A Pompos

A practical cone-beam CT scatter correction method with optimized Monte Carlo simulations for image-guided radiation therapy

Cone-beam CT (CBCT) has become the standard image guidance tool for patient setup in image-guided radiation therapy. However, due to its large illumination field, scattered photons severely degrade its image quality. While kernel-based scatter correction methods have been used routinely in the clinic, it is still desirable to develop Monte Carlo (MC) simulation-based methods due to their accuracy. However, the high computational burden of the MC method has prevented routine clinical application. This paper reports our recent development of a practical method of MC-based scatter estimation and removal for CBCT. In contrast with conventional MC approaches that estimate scatter signals using a scatter-contaminated CBCT image, our method used a planning CT image for MC simulation, which has the advantages of accurate image intensity and absence of image truncation. In our method, the planning CT was first rigidly registered with the CBCT. Scatter signals were then estimated via MC simulation. After scatter signals were removed from the raw CBCT projections, a corrected CBCT image was reconstructed. The entire workflow was implemented on a GPU platform for high computational efficiency. Strategies such as projection denoising, CT image downsampling, and interpolation along the angular direction were employed to further enhance the calculation speed. We studied the impact of key parameters in the workflow on the resulting accuracy and efficiency, based on which the optimal parameter values were determined. Our method was evaluated in numerical simulation, phantom, and real patient cases. In the simulation cases, our method reduced mean HU errors from 44 to 3 HU and from 78 to 9 HU in the full-fan and the half-fan cases, respectively. In both the phantom and the patient cases, image artifacts caused by scatter, such as ring artifacts around the bowtie area, were reduced. With all the techniques employed, we achieved computation time of less than 30 s including the time for both the scatter estimation and CBCT reconstruction steps. The efficacy of our method and its high computational efficiency make our method attractive for clinical use.

Carbon ion radiotherapy: A review of clinical experiences and preclinical research, with an emphasis on DNA damage/repair

Compared to conventional photon-based external beam radiation (PhXRT), carbon ion radiotherapy (CIRT) has superior dose distribution, higher linear energy transfer (LET), and a higher relative biological effectiveness (RBE). This enhanced RBE is driven by a unique DNA damage signature characterized by clustered lesions that overwhelm the DNA repair capacity of malignant cells. These physical and radiobiological characteristics imbue heavy ions with potent tumoricidal capacity, while having the potential for simultaneously maximally sparing normal tissues. Thus, CIRT could potentially be used to treat some of the most difficult to treat tumors, including those that are hypoxic, radio-resistant, or deep-seated. Clinical data, mostly from Japan and Germany, are promising, with favorable oncologic outcomes and acceptable toxicity. In this manuscript, we review the physical and biological rationales for CIRT, with an emphasis on DNA damage and repair, as well as providing a comprehensive overview of the translational and clinical data using CIRT.

Breaking bad IMRT QA practice

Agreement between planned and delivered dose distributions for patient‐specific quality assurance in routine clinical practice is predominantly assessed utilizing the gamma index method. Several reports, however, fundamentally question current IMRT QA practice due to poor sensitivity and specificity of the standard gamma index implementation. An alternative is to employ dose volume histogram (DVH)‐based metrics. An analysis based on the AAPM TG 53 and ESTRO booklet No.7 recommendations for QA of treatment planning systems reveals deficiencies in the current “state of the art” IMRT QA, no matter which metric is selected. The set of IMRT benchmark plans were planned, delivered, and analyzed by following guidance of the AAPM TG 119 report. The recommended point dose and planar dose measurements were obtained using a PinPoint ionization chamber, EDR2 radiographic film, and a 2D ionization chamber array. Gamma index criteria {3%(global),3 mm} and {3%(global),3 mm} were used to assess the agreement between calculated and delivered planar dose distributions. Next, the AAPM TG 53 and ESTRO booklet No.7 recommendations were followed by dividing dose distributions into four distinct regions: the high‐dose (HD) or umbra region, the high‐gradient (HG) or penumbra region, the medium‐dose (MD) region, and the low‐dose (LD) region. A different gamma passing criteria was defined for each region, i.e., a “divide and conquer” (D&C) gamma method was utilized. The D&C gamma analysis was subsequently tested on 50 datasets of previously treated patients. Measured point dose and planar dose distributions compared favorably with TG 119 benchmark data. For all complex tests, the percentage of points passing the conventional {3%(global),3 mm} gamma criteria was 97.2%±3.2% and 95.7%±1.2% for film and 2D ionization chamber array, respectively. By dividing 2D ionization chamber array dose measurements into regions and applying 3 mm isodose point distance and variable local point dose difference criteria of 7%, 15%, 25%, and 40% for HD, HG, MD, and LD regions, respectively, a 93.4%±2.3% gamma passing rate was obtained. Identical criteria applied using the D&C gamma technique on 50 clinical treatment plans resulted in a 97.9%±2.3% gamma passing score. Based on the TG 119 standard, meeting or exceeding the benchmark results would indicate an exemplary IMRT QA program. In contrast to TG 119 analysis, a different scrutiny on the same set of data, which follows the AAPM TG 53 and ESTRO booklet No.7 guidelines, reveals a much poorer agreement between calculated and measured dose distributions with large local point dose differences within different dose regions. This observation may challenge the conventional wisdom that an IMRT QA program is producing acceptable results. PACS number: 87.55.Qr

The Role of Hypofractionated Radiation Therapy with Photons, Protons, and Heavy Ions for Treating Extracranial Lesions.

Traditionally, the ability to deliver large doses of ionizing radiation to a tumor has been limited by radiation-induced toxicity to normal surrounding tissues. This was the initial impetus for the development of conventionally fractionated radiation therapy, where large volumes of healthy tissue received radiation and were allowed the time to repair the radiation damage. However, advances in radiation delivery techniques and image guidance have allowed for more ablative doses of radiation to be delivered in a very accurate, conformal, and safe manner with shortened fractionation schemes. Hypofractionated regimens with photons have already transformed how certain tumor types are treated with radiation therapy. Additionally, hypofractionation is able to deliver a complete course of ablative radiation therapy over a shorter period of time compared to conventional fractionation regimens making treatment more convenient to the patient and potentially more cost-effective. Recently, there has been an increased interest in proton therapy because of the potential further improvement in dose distributions achievable due to their unique physical characteristics. Furthermore, with heavier ions the dose conformality is increased and, in addition, there is potentially a higher biological effectiveness compared to protons and photons. Due to the properties mentioned above, charged particle therapy has already become an attractive modality to further investigate the role of hypofractionation in the treatment of various tumors. This review will discuss the rationale and evolution of hypofractionated radiation therapy, the reported clinical success with initially photon and then charged particle modalities, and further potential implementation into treatment regimens going forward.

Initial development of goCMC: a GPU-oriented fast cross-platform Monte Carlo engine for carbon ion therapy

Monte Carlo (MC) simulation is considered as the most accurate method for calculation of absorbed dose and fundamental physics quantities related to biological effects in carbon ion therapy. To improve its computational efficiency, we have developed a GPU-oriented fast MC package named goCMC, for carbon therapy. goCMC simulates particle transport in voxelized geometry with kinetic energy up to 450 MeV u-1. Class II condensed history simulation scheme with a continuous slowing down approximation was employed. Energy straggling and multiple scattering were modeled. δ-electrons were terminated with their energy locally deposited. Four types of nuclear interactions were implemented in goCMC, i.e. carbon-hydrogen, carbon-carbon, carbon-oxygen and carbon-calcium inelastic collisions. Total cross section data from Geant4 were used. Secondary particles produced in these interactions were sampled according to particle yield with energy and directional distribution data derived from Geant4 simulation results. Secondary charged particles were transported following the condensed history scheme, whereas secondary neutral particles were ignored. goCMC was developed under OpenCL framework and is executable on different platforms, e.g. GPU and multi-core CPU. We have validated goCMC with Geant4 in cases with different beam energy and phantoms including four homogeneous phantoms, one heterogeneous half-slab phantom, and one patient case. For each case [Formula: see text] carbon ions were simulated, such that in the region with dose greater than 10% of maximum dose, the mean relative statistical uncertainty was less than 1%. Good agreements for dose distributions and range estimations between goCMC and Geant4 were observed. 3D gamma passing rates with 1%/1 mm criterion were over 90% within 10% isodose line except in two extreme cases, and those with 2%/1 mm criterion were all over 96%. Efficiency and code portability were tested with different GPUs and CPUs. Depending on the beam energy and voxel size, the computation time to simulate [Formula: see text] carbons was 9.9-125 s, 2.5-50 s and 60-612 s on an AMD Radeon GPU card, an NVidia GeForce GTX 1080 GPU card and an Intel Xeon E5-2640 CPU, respectively. The combined accuracy, efficiency and portability make goCMC attractive for research and clinical applications in carbon ion therapy.

Dosimetric comparison of Acuros XB with collapsed cone convolution/superposition and anisotropic analytic algorithm for stereotactic ablative radiotherapy of thoracic spinal metastases

The aim of this study is to compare the recent Eclipse Acuros XB (AXB) dose calculation engine with the Pinnacle collapsed cone convolution/superposition (CCC) dose calculation algorithm and the Eclipse anisotropic analytic algorithm (AAA) for stereotactic ablative radiotherapy (SAbR) treatment planning of thoracic spinal (T-spine) metastases using IMRT and VMAT delivery techniques. The three commissioned dose engines (CCC, AAA, and AXB) were validated with ion chamber and EBT2 film measurements utilizing a heterogeneous slab-geometry water phantom and an anthropomorphic phantom. Step-and-shoot IMRT and VMAT treatment plans were developed and optimized for eight patients in Pinnacle, following our institutional SAbR protocol for spinal metastases. The CCC algorithm, with heterogeneity corrections, was used for dose calculations. These plans were then exported to Eclipse and recalculated using the AAA and AXB dose calculation algorithms. Various dosimetric parameters calculated with CCC and AAA were compared to that of the AXB calculations. In regions receiving above 50% of prescription dose, the calculated CCC mean dose is 3.1%-4.1% higher than that of AXB calculations for IMRT plans and 2.8%-3.5% higher for VMAT plans, while the calculated AAA mean dose is 1.5%-2.4% lower for IMRT and 1.2%-1.6% lower for VMAT. Statistically significant differences (p<0.05) were observed for most GTV and PTV indices between the CCC and AXB calculations for IMRT and VMAT, while differences between the AAA and AXB calculations were not statistically significant. For T-spine SAbR treatment planning, the CCC calculations give a statistically significant overestimation of target dose compared to AXB. AAA underestimates target dose with no statistical significance compared to AXB. Further study is needed to determine the clinical impact of these findings. PACS number: 87.55.D-, 87.53.Ly.The aim of this study is to compare the recent Eclipse Acuros XB (AXB) dose calculation engine with the Pinnacle collapsed cone convolution/superposition (CCC) dose calculation algorithm and the Eclipse anisotropic analytic algorithm (AAA) for stereotactic ablative radiotherapy (SAbR) treatment planning of thoracic spinal (T‐spine) metastases using IMRT and VMAT delivery techniques. The three commissioned dose engines (CCC, AAA, and AXB) were validated with ion chamber and EBT2 film measurements utilizing a heterogeneous slab‐geometry water phantom and an anthropomorphic phantom. Step‐and‐shoot IMRT and VMAT treatment plans were developed and optimized for eight patients in Pinnacle, following our institutional SAbR protocol for spinal metastases. The CCC algorithm, with heterogeneity corrections, was used for dose calculations. These plans were then exported to Eclipse and recalculated using the AAA and AXB dose calculation algorithms. Various dosimetric parameters calculated with CCC and AAA were compared to that of the AXB calculations. In regions receiving above 50% of prescription dose, the calculated CCC mean dose is 3.1%–4.1% higher than that of AXB calculations for IMRT plans and 2.8%–3.5% higher for VMAT plans, while the calculated AAA mean dose is 1.5%–2.4% lower for IMRT and 1.2%–1.6% lower for VMAT. Statistically significant differences (p<0.05) were observed for most GTV and PTV indices between the CCC and AXB calculations for IMRT and VMAT, while differences between the AAA and AXB calculations were not statistically significant. For T‐spine SAbR treatment planning, the CCC calculations give a statistically significant overestimation of target dose compared to AXB. AAA underestimates target dose with no statistical significance compared to AXB. Further study is needed to determine the clinical impact of these findings. PACS number: 87.55.D‐, 87.53.Ly

SU-C-BRC-06: OpenCL-Based Cross-Platform Monte Carlo Simulation Package for Carbon Ion Therapy

PURPOSE Monte Carlo (MC) simulation is considered to be the most accurate method for calculation of absorbed dose and fundamental physical quantities related to biological effects in carbon ion therapy. Its long computation time impedes clinical and research applications. We have developed an MC package, goCMC, on parallel processing platforms, aiming at achieving accurate and efficient simulations for carbon therapy. METHODS goCMC was developed under OpenCL framework. It supported transport simulation in voxelized geometry with kinetic energy up to 450 MeV/u. Class II condensed history algorithm was employed for charged particle transport with stopping power computed via Bethe-Bloch equation. Secondary electrons were not transported with their energy locally deposited. Energy straggling and multiple scattering were modeled. Production of secondary charged particles from nuclear interactions was implemented based on cross section and yield data from Geant4. They were transported via the condensed history scheme. goCMC supported scoring various quantities of interest e.g. physical dose, particle fluence, spectrum, linear energy transfer, and positron emitting nuclei. RESULTS goCMC has been benchmarked against Geant4 with different phantoms and beam energies. For 100 MeV/u, 250 MeV/u and 400 MeV/u beams impinging to a water phantom, range difference was 0.03 mm, 0.20 mm and 0.53 mm, and mean dose difference was 0.47%, 0.72% and 0.79%, respectively. goCMC can run on various computing devices. Depending on the beam energy and voxel size, it took 20∼100 seconds to simulate 107 carbons on an AMD Radeon GPU card. The corresponding CPU time for Geant4 with the same setup was 60∼100 hours. CONCLUSION We have developed an OpenCL-based cross-platform carbon MC simulation package, goCMC. Its accuracy, efficiency and portability make goCMC attractive for research and clinical applications in carbon therapy.

SU-E-T-389: Evaluation of Flattening-Filter-Free Arcs for Lung SBRT

Purpose: To evaluate dynamic conformal arc therapy (DCAT) and volumetric-modulated arc therapy (VMAT) using flattening-filter-free (FFF) beams for treating non-small cell lung cancer (NSCLC) with stereotactic body radiation therapy (SBRT). Methods: Five clinical patients, previously treated with SBRT using non-coplanar 3D conformal radiation therapy (3DCRT), were selected and re-planned with DCAT and VMAT with both FFF beam (6xFFF with a dose rate of 1200MU/min) and flattened beams (6x with 600 MU/min). All the arc plans were planned with one 360° arc and normalized to the same PTV coverage (100% prescription cover 95% PTV volume) for comparison. Treatment planning metrics such as R100%, R50%, D2cm and lung V20 were compared to the original plans. To evaluate the treatment efficiency differences, all the arc plans were delivered and plan delivery time was compared to that of the clinical treatment as recorded in Mosaiq. Results: All plans meet RTOG conformality constraints and normal tissue tolerances. Average R100% was similar for FFFDCAT (1.07±0.05), FFFVMAT (1.03±0.08) and flattened VMAT (fVMAT) (1.03±0.09) while flattened DCAT (fDCAT) (1.09±0.07) and 3DCRT (1.11±0.06) were significantly inferior (p<0.05, t test). FFFDCAT produced the best average intermediate dose conformality as indicated by R50% (3.86±0.44) and D2cm (43.7±5.3%) when compared to all the other techniques. Significant improvement (p<0.05) in lung V20 was also found with FFFDCAT (2.33±2.06%) when compared to FFFVMAT (2.48±2.03%), fVMAT (2.52±2.07%) and fDCAT (2.64±2.11%) and was slightly better than 3DCRT (2.43±2.04%), though not significant. The FFFDCAT delivery significantly improves the treatment efficiency with an average plan delivery time of 2.70±1.57 min (p<0.05), as compared to fDCAT (5.98±3.45min), fVMAT (6.51±2.94) and 3DCRT (25.14±5.67), but is not significantly better than the FFFVMAT (3.18±1.04). Conclusion: Combining FFF beams and DCAT provide promising improvements in NSCLC SBRT treatment in both plan quality and treatment efficiency and unlike VMAT, tumor coverage is not affected by MLC interplay effects.

SU-E-T-499: Initial Developments of An OpenCL-Based Cross-Platform Monte Carlo Dose Engine for Carbon Ion Therapy

Purpose Dose calculation is of critical importance for carbon ion therapy. Monte Carlo (MC) simulation is considered to be the most accurate method for calculation of absorbed dose and of all the more fundamental physical quantities related to biological effects. The long computation time, however, limits its routine clinical applications. We have recently started developing a fast MC package, gCMC for carbon therapy on a parallel processing platform, e.g. GPU, aiming at achieving sufficient efficiency to enable MC in clinically important tasks. This abstract reports our progress. Methods gCMC was developed in OpenCL environment. Our initial developments focused on water material. gCMC supported carbon ion transport in the energy range of 1–450 MeV/u. A Class II condensed history algorithm was implemented for charged particle transport simulations with stopping power computed via Bethe-Bloch equation. Energy straggling and multiple scattering were modeled. Total cross section of nuclear interaction was extracted from Geant4. At present, nuclear interaction events were sampled but transports of secondary particles were not included. Results We tested cases with a homogeneous water phantom and a pencil carbon ion beam with energy of 200–400 MeV/u. When only electro-magnetic channel was included, dose/fluence difference between gCMC and Geant4 results averaged within 10% isodose line was <0.5% of the maximum dose/fluence. After enabling nuclear interactions without transporting secondary particles, dose and fluence agreed with the corresponding results computed by Geant4 with <1% difference. Due to the support for multiple platforms of OpenCL, gCMC was executable on NVidia and AMD GPUs, and Intel CPUs. It took ∼50 sec to transport 107 200MeV/u source carbon ions on an NVidia Titan GPU card. Conclusion Preliminary studies have demonstrated the accuracy and efficiency of gCMC. With further developments in near future, gCMC will potentially achieve clinically acceptable fast and accurate MC simulations for carbon ion therapy.

International Symposium on Ion Therapy: Planning the First Hospital-Based Heavy Ion Therapy Center in the United States

Investigation into the use of heavy ions for therapeutic purposes was initially pioneered at Lawrence Berkeley National Laboratory in the 1970s [1, 2]. More recently, however, significant advances in determining the safety and efficacy of using heavy ions in the hospital setting have been reported in Japan and Germany [3, 4]. These promising results have helped to resurrect interest in the establishment of hospital-based heavy ion therapy in the United States. In line with these efforts, world experts in the field of heavy ion therapy were invited to attend the first annual International Symposium on Ion Therapy, which was held at the University of Texas Southwestern Medical Center, Dallas, Texas, from November 12 to 14, 2014. A brief overview of the results and discussions that took place during the symposium are presented in this article.