For the past 50 years there has been interest in developing 3-D dosemeters for ionising radiation. Particular emphasis has been put on those dosemeters that change their optical properties in proportion to the absorbed dose. Many of the dosemeters that have been evaluated have had limitations such as lack of transparency, diffusion of the image of the dose distribution or poor stability of baseline optical density. Many of these performance limitations have been overcome by the development of PRESAGE, an optically clear polyurethane-based radiochromic 3-D dosemeter. The solid PRESAGE dosemeter is formulated with a free radical initiator and a leuco dye and it does not require a container to maintain its shape. The polyurethane matrix is tissue equivalent and prevents the diffusion of the dose distribution image. There is a linear dose-response, which is independent of both photon energy and dose rate. Simple precautions such as preventing long-term exposure to additional ionising radiation including ultraviolet and controlling storage temperatures prevent the bleaching of the radiochromic response field within the irradiated dosemeter.

The development of intensity-modulated radiotherapy (IMRT) has created a clear need for a dosimeter that can accurately and conveniently measure dose distributions in three dimensions to assure treatment quality. PRESAGE™ is a new three dimensional (3D) dosimetry material consisting of an optically clear polyurethane matrix, containing a leuco dye that exhibits a radiochromic response when exposed to ionizing radiation. A number of potential advantages accrue over other gel dosimeters, including insensitivity to oxygen, radiation induced light absorption contrast rather than scattering contrast, and a solid texture amenable to machining to a variety of shapes and sizes without the requirement of an external container. In this paper, we introduce an efficient method to investigate the basic properties of a 3D dosimetry material that exhibits an optical dose response. The method is applied here to study the key aspects of the optical dose response of PRESAGE™: linearity, dose rate dependency, reproducibility, stability, spectral changes in absorption, and temperature effects. PRESAGE™ was prepared in 1×1×4.5 cm 3 optical cuvettes for convenience and was irradiated by both photon and electron beams to different doses, dose rates, and energies. Longer PRESAGE™ columns (2 ×2×13 cm 3 ) were formed without an external container, for measurements of photon and high energy electron depth-dose curves. A linear optical scanning technique was used to detect the depth distribution of radiation induced optical density (OD) change along the PRESAGE™ columns and cuvettes. Measured depth-OD curves were compared with percent depth dose (PDD). Results indicate that PRESAGE™ has a linear optical response to radiation dose (with a root mean square error of ∼1%), little dependency on dose rate (∼2%), high intrabatch reproducibility (<2%), and can be stable (∼2%) during 2 hours to 2 days post irradiation. Accurate PRESAGE™ dosimetry requires temperature control within 1 °C. Variations in the PRESAGE™ formulation yield corresponding variations in sensitivity, stability, and density. CT numbers in the range 100-470 were observed. In conclusion, the small volume studies presented here indicate PRESAGE™ to be a promising, versatile, and practical new dosimetry material with applicability for radiation therapy.

This work presents extensive investigations to evaluate the robustness (intradosimeter consistency and temporal stability of response), reproducibility, precision, and accuracy of a relatively new 3D dosimetry system comprising a leuco-dye doped plastic 3D dosimeter (PRESAGE) and a commercial optical-CT scanner (OCTOPUS 5x scanner from MGS Research, Inc). Four identical PRESAGE 3D dosimeters were created such that they were compatible with the Radiologic Physics Center (RPC) head-and-neck (H&N) IMRT credentialing phantom. Each dosimeter was irradiated with a rotationally symmetric arrangement of nine identical small fields (1 x 3 cm2) impinging on the flat circular face of the dosimeter. A repetitious sequence of three dose levels (4, 2.88, and 1.28 Gy) was delivered. The rotationally symmetric treatment resulted in a dose distribution with high spatial variation in axial planes but only gradual variation with depth along the long axis of the dosimeter. The significance of this treatment was that it facilitated accurate film dosimetry in the axial plane, for independent verification. Also, it enabled rigorous evaluation of robustness, reproducibility and accuracy of response, at the three dose levels. The OCTOPUS 5x commercial scanner was used for dose readout from the dosimeters at daily time intervals. The use of improved optics and acquisition technique yielded substantially improved noise characteristics (reduced to approximately 2%) than has been achieved previously. Intradosimeter uniformity of radiochromic response was evaluated by calculating a 3D gamma comparison between each dosimeter and axially rotated copies of the same dosimeter. This convenient technique exploits the rotational symmetry of the distribution. All points in the gamma comparison passed a 2% difference, 1 mm distance-to-agreement criteria indicating excellent intradosimeter uniformity even at low dose levels. Postirradiation, the dosimeters were all found to exhibit a slight increase in opaqueness with time. However, the relative dose distribution was found to be extremely stable up to 90 h postirradiation indicating excellent temporal stability. Excellent interdosimeter reproducibility was also observed between the four dosimeters. Gamma comparison maps between each dosimeter and the average distribution of all four dosimeters showed full agreement at the 2% difference, 2 mm distance-to-agreement level. Dose readout from the 3D dosimetry system was found to agree better with independent film measurement than with treatment planning system calculations in penumbral regions and was generally accurate to within 2% dose difference and 2 mm distance-to-agreement. In conclusion, these studies demonstrate excellent precision, accuracy, robustness, and reproducibility of the PRESAGE/optical-CT system for relative 3D dosimetry and support its potential integration with the RPC H&N credentialing phantom for IMRT verification.

Purpose: A 3D dosimetry system is described which consists of two parts: a radiochromic plastic dosimeter PRESAGE V R (which responds to absorbed dose with a linear change in optical-density) and the Duke large-field-of-view optical-CT scanner (DLOS). The DLOS/PRESAGE system has recently been commissioned and benchmarked for clinical use and, in particular, for verification and commissioning of complex radiation treatments. Methods: DLOS commissioning involved determining the dynamic range, spatial resolution, noise, temporal, and other characteristics of the light source and imaging components. Benchmarking tests were performed on the combined DLOS/PRESAGE system to establish baseline dosimetric performance. The tests consisted of delivering simple radiation treatments to PRESAGE dosimeters, and comparing the measured 3D relative dose distributions with the known gold standard. The gold standard distribution was obtained from machine beam-data or the treatment planning system (TPS). All studies used standardized procedures to ensure consistency. Results: For commissioning, isotropic spatial resolution was submillimeter (MTF > 0.5 for frequencies of 1.5 lp/mm) and the dynamic range was $60 dB. Flood field uniformity was within 10% and stable after 45 min of warm-up. Stray-light is small, due to telecentricity, but even the residual can be removed through deconvolution by a point-spread-function. For benchmarking, the mean 3D passing NDD (normalized dose distribution) rate (3%, 3mm, 5% dose threshold) over the benchmark data sets was 97.3% 6 0.6% (range 96%-98%), which is on par with other planar dosimeters used in external beam radiation therapy indicating excellent agreement. Noise was low at <2% of maximum dose (4-12 Gy) for 2 mm reconstructions. The telecentric design was critical to enabling fast imaging with minimal stray-light artifacts. Conclusions: This work presents the first comprehensive benchmarking of a 3D dosimetry system for clinical use. The DLOS/PRESAGE benchmark tests show consistently good agreement to simple known distributions. The system produces accurate isotropic 2 mm dose data over clinical volumes (e.g., 16 cm diameter phantoms, 12 cm height), in under 15 min. It represents a uniquely useful and versatile new tool for commissioning and verification of complex therapy treatments.

There is a pressing need for a practical three-dimensional (3D) dosimetry system, convenient for clinical use, and with the accuracy and resolution to enable comprehensive verification of the complex dose distributions typical of modern radiation therapy. Here we introduce a dosimetry system that can achieve this challenge, consisting of a radiochromic dosimeter (PRESAGE™) and a commercial optical computed tomography (CT) scanning system (OCTOPUS™). PRESAGE™ is a transparent material with compelling properties for dosimetry, including insensitivity of the dose response to atmospheric exposure, a solid texture negating the need for an external container (reducing edge effects), and amenability to accurate optical CT scanning due to radiochromic optical contrast as opposed to light-scattering contrast. An evaluation of the performance and viability of the PRESAGE™/OCTOPUS, combination for routine clinical 3D dosimetry is presented. The performance of the two components (scanner and dosimeter) was investigated separately prior to full system test. The optical CT scanner has a spatial resolution of ≤1 mm, geometric accuracy within 1 mm, and high reconstruction linearity (with a R 2 value of 0.9979 and a standard error of estimation of ~1%) relative to independent measurement. The overall performance of the PRESAGE™/ OCTOPUS system was evaluated with respect to a simple known 3D dose distribution, by comparison with GAFCHROMIC ® EBT film and the calculated dose from a commissioned planning system. The "measured" dose distribution in a cylindrical PRESAGE™ dosimeter (16 cm diameter and 11 cm height) was determined by optical-CT, using a filtered backprojection reconstruction algorithm. A three-way Gamma map comparison (4% dose difference and 4 mm distance to agreement), between the PRESAGE™, EBT and calculated dose distributions, showed full agreement in measurable region of PRESAGE™ dosimeter (~90% of radius). The EBT and PRESAGE™ distributions agreed more closely with each other than with the calculated plan, consistent with penumbral blurring in the planning data which was acquired with an ion chamber. In summary, our results support the conclusion that the PRESAGE™ optical-CT combination represents a significant step forward in 3D dosimetry, and provides a robust, clinically effective and viable high-resolution relative 3D dosimetry system for radiation therapy.