TOPAS Simulation of the Mevion S250 compact proton therapy unit

A Python package for fast GPU-based proton pencil beam dose calculation

PURPOSE

Open-source GPU-based Monte Carlo (MC) proton dose calculation algorithms provide high speed and unparalleled accuracy but can be complex to integrate with new applications and remain slower than GPU-based pencil beam (PB) methods, which sacrifice some physical accuracy for sub-second plan calculation. We developed and validated a Python package implementing a GPU-based double Gaussian PB algorithm for intensity-modulated proton therapy (IMPT) planning research applications requiring a simple, widely compatible, and ultra-fast proton dose calculation solution.

METHODS

Beam parameters were derived from pristine Bragg peaks generated with MC for 98 energies in our clinical treatment planning system (TPS). We validated the PB approach against measurements by comparing lateral spot profiles (using single-Gaussian sigma) and proton ranges (using R80) for pristine Bragg peaks, as well as spread-out Bragg peaks (SOBPs) in water. Further comparisons of PB and MC from the TPS were performed in a heterogeneous digital phantom and patient plans for four cancer sites using 3D gamma passing rates and dose metrics.

RESULTS

The PB algorithm enabled dose calculation following a single Python import statement. Mean ± standard deviation (SD) errors in sigma, R80, and SOBP dose were 0.05 ± 0.01, 0.0 ± 0.1 mm, and 0.4 ± 1.1%, respectively. Mean ± SD patient plan computation time was 0.28 ± 0.07 s for PB versus 4.68 ± 2.68 s for MC. Mean ± SD gamma passing rate at 2%/2 mm criteria was 96.0 ± 5.1%, and the mean ± SD percent difference in dose metrics was 0.5 ± 3.6%. PB accuracy degraded beyond bone and lung boundaries, characterized by inaccuracies in lateral proton scatter.

CONCLUSION

We developed a GPU-based proton PB algorithm compiled as a Python package, providing simple beam modeling, interface, and fast dose calculation for IMPT plan optimization research and development. Like other PB algorithms, accuracy is limited in highly heterogeneous regions such as the thorax.

4Din vivodosimetry for a FLASH electron beam using radiation-induced acoustic imaging

Objective. The primary goal of this research is to demonstrate the feasibility of radiation-induced acoustic imaging (RAI) as a volumetric dosimetry tool for ultra-high dose rate FLASH electron radiotherapy (FLASH-RT) in real time. This technology aims to improve patient outcomes by accurate measurements ofin vivodose delivery to target tumor volumes.Approach. The study utilized the FLASH-capable eRT6 LINAC to deliver electron beams under various doses (1.2 Gy pulse-1to 4.95 Gy pulse-1) and instantaneous dose rates (1.55 × 105Gy s-1to 2.75 × 106Gy s-1), for imaging the beam in water and in a rabbit cadaver with RAI. A custom 256-element matrix ultrasound array was employed for real-time, volumetric (4D) imaging of individual pulses. This allowed for the exploration of dose linearity by varying the dose per pulse and analyzing the results through signal processing and image reconstruction in RAI.Main Results. By varying the dose per pulse through changes in source-to-surface distance, a direct correlation was established between the peak-to-peak amplitudes of pressure waves captured by the RAI system and the radiochromic film dose measurements. This correlation demonstrated dose rate linearity, including in the FLASH regime, without any saturation even at an instantaneous dose rate up to 2.75 × 106Gy s-1. Further, the use of the 2D matrix array enabled 4D tracking of FLASH electron beam dose distributions on animal tissue for the first time.Significance. This research successfully shows that 4Din vivodosimetry is feasible during FLASH-RT using a RAI system. It allows for precise spatial (∼mm) and temporal (25 frames s-1) monitoring of individual FLASH beamlets during delivery. This advancement is crucial for the clinical translation of FLASH-RT as enhancing the accuracy of dose delivery to the target volume the safety and efficacy of radiotherapeutic procedures will be improved.

Development and validation of an optimal GATE model for proton pencil-beam scanning delivery

OBJECTIVE

To develop and validate a versatile Monte Carlo (MC)-based dose calculation engine to support MC-based dose verification of treatment planning systems (TPSs) and quality assurance (QA) workflows in proton therapy.

METHODS

The GATE MC toolkit was used to simulate a fixed horizontal active scan-based proton beam delivery (SIEMENS IONTRIS). Within the nozzle, two primary and secondary dose monitors have been designed to enable the comparison of the accuracy of dose estimation from MC simulations with respect to physical QA measurements. The developed beam model was validated against a series of commissioning measurements using pinpoint chambers and 2D array ionization chambers (IC) in terms of lateral profiles and depth dose distributions. Furthermore, beam delivery module and treatment planning has been validated against the literature deploying various clinical test cases of the AAPM TG-119 (c-shape phantom) and a prostate patient.

RESULTS

MC simulations showed excellent agreement with measurements in the lateral depth-dose parameters and spread-out Bragg peak (SOBP) characteristics within a maximum relative error of 0.95 mm in range, 1.83% in entrance to peak ratio, 0.27% in mean point-to-point dose difference, and 0.32% in peak location. The mean relative absolute difference between MC simulations and measurements in terms of absorbed dose in the SOBP region was 0.93% ± 0.88%. Clinical phantom studies showed a good agreement compared to research TPS (relative error for TG-119 planning target volume PTV-D95 ∼ 1.8%; and for prostate PTV-D95 ∼ -0.6%).

CONCLUSION

We successfully developed a MC model for the pencil beam scanning system, which appears reliable for dose verification of the TPS in combination with QA information, prior to patient treatment.

Neutron dosimetry and shielding verification in commissioning of Compact Proton Therapy Centers (CPTC) using MCNP6.2 Monte Carlo code

Proton therapy (PT) is an external radiotherapy using proton beams with energies between 70 and 230 MeV to treat some type of tumours with outstanding benefits, due to its energy transfer plot. There is a growing demand of facilities taking up small spaces and Compact Proton Therapy Centers (CPTC), with one or two treatment rooms, supposing the technical response of manufacturers to this request. A large amount of stray radiation is produced in the interaction of protons used in therapy, neutrons mainly, hence, optimal design of shielding and verifications must be carried out in commissioning stages. Currently, almost 50 CPTC are under construction and start up in many countries, including several in Spain. In the present work, the effectiveness of shielding in a CPTC was verified with the Monte Carlo code MCNP6 by calculating the ambient dose equivalent, H*(10) due to secondary neutrons, outside the enclosures and walls of the center. The facility modelled was similar to one planned to start operating in 2019 in Spain, a CPTC, made up of a superconducting synchrocyclotron and one treatment room, with a configuration standard, shielding and width of barriers based on dimensions proposed a priori by the vendor. Therefore, the paper is focused in check the suitability of the materials and thickness of the walls of the center and develop the assessment of enclosures. Several models of the radiation sources and type of concrete in walls were simulated, starting from a conservative assumptions, followed by more realistic models. In all cases, the results were below 1 mSv/year, which is the international legal limit considered for the general public. This work is part of the project Contributions to Shielding and Dosimetry of Neutrons in Compact Proton Therapy Centers (CPTC).

Simulation study of proton arc therapy with the compact single-room MEVION-S250 proton therapy system

Aim:

The purpose of this study is to investigate the feasibility of proton arc therapy (PAT) using the double-scattering MEVION-S250 proton system. The treatment planning and dose delivery parameters from PAT were compared with conventional treatment planning techniques.

Materials and methods:

PAT was simulated with multiple conformal and fixed-aperture beams (5–15) using the MEVION-S250-double-scattering proton system. Conformal apertures were simulated with the Eclipse-treatment-planning system: (a) using a static single aperture that provides the best average conformal circular or rectangular apertures to cover the tumour from different angular views (SPAT), and (b) dynamic conformal apertures of the tumour shape at each irradiation angle that can be obtained from a multi-leaf-collimator system (DPAT).

Results:

The DPAT and SPAT plans provided superior dose coverage and sparing of normal tissues in comparison with conventional plans (CPT). The entrance normal tissue and skin doses (<40%) were lowered significantly by delivering dose from different directions over a wider angular view compared to conventional plans that have large entrance dose from only two fields. While the mean and minimum doses from PAT and CPT were comparable, the maximum doses from arc plans were lower than the maximum doses in conventional plans. The SPAT and DPAT plans had comparable dose parameters for regularly shaped targets. The heterogeneity index (HI) was superior in PAT plans which improved with increasing number of beams in arc plans for the different treatment sites. The conformality index (CI) depends on the treatment site and complexity of the shape of the planning target volume where for brain, pancreatic and lung tumours, PAT plans conformality was comparable and sometimes superior to CPT; and HI and CI were generally better in DPAT compared to SPAT.

Conclusions:

PAT plans have superior dose coverage and sparing of normal tissues compared to CPT plans using the MEVION double-scattering system as shown in this simulation study. Ideally, conformal proton arcs require beam shaping and dose delivery with the gantry moving; however, the MEVION double-scattering system lacks a multi-leaf collimator system and cannot deliver dose during gantry rotation. The single aperture conformal proton therapy technique is more time and cost effective compared with conventional techniques that are used currently with the MEVION proton therapy system because of the elimination of the need for patient-specific compensators. In present study, PAT was simulated with the MEVION double-scattering proton therapy system; however, it can be performed also with other proton therapy systems.

A Monte Carlo based analytic model of the in-room neutron ambient dose equivalent for a Mevion gantry-mounted passively scattered proton system

The goal of this study was to develop a Monte Carlo (MC)-based analytical model that can predict the in-room ambient dose equivalent from a Mevion gantry-mounted passively scattered proton system. The Mevion S250 and treatment vault were simulated using the MCNPX MC code. The results of the in-room neutron dose measurements, using an FHT 762 WENDI-II detector, were employed to benchmark the MC-derived values. After tuning the MCNPX MC code, for the same beam delivery parameters, the code was used to calculate the neutron spectra and ambient dose equivalent in the vault and at varying angles from the isocenter. Then, based on the calculations, an analytical model was reconstructed and data were fitted to derive the model parameters at 95% confidence intervals (CI). The MCNPX codes were tuned to within about 19% of the measured values for most of the measurements in the vault. For the maze, up to 0.08 mSv Gy-1 discrepancies were found between the experimental measurements and MCNPX calculated results. The analytical model showed up to 18% discrepancy for distances between 100 and 600 cm from the isocenter compared to the MC calculations. The model may underestimate the neutron ambient dose equivalent up to 21% for distances less than 100 cm from the isocenter. The proposed analytical model can be used to estimate the contribution of the secondary neutron dose from the Mevion S250 for the design of local shielding inside the proton therapy treatment vault.

Neutron radiation effects on microcomputers in radiation therapy environments

Aim:

Microcomputers play an increasingly important role in the delivery of radiation therapy. Exposure to neutron irradiation can produce undesirable effects in modern microcomputers. The objective of this study is to measure acute and cumulative effects of neutron exposure of Intel-based microcomputers in photon and proton therapy treatment environments.

Materials and methods:

Multiple computers were irradiated with neutrons produced from MEVION S250 passive scattering proton therapy and from Varian 21EX Linear Accelerator photon therapy systems. The energy of the proton beam was 232 MeV and the photon beam energies were 6 and 18 MV. Rates of fatal errors in computer processing unit (CPU) cores were measured.

Results:

Varying rates of fatal system errors due to upsets in the CPU cores were observed. Post-exposure routine stress testing revealed no permanent hardware defects in the random access memory (RAM) or hard disk drive (HDD) of any tested systems. Microchip manufacturers fit increasingly high numbers of transistors in the same volume and the susceptibility to radiation thus increases.

Conclusions:

This work explores if the process size of a microchip is the dominant factor and also looked at the short- and long-term effects of neutron irradiation on modern microprocessors in a clinical environment. Additionally, methods of effective shielding are proposed.

A Monte Carlo-based analytic model of neutron dose equivalent for a mevion gantry-mounted passively scattered proton system for craniospinal irradiation

PURPOSE

To calculate in- and out-of-field neutron spectra and dose equivalent, using Monte Carlo (MC) simulation, for a Mevion gantry-mounted passively scattered proton system in craniospinal irradiation. An analytical model based on the MC calculations that estimates in- and out-of-field neutron dose equivalent from proton Craniospinal irradiation (CSI) was also developed.

METHODS

The MCNPX MC code was used to simulate a Mevion S250 proton therapy system. The simulated proton depth doses and profiles for pristine and spread-out Bragg peaks were benchmarked against the measured data. Previous measurements using extended-range Bonner spheres were used to verify the calculated neutron spectra and dose equivalent. Using the benchmarked results as a reference condition, a correction-based analytical model was reconstructed by fitting the data to derive model parameters at 95% confidence interval. Sensitivity analysis of brass aperture opening, thickness of the Lucite (PMMA) range compensator, and modulation width was performed to obtain correction parameters for nonreference conditions.

RESULTS

For the neutron dose equivalent per therapeutic proton dose, the MCNPX calculated dose equivalent matched the measured values to within 8%. The benchmarked neutron dose equivalent at the isocenter was 41.2 and 20.8 mSv/Gy, for cranial and spinal fields, respectively. For in- and out-of-field neutron dose calculations, the correction-based analytical model showed up to 17% discrepancy compared to the MC calculations. The correction factors may provide a conservative estimation of neutron dose, especially for depth ≤ 5 cm and regions underneath the brass aperture.

CONCLUSION

The proposed analytical model can be used to estimate the contribution of the neutron dose to the overall CSI treatment dose. Moreover, the model can be employed to estimate the neutron dose to the implantable cardiac electronic devices.

Developing a Monte Carlo model for MEVION S250i with HYPERSCAN and Adaptive Aperture™ pencil beam scanning proton therapy system

Aim:

As the number of proton therapy facilities has steadily increased, the need for the tool to provide precise dose simulation for complicated clinical and research scenarios also increase. In this study, the treatment head of Mevion HYPERSCAN pencil beam scanning (PBS) proton therapy system including energy modulation system (EMS) and Adaptive Aperture™ (AA) was modelled using TOPAS (TOolkit for PArticle Simulation) Monte Carlo (MC) code and was validated during commissioning process.

Materials and methods:

The proton beam characteristics including integral depth doses (IDDs) of pristine Bragg peak and in-air beam spot sizes were simulated and compared with measured beam data. The lateral profiles, with and without AA, were also verified against calculation from treatment planning system (TPS).

Results:

All beam characteristics for IDDs and in-air spot size agreed well within 1 mm and 10% separately. The full width at half maximum and penumbra of lateral dose profile also agree well within 2 mm.

Finding:

The TOPAS MC simulation of the MEVION HYPERSCAN PBS proton therapy system has been modelled and validated; it could be a viable tool for research and verification of the proton treatment in the future.

An Integrated Framework Based on Full Monte Carlo Simulations for Double-Scattering Proton Therapy

PURPOSE

We developed an integrated framework that employs a full Monte Carlo (MC) model for treatment-plan simulations of a passive double-scattering proton system.

MATERIALS AND METHODS

We have previously validated a virtual machine source model for full MC proton-dose calculations by comparing the percentage of depth-dose curves, spread-out Bragg peaks, and lateral profiles against measured commissioning data. This study further expanded our previous work by developing an integrate framework that facilitates its clinical use. Specifically, we have (1) constructed patient-specific applicator and compensator numerically from the plan data and incorporated them into the beamline, (2) created the patient anatomy from the computed tomography image and established the transformation between patient and machine coordinate systems, and (3) developed a graphical user interface to ease the whole process from importing the treatment plan in the Digital Imaging and Communications in Medicine format to parallelization of the MC calculations. End-to-end tests were performed to validate the functionality, and 3 clinical cases were used to demonstrate clinical utility of the framework.

RESULTS

The end-to-end tests demonstrated that the framework functioned correctly for all tested functionality. Comparisons between the treatment planning system calculations and MC results in 3 clinical cases revealed large dose difference up to 17%, especially in the beam penumbra and near the end of beam range. The discrepancy likely originates from a variety of sources, such as the dose algorithms, modeling of the beamline, and the dose metric. The agreement for other regions was acceptable.

CONCLUSION

An integrated framework was developed for full MC simulations of double-scattering proton therapy. It can be a valuable tool for dose verification and plan evaluation.

Sensitivity analysis of Monte Carlo model of a gantry-mounted passively scattered proton system

Purpose

This study aimed to present guidance on the correlation between treatment nozzle and proton source parameters, and dose distribution of a passive double scattering compact proton therapy unit, known as Mevion S250.

Methods

All 24 beam options were modeled using the MCNPX MC code. The calculated physical dose for pristine peak, profiles, and spread out Bragg peak (SOBP) were benchmarked with the measured data. Track‐averaged LET (LET_t) and dose‐averaged LET (LET_d) distributions were also calculated. For the sensitivity investigations, proton beam line parameters including Average Energy (AE), Energy Spread (ES), Spot Size (SS), Beam Angle (BA), Beam Offset (OA), and Second scatter Offset (SO) from central Axis, and also First Scatter (FS) thickness were simulated in different stages to obtain the uncertainty of the derived results on the physical dose and LET distribution in a water phantom.

Results

For the physical dose distribution, the MCNPX MC model matched measurements data for all the options to within 2 mm and 2% criterion. The Mevion S250 was found to have a LET_t between 0.46 and 8.76 keV.μm^–1 and a corresponding LET_d between 0.84 and 15.91 keV.μm^–1. For all the options, the AE and ES had the greatest effect on the resulting depth of pristine peak and peak‐to‐plateau ratio respectively. BA, OA, and SO significantly decreased the flatness and symmetry of the profiles. The LETs were found to be sensitive to the AE, ES, and SS, especially in the peak region.

Conclusions

This study revealed the importance of considering detailed beam parameters, and identifying those that resulted in large effects on the physical dose distribution and LETs for a compact proton therapy machine.

A complete workflow for utilizing Monte Carlo toolkits in clinical cases for a double-scattering proton therapy system

The methods described in this paper allow end users to utilize Monte Carlo (MC) toolkits for patient‐specific dose simulation and perform analysis and plan comparisons for double‐scattering proton therapy systems. The authors aim to fill two aspects of this process previously not explicitly published. The first one addresses the modeling of field‐specific components in simulation space. Patient‐specific compensator and aperture models are exported from treatment planning system and converted to STL format using a combination of software tools including Matlab and Autodesk's Netfabb. They are then loaded into the MC geometry for simulation purpose. The second details a method for easily visualizing and comparing simulated doses with the dose calculated from the treatment planning system. This system is established by utilizing the open source software 3D Slicer. The methodology was demonstrated with a two‐field proton treatment plan on the IROC lung phantom. Profiles and two‐dimensional (2D) dose planes through the target isocenter were analyzed using our in‐house software tools. This present workflow and set of codes can be easily adapted by other groups for their clinical practice.

Investigation on Patient/Compensator Scatter Factor for Monitor Unit Calculation in Proton Therapy

Purpose:

It is the goal of this study to use both Monte Carlo (MC) simulation and the pencil beam dose algorithm (PBA) in the treatment planning system to investigate Patient scatter factor (PSF) and Compensator scatter factor (CSF) for calibrating the dose per monitor unit (DMU) for a passive scattering proton therapy system.

Materials and Methods:

PSFs and CSFs for brain, lung, pancreas, and prostate treatment sites were calculated by using MC simulation and PBA from the treatment planning software to evaluate the agreement between the two.

Results:

This study shows that the CSF values are always greater than 1, with some reaching nearly 4% above unity, and depending strongly on the shape of the compensator. Monte Carlo and PBA-calculated CSF factors agree very well, with average differences below 1%. PSF values calculated in this study ranged from 0.919 to 1.023 and are largely dependent on the type of tissue heterogeneities in the treatment field. Monte Carlo and PBA-calculated PSF factors show differences, with the largest discrepancies seen in lung cases, with an average difference of 1.9%. It is also shown that dense bone will drive a PSF to values greater than unity, while large quantities of air decrease the PSF to below unity.

Conclusion:

We have showed that the compensator and patient anatomy can have a significant impact on clinical proton dose distribution. It is recommended that both Monte Carlo and treatment planning system should be used to take these factors into account in the final DMU calculation.

Technical Note: An approach to building a Monte Carlo simulation model for a double scattering proton beam system

PURPOSE

The purpose of this study was to demonstrate and develop a Monte Carlo (MC) simulation model for a passive double scattering compact proton therapy system based on limited information of the mechanical components.

METHOD

We built a virtual machine source model (VMSM) which included a detailed definition of each beam-modifying component in the nozzle. Conceptually, it is similar to the conventional virtual analytical source model (VASM), except that the numerical machine nozzle or beamline is constructed in the VMSM, whereas in the VASM analytical parameters characterizing the energy spectrum and source fluence distribution are sought. All major beam shaping components were included in the VMSM and the model simulates interactions of the beam with a rotating range modulation wheel (RMW) combined with the beam current modulation. The RMWs, the first and second scatterer in the system were generated and tuned to reproduce measurement data as closely as possible. To validate the model, we compared the percent depth dose curves, spread out Bragg peaks (SOBPs) and lateral profiles against measured commissioning beam data.

RESULTS

The agreement of beam range between the MC calculation and measurement was within 1 mm for all beam options. The distal-falloff length was in good agreement as well (<1 mm for the large and deep groups, <1.5 mm for the small group). Agreement to within 2.5 mm of measured SOBP widths was obtained for all MC calculations. For lateral profiles, differences were found to be less than 2 mm.

CONCLUSIONS

We demonstrated that with limited geometrical information it is possible to build an acceptable source model for MC simulations of a passive double scattering compact proton therapy system. The agreement between the measurements and the MC model provides validation for use of the model for further studies of the dosimetric effects in patient treatments.

Shielding verification and neutron dose evaluation of the Mevion S250 proton therapy unit

For passive scattering proton therapy systems, neutron contamination is the main concern both from an occupational and patient safety perspective. The Mevion S250 compact proton therapy system is the first of its kind, offering an in-room cyclotron design which prompts more concern for shielding assessment. The purpose of this study was to accomplish an in-depth evaluation of both the shielding design and in-room neutron production at our facility using both Monte Carlo simulation and measurement. We found that the shielding in place at our facility is adequate, with simulated annual neutron ambient dose equivalents at 30 cm outside wall/door perimeter ranging from background to 0.07 mSv and measured dose equivalents ranging from background to 0.06 mSv. The in-room measurements reveal that the H*/D decreases when the distance from isocenter and field size increases. Furthermore, the H*/D generally increases when the angle around isocenter increases. Our results from in-room measurements show consistent trends with our Monte Carlo model of the Mevion system.