Nobuyuki Kanematsu

A CT calibration method based on the polybinary tissue model for radiotherapy treatment planning

A method to establish the relationship between CT number and effective density for therapeutic radiations is proposed. We approximated body tissues to mixtures of muscle, air, fat and bone. Consequently, the relationship can be calibrated only with a CT scan of their substitutes, for which we chose water, air, ethanol and potassium phosphate solution, respectively. With simple and specific corrections for non-equivalencies of the substitutes, a calibration accuracy of 1% will be achieved. We tested the calibration method with some biological materials to verify that the proposed method would offer the accuracy, simplicity and specificity required for a standard in radiotherapy treatment planning, in particular with heavy charged particles.

Treatment planning for the layer-stacking irradiation system for three-dimensional conformal heavy-ion radiotherapy

We have upgraded a heavy-ion radiotherapy treatment-planning system to adapt for the layer-stacking irradiation method, which is to conform a variable spread-out Bragg peak to a target volume by means of dynamic control of the conventional beam-modifying devices. The biophysical model, the beam-setup logic, and the dose-calculation algorithm implemented for the layer-stacking method are described and the expected clinical usability is discussed. The layer-stacking method was integrated in perfect accordance with the ongoing conventional treatments so that the established protocols, which are the clinically optimized dose fractionation schemes, will still be valid. On the other hand, a simulation study indicated a substantial improvement of dose distribution with the layer-stacking method though the significance may depend on the size, shape, and location of the tumor. The completed treatment system will provide an option for improved conformal radiotherapy without interfering with the conventional method and we expect a gradual expansion of the clinical cases applicable to the layer-stacking method.

Reformulation of a clinical-dose system for carbon-ion radiotherapy treatment planning at the National Institute of Radiological Sciences, Japan

At the National Institute of Radiological Sciences (NIRS), more than 8,000 patients have been treated for various tumors with carbon-ion (C-ion) radiotherapy in the past 20 years based on a radiobiologically defined clinical-dose system. Through clinical experience, including extensive dose escalation studies, optimum dose-fractionation protocols have been established for respective tumors, which may be considered as the standards in C-ion radiotherapy. Although the therapeutic appropriateness of the clinical-dose system has been widely demonstrated by clinical results, the system incorporates several oversimplifications such as dose-independent relative biological effectiveness (RBE), empirical nuclear fragmentation model, and use of dose-averaged linear energy transfer to represent the spectrum of particles. We took the opportunity to update the clinical-dose system at the time we started clinical treatment with pencil beam scanning, a new beam delivery method, in 2011. The requirements for the updated system were to correct the oversimplifications made in the original system, while harmonizing with the original system to maintain the established dose-fractionation protocols. In the updated system, the radiation quality of the therapeutic C-ion beam was derived with Monte Carlo simulations, and its biological effectiveness was predicted with a theoretical model. We selected the most used C-ion beam with αr = 0.764 Gy(-1) and β = 0.0615 Gy(-2) as reference radiation for RBE. The C-equivalent biological dose distribution is designed to allow the prescribed survival of tumor cells of the human salivary gland (HSG) in entire spread-out Bragg peak (SOBP) region, with consideration to the dose dependence of the RBE. This C-equivalent biological dose distribution is scaled to a clinical dose distribution to harmonize with our clinical experiences with C-ion radiotherapy. Treatment plans were made with the original and the updated clinical-dose systems, and both physical and clinical dose distributions were compared with regard to the prescribed dose level, beam energy, and SOBP width. Both systems provided uniform clinical dose distributions within the targets consistent with the prescriptions. The mean physical doses delivered to targets by the updated system agreed with the doses by the original system within ± 1.5% for all tested conditions. The updated system reflects the physical and biological characteristics of the therapeutic C-ion beam more accurately than the original system, while at the same time allowing the continued use of the dose-fractionation protocols established with the original system at NIRS.

Verification of the dose distributions with GEANT4 simulation for proton therapy

The GEANT4 based simulation of an irradiation system for the proton therapy has been developed for the verification of dose distributions. The simulation represents a treatment room with the beam irradiation system at the Hyogo Ion Beam Medical Center (HIBMC). The beam irradiation system consists of a lateral beam-spreading system and a range modulating system, so that the dose distribution is achieved in three dimensionally. The simulation was carried out for the proton beams at the isocentric gantry nozzle for the therapeutic energy of 150, 190, and 230 MeV, respectively. The simulated dose distributions are compared with measurements, where dose distributions are obtained using a water phantom at an isocenter, which simulate practical situations of the beam irradiation to the patients. The validation of the simulation was performed for the proton ranges in important materials at beam line and lateral uniformity of the irradiation field at an isocenter, respectively. Then, the dose distribution in simulation based on GEANT4 were verified with measurements for Bragg peak and spread out Bragg peak, respectively. The result of verification shows the depth-dose distributions in simulation are in good agreement with measurements.

Evaluation of hybrid depth scanning for carbon-ion radiotherapy

PURPOSE In radiotherapy with a scanned carbon-ion beam, its Bragg peak is shifted along the depth direction either by inserting the range shifter plates or by changing the beam-extraction energy of a synchrotron. In the former technique (range shifter scanning: RS), the range shifter plates broaden the beam size and produce secondary fragments through nuclear reactions. In the latter technique (active-energy scanning: ES), it may take several seconds to change the beam energy depending on the synchrotron operation cycle, leading to a long treatment time. The authors propose a hybrid depth scan technique (hybrid scanning: HS), where several beam energies are used in conjunction with the range shifter plates for finer range shift. In this study, HS is evaluated from the viewpoints of dose distribution and treatment time. METHODS Assuming realistic accelerator and beam-delivery systems, the authors performed computer simulations using GEANT4 Monte Carlo code for beam modeling and a treatment planning system to evaluate HS. Three target volumes with the same dimensions of 60 × 60 × 60 mm(3) were generated at depths of 45, 85, and 125 mm in water phantom, and uniform clinical dose was planned for these targets. The sizes of lateral dose falloff and the peak to plateau ratio defined as the ratio of the clinical dose averaged over the target to the clinical dose at the entrance as well as the treatment time were compared among the three depth scan techniques. RESULTS The sizes of lateral dose falloffs at the center of SOBP are 11.4, 8.5, and 5.9 mm for the three targets in RS, while they are 5.7, 4.8, and 4.6 mm in ES and 6.6, 5.7, and 5.0 mm in HS, respectively. The peak to plateau ratios are 1.39, 1.96, and 2.15 in RS, while they are 1.48, 2.04, and 2.19 in ES and 1.47, 2.03, and 2.18 in HS, respectively. The treatment times are 128.7, 128.6, and 128.6 s in ES, while they are 61.2, 54.6, and 47.8 s in RS and 43.2, 44.1, and 44.7 s in HS, respectively. The multiple scattering and the nuclear reaction by range shifter degraded the beam qualities such as lateral dose falloff and peak to plateau ratio, which was especially pronounced for the shallow target in RS. The depth scan timing was limited by accelerator cycle in ES. That increased the treatment time by a few times. CONCLUSIONS This study revealed that HS can provide dose distributions with steeper lateral dose falloffs and higher peak to plateau ratio comparing to RS and comparable to ES. In addition, the treatment time can be considerably reduced in HS compared to ES.

Biological dose calculation with Monte Carlo physics simulation for heavy-ion radiotherapy.

Treatment planning of heavy-ion radiotherapy involves predictive calculation of not only the physical dose but also the biological dose in a patient body. The biological dose is defined as the product of the physical dose and the relative biological effectiveness (RBE). In carbon-ion radiotherapy at National Institute of Radiological Sciences, the RBE value has been defined as the ratio of the 10% survival dose of 200 kVp x-rays to that of the radiation of interest for in vitro human salivary gland tumour cells. In this note, the physical and biological dose distributions of a typical therapeutic carbon-ion beam are calculated using the GEANT4 Monte Carlo simulation toolkit in comparison with those with the biological dose estimate system based on the one-dimensional beam model currently used in treatment planning. The results differed between the GEANT4 simulation and the one-dimensional beam model, indicating the physical limitations in the beam model. This study demonstrates that the Monte Carlo physics simulation technique can be applied to improve the accuracy of the biological dose distribution in treatment planning of heavy-ion radiotherapy.

Extended collimator model for pencil-beam dose calculation in proton radiotherapy

We have developed a simple collimator model to improve the accuracy of penumbra behaviour in pencil-beam dose calculation for proton radiotherapy. In this model, transmission of particles through a three-dimensionally extended opening of a collimator is calculated in conjunction with phase-space distribution of the particles. Comparison of the dose distributions calculated using the new three-dimensional collimator model and the conventional two-dimensional model to lateral dose profiles experimentally measured with collimated proton beams showed the superiority of the new model over the conventional one.

Commissioning of a conformal irradiation system for heavy-ion radiotherapy using a layer-stacking method.

The commissioning of conformal radiotherapy system using heavy-ion beams at the Heavy Ion Medical Accelerator in Chiba (HIMAC) is described in detail. The system at HIMAC was upgraded for a clinical trial using a new technique: large spot uniform scanning with conformal layer stacking. The system was developed to localize the irradiation dose to the target volume more effectively than with the old system. With the present passive irradiation method using a ridge filter, a scatterer, a pair of wobbler magnets, and a multileaf collimator, the width of the spread-out Bragg peak (SOBP) in the radiation field could not be changed. With dynamic control of the beam-modifying devices during irradiation, a more conformal radiotherapy could be achieved. In order to safely perform treatments with this conformal therapy, the moving devices should be watched during irradiation and the synchronousness among the devices should be verified. This system, which has to be safe for patient irradiations, was constructed and tested for safety and for the quality of the dose localization realized. Through these commissioning tests, we were successfully able to prepare the conformal technique using layer stacking for patients. Subsequent to commissioning the technique has been applied to patients in clinical trials.

Alternative scattering power for Gaussian beam model of heavy charged particles

Abstract This study provides an accurate, efficient and simple multiple scattering formulation for heavy charged particles such as protons and heavier ions with a new form of scattering power that is a key quantity for beam transport in matter. The Highland formula for multiple scattering angle was modified to a scattering power formula to be used within the Fermi–Eyges theory in the presence of heterogeneity. An analytical formula for RMS end-point displacement in homogeneous matter was also derived for arbitrary ions. The formulation was examined in terms of RMS angles and displacements in comparison with other formulations and measurements. The results for protons, helium ions and carbon ions in water agreed with them at a level of 2% or the differences were discussed.

Evaluation of beam wobbling methods for heavy-ion radiotherapy

The National Institute of Radiological Sciences (NIRS) has extensively studied carbon-ion radiotherapy at the Heavy-Ion Medical Accelerator in Chiba (HIMAC) with some positive outcomes, and has established its efficacy. Therefore, efforts to distribute the therapy to the general public should be made, for which it is essential to enable direct application of clinical and technological experiences obtained at NIRS. For widespread use, it is very important to reduce the cost through facility downsizing with minimal acceleration energy to deliver the HIMAC-equivalent clinical beams. For the beam delivery system, the requirement of miniaturization is translated to reduction in length while maintaining the clinically available field size and penetration range for range-modulated uniform broad beams of regular fields that are either circular or square for simplicity. In this paper, we evaluate the various wobbling methods including original improvements, especially for application to the compact facilities through the experimental and computational studies. The single-ring wobbling method used at HIMAC is the best one including a lot of experience at HIMAC but the residual range is a fatal problem in the case of a compact facility. On the other hand, uniform wobbling methods such as the spiral and zigzag wobbling methods are effective and suitable for a compact facility. Furthermore, these methods can be applied for treatment with passive range modulation including respiratory gated irradiation. In theory, the choice between the spiral and zigzag wobbling methods depends on the shape of the required irradiation field. However, we found that it is better to use the zigzag wobbling method with transformation of the wobbling pattern even when a circular uniform irradiation field is required, because it is difficult to maintain the stability of the wobbler magnet due to the rapid change of the wobbler current in the spiral wobbling method. The regulated wobbling method, which is our improvement, can well expand the uniform irradiation field and lead to reducing the power requirement of the wobbler magnets. Our evaluations showed that the regulated zigzag wobbling method is the most suitable method for use in currently designed compact carbon-therapy facilities.