Dieter Schardt

Magnetic scanning system for heavy ion therapy

Abstract Beams of heavy ions have favourable physical and biological properties for the use in radiotherapy. These advantages are most pronoucced if the beam is delivered in a tumor-conform way by active beam scanning. A magnetic scanning technique is used to spread the beam laterally. The range of the particles in tissue is controlled by the variation of the beam energy in the accelerator. Computer simulations were used to compare a discrete scan mode (pixel scan) with a continous scan mode (raster scan). It was found that both methods lead to nearly identical results. The design and technical realization of the magnetic scanning system at GSI combines features of both scan techniques. First results using the lateral beam scanning method as well as the combination of the active energy variation with the magnetic beam scanning are presented.

Treatment planning for heavy-ion radiotherapy: physical beam model and dose optimization

We describe a novel code system, TRiP, dedicated to the planning of radiotherapy with energetic ions, in particular 12C. The software is designed to cooperate with three-dimensional active dose shaping devices like the GSI raster scan system. This unique beam delivery system allows us to select any combination from a list of 253 individual beam energies, 7 different beam spot sizes and 15 intensity levels. The software includes a beam model adapted to and verified for carbon ions. Inverse planning techniques are implemented in order to obtain a uniform target dose distribution from clinical input data, i.e. CT images and patient contours. This implies the automatic generation of intensity modulated fields of heavy ions with as many as 40000 raster points, where each point corresponds to a specific beam position, energy and particle fluence. This set of data is directly passed to the beam delivery and control system. The treatment planning code has been in clinical use since the start of the GSI pilot project in December 1997. Forty-eight patients have been successfully planned and treated.

Treatment planning for scanned ion beams

Since 1997 a radiotherapy unit using fast carbon ions is operational at GSI. An intensity-controlled magnetic raster scanner together with a synchrotron allowing fast energy variation enable a unique method of purely active dose shaping in three dimensions. This contribution describes the necessary steps to establish a treatment planning system for this novel modality. We discuss the requirements for the physical beam model and the radiobiological model. Based on these we chose to implement a home-grown pencil beam model to describe the ion-tissue interaction and the Local Effect Model to calculate the RBE voxel-by-voxel. Given the large number of degrees of freedom biological dose optimization must be achieved by means of inverse treatment planning. All ion-related aspects are collected in our TRiP98 software. Biological dosimetry measuring cell survival in two dimensions turns out to be a good way to verify the model predictions as well as the actual irradiation procedure. We show a patient example and outline the future steps towards a dedicated clinic facility for all light ions.

Target motion tracking with a scanned particle beam

Treatment of moving targets with scanned particle beams results in local over- and under-dosage due to interplay of beam and target motion. To mitigate the impact of respiratory motion, a motion tracking system has been developed and integrated in the therapy control system at Gesellschaft für Schwerionenforschung. The system adapts pencil beam positions as well as the beam energy according to target motion to irradiate the planned position. Motion compensation performance of the tracking system was assessed by measurements with radiographic films and a 3D array of 24 ionization chambers. Measurements were performed for stationary detectors and moving detectors using the tracking system. Film measurements showed comparable homogeneity inside the target area. Relative differences of 3D dose distributions within the target volume were 1 +/- 2% with a maximum of 4%. Dose gradients and dose to surrounding areas were in good agreement. The motion tracking system successfully preserved dose distributions delivered to moving targets and maintained target conformity.

Relation between carbon ion ranges and x-ray CT numbers.

Measurements of carbon ion ranges in various phantom materials and real bones are presented. Together with measured Hounsfield values, an empirical relation between ranges and Hounsfield units is derived, which is an important prerequisite for treatment planning in carbon ion therapy.

Speed and accuracy of a beam tracking system for treatment of moving targets with scanned ion beams

The technical performance of an integrated three-dimensional carbon ion pencil beam tracking system that was developed at GSI was investigated in phantom studies. Aim of the beam tracking system is to accurately treat tumours that are subject to respiratory motion with scanned ion beams. The current system provides real-time control of ion pencil beams to track a moving target laterally using the scanning magnets and longitudinally with a dedicated range shifter. The system response time was deduced to be approximately 1 ms for lateral beam tracking. The range shifter response time has been measured for various range shift amounts. A value of 16 +/- 2 ms was achieved for a water equivalent shift of 5 mm. An additional communication delay of 11 +/- 2 ms was taken into account in the beam tracking process via motion prediction. Accuracy of the lateral beam tracking was measured with a multi-wire position detector to < or =0.16 mm standard deviation. Longitudinal beam tracking accuracy was parameterized based on measured responses of the range shifter and required time durations to maintain a specific particle range. For example, 5 mm water equivalence (WE) longitudinal beam tracking results in accuracy of 1.08 and 0.48 mm WE in root mean square for time windows of 10 and 50 ms, respectively.

Range accuracy in carbon ion treatment planning based on CT-calibration with real tissue samples

BackgroundThe precision in carbon ion radiotherapy depends on the calibration of Hounsfield units (HU) as measured with computed tomography (CT) to water equivalence. This calibration can cause relevant differences between treatment planning and treatment delivery.MethodsCalibration data for several soft tissues were measured repeatedly to assess the accuracy of range calibration. Samples of fresh animal tissues including fat, brain, kidney, liver, and several muscle tissues were used. First, samples were CT scanned. Then carbon ion radiographic measurements were performed at several positions. Residual ranges behind the samples were compared to ranges in water.ResultsBased on the measured data the accuracy of the current Hounsfield look-up table for range calibration of soft tissues is 0.2 ± 1.2%. Accuracy in range calibration of 1% corresponds to ~1 mm carbon ion range control in 10 cm water equivalent depth which is comparable to typical treatment depths for head and neck tumors.ConclusionCarbon ion ranges can be controlled within ~1 mm in soft tissue for typical depths of head and neck treatments.

A dosimetry system for fast measurement of 3D depth–dose profiles in charged-particle tumor therapy with scanning techniques

Abstract The high complexity and high instantaneous dose rates of the intensity modulated treatment plans performed using carbon beams at GSI require a good granularity of the dose verification procedures. As a consequence, a new detector system was developed in order to obtain a 3D reconstruction of the relative depth–dose distributions in a short time, with high granularity and over large volumes. The system takes advantage of the active beam delivery system operative in the therapy facility of GSI and consists of one position sensitive detector with a stack of ionization chambers and a range-shifter. After a technical description of the apparatus, the procedure to reconstruct the 3D measurements is explained and the possible sources of errors in the measurements are analyzed. Finally, the results of the measurement of some treatment plans are shown.

Experimental study of nuclear fragmentation of 200 and 400 MeV/u 12C ions in water for applications in particle therapy

Carbon ion beams in the energy range of about 100-450 MeV/u offer excellent conditions for tumour therapy, in particular for the treatment of deep-seated radio-resistant tumours. Their depth-dose distribution is characterized by a low dose in the entrance channel, small lateral beam spread and an elevated biological effectiveness in the Bragg peak region. In comparison to protons the radiation field of heavier ions stopping in tissue is however more complex due to nuclear fragmentation reactions occurring along their stopping path. This results in an attenuation of the primary beam flux and a build-up of lower-Z fragments with longer ranges causing the characteristic dose tail beyond the Bragg peak. In the present work the characteristics of secondary charged particles at various depths of water were investigated experimentally using (12)C ion beams of 200 and 400 MeV/u delivered by the heavy-ion synchrotron SIS-18 at GSI Darmstadt. The nuclear charge Zf of secondary fragments was identified by combining energy loss and time-of-flight (TOF) measurements. Energy spectra and yields were recorded at lab angles of 0° - 10° and at seven different water depths corresponding to the entrance channel, the Bragg peak region and the tail of the Bragg curve.

Dosimetric precision of an ion beam tracking system

BackgroundScanned ion beam therapy of intra-fractionally moving tumors requires motion mitigation. GSI proposed beam tracking and performed several experimental studies to analyse the dosimetric precision of the system for scanned carbon beams.MethodsA beam tracking system has been developed and integrated in the scanned carbon ion beam therapy unit at GSI. The system adapts pencil beam positions and beam energy according to target motion.Motion compensation performance of the beam tracking system was assessed by measurements with radiographic films, a range telescope, a 3D array of 24 ionization chambers, and cell samples for biological dosimetry. Measurements were performed for stationary detectors and moving detectors using the beam tracking system.ResultsAll detector systems showed comparable data for a moving setup when using beam tracking and the corresponding stationary setup. Within the target volume the mean relative differences of ionization chamber measurements were 0.3% (1.5% standard deviation, 3.7% maximum). Film responses demonstrated preserved lateral dose gradients. Measurements with the range telescope showed agreement of Bragg peak depth under motion induced range variations. Cell survival experiments showed a mean relative difference of -5% (-3%) between measurements and calculations within the target volume for beam tracking (stationary) measurements.ConclusionsThe beam tracking system has been successfully integrated. Full functionality has been validated dosimetrically in experiments with several detector types including biological cell systems.