We present an evaluation of the precision and accuracy of image-based radiochromic film (RCF) dosimetry performed using a commercial RCF product (Gafchromic MD-55-2, Nuclear Associates, Inc.) and a commercial high-spatial resolution (100 microm pixel size) He-Ne scanning-laser film-digitizer (Personal Densitometer, Molecular Dynamics, Inc.) as an optical density (OD) imaging system. The precision and accuracy of this dosimetry system are evaluated by performing RCF imaging dosimetry in well characterized conformal external beam and brachytherapy high dose-rate (HDR) radiation fields. Benchmarking of image-based RCF dosimetry is necessary due to many potential errors inherent to RCF dosimetry including: a temperature-dependent time evolution of RCF dose response; nonuniform response of RCF; and optical-polarization artifacts. In addition, laser-densitometer imaging artifacts can produce systematic OD measurement errors as large as 35% in the presence of high OD gradients. We present a RCF exposure and readout protocol that was developed for the accurate dosimetry of high dose rate (HDR) radiation sources. This protocol follows and expands upon the guidelines set forth by the American Association of Physicists in Medicine (AAPM) Task Group 55 report. Particular attention is focused on the OD imaging system, a scanning-laser film digitizer, modified to eliminate OD artifacts that were not addressed in the AAPM Task Group 55 report. RCF precision using this technique was evaluated with films given uniform 6 MV x-ray doses between 1 and 200 Gy. RCF absolute dose accuracy using this technique was evaluated by comparing RCF measurements to small volume ionization chamber measurements for conformal external-beam sources and an experimentally validated Monte Carlo photon-transport simulation code for a 192Ir brachytherapy source. Pixel-to-pixel standard deviations of uniformly irradiated films were less than 1% for doses between 10 and 150 Gy; between 1% and 5% for lower doses down to 1 Gy and 1% and 1.5% for higher doses up to 200 Gy. Pixel averaging to form 200-800 microm pixels reduces these standard deviations by a factor of 2 to 5. Comparisons of absolute dose show agreement within 1.5%-4% of dose benchmarks, consistent with a highly accurate dosimeter limited by its observed precision and the precision of the dose standards to which it is compared. These results provide a comprehensive benchmarking of RCF, enabling its use in the commissioning of novel HDR therapy sources.

The tumor physiological environment is one of the least understood and most important factors in determining the response of solid tumors to cancer therapy. To examine several important characteristics of the tumor physiological environment we have used in situ photon activation-15O decay measurements (perfusion characteristics) and 31P surface coil-NMR spectroscopy (metabolic characteristics) to observe in vivo subcutaneous RIF-1 tumors grown in female C3H/Anf mice. The following correlations between the 15O perfusion characteristics and the 31P NMR metabolic characteristics in individual tumors were observed: a negative correlation between pH, as measured by NMR (pHNMR), and the inorganic phosphate to nucleosides triphosphate peak height ratio (Pi:NTP); for the well-perfused fraction of the tumor there is a positive correlation with both pHNMR and the phosphocreatine to nucleosides triphosphate peak height ratio (PCr:NTP), and a negative correlation with Pi:NTP. These correlations are interpreted as evidence for a direct relationship between the distribution of cellular physiological environments and the tumor metabolic state. Because these physiological characteristics affect tumor response to various therapeutic modalities and both measurements can be made on humans, it is suggested that these techniques may be of prognostic value in the clinical management of human cancer.

Specific capillary blood flow and small-vessel pathology in animal tumors (rhabdomyosarcoma BA-1112) of WAG/Rij rats were examined following local tumor heating to 40-44.5 degrees C. Blood flow in tumors heated to 40-41 degrees C for 40 minutes was reduced initially by about 50%, but returned to near preheating values within 72 hours, consistent with the histopathological observations indicating small-vessel dilation and temporary congestion. The application of hyperthermia greater than 43 degrees C (for 40 minutes) resulted in the virtual elimination of capillary blood flow, consistent with pathological findings of widespread vessel rupture and hemorrhage in this temperature range.

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A direct, noninvasive method for measuring absolute values of specific capillary blood flow in living tissue is described. The method is based on the photon activation, in situ, of tissue elements and the measurement of the subsequent decay of the positron activity induced, employing coincidence detection of the photon pairs produced in positron annihilation. Analysis of the time-dependent coincidence spectrum reveals the contribution to the total signal from the decay of 15O, from which the specific capillary blood flow in the imaged, activated volume is ultimately determined. By virtue of its introduction of the radioisotope of interest (15O) directly and uniformly into the tissue volume under investigation, the method described permits both the nonperfused and well perfused fractions of an activated volume to be estimated and hence, the average specific blood flow within imaged tumor volumes to be computed. The model employed to describe and analyze the data is discussed in detail. Results of application of the technique to measurement of specific blood flow in rhabdomyosarcoma tumors grown in WAG/Rij rats are presented and discussed. The method is shown to be reliable and well suited to studies designed to determined the effects of various agents, such as heat, radiation and drugs, on tumor blood flow.