Energy spectrum control for modulated proton beams

Evaluation of Delivered Doses in Proton Beam Therapy for Prostate Cancer Using Positron Emission Tomography/Computed Tomography Imaging

AIMS

Proton beams deposit energy along their paths and stop abruptly without penetrating the opposite side, making it difficult to detect their actual paths. However, confirming the path may lead to evaluating the actual doses to organs at risk in proton therapy for prostate cancer. As proton beams produce positron emitters through nuclear fragmentation reactions, theoretically, proton beam paths can be measured by positron emission tomography/computed tomography (PET/CT). Therefore, this study investigated whether conducting PET/CT examinations immediately after proton beam therapy helps to assess the doses delivered to the rectal and urinary bladder walls, which are the major sites of radiation-related toxicity.

MATERIALS AND METHODS

Between June 2022 and June 2023, 51 consecutive patients with prostate cancer who underwent proton beam therapy were enrolled and imaged with PET/CT to measure these radioactive particles and validate the actual dose delivered to the rectal and urinary bladder walls.

RESULTS

The delivered doses assessed using PET/CT after proton beam therapy strongly correlated with the planned volume for proton beam treatment.

CONCLUSIONS

PET/CT exhibited potential as a valuable tool for validating the irradiated dose to organs at risk.

Validation of a deep learning-based material estimation model for Monte Carlo dose calculation in proton therapy

Objective. Computed tomography (CT) to material property conversion dominates proton range uncertainty, impacting the quality of proton treatment planning. Physics-based and machine learning-based methods have been investigated to leverage dual-energy CT (DECT) to predict proton ranges. Recent development includes physics-informed deep learning (DL) for material property inference. This paper aims to develop a framework to validate Monte Carlo dose calculation (MCDC) using CT-based material characterization models.Approach.The proposed framework includes two experiments to validatein vivodose and water equivalent thickness (WET) distributions using anthropomorphic and porcine phantoms. Phantoms were irradiated using anteroposterior proton beams, and the exit doses and residual ranges were measured by MatriXX PT and a multi-layer strip ionization chamber. Two pre-trained conventional and physics-informed residual networks (RN/PRN) were used for mass density inference from DECT. Additional two heuristic material conversion models using single-energy CT (SECT) and DECT were implemented for comparisons. The gamma index was used for dose comparisons with criteria of 3%/3 mm (10% dose threshold).Main results. The phantom study showed that MCDC with PRN achieved mean gamma passing rates of 95.9% and 97.8% for the anthropomorphic and porcine phantoms. The rates were 86.0% and 79.7% for MCDC with the empirical DECT model. WET analyses indicated that the mean WET variations between measurement and simulation were -1.66 mm, -2.48 mm, and -0.06 mm for MCDC using a Hounsfield look-up table with SECT and empirical and PRN models with DECT. Validation experiments indicated that MCDC with PRN achieved consistent dose and WET distributions with measurement.Significance. The proposed framework can be used to identify the optimal CT-based material characterization model for MCDC to improve proton range uncertainty. The framework can systematically verify the accuracy of proton treatment planning, and it can potentially be implemented in the treatment room to be instrumental in online adaptive treatment planning.

Technical note: Extraction of proton pencil beam energy spectrum from measured integral depth dose in a cyclotron proton beam system

PURPOSE

Proton pencil beam energy spectrum is an essential parameter for calculations of dose and linear energy transfer. We extract the energy spectrum from measured integral depth dose (IDD).

METHODS

A measured IDD (measIDD) in water is decomposed into many IDDs of mono-energetic pencil beams (monoIDDs) in water. A simultaneous iterative technique is used to do the decomposition that extracts the energy spectrum of protons from the measIDD. The monoIDDs are generated by our analytic random walk model-based proton dose calculation algorithm. The linear independence of the monoIDDs is considered and high spatial resolution monoIDDs are used to improve their linear independence. To validate the extraction, first we use synthesized IDDs (synIDD) with Gaussian energy spectrum and compare the extracted energy spectrum with the Gaussian; second, for the energy spectrum extracted from measIDDs, the accuracy of the extraction is validated by comparing the calculated IDD from the energy spectrum with the measIDD. The measIDDs are derived from commissioning of a cyclotron proton pencil beam system with a Bragg peak ionization chamber. The nominal energy of the pencil beams is from 70 to 245 MeV. The monoIDDs are generated for energies from 0.05 to 275 MeV in steps of 0.05 MeV with a spatial resolution of 1 mm.

RESULTS

The difference of the extracted and original Gaussian energy spectrum peaked at 75 and 80 MeV was <1%. As the energy decreased, the difference increased but was reduced by using 0.1-mm monoIDDs. The difference was not sensitive to the energy interval of monoIDDs when the interval increased from 0.05 to 1 MeV. For the energy spectrum extraction from measIDDs, there was a main peak near the nominal energy but the spectrum was not in Gaussian distribution. In three example cases (70, 160, and 245 MeV), the relative differences of the measIDDs and calculated IDDs were within 3.4%, 2.9%, and 4.7% of the Bragg peak value, respectively. Fitting the spectrum by Gaussian distribution, we had σ = 0.87, 1.51, and 0.86 MeV, respectively, for these three examples, and the relative differences of the resultant calculated IDDs from the measIDDs were within 4.7%, 7.4%, and 4.5%, respectively.

CONCLUSIONS

Our algorithm accurately extracted the energy spectrum from the synIDDs and measIDDs. High-resolution monoIDDs are necessary to extract low-energy spectrum. Energy spectrum extraction from measIDD reveals important information for beam modeling.

Design of a light and fast energy degrader for a compact superconducting gantry with large momentum acceptance

PURPOSE

Proton therapy is a precise radiation cancer treatment with low side effects. To reduce the cost and footprint of the facility, the superconducting gantry with large momentum acceptance becomes a potential solution. Benefit from this feature, beam delivery time depends largely on the energy-switching process and short time is helpful for increasing the number of volume repaintings.

METHODS

This note introduces an energy degrader with lightweight moving parts and a new hybrid structure (wedge-block-block). The total energies are separated into three stages and are degraded at fixed rates in two boron carbide blocks. As only one pair of graphite wedges is used for energy modulation, the energy switching at each step reaches a 10 ms level.

RESULTS

The transport process in the degrader was simulated in TOPAS. After the degradation, the maximum energy spread (1σ) was approximately 5.5%, and the distance between successive energy layers can be increased for treating non-sensitive tissues. Six configurations of the hybrid degrader achieved distinctly higher transmission efficiencies than the usual graphite multi-wedge degrader. Finally, the configuration that maximized the beam transmission in the lower-energy range (namely, the W-B₁-B₂ configuration) was chosen as the degrader.

CONCLUSIONS

This new degrader not only improved the transmission efficiency, but also reduced the energy-switching time by virtue of its light and compact structure.

Activation of Collimators Irradiated With Clinical Proton Beams and Development of a Semiempirical Model for Activity Calculation

Patient-specific collimators used in proton therapy are activated after use. The aim of this work is to assess the residual activity in brass collimators considering clinical beams, so far studied only for monoenergetic beams, and to develop a model to calculate the activity. Eight brass collimators irradiated with different clinical and monoenergetic beams were included in the study. The collimators were analyzed with gamma spectrometry in the framework of three independent studies carried out at the two French proton therapy sites. Using FLUKA (a fully integrated particle physics Monte Carlo simulation package), simulations were performed to determine radionuclides and activities for all the collimators. The semiempirical model was built using data calculated with FLUKA for a range of clinical beams (different maximum proton energies, modulations, and doses). It was found that there was global coherence in experimental results from different studies. The relevant radionuclides at 1 mo postirradiation were Co, Co, and Zn, and additionally, Mn, Co, and Co for high-energy beams. For nondegraded monoenergetic beams, differences between FLUKA and spectrometry were within those reported in reference benchmark studies (±30%). Due to the use of perfect monochromatic sources in the FLUKA model, FLUKA results systematically underestimated experimental activities for clinical beams, especially for Zn, depending on the beam energy spread (modulation, degradation, beam line characteristics). To account for the energy spread, correction factors were derived for the semiempirical model. The model is applicable to the most relevant radionuclides and total amounts. Secondary neutrons have a negligible contribution to the activity during treatment with respect to proton activation.

Comparison of multi-institutional Varian ProBeam pencil beam scanning proton beam commissioning data

Purpose

Commissioning beam data for proton spot scanning beams are compared for the first two Varian ProBeam sites in the United States, at the Maryland Proton Treatment Center (MPTC) and Scripps Proton Therapy Center (SPTC). In addition, the extent to which beams can be matched between gantry rooms at MPTC is investigated.

Method

Beam data for the two sites were acquired with independent dosimetry systems and compared. Integrated depth dose curves (IDDs) were acquired with Bragg peak ion chambers in a 3D water tank for pencil beams at both sites. Spot profiles were acquired at different distances from the isocenter at a gantry angle of 0° as well as a function of gantry angles. Absolute dose calibration was compared between SPTC and the gantries at MPTC. Dosimetric verification of test plans, output as a function of gantry angle, monitor unit (MU) linearity, end effects, dose rate dependence, and plan reproducibility were compared for different gantries at MPTC.

Results

The IDDs for the two sites were similar, except in the plateau region, where the SPTC data were on average 4.5% higher for lower energies. This increase in the plateau region decreased as energy increased, with no marked difference for energies higher than 180 MeV. Range in water coincided for all energies within 0.5 mm. The sigmas of the spot profiles in air were within 10% agreement at isocenter. This difference increased as detector distance from the isocenter increased. Absolute doses for the gantries measured at both sites were within 1% agreement. Test plans, output as function of gantry angle, MU linearity, end effects, dose rate dependence, and plan reproducibility were all within tolerances given by TG142.

Conclusion

Beam data for the two sites and between different gantry rooms were well matched.

Depth dose perturbation by a hydrogel fiducial marker in a proton beam

The purpose of this study was to evaluate proton depth dose perturbation caused by a radio‐opaque hydrogel fiducial marker. Electronic proton stopping powers in the hydrogel were calculated for energies 0.5–250 MeV, and Monte Carlo simulations were generated of hydrogel vs. gold markers placed at various water phantom depths in a generic proton beam. Across the studied energy range, the gel/water stopping power ratio was 1.0146 to 1.0160. In the Monte Carlo simulation, the hydrogel marker caused no discernible perturbation of the proton percent depth‐dose (PDD) curve. In contrast, the gold marker caused dose reductions of as much as 20% and dose shadowing regions as long as 6.5 cm. In contrast to gold markers, the radio‐opaque hydrogel marker causes negligible proton depth dose perturbation. This factor may be taken into consideration for image‐guided proton therapy at facilities with suitable imaging modalities.

PACS number: 87.55.Qr

Review on the characteristics of radiation detectors for dosimetry and imaging

The enormous advances in the understanding of human anatomy, physiology and pathology in recent decades have led to ever-improving methods of disease prevention, diagnosis and treatment. Many of these achievements have been enabled, at least in part, by advances in ionizing radiation detectors. Radiology has been transformed by the implementation of multi-slice CT and digital x-ray imaging systems, with silver halide films now largely obsolete for many applications. Nuclear medicine has benefited from more sensitive, faster and higher-resolution detectors delivering ever-higher SPECT and PET image quality. PET/MR systems have been enabled by the development of gamma ray detectors that can operate in high magnetic fields. These huge advances in imaging have enabled equally impressive steps forward in radiotherapy delivery accuracy, with 4DCT, PET and MRI routinely used in treatment planning and online image guidance provided by cone-beam CT. The challenge of ensuring safe, accurate and precise delivery of highly complex radiation fields has also both driven and benefited from advances in radiation detectors. Detector systems have been developed for the measurement of electron, intensity-modulated and modulated arc x-ray, proton and ion beams, and around brachytherapy sources based on a very wide range of technologies. The types of measurement performed are equally wide, encompassing commissioning and quality assurance, reference dosimetry, in vivo dosimetry and personal and environmental monitoring. In this article, we briefly introduce the general physical characteristics and properties that are commonly used to describe the behaviour and performance of both discrete and imaging detectors. The physical principles of operation of calorimeters; ionization and charge detectors; semiconductor, luminescent, scintillating and chemical detectors; and radiochromic and radiographic films are then reviewed and their principle applications discussed. Finally, a general discussion of the application of detectors for x-ray nuclear medicine and ion beam imaging and dosimetry is presented.

Beam characteristics in two different proton uniform scanning systems: a side-by-side comparison

PURPOSE

To compare clinically relevant dosimetric characteristics of proton therapy fields produced by two uniform scanning systems that have a number of similar hardware components but employ different techniques of beam spreading.

METHODS

This work compares two technologically distinct systems implementing a method of uniform scanning and layer stacking that has been developed independently at Indiana University (IU) and by Ion Beam Applications, S. A. (IBA). Clinically relevant dosimetric characteristics of fields produced by these systems are studied, such as beam range control, peak-to-entrance ratio (PER), lateral penumbra, field flatness, effective source position, precision of dose delivery at different gantry angles, etc.

RESULTS

Under comparable conditions, both systems controlled beam range with an accuracy of 0.5 mm and a precision of 0.1 mm. Compared to IBA, the IU system produced pristine peaks with a slightly higher PER (3.23 and 3.45, respectively) and smaller, symmetrical, lateral in-air penumbra of 1 mm compared to about 1.9/2.4 mm in the inplane/crossplane (IP/CP) directions for IBA. Large field flatness results in the IP/CP directions were similar: 3.0/2.4% for IU and 2.9/2.4% for IBA. The IU system featured a longer virtual source-to-isocenter position, which was the same for the IP and CP directions (237 cm), as opposed to 212/192 cm (IP/CP) for IBA. Dose delivery precision at different gantry angles was higher in the IBA system (0.5%) than in the IU system (1%).

CONCLUSIONS

Each of the two uniform scanning systems considered in this work shows some attractive performance characteristics while having other features that can be further improved. Overall, radiation field characteristics of both systems meet their clinical specifications and show comparable results. Most of the differences observed between the two systems are clinically insignificant.

Range and modulation dependencies for proton beam dose per monitor unit calculations

Calculations of dose per monitor unit (D/MU) are required in addition to measurements to increase patient safety in the clinical practice of proton radiotherapy. As in conventional photon and electron therapy, the D/MU depends on several factors. This study focused on obtaining range and modulation dependence factors used in D/MU calculations for the double scattered proton beam line at the Midwest Proton Radiotherapy Institute. Three dependencies on range and one dependency on modulation were found. A carefully selected set of measurements was performed to discern these individual dependencies. Dependencies on range were due to: (1) the stopping power of the protons passing through the monitor chamber; (2) the reduction of proton fluence due to nuclear interactions within the patient; and (3) the variation of proton fluence passing through the monitor chamber due to different source-to-axis distances (SADs) for different beam ranges. Different SADs are produced by reconfigurations of beamline elements to provide different field sizes and ranges. The SAD effect on the D/MU varies smoothly as the beam range is varied, except at the beam range for which the first scatterers are exchanged and relocated to accommodate low and high beam ranges. A geometry factor was devised to model the SAD variation effect on the D/MU. The measured D/MU variation as a function of range can be predicted within 1% using the three modeled dependencies on range. Investigation of modulated beams showed that an analytical formula can predict the D/MU dependency as a function of modulation to within 1.5%. Special attention must be applied when measuring the D/MU dependence on modulation to avoid interplay between range and SAD effects.