Hermann Fuchs

A pencil beam algorithm for helium ion beam therapy

PURPOSEnTo develop a flexible pencil beam algorithm for helium ion beam therapy. Dose distributions were calculated using the newly developed pencil beam algorithm and validated using Monte Carlo (MC) methods.nnnMETHODSnThe algorithm was based on the established theory of fluence weighted elemental pencil beam (PB) kernels. Using a new real-time splitting approach, a minimization routine selects the optimal shape for each sub-beam. Dose depositions along the beam path were determined using a look-up table (LUT). Data for LUT generation were derived from MC simulations in water using GATE 6.1. For materials other than water, dose depositions were calculated by the algorithm using water-equivalent depth scaling. Lateral beam spreading caused by multiple scattering has been accounted for by implementing a non-local scattering formula developed by Gottschalk. A new nuclear correction was modelled using a Voigt function and implemented by a LUT approach. Validation simulations have been performed using a phantom filled with homogeneous materials or heterogeneous slabs of up to 3 cm. The beams were incident perpendicular to the phantoms surface with initial particle energies ranging from 50 to 250 MeV/A with a total number of 10(7) ions per beam. For comparison a special evaluation software was developed calculating the gamma indices for dose distributions.nnnRESULTSnIn homogeneous phantoms, maximum range deviations between PB and MC of less than 1.1% and differences in the width of the distal energy fall off of the Bragg-Peak from 80% to 20% of less than 0.1 mm were found. Heterogeneous phantoms using layered slabs satisfied a γ-index criterion of 2%/2mm of the local value except for some single voxels. For more complex phantoms using laterally arranged bone-air slabs, the γ-index criterion was exceeded in some areas giving a maximum γ-index of 1.75 and 4.9% of the voxels showed γ-index values larger than one. The calculation precision of the presented algorithm was considered to be sufficient for clinical practice. Although only data for helium beams was presented, the performance of the pencil beam algorithm for proton beams was comparable.nnnCONCLUSIONSnThe pencil beam algorithm developed for helium ions presents a suitable tool for dose calculations. Its calculation speed was evaluated to be similar to other published pencil beam algorithms. The flexible design allows easy customization of measured depth-dose distributions and use of varying beam profiles, thus making it a promising candidate for integration into future treatment planning systems. Current work in progress deals with RBE effects of helium ions to complete the model.

Comparison of basic features of proton and helium ion pencil beams in water using GATE.

PURPOSEnThe aim of this study was to investigate the basic features of helium ions for their possible application in advanced radiotherapy and to benchmark them against protons, the current particle of choice in the low linear energy transfer (LET) range.nnnMATERIAL AND METHODSnGeant4 Application for Emission Tomography (GATE) simulations were performed with beams of 1x10(7) monodirectional particles traversing a water phantom. Initial energies ranged from 50 to 250xa0MeV per nucleon (MeV/A). The following parameters were evaluated: particle range at the distal 80% of maximum energy deposition (E(max)), width of the Bragg peak (BP) at 60% of E(max), and dose fall-off width between 80% and 20% of E(max) for longitudinal spectra. In addition the fragmentation tail was quantified in terms of length, percental energy deposition, and contributing particles. For each energy lateral profiles were registered along the beam axis and the FWHM at four different depths was extracted. Besides the comparison of parameters between the two particle types, results were also compared to data in the literature.nnnRESULTSnAs expected, the position of the BP as a function of initial kinetic energy showed similar values for protons and helium ions, with deviations smaller than 1.3%. The quantitative results of the Monte Carlo (MC) study showed less range straggling effects and smaller lateral deflections for helium ions compared to protons for the investigated energy range. On average, an about 56% reduction of the width of the BP and a 48% reduction of the dose fall-off was observed for helium ions compared to protons. Both the width of the BP and the dose fall-off width as a function of particle range or energy showed an almost linear increase with increasing energy. The tail length increased from 55.9xa0mm to 592.7xa0mm and the deposited energy increased from 0.5% to 7.3% for energies between 90 and 250xa0MeV/A. Lateral profiles of helium ions were about 52% narrower than those of protons.nnnCONCLUSIONSnDue to their mass and charge helium ions distinguish themselves from protons in reduced range straggling effects, smaller lateral deflections, and a fragmentation tail. The MC based comprehensive data set for 21 clinically relevant energies can be used to create look-up tables for semi-analytical pencil beam model for helium ions.

Implementation of spot scanning dose optimization and dose calculation for helium ions in Hyperion

PURPOSEnHelium ions ((4)He) may supplement current particle beam therapy strategies as they possess advantages in physical dose distribution over protons. To assess potential clinical advantages, a dose calculation module accounting for relative biological effectiveness (RBE) was developed and integrated into the treatment planning system Hyperion.nnnMETHODSnCurrent knowledge on RBE of (4)He together with linear energy transfer considerations motivated an empirical depth-dependent zonal RBE model. In the plateau region, a RBE of 1.0 was assumed, followed by an increasing RBE up to 2.8 at the Bragg-peak region, which was then kept constant over the fragmentation tail. To account for a variable proton RBE, the same model concept was also applied to protons with a maximum RBE of 1.6. Both RBE models were added to a previously developed pencil beam algorithm for physical dose calculation and included into the treatment planning system Hyperion. The implementation was validated against Monte Carlo simulations within a water phantom using γ-index evaluation. The potential benefits of (4)He based treatment plans were explored in a preliminary treatment planning comparison (against protons) for four treatment sites, i.e., a prostate, a base-of-skull, a pediatric, and a head-and-neck tumor case. Separate treatment plans taking into account physical dose calculation only or using biological modeling were created for protons and (4)He.nnnRESULTSnComparison of Monte Carlo and Hyperion calculated doses resulted in a γ mean of 0.3, with 3.4% of the values above 1 and γ 1% of 1.5 and better. Treatment plan evaluation showed comparable planning target volume coverage for both particles, with slightly increased coverage for (4)He. Organ at risk (OAR) doses were generally reduced using (4)He, some by more than to 30%. Improvements of (4)He over protons were more pronounced for treatment plans taking biological effects into account. All OAR doses were within tolerances specified in the QUANTEC report.nnnCONCLUSIONSnThe biological (4)He model proposed above is a first approach matching biological data published so far. The advantage of (4)He seems to lie in the reduction of dose to surrounding tissue and to OARs. Nevertheless, additional biological experiments and treatment planning studies with larger patient numbers and more tumor indications are necessary to study the possible benefits of helium ion beam therapy in detail.

Can particle beam therapy be improved using helium ions? - a planning study focusing on pediatric patients.

Abstract Aim To explore the potential of scanned helium ion beam therapy (4He) compared to proton therapy in a comparative planning study focusing on pediatric patients. This was motivated by the superior biological and physical characteristics of 4He. Material and methods For eleven neuroblastoma (NB), nine Hodgkin lymphoma (HL), five Wilms tumor (WT), five ependymoma (EP) and four Ewing sarcoma (EW) patients, treatment plans were created for protons and 4He. Dose prescription to the planning target volume (PTV) was 21u2009Gy [relative biological effectiveness (RBE)] (NB), 19.8u2009Gy (RBE) (HL), 25.2u2009Gy (RBE) for the WT boost volume and 54u2009Gy (RBE) for EP and EW patients. A pencil beam algorithm for protons (constant RBEu2009=u20091.1) and 4He was implemented in the treatment planning system Hyperion. For 4He the relative biological effectiveness (RBE) was calculated with a ‘zonal’ model based on different linear energy transfer regions. Results Target constraints were fulfilled for all indications. For NB patients differences for kidneys and liver were observed for all dose-volume areas, except the high-dose volume. The body volume receiving up to 12.6u2009Gy (RBE) was reduced by up to 10% with 4He. For WT patients the mean and high-dose volume for the liver was improved when using 4He. For EP normal tissue dose was reduced using 4He with 12.7% of the voxels receiving higher doses using protons. For HL and EW sarcoma patients the combination of large PTV volumes with the position of the organs at risk (OARs) obliterated the differences between the two particle species, while patients with the heart close to the PTV could benefit from 4He. Conclusion Treatment plan quality improved with 4He compared to proton plans, but advantages in OAR sparing were depending on indication and tumor geometries. These first results of scanned 4He therapy motivate comprehensive research on 4He, including acquisition of experimental data to improve modeling of 4He.

Magnetic field effects on particle beams and their implications for dose calculation in MR guided particle therapy

Purpose: To investigate and model effects of magnetic fields on proton and carbon ion beams for dose calculation. Methods: In a first step, Monte Carlo simulations using Gate 7.1/Geant4.10.0.p03 were performed for proton and carbon ion beams in magnetic fields ranging from 0 to 3 T. Initial particle energies ranged from 60 to 250 MeV (protons) and 120 to 400 MeV/u (carbon ions), respectively. The resulting dose distributions were analyzed focusing on beam deflection, dose deformation, as well as the impact of material heterogeneities. In a second step, a numerical algorithm was developed to calculate the lateral beam position. Using the Runge–Kutta method, an iterative solution of the relativistic Lorentz equation, corrected for the changing particle energy during penetration, was performed. For comparison, a γ‐index analysis was utilized, using a criteria of 2%/2 mm of the local maximum. Results: A tilt in the dose distribution within the Bragg peak area was observed, leading to non‐negligible dose distribution changes. The magnitude was found to depend on the magnetic field strength as well as on the initial beam energy. Comparison of the 3 T dose distribution with non‐B field (nominal) dose distributions, resulted in a γmean (mean value of the γ distribution) of 0.6, with 14.4% of the values above 1 and γ1% (1% of all points have an equal or higher γ value) of 1.8. The presented numerical algorithm calculated the lateral beam offset with maximum errors of less than 2% with calculation times of less than 5 μs. The impact of tissue interfaces on the proton dose distributions was found to be less than 2% for a dose voxel size of 1 × 1 × 1 mm3. Conclusion: Non‐negligible dose deformations at the Bragg peak area were identified for high initial energies and strong magnetic fields. A fast numerical algorithm based on the solution of the energy‐corrected relativistic Lorentz equation was able to describe the beam path, taking into account the particle energy, magnetic field, and material.

Towards offline PET monitoring of proton therapy at MedAustron

The characteristic depth-dose profile of protons traveling through material is the main advantage of proton therapy over conventional radiotherapy with photons or electrons. However, uncertainties regarding the range of the protons in human tissue prevent to exploit the full potential of proton therapy. Therefore, a non-invasive in-vivo dose monitoring is desired. At the ion beam center MedAustron in Wiener Neustadt/Austria, patient treatment with proton beams started in December 2016. A PET/CT is available in close vicinity of the treatment rooms, exclusively dedicated to offline PET monitoring directly after the therapeutic irradiation. Preparations for a patient study include workflow tests under realistic clinical conditions using two different phantoms, irradiated with protons prior to the scan in the PET/CT. GATE simulations of the C-11 production are used as basis for the prediction of the PET measurement. We present results from the workflow tests in comparison with simulation results, and by this, we demonstrate the applicability of the PET monitoring at the MedAustron facility.

Characteristic of EBT-XD and EBT3 radiochromic film dosimetry for photon and proton beams

Recently, a new type of radiochromic film, the EBT-XD film, has been introduced for high dose radiotherapy. The EBT-XD film contains the same structure as the EBT3 film but has a slightly different composition and a thinner active layer. This study benchmarks the EBT-XD against EBT3 film for 6 MV and 10 MV photon beams, as well as for 97.4 MeV and 148.2 MeV proton beams and 15-100u2009kV x-rays. Dosimetric and film reading characteristics, such as post irradiation darkening, film orientation effect, lateral response artifact (LRA), film sensitivity, energy and beam quality dependency were investigated. Furthermore, quenching effects in the Bragg peak were investigated for a single proton beam energy for both film types, in addition measurements were performed in a spread-out Bragg peak. EBT-XD films showed the same characteristic on film darkening as EBT3. The effects between portrait and landscape orientation were reduced by 3.1% (in pixel value) for EBT-XD compared to EBT3 at a dose of 2000 cGy. The LRA is reduced for EBT-XD films for all investigated dose ranges. The sensitivity of EBT-XD films is superior to EBT3 for doses higher than 500 cGy. In addition, EBT-XD showed a similar dosimetric response for photon and proton irradiation with low energy and beam quality dependency. A quenching effect of 10% was found for both film types. The slight decrease in the thickness of the active layer and different composition configuration of EBT-XD resulted in a reduced film orientation effect and LRA, as well as a sensitivity increase in high-dose regions for both photon and proton beams. Overall, the EBT-XD film improved regarding film reading characteristics and showed advantages in the high-dose region for photon and proton beams.

A pencil beam algorithm for magnetic resonance image‐guided proton therapy

Purpose The feasibility of magnetic resonance image (MRI)‐based proton therapy is based, among several other factors, on the implementation of appropriate extensions on current dose calculation methods. This work aims to develop a pencil beam algorithm (PBA) for dose calculation of proton beams within magnetic field regions of up to 3 T. Methods Monte Carlo (MC) simulations using the GATE 7.1/GEANT4.9.4p02 toolkit were performed to generate calibration and benchmarking data for the PBA. Dose distributions from proton beams in the clinical required energy range 60–250 MeV impinging on a 400 × 400 × 400 mm3 water phantom and transverse magnetic fields ranging from 0 to 3 T were considered. Energy depositions in homogeneous and heterogeneous phantoms filled with water, adipose, bone, and air were evaluated for proton energies of 80, 150, and 240 MeV, combining a trajectory calculation method and look‐up tables (LUT). A novel parametrization model, using independent tailed Gauss fitting functions, was employed to describe the nonsymmetric shape of lateral beam profiles. Integrated depth‐dose curves (IDD), lateral dose profiles, and two‐dimensional dose distributions calculated with the PBA were compared with results from MC simulations to assess the performance of the algorithm. A gamma index criterion of 2%/2 mm was used for analysis. Results A close to perfect agreement was observed for PB‐based dose calculations in water in magnetic fields of 0.5, 1.5, and 3 T. IDD functions showed differences between the PBA and MC of less than 0.1% before the Bragg peak, and deviations of 2–8% in the distal energy falloff region. Gamma index pass rates higher than 99% and mean values lower than 0.1 were encountered for all analyzed configurations. For homogeneous phantoms, only the full bone configuration offered deviations in the Bragg peak position of up to 1.7% and overestimations of the lateral beam spot width for high‐energy protons and magnetic field intensities. An excellent agreement between PBA and MC dose calculation was also achieved using slab‐like and lateral heterogeneous phantoms, with gamma index passing rates above 98% and mean values between 0.1 and 0.2. As expected, agreement reduced for high‐energy protons and high‐intensity magnetic fields, although results remained good enough to be considered for future implementation in clinical practice. Conclusions The proposed pencil beam algorithm for protons can accurately account for dose distortion effects induced by external magnetic fields. The application of an analytical model for dose estimation and corrections reduces the calculation times considerably, making the presented PBA a suitable candidate for integration in a treatment planning system.

Implementation of dosimetry equipment and phantoms at the MedAustron light ion beam therapy facility

PURPOSEnTo describe the implementation of dosimetry equipment and phantoms into clinical practice of light ion beam therapy facilities. This work covers not only standard dosimetry equipment such as computerized water scanners, films, 2D-array, thimble, and plane parallel ionization chambers, but also dosimetry equipment specifically devoted to the pencil beam scanning delivery technique such as water columns, scintillating screens or multilayer ionization chambers.nnnMETHODnAdvanced acceptance testing procedures developed at MedAustron and complementary to the standard acceptance procedures proposed by the manufacturer are presented. Detailed commissioning plans have been implemented for each piece of dosimetry equipment and include an estimate of the overall uncertainty budget for the range of clinical use of each device. Some standard dosimetry equipment used in many facilities was evaluated in detail: for instance, the recombination of a 2D-array or the potential use of a microdiamond detector to measure reference transverse dose profiles in water in the core of the primary pencil beams and in the low-dose nuclear halo (over four orders of magnitude in dose).nnnRESULTSnThe implementation of dosimetry equipment as described in this work allowed determining absolute spot sizes and spot positions with an uncertainty better than 0.3xa0mm. Absolute ranges are determined with an uncertainty comprised of 0.2-0.6xa0mm, depending on the measured range and were reproduced with a maximum difference of 0.3xa0mm over a period of 12xa0months using three different devices.nnnCONCLUSIONnThe detailed evaluation procedures of dosimetry equipment and phantoms proposed in this work could serve as a guidance for other medical physicists in ion beam therapy facilities and also in conventional radiation therapy.

Benchmarking GATE/Geant4 for 16O ion beam therapy

Oxygen ([Formula: see text]) ions are a potential alternative to carbon ions in ion beam therapy. Their enhanced linear energy transfer indicates a higher relative biological effectiveness and a reduced oxygen enhancement ratio. Due to the limited availability of [Formula: see text] ion beams, Monte Carlo (MC) transport codes are important research tools for investigating their potential. The purpose of this study was to validate GATE/Geant4 for [Formula: see text] ion beam therapy using experimental data from literature. Five hadron physics lists and two electromagnetic options were benchmarked against measured depth dose distributions (DDDs) and charge-changing cross sections. The simulated beam ranges deviated by less than 0.5% for all physics configurations and only a few points exceeded the gamma index criterion (2%/1u2009mm). However, the simulated partial charge-changing cross sections deviated considerably for some hadron physics configurations. Best agreement with the experimental values was obtained with the quantum molecular dynamics model (QMD), and we therefore suggest using this model in Geant4 to accurately describe the fragmentation of [Formula: see text] ion beams into lighter fragments ([Formula: see text]).