Edgar Gelover

A method for modeling laterally asymmetric proton beamlets resulting from collimation.

PURPOSE To introduce a method to model the 3D dose distribution of laterally asymmetric proton beamlets resulting from collimation. The model enables rapid beamlet calculation for spot scanning (SS) delivery using a novel penumbra-reducing dynamic collimation system (DCS) with two pairs of trimmers oriented perpendicular to each other. METHODS Trimmed beamlet dose distributions in water were simulated with MCNPX and the collimating effects noted in the simulations were validated by experimental measurement. The simulated beamlets were modeled analytically using integral depth dose curves along with an asymmetric Gaussian function to represent fluence in the beams eye view (BEV). The BEV parameters consisted of Gaussian standard deviations (sigmas) along each primary axis (σ(x1),σ(x2),σ(y1),σ(y2)) together with the spatial location of the maximum dose (μ(x),μ(y)). Percent depth dose variation with trimmer position was accounted for with a depth-dependent correction function. Beamlet growth with depth was accounted for by combining the in-air divergence with Hongs fit of the Highland approximation along each axis in the BEV. RESULTS The beamlet model showed excellent agreement with the Monte Carlo simulation data used as a benchmark. The overall passing rate for a 3D gamma test with 3%/3 mm passing criteria was 96.1% between the analytical model and Monte Carlo data in an example treatment plan. CONCLUSIONS The analytical model is capable of accurately representing individual asymmetric beamlets resulting from use of the DCS. This method enables integration of the DCS into a treatment planning system to perform dose computation in patient datasets. The method could be generalized for use with any SS collimation system in which blades, leaves, or trimmers are used to laterally sharpen beamlets.

Theoretical Benefits of Dynamic Collimation in Pencil Beam Scanning Proton Therapy for Brain Tumors: Dosimetric and Radiobiological Metrics

PURPOSE To quantify the dosimetric benefit of using a dynamic collimation system (DCS) for penumbra reduction during the treatment of brain tumors by pencil beam scanning proton therapy (PBS PT). METHODS AND MATERIALS Collimated and uncollimated brain treatment plans were created for 5 patients previously treated with PBS PT and retrospectively enrolled in an institutional review board-approved study. The in-house treatment planning system, RDX, was used to generate the plans because it is capable of modeling both collimated and uncollimated beamlets. The clinically delivered plans were reproduced with uncollimated plans in terms of target coverage and organ at risk (OAR) sparing to ensure a clinically relevant starting point, and collimated plans were generated to improve the OAR sparing while maintaining target coverage. Physical and biological comparison metrics, such as dose distribution conformity, mean and maximum doses, normal tissue complication probability, and risk of secondary brain cancer, were used to evaluate the plans. RESULTS The DCS systematically improved the dose distribution conformity while preserving the target coverage. The average reduction of the mean dose to the 10-mm ring surrounding the target and the healthy brain were 13.7% (95% confidence interval [CI] 11.6%-15.7%; P<.0001) and 25.1% (95% CI 16.8%-33.4%; P<.001), respectively. This yielded an average reduction of 24.8% (95% CI 0.8%-48.8%; P<.05) for the brain necrosis normal tissue complication probability using the Flickinger model, and 25.1% (95% CI 16.8%-33.4%; P<.001) for the risk of secondary brain cancer. A general improvement of the OAR sparing was also observed. CONCLUSION The lateral penumbra reduction afforded by the DCS increases the normal tissue sparing capabilities of PBS PT for brain cancer treatment while preserving target coverage.

A method to select aperture margin in collimated spot scanning proton therapy

The use of collimator or aperture may sharpen the lateral dose gradient for spot scanning proton therapy. However, to date, there has not been a standard method to determine the aperture margin for a single field in collimated spot scanning proton therapy. This study describes a theoretical framework to select the optimal aperture margin for a single field, and also presents the spot spacing limit required such that the optimal aperture margin exists. Since, for a proton pencil beam partially intercepted by collimator, the maximum point dose (spot center) shifts away from the original pencil beam central axis, we propose that the optimal margin should be equal to the maximum pencil beam center shift under the condition that spot spacing is small with respect to the maximum pencil beam center shift, which can be numerically determined based on beam modeling data. A test case is presented which demonstrates agreement with the prediction made based on the proposed methods. When apertures are applied in a commercial treatment planning system this method may be implemented.

Toward improved target conformity for two spot scanning proton therapy delivery systems using dynamic collimation.

PURPOSE To quantify improvement in target conformity in brain and head and neck tumor treatments resulting from the use of a dynamic collimation system (DCS) with two spot scanning proton therapy delivery systems (universal nozzle, UN, and dedicated nozzle, DN) with median spot sizes of 5.2 and 3.2 mm over a range of energies from 100 to 230 MeV. METHODS Uncollimated and collimated plans were calculated with both UN and DN beam models implemented within our in-house treatment planning system for five brain and ten head and neck datasets in patients previously treated with spot scanning proton therapy. The prescription dose and beam angles from the clinical plans were used for both the UN and DN plans. The average reduction of the mean dose to the 10-mm ring surrounding the target between the uncollimated and collimated plans was calculated for the UN and the DN. Target conformity was analyzed using the mean dose to 1-mm thickness rings surrounding the target at increasing distances ranging from 1 to 10 mm. RESULTS The average reductions of the 10-mm ring mean dose for the UN and DN plans were 13.7% (95% CI: 11.6%-15.7%; p < 0.0001) and 11.5% (95% CI: 9.5%-13.5%; p < 0.0001) across all brain cases and 7.1% (95% CI: 4.4%-9.8%; p < 0.001) and 6.3% (95% CI: 3.7%-9.0%; p < 0.001), respectively, across all head and neck cases. The collimated UN plans were either more conformal (all brain cases and 60% of the head and neck cases) than or equivalent (40% of the head and neck cases) to the uncollimated DN plans. The collimated DN plans offered the highest conformity. CONCLUSIONS The DCS added either to the UN or DN improved the target conformity. The DCS may be of particular interest for sites with UN systems looking for a more economical solution than upgrading the nozzle to improve the target conformity of their spot scanning proton therapy system.

Technical Note: A treatment plan comparison between dynamic collimation and a fixed aperture during spot scanning proton therapy for brain treatment

PURPOSE To quantitatively assess the advantages of energy-layer specific dynamic collimation system (DCS) versus a per-field fixed aperture for spot scanning proton therapy (SSPT). METHODS Five brain cancer patients previously planned and treated with SSPT were replanned using an in-house treatment planning system capable of modeling collimated and uncollimated proton beamlets. The uncollimated plans, which served as a baseline for comparison, reproduced the target coverage and organ-at-risk sparing of the clinically delivered plans. The collimator opening for the fixed aperture-based plans was determined from the combined cross sections of the target in the beams eye view over all energy layers which included an additional margin equivalent to the maximum beamlet displacement for the respective energy of that energy layer. The DCS-based plans were created by selecting appropriate collimator positions for each row of beam spots during a Raster-style scanning pattern which were optimized to maximize the dose contributions to the target and limited the dose delivered to adjacent normal tissue. RESULTS The reduction of mean dose to normal tissue adjacent to the target, as defined by a 10 mm ring surrounding the target, averaged 13.65% (range: 11.8%-16.9%) and 5.18% (2.9%-7.1%) for the DCS and fixed aperture plans, respectively. The conformity index, as defined by the ratio of the volume of the 50% isodose line to the target volume, yielded an average improvement of 21.35% (19.4%-22.6%) and 8.38% (4.7%-12.0%) for the DCS and fixed aperture plans, respectively. CONCLUSIONS The ability of the DCS to provide collimation to each energy layer yielded better conformity in comparison to fixed aperture plans.

SU-F-T-298: The Impact of Modeling the Treatment Couch On Patient Specific VMAT QA

PURPOSE The aim of this work is to quantify the impact of modeling the treatment couch on the passing rate of ion chamber measurements during VMAT quality assurance. METHODS For the initial characterization, attenuation and surface dose measurements were performed following the guidelines of TG-176 for the Civco Universal couch top using an Elekta VersaHD accelerator at an energy of 6 MV. A simulation CT was performed to aid in the creation of contours for representing the shape and size of the couch top in the treatment planning system (TPS). A uniform value of density for the couch wall was determined by comparing the ratios of ion chamber measurements made in a 30×30×11 cm3 water phantom with the TPS dose values of a plan with the same geometry. At our institution, patient specific quality assurance is performed using a Sun Nuclear ArcCheck with a multi-plug for chamber measurements, a 0.125cc PTW TN31010 chamber, and a Sun Nuclear 1010 electrometer. Ten VMAT plans were transferred into the phantom geometry created in the TPS with two settings: with and without the couch. The chamber measurements were compared to both treatment plans. RESULTS A maximum attenuation of 3.6% was observed when the gantry angle was set to 120 and 240 degrees, passing obliquely through the couch. A uniform density of 0.6 g/cm3 for the couch wall was determined in the TPS by comparison with measured data. The VMAT ion chamber measurement/plan ratios systematically improved by 1.79% ±0.53% for all patients when the couch was included in the calculation. CONCLUSION The attenuation and surface dose changes produced by the Civco couch can generate observable dose difference in VMAT plans. Including a couch model in the phantom plan used for patient specific VMAT QA can improve the ionization chamber agreement by up to ∼2%.

Improving Head and Neck Cancer Treatments Using Dynamic Collimation in Spot Scanning Proton Therapy

Purpose Interest in using collimation for spot scanning proton therapy has recently increased in an attempt to improve the lateral penumbra. To investigate the advantages of such an approach for complex targets, a plan comparison between uncollimated and collimated beam spots was performed for patients with head and neck cancer. Patients and Methods For 10 patients with head and neck cancer, previously treated with spot scanning proton therapy, uncollimated and collimated treatment plans were created using an in-house treatment-planning system capable of modeling asymmetric-beamlet dose distributions resulting from the use of a dynamic collimation system. Both uncollimated and collimated plans reproduced clinically delivered plans in terms of target coverage. A relative plan comparison was performed using both physical and radiobiological metrics on the organs at risk. Results The dynamic collimation system improved dose-distribution conformity while preserving target coverage. The median reduction of the mean dose to the esophagus, uninvolved larynx, and uninvolved parotids were -11.9% (minimum to maximum, -6.4% to -24.1%), -7.2% (-0.8% to -60.1%), and -5.2% (-0.2% to -21.5%), respectively, and depended on the organ location relative to the target and radiation beam angle. The collimation did not improve dose to some organs at risk surrounded by the target or located upstream of Bragg peaks because of the priority on the target coverage. Conclusion In spot scanning proton therapy, the dynamic collimation system generally affords better target conformity, which results in improvement in organ-at-risk sparing in the head and neck region while preserving target coverage. However, the benefits of collimation and the increased complexity should be considered for each patient. Patients with large bilateral targets or organs at risk surrounded by the target showed the least benefit.

MSPT: An open-source motion simulator for proton therapy

The dosimetric benefits of proton therapy may be greatly degraded when the tumor or organs move during the treatment. Hence, mitigation or adaptive methods have become topics of research interest. These techniques require dose computation on time-dependent patient geometry. We developed an open-source four-dimensional dose computation and evaluation software, Motion Simulator for Proton Therapy (MSPT), for the spot-scanning delivery technique. It aims at highlighting the impact of the patient motion during a treatment delivery by computing dose on the moving patient. The main interest of this simulator lies in the ability to render the impact of a predicted patient motion on a prescribed treatment plan. MSPT used proton pencil beam algorithm for dose computation, and the dose in patient geometry computed by MSPT was able to match that computed by the commercial treatment planning system. MSPT was able to render the impact of motion on patient data sets. This capability makes it an innovative research tool to evaluate and compare different methods of motion management or mitigation. The open-source feature makes it appealing, since it is intended to evolve, to be improved and to be the starting point of new research on patient motion in proton therapy.

TH-C-BRD-03: Determining the Optimal Collimator Position for Collimated Pencil Beam Scanning Proton Therapy

PURPOSE There has been a growing interest in applying collimation to pencil beam scanning (PBS) proton therapy in order to sharpen the lateral dose falloff out of the target, especially at low energies. Currently, there is not a method to optimally determine the collimation position or margin around the target. A uniform margin would not be ideal due to the fact that an incoming symmetric pencil beam, after being intercepted by a collimator near the target boundary, will become asymmetric and experience a lateral shift away from its original spot location, leaving the target insufficiently covered. We demonstrate a method that optimally determines the collimator position on a per-spot basis, in order to maximize target dose while minimizing normal tissue dose. METHODS A library of collimated pencil beams were obtained through Monte Carlo simulation with a collimator placed at varying distances from the central axis of an incoming symmetrical pencil beam of 118 MeV and 5 mm sigma-in-air. Two-dimensional treatment plans were then created using this library of collimated pencil beams. For each spot position in a treatment plan, the collimator position was optimally determined in such a way that the resultant pencil beam maximized the ratio of in-target dose and out-of-target dose. For comparison, un-collimated treatment plans were also computed. RESULTS The spot-by-spot optimally determined collimator positions allowed the reduction of normal tissue dose while maintaining the same target coverage as un-collimated PBS. Quantitatively, the mean dose outside of the target was reduced by approximately 40% as compared to the plan without collimation. CONCLUSION The proposed method determines the optimal collimator position for each spot in collimated PBS proton therapy. The use of a collimator will improve PBS dose distributions achievable today and will continue to be the subject of future investigations.

TH-C-BRD-02: Analytical Modeling and Dose Calculation Method for Asymmetric Proton Pencil Beams

PURPOSE A dynamic collimation system (DCS), which consists of two pairs of orthogonal trimmer blades driven by linear motors has been proposed to decrease the lateral penumbra in pencil beam scanning proton therapy. The DCS reduces lateral penumbra by intercepting the proton pencil beam near the lateral boundary of the target in the beams eye view. The resultant trimmed pencil beams are asymmetric and laterally shifted, and therefore existing pencil beam dose calculation algorithms are not capable of trimmed beam dose calculations. This work develops a method to model and compute dose from trimmed pencil beams when using the DCS. METHODS MCNPX simulations were used to determine the dose distributions expected from various trimmer configurations using the DCS. Using these data, the lateral distribution for individual beamlets was modeled with a 2D asymmetric Gaussian function. The integral depth dose (IDD) of each configuration was also modeled by combining the IDD of an untrimmed pencil beam with a linear correction factor. The convolution of these two terms, along with the Highland approximation to account for lateral growth of the beam along the depth direction, allows a trimmed pencil beam dose distribution to be analytically generated. The algorithm was validated by computing dose for a single energy layer 5×5 cm2 treatment field, defined by the trimmers, using both the proposed method and MCNPX beamlets. RESULTS The Gaussian modeled asymmetric lateral profiles along the principal axes match the MCNPX data very well (R2 ≥0.95 at the depth of the Bragg peak). For the 5×5 cm2 treatment plan created with both the modeled and MCNPX pencil beams, the passing rate of the 3D gamma test was 98% using a standard threshold of 3%/3 mm. CONCLUSION An analytical method capable of accurately computing asymmetric pencil beam dose when using the DCS has been developed.