The accuracy of helium ion CT based particle therapy range prediction: an experimental study comparing different particle and x-ray CT modalities

Meeting the detector challenges for pre-clinical proton and ion computed tomography

Six decades after its conception, proton computed tomography (pCT) and proton radiography have yet to be used in medical clinics. However, good progress has been made on relevant detector technologies in the past two decades, and a few prototype pCT systems now exist that approach the performance needed for a clinical device. The tracking and energy-measurement technologies in common use are described, as are the few pCT scanners that are in routine operation at this time. Most of these devices still look like detector R&D efforts as opposed to medical devices, are difficult to use, are at least a factor of five slower than desired for clinical use, and are too small to image many parts of the human body. Recommendations are made for what to consider when engineering a pre-clinical pCT scanner that is designed to meet clinical needs in terms of performance, cost, and ease of use.

Energy painting: helium-beam radiography with thin detectors and multiple beam energies

Objective.Compact ion imaging systems based on thin detectors are a promising prospect for the clinical environment since they are easily integrated into the clinical workflow. Their measurement principle is based on energy deposition instead of the conventionally measured residual energy or range. Therefore, thin detectors are limited in the water-equivalent thickness range they can image with high precision. This article presents ourenergy paintingmethod, which has been developed to render high precision imaging with thin detectors feasible even for objects with larger, clinically relevant water-equivalent thickness (WET) ranges.Approach.A detection system exclusively based on pixelated silicon Timepix detectors was used at the Heidelberg ion-beam therapy center to track single helium ions and measure their energy deposition behind the imaged object. Calibration curves were established for five initial beam energies to relate the measured energy deposition to WET. They were evaluated regarding their accuracy, precision and temporal stability. Furthermore, a 60 mm × 12 mm region of a wedge phantom was imaged quantitatively exploiting the calibrated energies and five different mono-energetic images. These mono-energetic images were combined in a pixel-by-pixel manner by averaging the WET-data weighted according to their single-ion WET precision (SIWP) and the number of contributing ions.Main result.A quantitative helium-beam radiograph of the wedge phantom with an average SIWP of 1.82(5) % over the entire WET interval from 150 mm to 220 mm was obtained. Compared to the previously used methodology, the SIWP improved by a factor of 2.49 ± 0.16. The relative stopping power value of the wedge derived from the energy-painted image matches the result from range pullback measurements with a relative deviation of only 0.4 %.Significance.The proposed method overcomes the insufficient precision for wide WET ranges when employing detection systems with thin detectors. Applying this method is an important prerequisite for imaging of patients. Hence, it advances detection systems based on energy deposition measurements towards clinical implementation.

Focus stacking single-event particle radiography for high spatial resolution images and 3D feature localization

Objective.We demonstrate a novel focus stacking technique to improve spatial resolution of single-event particle radiography (pRad), and exploit its potential for 3D feature detection.Approach.Focus stacking, used typically in optical photography and microscopy, is a technique to combine multiple images with different focal depths into a single super-resolution image. Each pixel in the final image is chosen from the image with the largest gradient at that pixel's position. pRad data can be reconstructed at different depths in the patient based on an estimate of each particle's trajectory (called distance-driven binning; DDB). For a given feature, there is a depth of reconstruction for which the spatial resolution of DDB is maximal. Focus stacking can hence be applied to a series of DDB images reconstructed from a single pRad acquisition for different depths, yielding both a high-resolution projection and information on the features' radiological depth at the same time. We demonstrate this technique with Geant4 simulated pRads of a water phantom (20 cm thick) with five bone cube inserts at different depths (1 × 1 × 1 cm3) and a lung cancer patient.Main results.For proton radiography of the cube phantom, focus stacking achieved a median resolution improvement of 136% compared to a state-of-the-art maximum likelihood pRad reconstruction algorithm and a median of 28% compared to DDB where the reconstruction depth was the center of each cube. For the lung patient, resolution was visually improved, without loss in accuracy. The focus stacking method also enabled to estimate the depth of the cubes within few millimeters accuracy, except for one shallow cube, where the depth was underestimated by 2.5 cm.Significance.Focus stacking utilizes the inherent 3D information encoded in pRad by the particle's scattering, overcoming current spatial resolution limits. It further opens possibilities for 3D feature localization. Therefore, focus stacking holds great potential for future pRad applications.

A review of the clinical introduction of 4D particle therapy research concepts

Background and purpose

Many 4D particle therapy research concepts have been recently translated into clinics, however, remaining substantial differences depend on the indication and institute-related aspects. This work aims to summarise current state-of-the-art 4D particle therapy technology and outline a roadmap for future research and developments.

Material and methods

This review focused on the clinical implementation of 4D approaches for imaging, treatment planning, delivery and evaluation based on the 2021 and 2022 4D Treatment Workshops for Particle Therapy as well as a review of the most recent surveys, guidelines and scientific papers dedicated to this topic.

Results

Available technological capabilities for motion surveillance and compensation determined the course of each 4D particle treatment. 4D motion management, delivery techniques and strategies including imaging were diverse and depended on many factors. These included aspects of motion amplitude, tumour location, as well as accelerator technology driving the necessity of centre-specific dosimetric validation. Novel methodologies for X-ray based image processing and MRI for real-time tumour tracking and motion management were shown to have a large potential for online and offline adaptation schemes compensating for potential anatomical changes over the treatment course. The latest research developments were dominated by particle imaging, artificial intelligence methods and FLASH adding another level of complexity but also opportunities in the context of 4D treatments.

Conclusion

This review showed that the rapid technological advances in radiation oncology together with the available intrafractional motion management and adaptive strategies paved the way towards clinical implementation.

Emerging technologies for cancer therapy using accelerated particles

Cancer therapy with accelerated charged particles is one of the most valuable biomedical applications of nuclear physics. The technology has vastly evolved in the past 50 years, the number of clinical centers is exponentially growing, and recent clinical results support the physics and radiobiology rationale that particles should be less toxic and more effective than conventional X-rays for many cancer patients. Charged particles are also the most mature technology for clinical translation of ultra-high dose rate (FLASH) radiotherapy. However, the fraction of patients treated with accelerated particles is still very small and the therapy is only applied to a few solid cancer indications. The growth of particle therapy strongly depends on technological innovations aiming to make the therapy cheaper, more conformal and faster. The most promising solutions to reach these goals are superconductive magnets to build compact accelerators; gantryless beam delivery; online image-guidance and adaptive therapy with the support of machine learning algorithms; and high-intensity accelerators coupled to online imaging. Large international collaborations are needed to hasten the clinical translation of the research results.

An inception network for positron emission tomography based dose estimation in carbon ion therapy

Objective. We aim to evaluate a method for estimating 1D physical dose deposition profiles in carbon ion therapy via analysis of dynamic PET images using a deep residual learning convolutional neural network (CNN). The method is validated using Monte Carlo simulations of 12C ion spread-out Bragg peak (SOBP) profiles, and demonstrated with an experimental PET image. Approach. A set of dose deposition and positron annihilation profiles for monoenergetic 12C ion pencil beams in PMMA are first generated using Monte Carlo simulations. From these, a set of random polyenergetic dose and positron annihilation profiles are synthesised and used to train the CNN. Performance is evaluated by generating a second set of simulated 12C ion SOBP profiles (one 116 mm SOBP profile and ten 60 mm SOBP profiles), and using the trained neural network to estimate the dose profile deposited by each beam and the position of the distal edge of the SOBP. Next, the same methods are used to evaluate the network using an experimental PET image, obtained after irradiating a PMMA phantom with a 12C ion beam at QST’s Heavy Ion Medical Accelerator in Chiba facility in Chiba, Japan. The performance of the CNN is compared to that of a recently published iterative technique using the same simulated and experimental 12C SOBP profiles. Main results. The CNN estimated the simulated dose profiles with a mean relative error (MRE) of 0.7% ± 1.0% and the distal edge position with an accuracy of 0.1 mm ± 0.2 mm, and estimate the dose delivered by the experimental 12C ion beam with a MRE of 3.7%, and the distal edge with an accuracy of 1.7 mm. Significance. The CNN was able to produce estimates of the dose distribution with comparable or improved accuracy and computational efficiency compared to the iterative method and other similar PET-based direct dose quantification techniques.

Considerations for Upright Particle Therapy Patient Positioning and Associated Image Guidance

Particle therapy is a rapidly growing field in cancer therapy. Worldwide, over 100 centers are in operation, and more are currently in construction phase. The interest in particle therapy is founded in the superior target dose conformity and healthy tissue sparing achievable through the particles’ inverse depth dose profile. This physical advantage is, however, opposed by increased complexity and cost of particle therapy facilities. Particle therapy, especially with heavier ions, requires large and costly equipment to accelerate the particles to the desired treatment energy and steer the beam to the patient. A significant portion of the cost for a treatment facility is attributed to the gantry, used to enable different beam angles around the patient for optimal healthy tissue sparing. Instead of a gantry, a rotating chair positioning system paired with a fixed horizontal beam line presents a suitable cost-efficient alternative. Chair systems have been used already at the advent of particle therapy, but were soon dismissed due to increased setup uncertainty associated with the upright position stemming from the lack of dedicated image guidance systems. Recently, treatment chairs gained renewed interest due to the improvement in beam delivery, commercial availability of vertical patient CT imaging and improved image guidance systems to mitigate the problem of anatomical motion in seated treatments. In this review, economical and clinical reasons for an upright patient positioning system are discussed. Existing designs targeted for particle therapy are reviewed, and conclusions are drawn on the design and construction of chair systems and associated image guidance. Finally, the different aspects from literature are channeled into recommendations for potential upright treatment layouts, both for retrofitting and new facilities.

Experimental helium-beam radiography with a high-energy beam: Water-equivalent thickness calibration and first image-quality results

PURPOSE

A clinical implementation of ion-beam radiography (iRad) is envisaged to provide a method for on-couch verification of ion-beam treatment plans. The aim of this work is to introduce and evaluate a method for quantitative water-equivalent thickness (WET) measurements for a specific helium-ion imaging system for WETs that are relevant for imaging thicker body parts in the future.

METHODS

Helium-beam radiographs (αRads) are measured at the Heidelberg Ion-beam Therapy Center (HIT) with an initial beam energy of 239.5 MeV/ u. An imaging system based on three pairs of thin silicon pixel detectors is used for ion path reconstruction and measuring the energy deposition (dE) of each particle behind the object to be imaged. The dE behind homogeneous plastic blocks is related to their well-known WETs between 280.6mm and 312.6 mm with a calibration curve that is created by fitting the measured data points. The quality of the quantitative WET measurements is determined by the uncertainty of the measured WET of a single ion (single-ion WET precision) and the deviation of a measured WET value to the well-known WET (WET accuracy). Subsequently, the fitted calibration curve is applied to an energy deposition radiograph of a phantom with a complex geometry. The spatial resolution (modulation transfer function at 10% (MTF_10% )) and WET accuracy (mean absolute percentage difference (MAPD)) of the WET map, are determined.

RESULTS

In the optimal imaging WET-range from ∼  280 mm to 300 mm, the fitted calibration curve reached a mean single-ion WET precision of 1.55 ± 0.00%. Applying the calibration to an ion radiograph (iRad) of a more complex WET distribution, the spatial resolution was determined to be MTF_10% = 0.49 ± 0.03 lp/mm and the WET accuracy was assessed as MAPD to 0.21%.

CONCLUSIONS

Using a beam energy of 239.5MeV/ u and the proposed calibration procedure, quantitative αRads of WETs between ∼  280mm to 300 mm can be measured and show high potential for clinical use. The proposed approach with the resulting image qualities encourages further investigation towards the clinical application of helium-beam radiography. This article is protected by copyright. All rights reserved.

Evaluation of the impact of a scanner prototype on proton CT and helium CT image quality and dose efficiency with Monte Carlo simulation

Objective.The use of ion computed tomography (CT) promises to yield improved relative stopping power (RSP) estimation as input to particle therapy treatment planning. Recently, proton CT (pCT) has been shown to yield RSP accuracy on par with state-of-the-art x-ray dual energy CT. There are however concerns that the lower spatial resolution of pCT compared to x-ray CT may limit its potential, which has spurred interest in the use of helium ion CT (HeCT). The goal of this study was to investigate image quality of pCT and HeCT in terms of noise, spatial resolution, RSP accuracy and imaging dose using a detailed Monte Carlo (MC) model of an existing ion CT prototype.Approach.Three phantoms were used in simulated pCT and HeCT scans allowing estimation of noise, spatial resolution and the scoring of dose. An additional phantom was used to evaluate RSP accuracy. The imaging dose required to achieve the same image noise in a water and a head phantom was estimated at both native spatial resolution, and in a scenario where the HeCT spatial resolution was reduced and matched to that of pCT using Hann windowing of the reconstruction filter. A variance reconstruction formalism was adapted to account for Hann windowing.Main results.We confirmed that the scanner prototype would produce higher spatial resolution for HeCT than pCT by a factor 1.8 (0.86 lp mm^-1versus 0.48 lp mm^-1at the center of a 20 cm water phantom). At native resolution, HeCT required a factor 2.9 more dose than pCT to achieve the same noise, while at matched resolution, HeCT required only 38% of the pCT dose. Finally, RSP mean absolute percent error (MAPE) was found to be 0.59% for pCT and 0.67% for HeCT.Significance.This work compared the imaging performance of pCT and HeCT when using an existing scanner prototype, with the spatial resolution advantage of HeCT coming at the cost of increased dose. When matching spatial resolution via Hann windowing, HeCT had a substantial dose advantage. Both modalities provided state-of-the-art RSP MAPE. HeCT might therefore help reduce the dose exposure of patients with comparable image noise to pCT, enhanced spatial resolution and acceptable RSP accuracy at the same time.