Much of the complex medical physics work requires radiation dose delivery, which requires dosimeters to accurately measure complex three-dimensional dose distribution with good spatial resolution. MAGIC-f polymer gel is one of the emerging new dosimeters widely used in medical physics research. The purpose of this study was to present an overview of polymer gel dosimetry, using MAGIC-f gel, including its composition, manufacture, imaging, calibration, and application to medical physics research. In this review, the history of polymer gel development is presented, along with the applications so far. Moreover, the most important experiments/applications of MAGIC-f polymer gel are discussed to illustrate the behavior of gel on different conditions of irradiation, imaging, and manufacturing techniques. Finally, various future works are suggested based on the past and present works on MAGIC-f gel and polymer gel in general, with the hope that these bits of knowledge can provide important clues for future research on MAGIC-f gel as a dosimeter.

Development and Application of MAGIC-f Gel in Cancer Research and Medical Imaging

ASTRO’s Advances in Radiation Oncology’s Top Downloaded Articles of 2023

The goal of the study was to assess the impact of deep inspiration breath hold technique (DIBH), surface-guided radiotherapy (SGRT), and daily kilovoltage cone-beam computed tomography (kV-CBCT) on the dose to organs at risk (OAR) in left-sided breast cancer radiotherapy. Twenty-six consecutive left-sided breast cancer patients treated using Volumetric Intensity Modulated Arc Therapy (VMAT), DIBH, SGRT, and a hypofractionated regimen were retrospectively evaluated in this study. Dose parameters were extracted from dose-volume histograms (DVH). The Wilcoxon Matched Pairs test was used to test dose parameters obtained in free breathing (FB) and DIBH for statistical significance. Multivariable analysis of variance (ANOVA) and receiver operating characteristics (ROC) analysis were used to identify parameters and cut-off points associated with the reduction of the mean heart dose (MHD) by DIBH. Based on published models, the risk of cardiac and lung toxicity (pneumonitis) using SGRT or daily kV-CBCT was estimated and compared. DIBH substantially reduced the MHD (median, 43.6%; range, 4.2% to 75.1%; P < 0.00001). The risk of cardiac toxicity using SGRT increased by 1%, compared to 3.6% to 20.5% using daily kV-CBCT. No significant difference in the risk of radiation-induced pneumonitis using SGRT versus daily kV-CBCT was detected. The ANOVA revealed the relative increase of the left lung volume by DIBH as the only significant impact factor for the MHD. The ROC analysis of this parameter showed an area under the curve (AUC) of 0.89 (95%CI, 0.71 to 0.98; P < 0.0001). DIBH can substantially reduce the MHD in left-sided breast cancer patients treated with modern radiotherapy techniques and hypofractionation. Patient setup using SGRT compared to daily kV-CBCT may be the preferred option for many patients. In our patient cohort, the relative reduction of the left lung volume by DIBH can be used as a predictor to select patients who benefit from DIBH. 

Impact of deep inspiration breath hold, surface-guided radiotherapy, and daily CBCT on the organs at risk in breast cancer radiotherapy

Abstract Background The applicability of ultra-hypofractionated (ultra-HF) whole-breast irradiation (WBI) remains unknown in Japanese women. This study aimed to evaluate the safety and efficacy of this approach among Japanese women and report the results of an interim analysis performed to assess acute adverse events (AEs) and determine whether it was safe to continue this study. Methods We enrolled Japanese women with invasive breast cancer or ductal carcinoma in situ who had undergone breast-conserving surgery, were aged ≥ 40 years, had pathological stages of Tis–T3 N0–N1, and had negative surgical margins. Ultra-HF-WBI was delivered at 26 Gy in five fractions over one week. When the number of enrolled patients reached 28, patient registration was paused for three months. The endpoint of the interim analysis was the proportion of acute AEs of grade ≥ 2 (Common Terminology Criteria for Adverse Events v5.0) within three months. Results Of the 28 patients enrolled from seven institutes, 26 received ultra-HF-WBI, and 2 were excluded due to postoperative infections. No AEs of grade ≥ 3 occurred. One patient (4%) experienced grade 2 radiation dermatitis, and 18 (69%) had grade 1 radiation dermatitis. The other acute grade 1 AEs experienced were skin hyperpigmentation (n = 10, 38%); breast pain (n = 4, 15%); superficial soft tissue fibrosis (n = 3, 12%); and fatigue (n = 1, 4%). No other acute AEs of grade ≥ 2 were detected. Conclusions Acute AEs following ultra-HF-WBI were within acceptable limits among Japanese women, indicating that the continuation of the study was appropriate. 

Acute adverse events of ultra-hypofractionated whole-breast irradiation after breast-conserving surgery for early breast cancer in Japan: an interim analysis of the multi-institutional phase II UPBEAT study.

https://journals.viamedica.pl/rpor/article/download/RPOR.a2023.0027/72108

Deep inspiration breath hold: dosimetric benefits to decrease cardiac dose during postoperative radiation therapy for breast cancer patients

Purpose: Evaluate the response of MAGIC‐f gel dosimeter after submitted to a conformai irradiation technique using small fields and to compare the results to Monte Carlo simulation with PENELOPE. Method and Materials: The gel was poured in a cylindrical phantom of 12 cm diameter and 18 cm height. The phantom containing the gel was irradiated with 9 fields of 6 MV photon beam, each one of 1 × 1 cm2, totalizing a prescribed dose of 16 Gy. The gel reading was performed through MRI using a 3 T scanner and head coil. Relaxometry images were obtained using a multi spin echo sequence with 16 echos times multiples of 22.5 ms, a repetition time of 3000 ms and a matrix size of 256 × 256 pixels. The slice thickness was 2mm and a FOV of 150 mm was used. The transverse relaxation rate R2 was calculated by fitting the signal intensities versus the echo time pixel by pixel. The R2 maps were related to absorbed dose using a specially designed software, which provides the dose distributions. PENELOPE simulations were used to mach faithfully the irradiation and geometry conditions as the experimental irradiation. The spatial resolution for the simulations was 0.5 mm. The two dose distributions were compared through beam profiles for each irradiated field. Both distributions were compared with the treatment planning system (TPS). Results: The comparisons between gel and PENELOPE and gel and the TPS showed maximum differences of 0.51% and 4.18%, respectively, both comparisons performed inside the volume of the 50% of isodose. Conclusions: From the results obtained it can be preliminary inferred that the response of the MAGIC‐f polymeric gel could be suitable and used as a dosimeter in clinical procedures using small fields, especially in radiosurgery. Besides of the concordance found, more measurements will be done.

SU-GG-I-90: Dose Distribution of Small Fields through MAGIC-F Gel Dosimetry and PENELOPE-Monte Carlo Simulation

To develop a specialist-based consensus of cochlear contouring to be used in patients undergoing stereotactic radiosurgery (SRS) treatment for vestibular schwannoma.Representative computed tomography (CT) and magnetic resonance imaging (MRI) were used for cochlear contouring. The semicircles, cochlea, vestibule, and internal acoustic meatus were delineated by 7 radiation oncology department physicians and reviewed by neuroradiologists. A total of 12 cases accrued from a single academic institution were studied for a similarity analysis by the Dice coefficient.The suggested guideline is an easily reproductive tool that allows radiation oncologists to accurately contour the vestibulocochlear system to avoid toxicity due to inadequate dosimetry of organs at risk. This could be a useful tool even for non-vestibular schwannoma radiation therapy. The Dice coefficient suggests reproducible results as long as the following contouring recommendations are observed.The template for vestibulocochlear delineation may be useful for an adequate organs at risk definition. Future studies are required to find specific constraints for each segment of the vestibulocochlear system, and to mitigate interobserver variations. 

Vestibulocochlear Delineation for Vestibular Schwannoma Treated With Radiation Therapy

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Deep inspiration breath hold: dosimetric benefits to decrease cardiac dose during postoperative radiation therapy for breast cancer patients

SU-GG-I-90: Dose Distribution of Small Fields through MAGIC-F Gel Dosimetry and PENELOPE-Monte Carlo Simulation

Vestibulocochlear Delineation for Vestibular Schwannoma Treated With Radiation Therapy