Background: Currently, radiotherapy represents the most widely employed therapeutic option in patients with uveal melanoma. Although the effects of proton beam radiotherapy on uveal melanoma end ocular tissues have been histologically documented, their appearance at MR imaging is still poorly understood. The purpose of our study was to elucidate the magnetic resonance (MR) semiotics of radiotherapy-induced changes to neoplastic tissues and ocular structures in patients with uveal melanoma undergoing secondary enucleation after proton beam radiotherapy. Methods: Nine patients with uveal melanoma who had undergone proton beam radiotherapy, MR imaging, and subsequent secondary enucleation were retrospectively selected. The histopathologic findings evaluated for irradiated tumors were necrosis, fibrosis, and viable tumor, while the histopathologic findings evaluated for extratumoral ocular/periocular tissues were radiation-related intraocular inflammation, vitreous hemorrhage, optic nerve degeneration, iris neovascularization, and periocular fibrotic adhesions. On MR images, the appearance of the abovementioned histologic features was assessed on conventional and diffusion-weighted sequences. Results: T2-weighted sequences performed better in detecting radiation-induced necrosis, fibrosis, optic nerve degeneration, and periocular fibrotic adhesions. T1-weighted sequences were preferable for identifying cataracts, vitreous hemorrhage, and inflammatory complications. Contrast-enhanced T1-weighted sequences were irreplaceable in assessing iris neovascularization, and in confirming inflammatory complications. Conclusions: In the light of their increasing role in the multidisciplinary management of patients with uveal melanoma, radiologists should be aware of the MR appearance of the effects of radiotherapy on neoplastic and ocular tissue, in order to improve the accuracy of follow-up MR examinations.

Necrosis in uveal melanomas can be spontaneous or induced by radiotherapy. The purpose of our study was to compare the histopathologic and MRI findings of radiation-induced necrosis of a group of proton beam-irradiated uveal melanomas with those of spontaneous necrosis of a control group of patients undergoing primary enucleation. 11 uveal melanomas who had undergone proton beam radiotherapy, MRI and secondary enucleation, and a control group of 15 untreated uveal melanomas who had undergone MRI and primary enucleation were retrospectively identified. Within the irradiated and nonirradiated group, 7 and 6 eyes with histological evidence of necrosis respectively, were furtherly selected for the final analysis; the appearance of necrosis was assessed at histopathologic examination and MRI. Irradiated melanomas showed a higher degree of necrosis as compared with nonirradiated tumors. Irradiated and nonirradiated lesions differed based on the appearance and distribution of necrosis. Irradiated tumors showed large necrotic foci, sharply demarcated from the viable neoplastic tissue; nonirradiated tumors demonstrated small, distinct foci of necrosis. Radiation-induced necrosis, more pigmented than surrounding viable tumor, displayed high signal intensity on T1-weighted and low signal intensity on T2-weighted images. The hemorrhagic/coagulative necrosis, more prevalent in nonirradiated tumors (4 out of 6 vs. 1 out of 7 cases), appeared hyperintense on T2-weighted and hypointense on T1-weighted images. Our study boosts the capability to recognize radiation-induced alterations in uveal melanomas at MRI and may improve the accuracy of radiologists in the evaluation of follow-up MR examination after radiotherapy.

Percentage depth–dose (PDD) distributions are fundamental to characterizing radiation beams in radiotherapy. This review provides an overview of both methods and sensor technologies for measuring PDD in photon, electron, proton, and carbon-ion beams. We summarize conventional dosimetry techniques, including water-phantom scanning with ionization chambers (cylindrical and parallel-plate) and radiochromic film, and discuss their strengths (established accuracy, calibration traceability) and limitations (volume averaging, delayed readout). We then examine emerging sensor technologies designed to improve spatial resolution, speed, and radiation hardness: multi-layer ionization chambers and Faraday cups for one-shot PDD acquisition; scintillator-based detectors (liquid, plastic, and fiber-optic) enabling real-time and high-resolution depth–dose measurements; advanced semiconductor detectors including silicon carbide diodes; as well as novel approaches such as ionoacoustic range sensing for proton beams. For each modality and detector type, we emphasize clinical relevance, measurement accuracy, spatial resolution, radiation durability, and suitability for high dose-per-pulse environments (e.g., FLASH radiotherapy). Current challenges, such as detector response in regions of steep dose gradient, saturation or recombination at ultra-high dose rates, and energy-dependent sensitivity in mixed radiation fields, are analyzed in detail. We also highlight the limitations of each technique and discuss ongoing improvements and prospects for clinical implementation. In summary, no single detector technology fully satisfies all requirements for fast, high-accuracy, high-resolution, radiation-hard PDD measurement, but the integration of emerging sensor innovations into clinical dosimetry promises to enhance the precision and efficiency of radiotherapy quality assurance.