses to the eye lenses of medical staff performing non-vascular imaging and interventional radiology procedures in Japan

PurposeThis study aimed to measure the eye lens doses received by physicians and other medical staff participating in non-vascular imaging and interventional radiology procedures in Japan.Material and methodsFrom October 2014 to March 2017, 34 physicians and 29 other medical staff engaged in non-vascular imaging and interventional radiology procedures at 18 Japanese medical facilities. These professionals wore radioprotective lead glasses equipped with small, optically stimulated luminescence dosimeters and additional personal dosimeters at the neck during a 1-month monitoring period. The H_p(3) and the H_p(10) and H_p(0.07) were obtained from these devices, respectively. The monthly H_p(3), H_p(10), and H_p(0.07) for each physician and other medical staff member were then rescaled to a 12-month period to enable comparisons with the revised occupational equivalent dose limit for the eye lens.ResultsAmong physicians, the average annual H_p(3) values measured by the small luminescence dosimeters on radioprotective glasses were 25.5 ± 38.3 mSv/y (range: 0.4–166.8 mSv/y) and 9.3 ± 16.6 mSv/y (range: 0.3–82.4 mSv/y) on the left and right sides, respectively. The corresponding values for other medical staff were 3.7 ± 3.1 mSv/y (range: 0.4–10.4 mSv/y) and 3.2 ± 2.7 mSv/y (range: 0.5–11.5 mSv/y), respectively.ConclusionsThe eye lens doses incurred by physicians and other medical staff who engaged in non-vascular imaging and interventional radiology procedures in Japan were provided. Physicians should wear radioprotective glasses and use additional radioprotective devices to reduce the amount of eye lens doses they receive.     

Dosimetric impact of failing to apply correction factors to ion recombination in percentage depth dose measurements and the volume-averaging effect in flattening filter-free beams

PurposeTo examine whether it is essential to apply correction factors for ion recombination (k_S) to percentage depth dose (PDD) measurements and to the volume-averaging effect (k_vol) to ensure accurate absolute dose calibration for flattening filter-free (FFF) beams for the most commonly used ionization chambers.MethodsWe surveyed medical physicists worldwide (n = 159) to identify the five most common ionization chamber combinations used for absolute and relative reference dosimetry of FFF beams. We then assessed the overall absolute dose calibration error for FFF beams of the Artiste Siemens and TrueBeam Varian linear accelerators resulting from failing to apply correction factors k_S in the PDD(10) and the volume-averaging effect (k_vol) to such chamber combinations.ResultsAll the chamber combinations examined—the Farmer PTW 30013 ionization chamber used for absolute dosimetry, and the PTW 31010, PTW 30013, IBA CC04, IBA CC13, and PTW 31021 ionization chambers used for PDD curves measurements—showed non-negligible errors (≥0.5%). The largest error (1.6%) was found for the combination of the Farmer PTW 30013 chamber with the IBA CC13 chamber, which was the most widely used chamber combination in our survey.ConclusionsBased on our findings, we strongly recommend assessing the impact of failing to apply correction factors k_S in the PDD(10) and k_vol prior to using any chamber type for FFF beam reference dosimetry purposes.     

In vivo monitoring of total skin electron dose using optically stimulated luminescence dosimeters

AimThis study retrospectively analysed the results of using optically stimulated radiation dosimeters (OSLDs) for in vivo dose measurements during total skin electron therapy (TSET, also known as TSEI, TSEB, TSEBT, TSI or TBE) treatments of patients with mycosis fungoides.BackgroundTSET treatments are generally delivered to standing patients, using treatment plans that are devised using manual dose calculations that require verification via in vivo dosimetry. Despite the increasing use of OSLDs for radiation dosimetry, there is minimal published guidance on the use of OSLDs for TSET verification.Materials and methodsThis study retrospectively reviewed in vivo dose measurements made during treatments of nine consecutive TSET patients, treated between 2013 and 2018. Landauer nanoDot OSLDs were used to measure the skin dose at reference locations on each patient, as well as at locations of clinical interest such as the head, hands, feet, axilla and groin.Results1301 OSLD measurements were aggregated and analysed, producing results that were in broad agreement with previous TLD studies, while providing additional information about the variation of dose across concave surfaces and potentially guiding future refinement of treatment setup. In many cases these in vivo measurements were used to identify deviations from the planned dose in reference locations and to identify anatomical regions where additional shielding or boost treatments were required.ConclusionsOSLDs can be used to obtain measurements of TSET dose that can inform monitor unit adjustments and identify regions of under and over dosage, while potentially informing continuous quality improvement in TSET treatment delivery.     

The effects of simulating a realistic eye model on the eye dose of an adult male undergoing head computed tomography

In head computed tomography, radiation upon the eye lens (as an organ with high radiosensitivity) may cause lenticular opacity and cataracts. Therefore, quantitative dose assessment due to exposure of the eye lens and surrounding tissue is a matter of concern. For this purpose, an accurate eye model with realistic geometry and shape, in which different eye substructures are considered, is needed. To calculate the absorbed radiation dose of visual organs during head computed tomography scans, in this study, an existing sophisticated eye model was inserted at the related location in the head of the reference adult male phantom recommended by the International Commission on Radiological Protection (ICRP). Then absorbed doses and distributions of energy deposition in different parts of this eye model were calculated and compared with those based on a previous simple eye model. All calculations were done using the Monte Carlo code MCNP4C for tube voltages of 80, 100, 120 and 140 kVp. In spite of the similarity of total dose to the eye lens for both eye models, the dose delivered to the sensitive zone, which plays an important role in the induction of cataracts, was on average 3% higher for the sophisticated model as compared to the simple model. By increasing the tube voltage, differences between the total dose to the eye lens between the two phantoms decrease to 1%. Due to this level of agreement, use of the sophisticated eye model for patient dosimetry is not necessary. However, it still helps for an estimation of doses received by different eye substructures separately.     

A pilot study of a postal dosimetry system using the Fricke dosimeter for research irradiators

Cobalt-60 irradiators and soft X-ray machines are frequently used for research purposes, but the dosimetry is not always performed using the recommended protocols. This may lead to confusing and untrustworthy results within the conducted research. Postal dosimetry systems have already been approved by the IAEA, with thermoluminescence dosimeters (TLD) and optically stimulated luminescence (OSL) as the most commonly used dosimeter systems in these cases. The present study tests the Fricke dosimeter properties as a potential system to be used in postal dosimetry for a project using research irradiators. The Fricke solution was prepared according to the literature, and the linearity and fading tests were performed accordingly. All calculated doses were measured using a NE2571 Farmer ionization chamber as a reference. Doses ranging from 25 to 300 Gy were delivered by a research irradiator, with 150 kV and 22 mA to the Fricke solutions inside polyethylene (PE) bags (4 × 4 × 0.2 cm³). The results compared with the ionization chamber showed a linear response to the range of doses used. Fading tests showed no significant difference for the absorbed doses over 9 days, with a maximum difference of 1.5% found between days 0 and 3. The Fricke dosimeter presented good linearity, for low and high doses, and low uncertainties for the fading even for 9 days after irradiation. These preliminary results are motivating, and as the next step, we intend to design a postal dosimetry system using the PE bags of Fricke solution.     

Characterization of a low-cost PIN photodiode for dosimetry in diagnostic radiology

A commercial silicon PIN-photodiode was tested and characterized as ionizing radiation detector for radiological applications. A current-to-voltage amplification stage was designed and realized in order to acquire the photodiode signal in current mode. The system was tested with clinical beams routinely used for radiography and mammography. A Monte Carlo simulation of the detector was performed with the MCNPX code in order to model and fully understand, in particular, the impact of the sensor casing on the low energy response of the device. A reproducible output linearity was found over the dose range 0.03–4.5 mGy of great clinical relevance. The system sensitivity was found to be stable at 0.2 V s Gy⁻¹ for effective X-ray energies between 17 and 40 keV. The batch-to-batch reproducibility of the diodes was also experimentally investigated for two different batches of 14 diodes each. An inter-comparison with dosimeters routinely used in medical physics (i.e. Barracuda MPD RTI) showed a linear correlation between PIN-photodiode readout and absorbed dose measured with Barracuda, in the range of doses received by mammography and radiology patients.     

Three-dimensional printer-generated patient-specific phantom for artificial in vivo dosimetry in radiotherapy quality assurance

Pretreatment intensity-modulated radiotherapy quality assurance is performed using simple rectangular or cylindrical phantoms; thus, the dosimetric errors caused by complex patient-specific anatomy are absent in the evaluation objects. In this study, we construct a system for generating patient-specific three-dimensional (3D)-printed phantoms for radiotherapy dosimetry. An anthropomorphic head phantom containing the bone and hollow of the paranasal sinus is scanned by computed tomography (CT). Based on surface rendering data, a patient-specific phantom is formed using a fused-deposition-modeling-based 3D printer, with a polylactic acid filament as the printing material. Radiophotoluminescence glass dosimeters can be inserted in the 3D-printed phantom. The phantom shape, CT value, and absorbed doses are compared between the actual and 3D-printed phantoms. The shape difference between the actual and printed phantoms is less than 1 mm except in the bottom surface region. The average CT value of the infill region in the 3D-printed phantom is −6 ± 18 Hounsfield units (HU) and that of the vertical shell region is 126 ± 18 HU. When the same plans were irradiated, the dose differences were generally less than 2%. These results demonstrate the feasibility of the 3D-printed phantom for artificial in vivo dosimetry in radiotherapy quality assurance.     

Versatility of thermoluminescence materials and radiation dosimetry – A review

Thermoluminescence (TL) materials exhibit a wide range of applications in different areas such as personal dosimetry, environmental dosimetry, medical research etc. Doping of different rare earth impurities in different hosts is responsible for changing the properties of materials useful for various applications in different fields. These materials can be irradiated by different types of beams such as γ‐rays, X‐rays, electrons, neutrons etc. Various radiation regimes, as well as their dose–response range, play an important role in thermoluminescence dosimetry. Several TL materials, such as glass, microcrystalline, nanostructured inorganic materials and recently developed materials, are reviewed and described in this article.     

Under-response correction for EBT3 films in the presence of proton spread out Bragg peaks

We present a study of the under-response of the new Gafchromic EBT3 films and a procedure to accurately perform 2D and 3D proton dosimetry measurements for both pristine and spread out Bragg peaks (SOBP) of any energy. These new films differ from the previous EBT2 generation by a slightly different active layer composition, which we show has not effected appreciably their response. The procedure and the beam quality correction factor curve have been benchmarked using 29 MeV modulated proton beams. In order to show the correction to apply when EBT3 films are used as treatment verification tools in anthropomorphic phantoms, two simulation studies involving clinical energies are presented: a SOBP for eye treatments and a SOBP to treat 20 cm deep and 5 cm thick tumours. We find maximum under-responses of 37%, 30% and 7.7% for the modulated 29 MeV beam, eye and deep tumour treatment, respectively, which were attained close to the end of the peak tails, due to a higher proportion of very low energy protons. The maximum deviations between corrected and uncorrected doses were for the three cases, respectively, 20.7%, 8.3% and 2.1% of the average dose across flat region of the SOBP. These values were obtained close to the distal edge of the SOBPs, where the proportion of low energy protons was not as high as on the tail, but there still was a number of protons high enough to deposit a reasonable amount of dose in the films.     

Characterisation of two new radiochromic gel dosimeters TruView™ and ClearView™ in combination with the vista™ optical CT scanner: A feasibility study

PurposeThis study aims at characterising the properties of TruView™ and ClearView™ two new gel dosimeters (Modus Medical Devices Inc.) and at studying the feasibility of relative dosimetry using these dosimeters and the Vista™ Optical CT scanner to accurately evaluate dose.MethodsIn this work, we investigated key dosimetric aspects (dose response, energy and dose rate dependence) and stability of these radiochromic gels initiated in preliminary works (Huet et al., 2017; Colnot et al., 2017) using spectrophotometric measurements. Moreover, by mean of optical CT scanning (Vista™), their performances to measure relative depth dose (PDD) and cross profiles were analysed.ResultsTruView™ and ClearView™ present a linear dose response up to 20 Gy and up to 80 Gy respectively, independent of both photon beam energy (4–18 MV) and dose rate (up to 9.9 Gy/min) (Huet et al., 2017; Colnot et al., 2017). ClearView™ response proves to be stable for a week post-irradiation and uniform within the batch whereas TruView™ presents an unstable but uniform response. Optical CT scanning generates errors due to stray light that need to be corrected in order to use these gels; ClearView™ scanning particularly requires important precautions. After corrections, those gels used in combination with the Vista™ scanner show promising spatial and dosimetric precision (dose difference <5%). Finally, TruView™ is reusable and presents excellent reproducible response (maximum 3% difference) and the ClearView™ dosimeter presents good spatial stability (0.5% difference after 6 days).ConclusionThis study provides important knowledge about two gel dosimeters presenting interesting dosimetric properties. A study is ongoing to benchmark those promising candidates for clinical dose verification.     

Artifact-free CT images for electron beam therapy using a patient-specific non metallic shield

Patient’s CT images taken with metallic shields for radiotherapy suffer from artifacts. Furthermore, the treatment planning system (TPS) has a limitation on accurate dose calculations for high density materials. In this study, a Monte Carlo (MC)-based method was developed to accurately evaluate the dosimetric effect of the metallic shield. Two patients with a commercial tungsten shield of lens and two patients with a custom-made lead shield of lip were chosen to produce their non-metallic dummy shields using 3D scanner and printer. With these dummy shields, we generated artifact-free CT images. The maximum CT number allowed in TPS was assigned to metallic shields. MC simulations with real material information were carried out. In addition, clinically relevant dose-volumetric parameters were calculated for the comparison between MC and TPS. Relative dosimetry was performed using radiochromic films. The dose reductions below metallic structures were shown on MC dose distributions, but not evident on TPS dose distributions. The differences in dose-volumetric parameters of PTV between TPS and MC for eye shield cases were not clearly shown. However, the mean dose of lens from TPS and MC was different. The MC results were in superior agreement with measured data in relative dosimetry. The lens dose could be overestimated by TPS. The differences in dose-volumetric parameters of PTV between TPS and MC were generally larger in lip cases than in eye cases. The developed method is useful in predicting the realistic dose distributions around the organs blocked by the metallic shields.     

Experimental measurements and Monte Carlo calculations for 103Pd dosimetry of the 12 mm COMS eye plaque

Monte Carlo simulations and TLD dosimetry have been performed to determine the dose distributions along the central axis of the 12 mm COMS eye plaques loaded with IRA1-¹⁰³Pd seeds. Several simulations and measurements have been employed to investigate the effect of Silastic insert and air in front of the eye on dosimetry results along the central axis of the plaque and at some critical ocular structures. Measurements were performed using TLD-GR200A circular chip dosimeters in a PMMA eye phantom. The central axis TLD chips locations were arranged in one central column of eye phantom, in 3 mm intervals. The off-axis TLD chips locations were arranged in three off-axis columns around the central axis column. Version 5 of the MCNP code was also used to evaluate the dose distribution around the plaque. The presence of the Silastic insert results in dose reduction of 14% at 5 mm; also about 7% dose reduction appears at the interface point, due to the air presence and lack of the scattering condition. The overall dosimetric parameters for the COMS eye plaque loaded with new palladium seeds are similar to a commercial widely used seed such as Theragenics200. As the dose calculations under TG-43 assumptions do not consider the effect of the plaque backing and Silastic insert for accurate dosimetry, it's suggested to apply the effect of the eye plaque materials and air on dosimetry results along the central axis of the plaque and at some critical ocular structures.     

3D dosimetric validation of ultrasound-guided radiotherapy with a dynamically deformable abdominal phantom

ObjectivesThe purpose of this study was to dosimetrically benchmark gel dosimetry measurements in a dynamically deformable abdominal phantom for intrafraction image guidance through a multi-dosimeter comparison. Once benchmarked, the study aimed to perform a proof-of-principle study for validation measurements of an ultrasound image-guided radiotherapy delivery system.MethodsThe phantom was dosimetrically benchmarked by delivering a liver VMAT plan and measuring the 3D dose distribution with DEFGEL dosimeters. Measured doses were compared to the treatment planning system and measurements acquired with radiochromic film and an ion chamber. The ultrasound image guidance validation was performed for a hands-free ultrasound transducer for the tracking of liver motion during treatment.ResultsGel dosimeters were compared to the TPS and film measurements, showing good qualitative dose distribution matches, low γ values through most of the high dose region, and average 3%/5 mm γ-analysis pass rates of 99.2%(0.8%) and 90.1%(0.8%), respectively. Gel dosimeter measurements matched ion chamber measurements within 3%. The image guidance validation study showed the measurement of the treatment delivery improvements due to the inclusion of the ultrasound image guidance system. Good qualitative matching of dose distributions and improvements of the γ-analysis results were observed for the ultrasound-gated dosimeter compared to the ungated dosimeter.ConclusionsDEFGEL dosimeters in phantom showed good agreement with the planned dose and other dosimeters for dosimetric benchmarking. Ultrasound image guidance validation measurements showed good proof-of-principle of the utility of the phantom system as a method of validating ultrasound-based image guidance systems and potentially other image guidance methods.