In Vivo Absorbed Dose Measurements with Mini-TLDs Parameters affecting the reliability

Mini-TLDs have been proposed and widely used for in vivo measurements of absorbed doses in radionuclide therapies. The present investigation reports in detail on the signal dependence on different parameters and the accuracy of this method. Rodshaped Teflon-imbedded CaSO₄:Dy or LiF thermoluminescent dosimeters (TLDs) with dimensions 0.2 × 0.4 × 5 mm³ were prepared from TLD-discs. To remove paraffin mini-TLDs after cutting in a microtome the TLDs were Xylene-treated, which does not affect the sensitivity. Irradiated mini-TLDs are sensitive to illumination. Fading effects in darkness were examined after ⁶⁰Co-irradiation at temperatures 4, 22 and 37×C. For CaSO₄:Dy mini-TLDs fading in air is small. The observed signal loss after implanting CaSO₄:Dy mini-TLDs in gel and muscle tissue is the same at constant temperature and is increasing with the temperature. For LiF mini-TLDs the effect of signal loss in gel was smaller than for CaSO₄:Dy dosimeters. For ⁶⁰Co external irradiation supralinearity already starts between 0.5 and 1 Gy for both kinds of dosimeter material. There is a strong pH dependence of the signals mini-TLDs. For CaSO₄:Dy dosimeters the loss of sensitivity in gel is smaller at higher pHs. For LiF dosimeters the loss of sensitivity is smallest for neutral pH. We conclude that using mini-TLDs for in vivo dosimetry requires careful handling and proper calibration for accuracy in the measurements. Without such calibration errors exceeding 65% for CaSO₄:Dy and 40% for LiF may easily occur.     

Spatial resolution of a stacked radiochromic film dosimeter.

PURPOSE: The spatial resolution of stacked radiochromic film dosimeters, which have increased sensitivity from a single layer radiochromic film detector, has been studied. METHODS: A 5-layer film which can easily be constructed provided a 4.3-times increase in sensitivity over a single layer film at 670 nm readout wavelength which meant that doses as low as 0.6 Gy could be measured with an accuracy of +/-4% with the stacked dosimeter. The spatial resolution was tested by comparison of the 80%/20% penumbral widths of a 5 x 5 cm 6 MV X-ray field. RESULTS: The MD-55-2 film measured the penumbral width as 3.0 mm whereas the 5-layer stack dosimeter measured the same penumbra as 3.2 mm.Conclusion: The stack dosimeter can provide useful in vivo information such as the position of a diverging beam edge for treatments around critical structures such as eyes during the first fraction of treatment.     

An analysis of an implantable dosimeter system for external beam therapy

BACKGROUND AND PURPOSE: To review the data from an implantable radiation dosimetry system used in a clinical setting and to examine correlations between dosimeter readings and potential causative error sources. MATERIALS AND METHODS: MOSFET (metal oxide semiconductor field effect transistor) based encapsulated dosimeters were evaluated in a phantom (in vitro) and in a study with 18 patients. The dosimeters were placed in the gross tumor volume or in collateral normal tissue. Predicted dose values were established by imaging the dosimeters in the planning CTs. RESULTS: The in vitro study confirmed that bounding cumulative errors due to setup, planning, and machine output within a +/-5% level is achievable. In patients, it was found that deviations from the targeted dose often exceeded the 5% level. CONCLUSIONS: The use of an implantable dosimeter system could provide an effective empiric check on the dose delivered at depth. Such a tool may have value for institutional quality assurance, as well as for therapy delivered to individual patients.     

Evaluation of a commercial diode monitor for mailed quality control of therapy units

A commercial diode dosimeter was evaluated for use in a mailed radiotherapy quality control package. The quality control package contained the commercial diode dosimeter and four thermoluminescent dosimeters to measure the given dose, and it also contained a photographic film to measure the light/radiation field coincidence. The film also served as a backup dosimeter. Twenty small Midwestern hospitals participated in field measurements; approximately half of the hospitals had a consulting physicist and the others had one full-time physicist. Each hospital was asked to deliver 1.5 Gy (150 rads) to the device, which was returned to our laboratory for evaluation. Reliable results were obtained from three measurements at each hospital at about 3-month intervals. The diode dosimeter was more precise than thermoluminescent dosimeters or film.     

Technical evaluation of radiation dose delivered in prostate cancer patients as measured by an implantable MOSFET dosimeter

PURPOSE: To perform a comparison of the daily measured dose at depth in tissue with the predicted dose values from treatment plans for 29 prostate cancer patients involved in a clinical trial. METHODS AND MATERIALS: Patients from three clinical sites were implanted with one or two dosimeters in or near the prostatic capsule. The implantable device, known as the DVS, is based on a metal-oxide-semiconductor field effect transistor (MOSFET) detector. A portable telemetric readout system couples to the dosimeter antenna (visible on kilovoltage, computed tomography, and ultrasonography) for data transfer. The predicted dose values were determined by the location of the MOSFET on the treatment planning computed tomography scan. Serial computed tomography images were taken every 2 weeks to evaluate any migration of the device. The clinical protocol did not permit alteration of the treatment parameters using the dosimeter readings. For some patients, one of several image-guided radiotherapy (RT) modalities was used for target localization. RESULTS: The evaluation of dose discrepancy showed that in many patients the standard deviation exceeded the previous values obtained for the dosimeter in a phantom. In some patients, the cumulative dose disagreed with the planned dose by > or =5%. The data presented suggest that an implantable dosimeter can help identify dose discrepancies (random or systematic) for patients treated with external beam RT and could be used as a daily treatment verification tool for image-guided RT and adaptive RT. CONCLUSION: The results of our study have shown that knowledge of the dose delivered per fraction can potentially prevent over- or under-dosage to the treatment area and increase the accuracy of RT. The implantable dosimeter could also be used as a localizer for image-guided RT.     

Two-dimensional mapping of underdosed areas using radiochromic film for patients undergoing total skin electron beam radiotherapy

PURPOSE: To demonstrate the viability of radiochromic film as an in vivo, two-dimensional dosimeter for the measurement of underdosed areas in patients undergoing total skin electron beam (TSEB) radiotherapy. The results were compared with thermoluminescent dosimeter measurements. METHODS AND MATERIALS: Dosimetry results are reported for an inframammary fold of 2 patients treated using a modified version of the Stanford six-position (i.e., six-field and dual-beam) TSEB technique. The results are presented as contour plots of film optical density and percentage of dose. A linear dose profile measured from film was compared with the thermoluminescent dosimeter measurements. RESULTS: The results showed that the percentage doses as measured by film are in good agreement with those measured by the thermoluminescent dosimeters. The isodose contour plots provided by film can be used as a two-dimensional dose map for a patient when determining the size of the supplemental patch fields. CONCLUSION: Radiochromic film is a viable dosimetry tool that the radiation oncologist can use to understand the surface dose heterogeneity better across complex concave regions of skin to help establish more appropriate margins to patch underdosed areas. Film could be used for patients undergoing TSEB for disorders such as mycosis fungoides or undergoing TSEB or regional skin electron beam for widespread skin metastases from breast cancer and other malignancies.     

Miniature radiation dosimeter for in vivo radiation measurements

We have made initial characterization measurements on a miniature radiation dosimeter which can be used for in vivo radiation measurements. It consists of a radiation sensing field effect transistor (RADFET) mounted in a 0.8 mm OD plastic catheter. The RADFET acts as a dosimeter by storing trapped charge proportional to absorbed dose. The stored charge signal can be differentiated to give dose rate. We report on the techniques for mounting, a circuit for dose readout, drift of the readings, linearity of response, temperature and angular dependence, and unpowered operation of the device.     

Gel dosimetry for the dose verification of intensity modulated radiotherapy treatments

To meet the requirements for 3D dose verification of high-precision radiotherapy treatments (such as in intensity modulated radiotherapy; IMRT), two different kinds of gel dosimeters were developed. In the Fricke gel, an oxidation of ferrous-ions into ferric-ions occurs upon irradiation. As the ferrous and ferric ions possess different magnetic moments, the dose distribution can be read out by use of magnetic resonance imaging (MRI). However, this method is susceptible to spatial instabilities as the ions are able to diffuse through the gel matrix. Attempts have been made to reduce the diffusion by changing the gelling substance. In monomer/polymer gel dosimetry, the spin-spin relaxation rate, R2, is related to the radiation dose that was delivered to the phantom, as ionizing irradiation causes the formation of polymer aggregates. The intended target figure of accuracy in gel dosimetry for IMRT is approximately 3% to 5% of the maximum dose. However, in a conventional MR scanner several imaging artefacts may cause dose inaccuracies. Studies of these different artefacts have resulted in different compensation strategies, otherwise the dose maps will also contain stochastic noise. To minimize the stochastic noise in the images, the imaging sequence parameters should be optimized. Monomer/polymer gels are proven to be valuable dosimeters for IMRT applications. They are able to provide a three-dimensional dose distribution that is integrated over all beams delivered in the treatment. The gels can be molded in humanoid shapes. As a result, gel dosimeters are able to simulate the complete treatment. Gel dosimetry can therefore be regarded as a dosimetric tool to verify dose distributions calculated by the computer planning. Furthermore, gel dosimetry has also been very useful in quality control and investigation of extreme beam configurations possibly occurring in IMRT, in dose verification after implementation of additional devices, and in investigating dose disturbances by low-density structures. The search for new chemical compositions may result in dosimeter gels that are easier to fabricate and possess higher sensitivity. Besides MRI, other imaging techniques are investigated to read out the dosimeters.     

In vivo dosimetry of high-dose-rate interstitial brachytherapy in the pelvic region: use of a radiophotoluminescence glass dosimeter for measurement of 1004 points in 66 patients with pelvic malignancy

PURPOSE: To perform the largest in vivo dosimetry study for interstitial brachytherapy yet to be undertaken using a new radiophotoluminescence glass dosimeter (RPLGD) in patients with pelvic malignancy and to study the limits of contemporary planning software based on the results. PATIENTS AND METHODS: Sixty-six patients with pelvic malignancy were treated with high-dose-rate interstitial brachytherapy, including prostate (n = 26), gynecological (n = 35), and miscellaneous (n = 5). Doses for a total of 1004 points were measured by RPLGDs and calculated with planning software in the following locations: rectum (n = 549), urethra (n = 415), vagina (n = 25), and perineum (n = 15). Compatibility (measured dose/calculated dose) was analyzed according to dosimeter location. RESULTS: The compatibility for all dosimeters was 0.98 +/- 0.23, stratified by location: rectum, 0.99 +/- 0.20; urethra, 0.96 +/- 0.26; vagina, 0.91 +/- 0.08; and perineum, 1.25 +/- 0.32. CONCLUSIONS: Deviations between measured and calculated doses for the rectum and urethra were greater than 20%, which is attributable to the independent movements of these organs and the applicators. Missing corrections for inhomogeneity are responsible for the 9% negative shift near the vaginal cylinder (specific gravity = 1.24), whereas neglect of transit dose contributes to the 25% positive shift in the perineal dose. Dose deviation of >20% for nontarget organs should be taken into account in the planning process. Further development of planning software and a real-time dosimetry system are necessary to use the current findings and to achieve adaptive dose delivery.     

Quality control of the stereotactic radiosurgery procedure with the polymer-gel dosimetry.

PURPOSE: To assess the entire geometric and dosimetric (relative) uncertainties of the radiosurgery procedure with the Leksell gamma knife. MATERIALS AND METHODS: The entire Leksell gamma knife stereotactic radiosurgery treatment procedure was simulated with the use of a special water filled head phantom and polymer-gel dosimeter evaluated by nuclear magnetic resonance (NMR). A test vessel filled with the polymer-gel dosimeter was fixed in the head phantom. The phantom underwent stereotactic NMR imaging, treatment planning and then irradiation according to the treatment plan prepared exactly the same way as in the ordinary treatment procedure for a patient. The treatment plan was represented by one isocenter positioned approximately centrally in the head phantom. This procedure was subsequently repeated for all four collimators (4, 8, 14, 18mm) used on the Leksell gamma knife. Evaluation of dosimeters was performed on a Siemens EXPERT 1T NMR scanner. Dose profiles in X, Y and Z axes through the ellipsoidal shaped dose distribution were obtained to compare experimental results from the irradiated phantom with the treatment planning system calculations. RESULTS: Reasonable agreement was observed between the treatment planning system calculations of relative dose distribution and the measured data. The maximum observed deviation in the spatial position between the center of the measured and calculated dose profiles was 0.6mm. The maximum observed difference in full width of half maximum between calculated and measured profiles was 1.2mm. CONCLUSIONS: The use of polymer-gel dosimetry for a verification of stereotactic procedures has some unique advantages that can be summarized as follows: the dosimeter itself is tissue equivalent, three-dimensional dose distributions can be measured and the dosimeter allows simulation of the patient's procedures without any limitations.     

Dosimetry of Gold-198 Seed Implants

For single plane implants with gold seeds, assuming a matrix distribution for the seeds, the optimum separation of the matrix elements and the optimum ratio of the activity of the seeds in the area to that of those in the periphery, have been calculated, so that the uniformity of dose- distribution is within 10%. Area dosages have also been computed and are tabulated. The dose variations in double plane implants and volume implants also have been studied and the results are presented. Dosage graphs have been given for both cases. The theoretical dose distributions have been verified for a few implants experimentally using LiF thermoluminescence dosimeters.     

Suitability of superficial electron paramagnetic resonance dosimetry for in vivo measurement and verification of cumulative total doses during IMRT: A proof of principle

PurposeThe present study investigates superficial in vivo dosimetry (IVD) by means of a previously proposed electron paramagnetic resonance (EPR) dosimetry system aiming at measuring and verifying total doses delivered by complex radiotherapy treatments. In view of novel regulatory requirements in Germany, differences between measured and planned total doses to the EPR dosimeters are analyzed and compared to reporting thresholds for significant occurrences.MethodsEPR dosimeters, each consisting of one lithium formate monohydrate (LFM) and one polycrystalline l-alanine (ALA) pellet, were attached to the surface of an anthropomorphic head phantom. Three head and neck treatments with total target doses ranging from 30 to 64 Gy were fully delivered to the phantom by helical tomotherapy. During each treatment, eight EPR dosimeters were placed at distinct spots: (i) within or next to the planning target volume (PTV), (ii) near to organs at risk including the parotids and the lenses, (iii) at the thyroid lying out-of-field. EPR read out was always performed after all fractions were delivered. EPR results were compared to thermoluminescence dosimeter (TLD) measurements and to the planned total doses derived from the treatment planning system (TPS). Planned total doses to the EPR dosimeters ranged from about 2 to 64 Gy.ResultsBy taking uncertainties into account, the measured and planned doses were in good agreement. Exceptions occurred mainly at the thyroid (out-of-field) and lenses (extreme sparing). The maximum total dose difference between EPR results and corresponding planned doses was 1.3 Gy occurring at the lenses. Remarkably, each LFM and ALA pellet placed within or next to the PTV provided dose values that were within ±4% of the planned dose. Dose deviations from planned dose values were comparable for EPR and TLD measurements.ConclusionThe results of this proof of principle study suggests that superficial EPR-IVD is applicable in a wide dose range and in various irradiation conditions – being a valuable tool for monitoring cumulative total doses delivered by complex IMRT treatments. EPR-IVD in combination with helical tomotherapy is suitable to reliably detect local dose deviations at superficial dosimeter spots in the order of current national reporting thresholds for significant occurrences (i.e. 10%/4 Gy).     

Radiotherapy dose compensation for lung patients

The purpose of the present paper is to provide a more homogeneous dose distribution in the target volume from compensated anterior and posterior fields while the healthy lung is spared by de-weighting the lateral fields. A compensation computation which used linear iterations to compute the most homogeneous dose distribution across the target volume was applied to produce optimum compensator designs. The equivalent tissue–air ratio (E-TAR) inhomogeneity correction was applied for the computations using a GE target series II planning computer. The compensators designed were tested for accuracy in a modified water/lung phantom using a scanning diode and an anthropomorphic phantom using thermoluminescent dosimeters. A comparison has been made between the compensated and uncompensated plans for the first nine patients who we have treated with this technique. The dose profiles produced by the computation agreed with the prediction of the computed isodose plans to within ± 2% at the target depth. The thermoluminescent dosimeter (TLD)-measured results in the anthropomorphic phantom agreed with the planning computer within ± 3%. A comparison of nine compensated plans of radiotherapy patients for large-volume targets in the lung region showed a maximum variation in the target to be 19% uncompensated versus 10% compensated. By providing compensated treatment fields from anterior and posterior treatment portals, a homogeneous dose that conforms well to the target volume is provided. As an added bonus, this enables the lateral lung fields to be significantly de-weighted and the healthy lung is spared considerable dose.     

Quality audit of radiotherapy with EORTC mailed in water TL-dosimetry.

A mailable TL-dosimetry (LiF) system has been designed and tested for the EORTC Radiotherapy Group for periodic monitoring of radiation therapy machines between and prior to on-site visits. Three TL-dosimeters were enclosed in a capsule which was placed in a holder and irradiated in photon beams in a water phantom. The institutes were instructed to irradiate the capsule to an absorbed dose of 2 Gy. After the irradiation, all capsules with dosimeter, the holder and completed data sheets were returned to Gothenburg for evaluation. The heating procedure used for reading the dosimeters was optimised regarding fading and reproducibility (less than 0.5%, 1. S.D.). The fading of the TL-signal was eliminated by adding an external annealing to the heating procedure. Both supralinearity and energy dependence were tested and routinely corrected for. The dosimeters were individually calibrated. During 1987, 1988 and the first part of 1989, dosimeters were mailed to 22 institutes, participating in clinical trials organised by the Radiotherapy Group. Of the 178 beams measured, 89% were within acceptable levels of variation for the absorbed dose states (less than or equal to 4%). The photon results gave a mean of 1.012 and a standard deviation of 0.025.     

Développement d’une procédure de contrôle de qualité externe des faisceaux du CyberKnife : étude préliminaire multicentrique

PurposeTo develop an external quality control procedure for CyberKnife^® beams. This work conducted in Nancy, has included a test protocol initially drawn by the medical physicist of Nancy and Lille in collaboration with Equal-Estro Laboratory.Materials and methodsA head and neck anthropomorphic phantom and a water-equivalent homogeneous cubic plastic test-object, so-called “MiniCube”, have been used. Powder and solid thermoluminescent dosimeters as well as radiochromic films have been used to perform absolute and relative dose studies, respectively. The comparison between doses calculated by Multiplan treatment planning system and measured doses have been studied in absolute dose. The dose distributions measured with films and treatment planning system calculations have been compared via the gamma function, configured with different tolerance criteria.ResultsThis work allowed, via solid thermoluminescent dosimeter measurements, verifying the beam reliability with a reproducibility of 1.7 %. The absolute dose measured in the phantom irradiated by the seven participating centres has shown an error inferior to the standard tolerance limits (±5 %), for most of participating centres. The relative dose measurements performed at Nancy and by the Equal-Estro laboratory allowed defining the most adequate parameters for gamma index (5 %/2 mm – with at least 95 % of pixels satisfying acceptability criteria: γ < 1). These parameters should be independent of the film analysis software.ConclusionThis work allowed defining a dosimetric external quality control for CyberKnife^® systems, based on a reproducible irradiation plan through measurements performed with thermoluminescent dosimeters and radiochromic films. This protocol should be validated by a new series of measurement and taking into account the lessons of this work.     

Computed tomography for radiotherapy planning

Images obtained by X-ray transmission computed tomography (CT) assist in planning external beam radiation therapy. Quantitatively, contiguous transverse tomograms may be used to compute radiation dose distributions, based on patient-specific geometry and density of the tissues irradiated. We present here our clinical experience with a computerized treatment planning system modified for this purpose. The importance of performing a CT examination under conditions which simulate treatment is emphasized, particularly for radiotherapy in the thorax. An approximate method for determining tissue electron densities from CT data of a single scan has been verified for tissues in vivo. These tissue densities are used to compute dose distributions for Cobalt-60 and 25 MV X-ray beams, using the equivalent tissue-air ratio method. Predicted doses have been verified to an accuracy of 2%, using intra-rectal thermoluminescent dosimeters. Three clinical examples, dealing with radiotherapy of the esophagus, the rectum, and the upper half body are discussed. Comparison of dose distributions, corrected for tissue inhomogeneities, to those based on a water-like patient indicate differences in the dose to tumor or to surrounding healthy tissue, which are considered clinically significant.     

Development of an 241Am applicator for continuous low-dose-rate irradiation of the rat sarcoma BA1112

An 241Am applicator for continuous low-dose-rate irradiation of the rat sarcoma BA1112 has been developed. The irradiator consists of two disc sources, each containing 800 mCi of 241Am, an isotope which emits primarily 60 keV photons. The disc sources are held in a specially-designed light-weight helmet which surrounds the tumor on the head of the rat. Dose distributions produced by these sources have been measured using an ionization chamber, thermoluminescent dosimeters and Fricke dosimeter. A computerized treatment planning system has been modified to compute dose distributions from 241Am sources, to optimize the design of this applicator. Computed and measured dose distributions for several values of separation between the 241Am discs are presented. A survival curve for cells from tumors irradiated in vivo with this applicator has been determined by an in vitro colony formation technique. The mean lethal dose DO was found to be 720 cGy for an average tumor dose rate of 95 +/- 7 cGy/hr. The major advantages of the 241Am applicator in comparison with the 192Ir applicator used previously for continuous low-dose-rate studies are: a considerably smaller half value layer thickness and the longer half life of the radionuclide. These features make it more suitable for long-term tumor cure studies because of the lower whole body dose to the animal, the availability of relatively constant dose-rate irradiators for many years, the decreased shielding requirements for the animal care facility and the diminished exposure to laboratory personnel involved with the implants on the animals.     

The Study of Dose Distribution in Radiotherapy using Three Types of Thermoluminescent Dosimeters*

Three types of commercially available thermoluminescent dosimeters have been used to study the dose distribution in a commonly employed treatment technique for the head and neck region using wedge filters. The dose distributions measured in an Alderson Rando phantom have been compared with the computed dose distributions obtained using an IBM 360 computer. Some characteristics of the phosphors have also been compared.     

Three-dimensional visualization and measurement of conformal dose distributions using magnetic resonance imaging of bang polymer gel dosimeters

: The measurement of complex dose distributions (those created by irradiation through multiple beams, multiple sources, or multiple source dwell positions) requires a dosimeter that can integrate the dose during a complete treatment. Integrating dosimeter devices generally are capable of measuring only dose at a point (ion chamber, diode, TLD) or in a plane (film). With increasing use of conformal dose distributions requiring shaped, noncoplanar beams, there will be an increased requirement for a dosimeter that can record and display a 3D dose distribution. The use of a 3D dosimeter will be required to confirm the accuracy of treatment plans produced by the current generation of 3D treatment-planning computers.

: The use of a Fricke-infused gel and magnetic resonance imaging (MRI) to demonstrate the localization of stereotactic beams has been demonstrated (11). The recently developed BANG polymer gel dosimetry system (MGS Research, Inc., Guilford, CT), based on radiation-induced chain polymerization of acrylic monomers dispersed in a tissue-equivalent gel, surpasses ther Fricke-gel method by providing accurate, quantitative dose distribution data that do not deteriorate with time (6, 9). The improved BANG2 formulation contains 3% N,N′-methylene-bisacrylamide, 3% acrylic acid, 1% sodium hydroxide, 5% gelatin, and 88% water, where all percentage are by weight. The gel was poured into volumetric flasks, of dimensions comparable to a human head. The gels were irradiated with complex beam arrangements, similar to those used for conformal radiation therapy. Images of the gels were acquired using a Siemens 1.5T imager and a Hahn spin-echo pulse sequence (90°-τ-180°-τ-acquire, for different values of τ). The images were transferred via network to a Macintosh computer for which a data analysis and display program was written. The program calculates R2 maps on the basis of multiple TE images, using a monoexponential nonlinear least-squares fit based on the Levenberg-Marquardt algorithm. The program also creates a dose-to-R2 calibration function by fitting a polynomial to a set of dose and R2 data points, obtained from gels irradiated in test tubes to known doses. This function can then be applied to any other R2 map, so that a dose map can be computed and displayed.

: Through exposure to known doses of radiation, the gel has been shown to respond linearly with dose in the range of 0 to 10 Gy, and its response is independent of the beam energy or modality. Dose distributions have been imaged in orthogonal planes, and can be displayed in a convenient form for comparison with isodose plans. The response of the gel is stable; the gel can be irradiated at any time after its manufacture, and imaging can be conducted any time following a brief interval after irradiation.

: The polymer gel dosimeter has been shown to be a valuable device for displaying three-dimensional dose distributions. The imaged dose distribution can be compared easily with calculated dose distributions, to validate a treatment planning system. In the future, gels may be prepared in anthropomorphic phantoms, to confirm unique patient dose distributions.     

Focal Cholesterol Granuloma in the Anterior Mediastinum: [18F]-Fluoro-2-Deoxy-D-Glucose-Positron Emission Tomography and Magnetic Resonance Imaging Findings

Cholesterol granuloma is a foreign-body type granuloma that forms in reaction to cholesterol crystals. We report a rare case of focal cholesterol granuloma in the anterior mediastinum of a 62-year-old asymptomatic man that presented as an indeterminate anterior mediastinal nodule on [18F]-fluoro-2-deoxy-D-glucose-positron emission tomography and computed tomography scans. T1- and T2-weighted magnetic resonance images revealed markedly hypo-intense signals reflecting pathologic hyalinized collagen fibers. Magnetic resonance signal characteristics might be helpful for distinguishing benign cholesterol granulomas from malignant neoplasms.