Pierluigi Piersimoni

A Fast Experimental Scanner for Proton CT: Technical Performance and First Experience With Phantom Scans

We report on the design, fabrication, and first tests of a tomographic scanner developed for proton computed tomography (pCT) of head-sized objects. After extensive preclinical testing, pCT is intended to be employed in support of proton therapy treatment planning and pre-treatment verification in patients undergoing particle-beam therapy. The scanner consists of two silicon-strip telescopes that track individual protons before and after the phantom, and a novel multistage scintillation detector that measures a combination of the residual energy and range of the proton, from which we derive the water equivalent path length (WEPL) of the protons in the scanned object. The set of WEPL values and the associated paths of protons passing through the object over a 360 ° angular scan are processed by an iterative, parallelizable reconstruction algorithm that runs on modern GP-GPU hardware. In order to assess the performance of the scanner, we have performed tests with 200 MeV protons from the synchrotron of the Loma Linda University Medical Center and the IBA cyclotron of the Northwestern Medicine Chicago Proton Center. Our first objective was calibration of the instrument, including tracker channel maps and alignment as well as the WEPL calibration. Then we performed the first CT scans on a series of phantoms. The very high sustained rate of data acquisition, exceeding one million protons per second, allowed a full 360 ° scan to be completed in less than 10 minutes, and reconstruction of a CATPHAN 404 phantom verified accurate reconstruction of the proton relative stopping power in a variety of materials.

Software platform for simulation of a prototype proton CT scanner

Purpose: Proton computed tomography (pCT) is a promising imaging technique to substitute or at least complement x‐ray CT for more accurate proton therapy treatment planning as it allows calculating directly proton relative stopping power from proton energy loss measurements. A proton CT scanner with a silicon‐based particle tracking system and a five‐stage scintillating energy detector has been completed. In parallel a modular software platform was developed to characterize the performance of the proposed pCT. Method: The modular pCT software platform consists of (1) a Geant4‐based simulation modeling the Loma Linda proton therapy beam line and the prototype proton CT scanner, (2) water equivalent path length (WEPL) calibration of the scintillating energy detector, and (3) image reconstruction algorithm for the reconstruction of the relative stopping power (RSP) of the scanned object. In this work, each component of the modular pCT software platform is described and validated with respect to experimental data and benchmarked against theoretical predictions. In particular, the RSP reconstruction was validated with both experimental scans, water column measurements, and theoretical calculations. Results: The results show that the pCT software platform accurately reproduces the performance of the existing prototype pCT scanner with a RSP agreement between experimental and simulated values to better than 1.5%. Conclusions: The validated platform is a versatile tool for clinical proton CT performance and application studies in a virtual setting. The platform is flexible and can be modified to simulate not yet existing versions of pCT scanners and higher proton energies than those currently clinically available.

An evaluation of spatial resolution of a prototype proton CT scanner

PURPOSE To evaluate the spatial resolution of proton CT using both a prototype proton CT scanner and Monte Carlo simulations. METHODS A custom cylindrical edge phantom containing twelve tissue-equivalent inserts with four different compositions at varying radial displacements from the axis of rotation was developed for measuring the modulation transfer function (MTF) of a prototype proton CT scanner. Two scans of the phantom, centered on the axis of rotation, were obtained with a 200 MeV, low-intensity proton beam: one scan with steps of 4°, and one scan with the phantom continuously rotating. In addition, Monte Carlo simulations of the phantom scan were performed using scanners idealized to various degrees. The data were reconstructed using an iterative projection method with added total variation superiorization based on individual proton histories. Edge spread functions in the radial and azimuthal directions were obtained using the oversampling technique. These were then used to obtain the modulation transfer functions. The spatial resolution was defined by the 10% value of the modulation transfer function (MTF10%) in units of line pairs per centimeter (lp/cm). Data from the simulations were used to better understand the contributions of multiple Coulomb scattering in the phantom and the scanner hardware, as well as the effect of discretization of proton location. RESULTS The radial spatial resolution of the prototype proton CT scanner depends on the total path length, W, of the proton in the phantom, whereas the azimuthal spatial resolution depends both on W and the position, u-, at which the most-likely path uncertainty is evaluated along the path. For protons contributing to radial spatial resolution, W varies with the radial position of the edge, whereas for protons contributing to azimuthal spatial resolution, W is approximately constant. For a pixel size of 0.625 mm, the radial spatial resolution of the image reconstructed from the fully idealized simulation data ranged between 6.31 ± 0.36 lp/cm for W = 197 mm i.e., close to the center of the phantom, and 13.79 ± 0.36 lp/cm for W = 97 mm, near the periphery of the phantom. The azimuthal spatial resolution ranged from 6.99 ± 0.23 lp/cm at u- = 75 mm (near the center) to 11.20 ± 0.26 lp/cm at u- = 20 mm (near the periphery). Multiple Coulomb scattering limits the radial spatial resolution for path lengths greater than approximately 130 mm, and the azimuthal spatial resolution for positions of evaluation greater than approximately 40 mm for W = 199 mm. The radial spatial resolution of the image reconstructed from data from the 4° stepped experimental scan ranged from 5.11 ± 0.61 lp/cm for W = 197 mm to 8.58 ± 0.50 lp/cm for W = 97 mm. In the azimuthal direction, the spatial resolution ranged from 5.37 ± 0.40 lp/cm at u- = 75 mm to 7.27 ± 0.39 lp/cm at u- = 20 mm. The continuous scan achieved the same spatial resolution as that of the stepped scan. CONCLUSIONS Multiple Coulomb scattering in the phantom is the limiting physical factor of the achievable spatial resolution of proton CT; additional loss of spatial resolution in the prototype system is associated with scattering in the proton tracking system and inadequacies of the proton path estimate used in the iterative reconstruction algorithm. Improvement in spatial resolution may be achievable by improving the most likely path estimate by incorporating information about high and low density materials, and by minimizing multiple Coulomb scattering in the proton tracking system.

The effect of beam purity and scanner complexity on proton CT accuracy

Purpose: To determine the dependence of the accuracy in reconstruction of relative stopping power (RSP) with proton computerized tomography (pCT) scans on the purity of the proton beam and the technological complexity of the pCT scanner using standard phantoms and a digital representation of a pediatric patient. Methods: The Monte Carlo method was applied to simulate the pCT scanner, using both a pure proton beam (uniform 200 MeV mono‐energetic, parallel beam) and the Northwestern Medicine Chicago Proton Center (NMCPC) clinical beam in uniform scanning mode. The accuracy of the simulation was validated with measurements performed at NMCPC including reconstructed RSP images obtained with a preclinical prototype pCT scanner. The pCT scanner energy detector was then simulated in three configurations of increasing complexity: an ideal totally absorbing detector, a single stage detector and a multi‐stage detector. A set of 15 cm diameter water cylinders containing either water alone or inserts of different material, size, and position were simulated at 90 projection angles (4° steps) for the pure and clinical proton beams and the three pCT configurations. A pCT image of the head of a detailed digital pediatric phantom was also reconstructed from the simulated pCT scan with the prototype detector. Results: The RSP error increased for all configurations for insert sizes under 7.5 mm in radius, with a sharp increase below 5 mm in radius, attributed to a limit in spatial resolution. The highest accuracy achievable using the current pCT calibration step phantom and reconstruction algorithm, calculated for the ideal case of a pure beam with totally absorbing energy detector, was 1.3% error in RSP for inserts of 5 mm radius or more, 0.7 mm in range for the 2.5 mm radius inserts, or better. When the highest complexity of the scanner geometry was introduced, some artifacts arose in the reconstructed images, particularly in the center of the phantom. Replacing the step phantom used for calibration with a wedge phantom led to RSP accuracy close to the ideal case, with no significant dependence of RSP error on insert location or material. The accuracy with the multi‐stage detector and NMCPC beam for the cylindrical phantoms was 2.2% in RSP error for inserts of 5 mm radius or more, 0.7 mm in range for the 2.5 mm radius inserts, or better. The pCT scan of the pediatric phantom resulted in mean RSP values within 1.3% of the reference RSP, with a range error under 1 mm, except in exceptional situations of parallel incidence on a boundary between low and high density. Conclusions: The pCT imaging technique proved to be a precise and accurate imaging tool, rivaling the current x‐rays based techniques, with the advantage of being directly sensitive to proton stopping power rather than photon interaction coefficients. Measured and simulated pCT images were obtained from a wobbled proton beam for the first time. Since the in‐silico results are expected to accurately represent the prototype pCT, upcoming measurements using the wedge phantom for calibration are expected to show similar accuracy in the reconstructed RSP.

Stopping power accuracy and achievable spatial resolution of helium ion imaging using a prototype particle CT detector system

Abstract A precise relative stopping power map of the patient is crucial for accurate particle therapy. Charged particle imaging determines the stopping power either tomographically – particle computed tomography (pCT) – or by combining prior knowledge from particle radiography (pRad) and x-ray CT. Generally, multiple Coulomb scattering limits the spatial resolution. Compared to protons, heavier particles scatter less due to their lower charge/mass ratio. A theoretical framework to predict the most likely trajectory of particles in matter was developed for light ions up to carbon and was found to be the most accurate for helium comparing for fixed initial velocity. To further investigate the potential of helium in particle imaging, helium computed tomography (HeCT) and radiography (HeRad) were studied at the Heidel-berg Ion-Beam Therapy Centre (HIT) using a prototype pCT detector system registering individual particles, originally developed by the U.S. pCT collaboration. Several phantoms were investigated: modules of the Catphan QA phantom for analysis of spatial resolution and achievable stopping power accuracy, a paediatric head phantom (CIRS) and a custom-made phantom comprised of animal meat enclosed in a 2 % agarose mixture representing human tissue. The pCT images were reconstructed applying the CARP iterative reconstruction algorithm. The MTF10% was investigated using a sharp edge gradient technique. HeRad provides a spatial resolution above that of protons (MTF1010%=6.07 lp/cm for HeRad versus MTF10%=3.35 lp/cm for proton radiography). For HeCT, the spatial resolution was limited by the number of projections acquired (90 projections for a full scan). The RSP accuracy for all inserts of the Catphan CTP404 module was found to be 2.5% or better and is subject to further optimisation. In conclusion, helium imaging appears to offer higher spatial resolution compared to proton imaging. In future studies, the advantage of helium imaging compared to other imaging modalities in clinical applications will be further explored.

Results from a pre-clinical head scanner for proton CT

We report on the first beam test results with our pre-clinical (Phase-II) head scanner developed for proton computed tomography (pCT). After extensive preclinical testing, pCT will be employed in support of proton therapy treatment planning and pre-treatment verification in patients undergoing treatment with particle beam therapy. The Phase-II pCT system consists of two silicon-strip telescopes that track individual protons before and after the phantom or patient, and a novel multistage scintillation detector that measures a combination of the residual energy and range of the proton, from which we derive the water equivalent path length (WEPL) of the protons in the scanned object. The set of WEPL values and associated paths of protons passing through the object over a 360° angular scan is processed by an iterative, parallelizable reconstruction algorithm that runs on modern GP-GPU hardware. In order to assess the performance of the scanner, we have performed beam tests with 200 MeV protons from the synchrotron of the Loma Linda University Medical Center. The first objective was the calibration of the instrument, including tracker channel maps and alignment as well as the WEPL calibration. Then we performed the first CT scans on a series of phantoms. The very high sustained rate of data acquisition, exceeding one million protons per second, allowed a full 360° scan to be completed in less than 10 minutes, and reconstruction of a CATPHAN 404 phantom verified accurate reconstruction of the proton relative stopping power in a variety of materials.

Dosimetric evaluation of proton CT using a prototype proton CT scanner

These instructions provide guidelines for preparing manuscripts for submission to the Conference Record (CR) of the 2016 IEEE Nuclear Science Symposium and Medical Imaging Conference. If you are using Microsoft Word to prepare your manuscript, you should use this document as a template. Define all symbols used in the abstract. Do not cite references in the abstract. Do not delete the blank line immediately above the abstract; it sets the footnote at the bottom of this column. Proton computed tomography has been suggested as an imaging technique alternative to x-ray CT for proton therapy treatment planning and image guidance. Dose, image quality, and range prediction accuracy are closely related and the calculation of the dose delivered during a proton CT scan is crucial for characterizing a proton CT scanner. Here we report on the dosimetric evaluation of proton CT scanner using a prototype built by the pCT collaboration between Loma Linda University, the University of California Santa Cruz, and Baylor University. The Catphan CTP554 16 cm acrylic dose phantom, representing a human head, was used to measure the dose to water during a typical proton CT scan at the Northwestern Medicine Chicago Proton Center in Warrenville, Illinois. A Farmer ionization chamber was installed in two locations (centre and periphery of the phantom) and the accumulated charge was measured with the 35040 Advanced Therapy Dosimeter (Fluke Biomedical). The proton CT scanner was exposed to a uniform beam profile of 200 MeV protons on the uniform scanning clinical proton beam line. At a rate of 1 M protons sec it takes 7 minutes in order collect about 400 M protons during a continuous 360 deg rotation. The proton fluence at the level of upstream inner tracker planes during the 7 minutes of exposure was estimated to be 1.4 M protons/cm2. The dose to water was 1.46 mGy in the peripheral location and 1.48 mGy in the central location, demonstrating that it is practically uniform across the phantom. According to these results, we can conclude that, based on an initial dosimetric characterization of a prototype pCT scanner conducted on a clinical proton beam line, proton CT is a promising modality for low-dose image guidance and adaptive proton therapy.

Geant4 simulation for a study of a possible use of carbon ion pencil beams for the treatment of ocular melanomas with the active scanning system at CNAO

The aim of this work was to study a possible use of carbon ion pencil beams (delivered with active scanning modality) for the treatment of ocular melanomas at the Centro Nazionale di Adroterapia Oncologica (CNAO). The promising aspect of carbon ions radiotherapy for the treatment of this disease lies in its superior relative radio-biological effectiveness (RBE). The Monte Carlo (MC) Geant4 10.00 toolkit was used to simulate the complete CNAO extraction beamline, with the active and passive components along it. A human eye modeled detector, including a realistic target tumor volume, was used as target. Cross check with previous studies at CNAO using protons allowed comparisons on possible benefits on using such a technique with respect to proton beams. Experimental data on proton and carbon ion beams transverse distributions were used to validate the simulation.

The impact of secondary fragments on the image quality of helium ion imaging

Single-event ion imaging enables the direct reconstruction of the relative stopping power (RSP) information required for ion-beam therapy. Helium ions were recently hypothesized to be the optimal species for such technique. The purpose of this work is to investigate the effect of secondary fragments on the image quality of helium CT (HeCT) and to assess the performance of a prototype proton CT (pCT) scanner when operated with helium beams in Monte Carlo simulations and experiment. Experiments were conducted installing the U.S. pCT consortium prototype scanner at the Heidelberg Ion-Beam Therapy Center (HIT). Simulations were performed with the scanner using the TOPAS toolkit. HeCT images were reconstructed for a cylindrical water phantom, the CTP404 (sensitometry), and the CTP528 (line-pair) [Formula: see text] ® modules. To identify and remove individual events caused by fragmentation, the multistage energy detector of the scanner was adapted to function as a [Formula: see text] telescope. The use of the developed filter eliminated the otherwise arising ring artifacts in the HeCT reconstructed images. For the HeCT reconstructed images of a water phantom, the maximum RSP error was improved by almost a factor 8 with respect to unfiltered images in the simulation and a factor 10 in the experiment. Similarly, for the CTP404 module, the mean RSP accuracy improved by a factor 6 in both the simulation and the experiment when the filter was applied (mean relative error 0.40% in simulation, 0.45% in experiment). In the evaluation of the spatial resolution through the CTP528 module, the main effect of the filter was noise reduction. For both simulated and experimental images the spatial resolution was  ∼4 lp cm-1. In conclusion, the novel filter developed for secondary fragments proved to be effective in improving the visual quality and RSP accuracy of the reconstructed images. With the filter, the pCT scanner is capable of accurate HeCT imaging.

Helium CT: Monte Carlo simulation results for an ideal source and detector with comparison to proton CT

Purpose To evaluate the accuracy of relative stopping power and spatial resolution of images reconstructed with simulated helium CT (HeCT) in comparison to proton CT (pCT). Methods A Monte Carlo (MC) study with the TOPAS tool was performed to compare the accuracy of relative stopping power (RSP) reconstruction and spatial resolution of low‐fluence HeCT to pCT, both using 200 MeV/u particles. An ideal setup consisting of a flat beam source and a totally absorbing energy‐range detector was implemented to estimate the theoretically best achievable RSP accuracy for the calibration and reconstruction methods currently used for pCT. The phantoms imaged included a cylindrical water phantom with inserts of different materials, sizes, and positions, a Catphan phantom with a module containing high‐contrast line pairs (CTP528) and a module with cylindrical inserts of different RSP (CTP404), as well as a voxelized 10‐year‐old female phantom. Dose to the cylindrical water phantom was also calculated. The RSP accuracy was studied for all phantoms except the CTP528 module. The latter was used for the estimation of the spatial resolution, evaluated as the modulation transfer function (MTF) at 10%. Results An overall error under 0.5% was achieved for HeCT for the water phantoms with the different inserts, in all cases better than that for pCT, in some cases by a factor 3. The inserts in the CTP404 module were reconstructed with an average RSP accuracy of 0.3% for HeCT and 0.2% for pCT. Anatomic structures (brain, bones, air cavities, etc.) in the digitized head phantom were well recognizable and no artifacts were visible with both HeCT and pCT. The three main tissue materials (soft tissue, brain, and cranium) were well identifiable in the reconstructed RSP‐volume distribution with both imaging modalities. Using 360 projection angles, the spatial resolution was 4 lp/cm for HeCT and 3 lp/cm for pCT. Generally, spatial resolution increased with the number of projection angles and was always higher for HeCT than for pCT for the same number of projections. When HeCT and pCT scan were performed to deliver the same dose in the phantom, the resolution for HeCT was higher than pCT. Conclusion MC simulations were used to compare HeCT and pCT image reconstruction. HeCT images had similar or better RSP accuracy and higher spatial resolution compared to pCT. Further investigation of the potential of helium ion imaging is warranted.