Dosimetric response of Gafchromic™ EBT-XD film to therapeutic protons

Proton minibeam (pMBRT) radiation therapy: experimental validation of Monte Carlo dose calculation in the RayStation TPS

Background.Proton minibeam radiation therapy (pMBRT) is a spatially fractionated radiation therapy modality that uses a multi-slit collimator (MSC) to create submillimeter slit openings for spatial dose modulation. The pMBRT dose profile is characterized by highly heterogeneous dose in the plane perpendicular to the beam and rapidly changing depth dose profiles. Dose measurements are typically benchmarked against in-house Monte Carlo (MC) simulation tools. For preclinical and clinical translation, a treatment planning system (TPS) capable of accurately predicting pMBRT doses in tissue and accessible on a commercial platform is essential. This study focuses on the beam modeling and verification of pMBRT using the RayStation TPS, a critical step in advancing its clinical implementation.Methods.The pMBRT system was implemented in RayStation for the IBA Proteus®ONE single-room compact proton machine. The RayStation pMBRT model is an extension of the clinical beam model, allowing pMBRT dose calculations through the MSC using the existing clinical beam model. Adjustable MSC parameters include air gap, slit thickness, slit pitch, number of slits, slits direction and slit thickness. The pMBRT TPS was validated experimentally against measurements using six different collimators with various slit widths (0.4-1.4 mm) and center-to-center slit distances (2.8-4.0 mm). Each collimator comprised five non-divergent slits. Validation involved MatriXX measurements for average dose, Gafchromic film placed at varying depths to measure lateral dose profiles, and film placed along the beam axis to measure depth-dose curves in solid water phantoms. A single 150 MeV energy layer with a 0.5 cm spot spacing was used to create a uniform radiation map across the MSC field.Results.The comparison of average depth dose measurements with RayStation MC calculations showed a gamma passing rate better than 95% using 3 mm/3% criteria, except for the 0.4 mm slit width. After adjusting the slit width by 40-60μm to account for machining uncertainties, the gamma passing rate exceeded 95% under the same criteria. For the peaks and valleys of the percentage depth doses, agreement between RayStation and film measurements was above 90% using 2 mm/5% criteria, except in the high linear energy transfer region. Lateral profile comparisons at depths of 2, 6, and 10 cm demonstrated over 90% agreement for all curves using 0.2 mm/5% criteria.Conclusions.The pMBRT beam model for the Proteus®ONE-based system has been successfully implemented in RayStation TPS, with its initial accuracy validated experimentally. Further measurements, including additional energies and Spread Out Bragg Peaks, are required to complete the clinical commissioning process.

Mimicking large spot-scanning radiation fields for proton FLASH preclinical studies with a robotic motion platform

Previously, a synchrotron-based horizontal proton beamline (87.2 MeV) was successfully commissioned to deliver radiation doses in FLASH and conventional dose rate modes to small fields and volumes. In this study, we developed a strategy to increase the effective radiation field size using a custom robotic motion platform to automatically shift the positions of biological samples. The beam was first broadened with a thin tungsten scatterer and shaped by customized brass collimators for irradiating cell/organoid cultures in 96-well plates (a 7-mm-diameter circle) or for irradiating mice (1-cm2 square). Motion patterns of the robotic platform were written in G-code, with 9-mm spot spacing used for the 96-well plates and 10.6-mm spacing for the mice. The accuracy of target positioning was verified with a self-leveling laser system. The dose delivered in the experimental conditions was validated with EBT-XD film attached to the 96-well plate or the back of the mouse. Our film-measured dose profiles matched Monte Carlo calculations well (1D gamma pass rate >95% with the criteria of 2%/1 mm/2% dose threshold). The FLASH dose rates were 113.7 Gy/s for cell/organoid irradiation and 191.3 Gy/s for mouse irradiation. These promising results indicate that this robotic platform can be used to effectively increase the field size for preclinical experiments with proton FLASH.

Mimicking large spot-scanning radiation fields for proton FLASH preclinical studies with a robotic motion platform

Previously, a synchrotron-based horizontal proton beamline (87.2 MeV) was successfully commissioned to deliver radiation doses in FLASH and conventional dose rate modes to small fields and volumes. In this study, we developed a strategy to increase the effective radiation field size using a custom robotic motion platform to automatically shift the positions of biological samples. The beam was first broadened with a thin tungsten scatterer and shaped by customized brass collimators for irradiating cell/organoid cultures in 96-well plates (a 7-mm-diameter circle) or for irradiating mice (1-cm2 square). Motion patterns of the robotic platform were written in G-code, with 9-mm spot spacing used for the 96-well plates and 10.6-mm spacing for the mice. The accuracy of target positioning was verified with a self-leveling laser system. The dose delivered in the experimental conditions was validated with EBT-XD film attached to the 96-well plate or the back of the mouse. Our film-measured dose profiles matched Monte Carlo calculations well (1D gamma pass rate >95%). The FLASH dose rates were 113.7 Gy/s for cell/organoid irradiation and 191.3 Gy/s for mouse irradiation. These promising results indicate that this robotic platform can be used to effectively increase the field size for preclinical experiments with proton FLASH.

Investigating the method of selection of background pixel values for the calibration of EBT-XD film dosimetry

Purpose

This study investigates three different calibration methods for the selection of background pixel intensity.

Methods

Film-by-Film (FBF) Method: Each film serves as its own control. Batch-by-Film (BBF) Method: A single film is used as a control for all calibration films. Generic (GEN) Method: A generic value (65535) is used as the background pixel value for all calibration films.Three calibration curves were established for the red, green, blue, and RGB channels, and the Radbard NIH (image) curve-fitting model was used to predict the dose. Sensitivity at different dose levels was quantified by calculating the first derivative of each color channel.

Results

The GEN method exhibited a difference of up to 6% between the predicted and delivered doses below 2 Gy. The changes in optical density when using the GEN method differed significantly (p<0.0001) from those of the FBF and BBF methods. In the dose range 5-30 Gy, the percentage difference between the predicted and delivered doses for the FBF, BBF, and GEN methods was within 2%. Both the red and green channels demonstrated higher sensitivity than the blue channel over the dose range of 2-30 Gy.

Conclusions

The FBF method is more accurate than the BBF and GEN methods because it accounts for inter-film variations. The Radbard NIH (image) curve-fitting function proved suitable for predicting the dose for all the three calibration methods.

Comprehensive dosimetric commissioning of proton minibeam radiotherapy on a single gantry proton system

Background

Proton minibeam radiation therapy (pMBRT) can deliver spatially fractionated dose distributions with submillimeter resolution. These dose distributions exhibit significant heterogeneity in both depth and lateral directions. Accurate characterization of pMBRT doses requires dosimetry devices with high spatial resolution and a wide dynamic range. Furthermore, the dependency of dosimetric measurements on Linear Energy Transfer (LET), as observed in conventional proton therapy, is also present in pMBRT depth dose measurements.

Purpose

This work demonstrates the process of performing comprehensive dosimetric measurements to characterize the pMBRT collimator on a clinical single-gantry proton machine, utilizing commercially available dosimetry devices.

Methods

The minibeam collimator is designed to be mounted on the clinical nozzle as a beam-modifying accessory. Three collimators, each with a slit opening of 0.4 mm, are thoroughly evaluated. The center-to-center (c-t-c) distances of the slits for these collimators are 2.8 mm, 3.2 mm, and 4.0 mm, respectively. High spatial resolution dosimetry devices are essential for PMBRT dose characterizations. To meet this requirement, two-dimensional (2D) dose measurement devices, Gafchromic films, are used to measure lateral profiles at various depths. Films are also used for depth dose profile measurements in solid water. Additionally, high-resolution point dose detectors, microDiamond, and Razor diode detectors are employed for lateral profile measurements at various depths. Percent depth dose (PDD) measurements of pMBRT in solid water, with various proton energies, collimators, and air gaps, are performed using Gafchromic films. The film's LET dependency for proton beams is corrected to ensure accurate pMBRT PDD measurements. The Monte Carlo simulation tool TOPAS is utilized to compare and validate all experimental measurements.

Results

At depths where LET is not a concern, film dose measurements were consistent with microDiamond and Razor diode point measurements. The point detectors need to be orientated with the thin side aligned to the incoming beam. Comparison of the lateral dose profiles extracted from TOPAS simulations, films, microDiamond, and Razor diode detectors shows a passing rate exceeding 98% in 1D gamma analysis at 3% 0.1 mm criteria.However, when the microDiamond detector is orientated to face the pMBRT beam, its spatial resolution may not be sufficient to capture the peak and valley dose accurately. Nevertheless, an accuracy within 2% can still be achieved when comparing the average dose. The PDD measurements show that the peak valley dose ratio (PVDR) of pMBRT can be altered at different depths with different air gaps using the same collimator or different collimators of different c-t-c distances.

Conclusion

Our study demonstrates that comprehensive dose measurements for pMBRT can be conducted using standard clinical dose measurement devices. These measurements are indispensable for guiding and ensuring accurate dose reporting in pre-clinical studies using the pMBRT technique.

Development of a novel fibre optic beam profile and dose monitor for very high energy electron radiotherapy at ultrahigh dose rates

Objective. Very high energy electrons (VHEE) in the range of 50-250 MeV are of interest for treating deep-seated tumours with FLASH radiotherapy (RT). This approach offers favourable dose distributions and the ability to deliver ultra-high dose rates (UHDR) efficiently. To make VHEE-based FLASH treatment clinically viable, a novel beam monitoring technology is explored as an alternative to transmission ionisation monitor chambers, which have non-linear responses at UHDR. This study introduces the fibre optic flash monitor (FOFM), which consists of an array of silica optical fibre-based Cherenkov sensors with a photodetector for signal readout.Approach. Experiments were conducted at the CLEAR facility at CERN using 200 MeV and 160 MeV electrons to assess the FOFM's response linearity to UHDR (characterised with radiochromic films) required for FLASH radiotherapy. Beam profile measurements made on the FOFM were compared to those using radiochromic film and scintillating yttrium aluminium garnet (YAG) screens.Main results. A range of photodetectors were evaluated, with a complementary-metal-oxide-semiconductor (CMOS) camera being the most suitable choice for this monitor. The FOFM demonstrated excellent response linearity from 0.9 Gy/pulse to 57.4 Gy/pulse (R2= 0.999). Furthermore, it did not exhibit any significant dependence on the energy between 160 MeV and 200 MeV nor the instantaneous dose rate. Gaussian fits applied to vertical beam profile measurements indicated that the FOFM could accurately provide pulse-by-pulse beam size measurements, agreeing within the error range of radiochromic film and YAG screen measurements, respectively.Significance. The FOFM proves to be a promising solution for real-time beam profile and dose monitoring for UHDR VHEE beams, with a linear response in the UHDR regime. Additionally it can perform pulse-by-pulse beam size measurements, a feature currently lacking in transmission ionisation monitor chambers, which may become crucial for implementing FLASH radiotherapy and its associated quality assurance requirements.

Initial experience with an electron FLASH research extension (FLEX) for the Clinac system

PURPOSE

Radiotherapy delivered at ultra-high-dose-rates (≥40 Gy/s), that is, FLASH, has the potential to effectively widen the therapeutic window and considerably improve the care of cancer patients. The underlying mechanism of the FLASH effect is not well understood, and commercial systems capable of delivering such dose rates are scarce. The purpose of this study was to perform the initial acceptance and commissioning tests of an electron FLASH research product for preclinical studies.

METHODS

A linear accelerator (Clinac 23EX) was modified to include a non-clinical FLASH research extension (the Clinac-FLEX system) by Varian, a Siemens Healthineers company (Palo Alto, CA) capable of delivering a 16 MeV electron beam with FLASH and conventional dose rates. The acceptance, commissioning, and dosimetric characterization of the FLEX system was performed using radiochromic film, optically stimulated luminescent dosimeters, and a plane-parallel ionization chamber. A radiation survey was conducted for which the shielding of the pre-existing vault was deemed sufficient.

RESULTS

The Clinac-FLEX system is capable of delivering a 16 MeV electron FLASH beam of approximately 1 Gy/pulse at isocenter and reached a maximum dose rate >3.8 Gy/pulse near the upper accessory mount on the linac gantry. The percent depth dose curves of the 16 MeV FLASH and conventional modes for the 10 × 10 cm2 applicator agreed within 0.5 mm at a range of 50% of the maximum dose. Their respective profiles agreed well in terms of flatness but deviated for field sizes >10 × 10 cm2 . The output stability of the FLASH system exhibited a dose deviation of <1%. Preliminary cell studies showed that the FLASH dose rate (180 Gy/s) had much less impact on the cell morphology of 76N breast normal cells compared to the non-FLASH dose rate (18 Gy/s), which induced large-size cells.

CONCLUSION

Our studies characterized the non-clinical Clinac-FLEX system as a viable solution to conduct FLASH research that could substantially increase access to ultra-high-dose-rate capabilities for scientists.

Feasibility of Synchrotron-Based Ultra-High Dose Rate (UHDR) Proton Irradiation with Pencil Beam Scanning for FLASH Research

BACKGROUND

This study aims to present the feasibility of developing a synchrotron-based proton ultra-high dose rate (UHDR) pencil beam scanning (PBS) system.

METHODS

The RF extraction power in the synchrotron system was increased to generate 142.4 MeV pulsed proton beams for UHDR irradiation at ~100 nA beam current. The charge per spill was measured using a Faraday cup. The spill length and microscopic time structure of each spill was measured with a 2D strip transmission ion chamber. The measured UHDR beam fluence was used to derive the spot dwell time for pencil beam scanning. Absolute dose distributions at various depths and spot spacings were measured using Gafchromic films in a solid-water phantom.

RESULTS

For proton UHDR beams at 142.4 MeV, the maximum charge per spill is 4.96 ± 0.10 nC with a maximum spill length of 50 ms. This translates to an average beam current of approximately 100 nA during each spill. Using a 2 × 2 spot delivery pattern, the delivered dose per spill at 5 cm and 13.5 cm depth is 36.3 Gy (726.3 Gy/s) and 56.2 Gy (1124.0 Gy/s), respectively.

CONCLUSIONS

The synchrotron-based proton therapy system has the capability to deliver pulsed proton UHDR PBS beams. The maximum deliverable dose and field size per pulse are limited by the spill length and extraction charge.

Development and characterization of a versatile mini-beam collimator for pre-clinical photon beam irradiation

BACKGROUND

Interest in spatial fractionation radiotherapy has exponentially increased over the last decade as a significant reduction of healthy tissue toxicity was observed by mini-beam irradiation. Published studies, however, mostly use rigid mini-beam collimators dedicated to their exact experimental arrangement such that changing the setup or testing new mini-beam collimator configurations becomes challenging and expensive.

PURPOSE

In this work, a versatile, low-cost mini-beam collimator was designed and manufactured for pre-clinical applications with X-ray beams. The mini-beam collimator enables variability of the full width at half maximum (FWHM), the center-to-center distance (ctc), the peak-to-valley dose ratio (PVDR), and the source-to-collimator distance (SCD).

METHODS

The mini-beam collimator is an in-house development, which was constructed of 10 ×  40 mm2 tungsten or brass plates. These metal plates were combined with 3D-printed plastic plates that can be stacked together in the desired order. A standard X-ray source was used for the dosimetric characterization of four different configurations of the collimator, including a combination of plastic plates of 0.5, 1, or 2 mm width, assembled with 1 or 2 mm thick metal plates. Irradiations were done at three different SCDs for characterizing the performance of the collimator. For the SCDs closer to the radiation source, the plastic plates were 3D-printed with a dedicated angle to compensate for the X-ray beam divergence, making it possible to study ultra-high dose rates of around 40 Gy/s. All dosimetric quantifications were performed using EBT-XD films. Additionally, in vitro studies with H460 cells were carried out.

RESULTS

Characteristic mini-beam dose distributions were obtained with the developed collimator using a conventional X-ray source. With the exchangeable 3D-printed plates, FWHM and ctc from 0.52 to 2.11 mm, and from 1.77 to 4.61 mm were achieved, with uncertainties ranging from 0.01% to 8.98%, respectively. The FWHM and ctc obtained with the EBT-XD films are in agreement with the design of each mini-beam collimator configuration. For dose rates in the order of several Gy/min, the highest PVDR of 10.09 ± 1.08 was achieved with a collimator configuration of 0.5 mm thick plastic plates and 2 mm thick metal plates. Exchanging the tungsten plates with the lower-density metal brass reduced the PVDR by approximately 50%. Also, increasing the dose rate to ultra-high dose rates was feasible with the mini-beam collimator, where a PVDR of 24.26 ± 2.10 was achieved. Finally, it was possible to deliver and quantify mini-beam dose distribution patterns in vitro.

CONCLUSIONS

With the developed collimator, we achieved various mini-beam dose distributions that can be adjusted according to the needs of the user in regards to FWHM, ctc, PVDR and SCD, while accounting for beam divergence. Therefore, the designed mini-beam collimator may enable low-cost and versatile pre-clinical research on mini-beam irradiation.

Characterization of GafchromicTM EBT4 film with clinical kV/MV photons and MeV electrons

Objective

A newly developed GafchromicTM EBT4 film model was released recently. According to the vendor-stated specifications, this new model maintains major features of its more recent predecessor, EBT3, but has a great improvement in the signal-to-noise ratio (SNR). The purpose of this study was to fully characterize the EBT4 model by testing its dose response dependence on beam energy using clinical photon and electron beams and validating its improvement in SNR.

Methods

In the beam energy dependence experiments, 6 MV and 15 MV photon beams, 6 MeV, 12 MeV and 20 MeV electron beams, 120 kVp and two 250 kVp x-ray beams (with different half-layer values) were selected, representing different clinical beam energies and radiation types. In the noise and SNR analyses, only the 6 MV photon beam was selected as the representative to compare between EBT4 and EBT3 models.

Results

The energy dependence test results showed that there was a slight difference (<2% at most dose levels) in the dose response among the clinical MV photons and MeV electrons. However, a large deviation (>10%) in the dose response was found for the 120 kVp x-ray beam. For the two 250 kVp x-ray beams, the difference in the dose response was moderate (<5%), but not negligible. The noise and SNR results showed a reduced noise and strengthened SNR in EBT4.

Conclusion

We conclude that the EBT4 film has a minimal energy dependence for MV photon and MeV electron beams but has a notable energy dependence for kilovoltage x-ray beams, and the vendor-stated features of the reduced noise and improved SNR in EBT4 are validated.