Matt Wronski

A solid-state amorphous selenium avalanche technology for low photon flux imaging applications

PURPOSE The feasibility of a practical solid-state technology for low photon flux imaging applications was investigated. The technology is based on an amorphous selenium photoreceptor with a voltage-controlled avalanche multiplication gain. If this photoreceptor can provide sufficient internal gain, it will be useful for an extensive range of diagnostic imaging systems. METHODS The avalanche photoreceptor under investigation is referred to as HARP-DRL. This is a novel concept in which a high-gain avalanche rushing photoconductor (HARP) is integrated with a distributed resistance layer (DRL) and sandwiched between two electrodes. The avalanche gain and leakage current characteristics of this photoreceptor were measured. RESULTS HARP-DRL has been found to sustain very high electric field strengths without electrical breakdown. It has shown avalanche multiplication gains as high as 10(4) and a very low leakage current (< or = 20 pA/mm2). CONCLUSIONS This is the first experimental demonstration of a solid-state amorphous photoreceptor which provides sufficient internal avalanche gain for photon counting and photon starved imaging applications.

Direct-conversion flat-panel imager with avalanche gain: Feasibility investigation for HARP-AMFPI

The authors are investigating the concept of a direct-conversion flat-panel imager with avalanche gain for low-dose x-ray imaging. It consists of an amorphous selenium (a-Se) photoconductor partitioned into a thick drift region for x-ray-to-charge conversion and a relatively thin region called high-gain avalanche rushing photoconductor (HARP) in which the charge undergoes avalanche multiplication. An active matrix of thin film transistors is used to read out the electronic image. The authors call the proposed imager HARP active matrix flat panel imager (HARP-AMFPI). The key advantages of HARP-AMFPI are its high spatial resolution, owing to the direct-conversion a-Se layer, and its programmable avalanche gain, which can be enabled during low dose fluoroscopy to overcome electronic noise and disabled during high dose radiography to prevent saturation of the detector elements. This article investigates key design considerations for HARP-AMFPI. The effects of electronic noise on the imaging performance of HARP-AMFPI were modeled theoretically and system parameters were optimized for radiography and fluoroscopy. The following imager properties were determined as a function of avalanche gain: (1) the spatial frequency dependent detective quantum efficiency; (2) fill factor; (3) dynamic range and linearity; and (4) gain nonuniformities resulting from electric field strength nonuniformities. The authors results showed that avalanche gains of 5 and 20 enable x-ray quantum noise limited performance throughout the entire exposure range in radiography and fluoroscopy, respectively. It was shown that HARP-AMFPI can provide the required gain while maintaining a 100% effective fill factor and a piecewise dynamic range over five orders of magnitude (10(-7)-10(-2) R/frame). The authors have also shown that imaging performance is not significantly affected by the following: electric field strength nonuniformities, avalanche noise for x-ray energies above 1 keV and direct interaction of x rays in the gain region. Thus, HARP-AMFPI is a promising flat-panel imager structure that enables high-resolution fully quantum noise limited x-ray imaging over a wide exposure range.

Scintillator high-gain avalanche rushing photoconductor active-matrix flat panel imager: zero-spatial frequency x-ray imaging properties of the solid-state SHARP sensor structure.

PURPOSE The authors are investigating the feasibility of a new type of solid-state x-ray imaging sensor with programmable avalanche gain: scintillator high-gain avalanche rushing photoconductor active matrix flat panel imager (SHARP-AMFPI). The purpose of the present work is to investigate the inherent x-ray detection properties of SHARP and demonstrate its wide dynamic range through programmable gain. METHODS A distributed resistive layer (DRL) was developed to maintain stable avalanche gain operation in a solid-state HARP. The signal and noise properties of the HARP-DRL for optical photon detection were investigated as a function of avalanche gain both theoretically and experimentally, and the results were compared with HARP tube (with electron beam readout) used in previous investigations of zero spatial frequency performance of SHARP. For this new investigation, a solid-state SHARP x-ray image sensor was formed by direct optical coupling of the HARP-DRL with a structured cesium iodide (CsI) scintillator. The x-ray sensitivity of this sensor was measured as a function of avalanche gain and the results were compared with the sensitivity of HARP-DRL measured optically. The dynamic range of HARP-DRL with variable avalanche gain was investigated for the entire exposure range encountered in radiography∕fluoroscopy (R∕F) applications. RESULTS The signal from HARP-DRL as a function of electric field showed stable avalanche gain, and the noise associated with the avalanche process agrees well with theory and previous measurements from a HARP tube. This result indicates that when coupled with CsI for x-ray detection, the additional noise associated with avalanche gain in HARP-DRL is negligible. The x-ray sensitivity measurements using the SHARP sensor produced identical avalanche gain dependence on electric field as the optical measurements with HARP-DRL. Adjusting the avalanche multiplication gain in HARP-DRL enabled a very wide dynamic range which encompassed all clinically relevant medical x-ray exposures. CONCLUSIONS This work demonstrates that the HARP-DRL sensor enables the practical implementation of a SHARP solid-state x-ray sensor capable of quantum noise limited operation throughout the entire range of clinically relevant x-ray exposures. This is an important step toward the realization of a SHARP-AMFPI x-ray flat-panel imager.

Investigation of Dose Falloff for Intact Brain Metastases and Surgical Cavities Using Hypofractionated Volumetric Modulated Arc Radiotherapy.

Introduction: Intact brain metastases tend to be small and spherical compared to postsurgery brain cavities, which tend to be large and irregular shaped and, as a result, a challenge with respect to treatment planning. The purpose of the present study is to develop guidelines for normal brain tissue dose and to investigate whether there is a dependence on target type for patients treated with hypofractionated volumetric modulated arc radiotherapy (HF-VMAT). Methods: Treatment plans from a total of 100 patients and 136 targets (55 cavity and 81 intact) were retrospectively reviewed. All targets were treated with HF-VMAT with total doses ranging between 20 and 30 gray (Gy) in 5 fractions. All plans met institutional objectives for organ-at-risk constraints and were clinically delivered. Dose falloff was quantified using gradient index (GI) and distance between the 100% and 50% isodose lines (R50). Additionally, the dose to normal brain tissue (brain contour excluding all gross tumor or clinical target volumes) was assessed using volume receiving specific doses (Vx) where x ranged from 5 to 30 Gy. Best-fit curves using power law relationships of the form y = axb were generated for GI, R50, and Vx (normal brain tissue) versus target volume. Results: There was a statistically significant difference in planning target volume (PTV) for cavities versus intact metastases with mean volumes of 37.8 cm3 and 9.5 cm3, respectively (P < .0001). The GI and R50 were statistically different: 3.4 and 9.8 mm for cavities versus 4.6 and 8.3 mm for intact metastases (P < .0001). The R50 increased with PTV with power law coefficients (a, b) = (6.3, 0.12) and (5.9, 0.15) for cavities and intact, respectively. GI decreased with PTV with coefficients (a, b) = (5.9, −0.18) and (5.7, −0.14) for cavities and intact, respectively. The normal brain tissue Vx also exhibited power law relationships with PTV for x = 20 to 28.8 Gy. In conclusion, target volume is the main predictor of dose falloff. The results of the present study can be used for determining target volume-based thresholds for dose falloff and normal brain tissue dose–volume constraints.

Backscatter dose effects for high atomic number materials being irradiated in the presence of a magnetic field: A Monte Carlo study for the MRI linac.

PURPOSE To quantify and explain the backscatter dose effects for clinically relevant high atomic number materials being irradiated in the presence of a 1.5 T transverse magnetic field. METHODS Interface effects were investigated using Monte Carlo simulation techniques. We used gpumcd (v5.1) and geant4 (v10.1) for this purpose. gpumcd is a commercial software written for the Elekta AB, MRI linac. Dose was scored using gpumcd in cubic voxels of side 1 and 0.5 mm, in two different virtual phantoms of dimensions 20 × 20 × 20 cm and 5 × 5 × 13.3 cm, respectively. A photon beam was generated from a point 143.5 cm away from the isocenter with energy distribution sampled from a histogram representing the true Elekta, MRI linac photon spectrum. A slab of variable thickness and position containing either bone, aluminum, titanium, stainless steel, or one of the two different dental filling materials was inserted as an inhomogeneity in the 20 × 20 × 20 cm phantom. The 5 × 5 × 13.3 cm phantom was used as a clinical test case in order to explain the dose perturbation effects for a head and neck cancer patient. The back scatter dose factor (BSDF) was defined as the ratio of the doses at a given depth with and without the presence of the inhomogeneity. Backscattered electron fluence was calculated at the inhomogeneity interface using geant4. A 1.5 T magnetic field was applied perpendicular to the direction of the beam in both phantoms, identical to the geometry in the Elekta MRI linac. RESULTS With the application of a 1.5 T magnetic field, all the BSDFs were reduced by 12%-47%, compared to the no magnetic field case. The corresponding backscattered electron fluence at the interface was also reduced by 45%-64%. The reduction in the BSDF at the interface, due to the application of the magnetic field, is manifested in a different manner for each material. In the case of bone, the dose drops at the interface contrary to the expected increase when no magnetic field is applied. In the case of aluminum, the dose at the interface is the same with and without the presence of the aluminum. For all of the other materials the dose increases at the interface. CONCLUSIONS The reduction in dose at the interface, in the presence of the magnetic field, is directly related to the reduction in backscattered electron fluence. This reduction occurs due to two different reasons. First, the electron spectrum hitting the interface is changed when the magnetic field is turned on, which results in changes in the electron scattering probability. Second, some electrons that have curved trajectories due to the presence of the magnetic field are absorbed by the higher density side of the interface and no longer contribute to the backscattered electron fluence.

The radiobiological impact of motion tracking of liver, pancreas and kidney SBRT tumors in a MR-linac

The purpose of this work is to evaluate and quantify the potential radiobiological advantages of tumor tracking using the MR-linac for three disease sites: liver, pancreas and kidney. From each disease site, three patients were selected and 4DCT data sets were used. We applied two planning methods using the Monaco treatment planning system (Elekta AB,Stockholm,Sweden): (1) the conventional ITV method using a 6MV Agility beam and (2) a simulated tracking method using MLC GTV tracking with a 7MV MR-linac beam model incorporating a 1.5 T transverse magnetic field. A 5 mm isotropic PTV margin was added to the ITV or the GTV, and 95% of the PTV volume received 100% of the prescription dose. To evaluate the potential radiobiological advantages of tumor tracking, the normal tissue complication probabilities (NTCPs) were calculated for each organ at risk (OAR) using the Layman Kutcher Burman (LKB) model. The average reduction in the target volume, due to tracking, was 31.1%, 26.3% and 26.9% for liver, pancreas and kidney patients, respectively. For each OAR, the % differences in NTCP between the two methods were calculated. The mean 2 Gy equivalent OAR dose for all patients was less than 29.1 Gy, below which the NTCP for most OARs was not sensitive to equivalent uniform dose (EUD). As a result, a NTCP benefit, due to tracking, was observed in 26% of the data. For all three disease sites, the maximum NTCP improvements were for the normal kidney, the bowels, and the duodenum, with reductions in associated toxicities of 79% (radiation nephropathy), 69% (stricture/fistula) and 25% (ulceration), respectively. This study demonstrates the potential benefit of using a MR-linac tracking system to reduce NTCPs. The normal kidney, the bowels and the duodenum showed the largest NTCP improvements. This, in part, is due to the rapid changes in NTCP for small EUD changes.

A Systematic Review of Heart Dose in Breast Radiotherapy

Abstract Radiotherapy (RT) for breast cancer improves survival, but poses risk to the heart, resulting from a linear relationship between RT dose and heart disease. This review presents studies worldwide reporting heart doses from whole breast RT after 2014 to update a previous systematic review (Taylor et al, Int J Radiat Oncol Biol Phys, 2015) in order to determine patterns of current heart dosimetry among varying RT regimens. Studies published between January 2014 and September 2017 were included if they reported whole heart dose based on whole breast RT technique or treatment position and had a sample size of ≥ 20 patients. Studies reporting brachytherapy, proton RT only, or boost to tumor bed were excluded. Among 99 studies, whole heart dose was reported by 231 regimens. The mean heart dose for left‐sided breast cancer, reported by 84 studies (196 regimens), was 3.6 Gy, compared with a review of those previously reported (5.4 Gy). Regimens employing breathing control in any position had a significantly lower mean heart dose (1.7 Gy) compared with regimens without breathing control (4.5 Gy) (P < .0001). The mean heart dose varied significantly between continents (P < .0001), with heterogeneity reported among countries within Europe (P = .04) although not within other continents. On average, the mean heart dose steadily decreased between 2014 (4.6 Gy) and 2017 (2.6 Gy) (P = .003). Other heart dose parameters including the mean dose to the left anterior descending artery were reported by 80 left‐sided regimens, and the mean left anterior descending artery dose was 12.4 Gy.

TH-AB-BRA-10: The Physics of Interface Effects for Radiation Treatments in a MRI-Linac: A Monte Carlo Study

PURPOSE To investigate and explain the interface effects for clinically relevant materials being irradiated in the presence of a 1.5 T transverse magnetic field. METHODS Interface effects were investigated using Geant4.10.1 both with (B-On) and without (B-Off) a magnetic field for an Elekta MRI-Linac. A slab of thickness 8 cm, representing inhomogeneity, was placed at a depth of 4 cm in a 20×20×20 cm water phantom. Backscattered electron fluence was calculated through a 20×20 cm plane aligned with the surface of the inhomogeneity. Inhomogeneities investigated were lung, bone, aluminum, titanium, stainless steel, and dental filling. A photon beam with field size of 2×2 cm at the isocenter and SAD of 143.5 cm was generated from a point source with energy distribution sampled from a histogram representing the true Elekta MRI-Linac photon spectrum. RESULTS In the B-On case, if the heterogeneity is a low Zeff material, such as lung, the backscattered electron fluence is increased considerably, i.e. by 54 %, and the corresponding dose is expected to be higher near the interface compared to the B-Off case. On the contrary, if the heterogeneity is a high Zeff material then the backscattered electron fluence is reduced in the B-On electron fluence is reduced in the B-On case. This reduction leads to a lower dose deposition at the interface compared to the B-Off case. CONCLUSION The reduction in dose at the interface, in the B-On case, is directly related to the reduction in backscattered electron fluence. The reduction in backscattered electron fluence occurs due to two different reasons. First, the electron energy spectrum hitting the interface is changed for the B-On case which changes the electron scattering probability. Second, some electrons that are looping under the influence of the magnetic field are captured by the higher density side of the interface and no longer contribute to the backscattered electron stream. Funding support for this study was provided by ElektaTM.

SU-F-T-374: Dosimetric Effects of Irradiation Through a Bilateral Hip Prosthesis in a MRI Linac

PURPOSE To evaluate the interface effects when irradiating through a hip prosthesis in the presence of an orthogonal 1.5 T magnetic field using Monte Carlo simulations. METHODS A 20×20×38 cm virtual phantom with two 5×5×5 cm sections of bilateral titanium hip prosthesis was created in GPU-based Monte Carlo (MC) algorithm (GPUMCD, Elekta AB, Stockholm Sweden). The lateral prosthesis spacing was based on a representative patient CT scan. A treatment SAD of 143.5 cm was chosen, corresponding to the Elekta AB MRI Linac and the beam energy distribution was sampled from a histogram representing the true MRI Linac spectrum. A magnetic field of 1.5 T was applied perpendicular to the plane of irradiation. Dose was calculated, in voxels of side 1 mm, for 2×2, 5×5, and 10×10 cm treatment field sizes with normal beam incidence (gantry at 90° or 270°) and at 5° and 10° from normal, representing the range of incidence through the bilateral prosthesis. RESULTS With magnetic field ON (B-On) and normal beam incidence the backscatter dose at the interfaces of proximal and distal implants is reduced for all the field sizes compared to the magnetic field OFF (B-Off) case. The absolute reduction in doses at the interface was in the range of 12.93% to 13.16% for the proximal implant and 13.57% to 16.12% for the distal implant. Similarly for the oblique incidences of 5o and 10o the dose in the plane adjacent to the prosthetic implants is lower when the magnetic field is ON. CONCLUSION The dosimetric effects of irradiating through a hip prosthesis in the presence of a transverse magnetic field have been determined using MC simulation. The backscatter dose reduction translates into significantly lower hot spots at the prosthetic interfaces, which are otherwise substantially high in the absence of the magnetic field. This project was supported through funding provided by ElektaTM.

Evaluation of lens dose from anterior electron beams: comparison of Pinnacle and Gafchromic EBT3 film.

Lens dose is a concern during the treatment of facial lesions with anterior electron beams. Lead shielding is routinely employed to reduce lens dose and minimize late complications. The purpose of this work is twofold: 1) to measure dose profiles under large‐area lead shielding at the lens depth for clinical electron energies via film dosimetry; and 2) to assess the accuracy of the Pinnacle treatment planning system in calculating doses under lead shields. First, to simulate the clinical geometry, EBT3 film and 4 cm wide lead shields were incorporated into a Solid Water phantom. With the lead shield inside the phantom, the film was positioned at a depth of 0.7 cm below the lead, while a variable thickness of solid water, simulating bolus, was placed on top. This geometry was reproduced in Pinnacle to calculate dose profiles using the pencil beam electron algorithm. The measured and calculated dose profiles were normalized to the central‐axis dose maximum in a homogeneous phantom with no lead shielding. The resulting measured profiles, functions of bolus thickness and incident electron energy, can be used to estimate the lens dose under various clinical scenarios. These profiles showed a minimum lead margin of 0.5 cm beyond the lens boundary is required to shield the lens to ≤10% of the dose maximum. Comparisons with Pinnacle showed a consistent overestimation of dose under the lead shield with discrepancies of ∼25% occurring near the shield edge. This discrepancy was found to increase with electron energy and bolus thickness and decrease with distance from the lead edge. Thus, the Pinnacle electron algorithm is not recommended for estimating lens dose in this situation. The film measurements, however, allow for a reasonable estimate of lens dose from electron beams and for clinicians to assess the lead margin required to reduce the lens dose to an acceptable level. PACS number(s): 87.53.Bn, 87.53.Kn, 87.55.‐x, 87.55.D‐Lens dose is a concern during the treatment of facial lesions with anterior electron beams. Lead shielding is routinely employed to reduce lens dose and minimize late complications. The purpose of this work is twofold: 1) to measure dose profiles under large-area lead shielding at the lens depth for clinical electron energies via film dosimetry; and 2) to assess the accuracy of the Pinnacle treatment planning system in calculating doses under lead shields. First, to simulate the clinical geometry, EBT3 film and 4 cm wide lead shields were incorporated into a Solid Water phantom. With the lead shield inside the phantom, the film was positioned at a depth of 0.7 cm below the lead, while a variable thickness of solid water, simulating bolus, was placed on top. This geometry was reproduced in Pinnacle to calculate dose profiles using the pencil beam electron algorithm. The measured and calculated dose profiles were normalized to the central-axis dose maximum in a homogeneous phantom with no lead shielding. The resulting measured profiles, functions of bolus thickness and incident electron energy, can be used to estimate the lens dose under various clinical scenarios. These profiles showed a minimum lead margin of 0.5 cm beyond the lens boundary is required to shield the lens to ≤10% of the dose maximum. Comparisons with Pinnacle showed a consistent overestimation of dose under the lead shield with discrepancies of ∼25% occurring near the shield edge. This discrepancy was found to increase with electron energy and bolus thickness and decrease with distance from the lead edge. Thus, the Pinnacle electron algorithm is not recommended for estimating lens dose in this situation. The film measurements, however, allow for a reasonable estimate of lens dose from electron beams and for clinicians to assess the lead margin required to reduce the lens dose to an acceptable level. PACS number(s): 87.53.Bn, 87.53.Kn, 87.55.-x, 87.55.D.