Roger Svensson

Simultaneous optimization of dynamic multileaf collimation and scanning patterns or compensation filters using a generalized pencil beam algorithm.

A very flexible iterative method for simultaneous optimization of dynamic multileaf collimation, scanning patterns and compensation filters has been developed. The algorithm can account for and optimize almost all the degrees of freedom available in a modern radiation therapy clinic. The method has been implemented for three dimensional treatment planning. The algorithm has been tested for a number of cases where both traditional wedge filters and block collimators, and modern equipment such as scanned beams and multileaf collimators are available. It is shown that the algorithm can improve heavily on traditional uniform dose plans with respect to the probability of achieving tumor control without causing severe complications (P+) simply by finding the optimal beam weights and block collimator settings. By allowing more complex equipment to deliver the dose and by accounting for their increased flexibility during the optimization, the dose plan can be substantially improved with respect to the applied objective functions. It is demonstrated that flexible lateral collimation combined with compensators or scanned beams in most cases allow close to optimal dose delivery. Here both the calculation time and the amount of primary computer memory needed has been reduced by performing the dose calculations in a cone beam coordinate system allowing the use of approximately spatially invariant energy deposition kernels. A typical calculation time for optimization of a two-field technique in a three dimensional volume is about 20 s per iteration step on a Hewlett-Packard 735 workstation. A well converged solution is normally obtained within about 50-100 iterations or within 15-30 min.

Development of dose delivery verification by PET imaging of photonuclear reactions following high energy photon therapy

A method for dose delivery monitoring after high energy photon therapy has been investigated based on positron emission tomography (PET). The technique is based on the activation of body tissues by high energy bremsstrahlung beams, preferably with energies well above 20 MeV, resulting primarily in 11C and 15O but also 13N, all positron-emitting radionuclides produced by photoneutron reactions in the nuclei of 12C, 16O and 14N. A PMMA phantom and animal tissue, a frozen hind leg of a pig, were irradiated to 10 Gy and the induced positron activity distributions were measured off-line in a PET camera a couple of minutes after irradiation. The accelerator used was a Racetrack Microtron at the Karolinska University Hospital using 50 MV scanned photon beams. From photonuclear cross-section data integrated over the 50 MV photon fluence spectrum the predicted PET signal was calculated and compared with experimental measurements. Since measured PET images change with time post irradiation, as a result of the different decay times of the radionuclides, the signals from activated 12C, 16O and 14N within the irradiated volume could be separated from each other. Most information is obtained from the carbon and oxygen radionuclides which are the most abundant elements in soft tissue. The predicted and measured overall positron activities are almost equal (-3%) while the predicted activity originating from nitrogen is overestimated by almost a factor of two, possibly due to experimental noise. Based on the results obtained in this first feasibility study the great value of a combined radiotherapy-PET-CT unit is indicated in order to fully exploit the high activity signal from oxygen immediately after treatment and to avoid patient repositioning. With an RT-PET-CT unit a high signal could be collected even at a dose level of 2 Gy and the acquisition time for the PET could be reduced considerably. Real patient dose delivery verification by means of PET imaging seems to be applicable provided that biological transport processes such as capillary blood flow containing mobile 15O and 11C in the activated tissue volume can be accounted for.

Design and characterization of a tissue-equivalent CVD-diamond detector for clinical dosimetry in high-energy photon beams

New solid-state detectors, based on chemical vapour deposited (CVD) polycrystalline diamonds produced by hot-filament (HF) or microwave plasma (MW) assisted deposition methods, were constructed for radiation therapy dosimetry. Properties of diamond crystals, such as high radiation sensitivity, resistance to radiation damage and tissue-equivalence giving a low-energy dependence are very advantageous for clinical dosimetry. Therefore the encapsulation was specially designed for these detectors to have as little influence as possible on the radiation response. The prototypes were irradiated with use of a wide range of photon beam qualities ((60)Co gamma-rays, 6 and 18 MV X-rays). The radiation sensitivity varied considerably between samples deposited with HF (9 nC Gy(-1)mm(-3)) and MW (66 and 144 nC Gy(-1)mm(-3)) methods. For all detectors the leakage current was of the order of 10% of the radiation-induced current (bias voltage 100 V, dose rate 0.3 Gy/min). When irradiated with (60)Co gamma-rays, the detectors showed a dose-rate linearity with an exponential Delta parameter close to unity. However, a difference of 8% was found between Delta values for the different beam qualities. A small energy dependence was observed, for which the most probable sources are interface effects due to the silver electrodes and partly the geometry of the encapsulation which needs to be further optimized. Despite some limitations in the performance of present prototype detectors, with an improved CVD technique producing crystals of better electrical and dosimetric properties, and with a well-designed tissue-equivalent encapsulation, CVD-diamonds could serve as very good dosimeters for radiotherapy.

Effective source size, yield and beam profile from multi-layered bremsstrahlung targets

Modern conformal radiotherapy benefits from heterogeneous dose delivery using scanned narrow bremsstrahlung beams of high energy in combination with dynamic double focused multi-leaf collimation and purging magnets. When using a purging magnet to remove electrons and positrons the target space is limited and unorthodox thin multi-layered targets are needed. A computational technique has therefore been developed to determine the forward yield and the angular distributions of the bremsstrahlung beam as well as the size and location of the effective and the virtual photon point source for arbitrary multi-layer bremsstrahlung targets. The Gaussian approximation of the diffusion equation for the electrons has been used and convolved with the bremsstrahlung production process. For electrons with arbitrary emittance impinging on targets of any multi-layer and atomic number combination, the model is well applicable, at least for energies in the range 1-100 MeV. The intrinsic bremsstrahlung photon profile has been determined accurately by deconvolving the electron multiple scattering process from thin experimental beryllium target profiles. For electron pencil beams incident on a target of high density and atomic number such as tungsten, the size of the effective photon source stays at around a tenth of a millimetre. The effective photon source for low-Z materials such as Be, C and Al is located at depths from 3-7 mm in the target, decreasing with increasing atomic number. The effective photon source at off-axis positions then moves out considerably from the central axis, which should be considered when aligning collimators. For high-Z materials such as tungsten, the location of the effective photon source is at a few tenths of a millimetre deep. The virtual photon point source is located only a few tenths of a millimetre upstream of the effective photon source both for high- and low-Z materials. For 50 MeV electrons incident on multi-layered full range targets the radial energy fluence distributions will have a full width at half maximum (FWHM) of 80 to 100 mm at 1 m from the target. The best target composition made of two layers when the space is limited to 15 mm was found to be 9 mm-Be followed by 6 mm W. A thin beryllium target (approximately 3 mm) results in a high-intensity bremsstrahlung lobe with a FWHM of about 35 mm at the isocentre. Interestingly, the forward dose rate in such a beam is as high as 62% of the maximum achievable with an optimal target design, even if on average only 1 MeV is lost by the electrons.

Beam characteristics and clinical possibilities of a new compact treatment unit design combining narrow pencil beam scanning and segmental multileaf collimation

Not until the last decade has flexible intensity modulated three-dimensional dose delivery techniques with photon beams become a clinical reality, first in the form of heavy metal transmission blocks and other beam compensators, then in dynamic and segmented multileaf collimation, and most recently by scanning high-energy narrow electron and photon beams. The merits of various treatment unit and bremsstrahlung target designs for high-energy photon therapy are investigated theoretically for two clinically relevant target sites, a cervix and a larynx cancer both in late stages. With an optimized bremsstrahlung target it is possible to generate photon beams with a half-width of about 3 cm at a source to axis distance (SAD) of 100 cm and an initial electron energy of 50 MeV. By making a more compact treatment head and shortening the SAD, it is possible to reduce the half-width even further to about 2 cm at a SAD of 70 cm and still have sufficient clearance between the collimator head and the patient. One advantage of a reduced SAD is that the divergence of the beam for a given field size on the patient is increased, and thus the exit dose is lowered by as much as 1%/cm of the patient cross section. A second advantage of a reduced SAD is that the electron beam on the patient surface will be only about 8 mm wide and very suitable for precision spot beam scanning. It may also be possible to reduce the beamwidth further by increasing the electron energy up to about 60 MeV to get a photon beam of around 15 mm half-width and an electron beam as narrow as 5 mm. The compact machine will be more efficient and easy to work with, due to the small gantry and the reduced isocentric height. For a given target volume and optimally selected static multileaf collimator, it is no surprise that the narrowest possible scanned elementary bremsstrahlung beam generates the best possible treatment outcome. In fact, by delivering a few static field segments with individually optimized scan patterns, it is possible to combine the advantage of being able to fine tune the fluence distribution by the scanning system with the steeper dose gradients that can be delivered by a few static multileaf collimator segments. It is demonstrated that in most cases a few collimator segments are sufficient and often a single segment per beam portal may suffice when narrow scanned photon beams are employed, and they can be delivered sequentially with a negligible time delay. A further advantage is the increase of therapeutically useful photons and improved patient protection, since the pencil beam is only scanned where the leaf collimator is open. Consequently, some of the problems associated with dynamic multileaf collimation such as the tongue and groove and edge leakage effects are significantly reduced. Fast scanning beam techniques combined with good treatment verification systems allow interesting future possibilities to counteract patient and internal organ motions in real time.

Influence of electrodes on the photon energy deposition in CVD-diamond dosimeters studied with the Monte Carlo code PENELOPE

A new dosimeter, based on chemical vapour deposited (CVD) diamond as the active detector material, is being developed for dosimetry in radiotherapeutic beams. CVD-diamond is a very interesting material, since its atomic composition is close to that of human tissue and in principle it can be designed to introduce negligible perturbations to the radiation field and the dose distribution in the phantom due to its small size. However, non-tissue-equivalent structural components, such as electrodes, wires and encapsulation, need to be carefully selected as they may induce severe fluence perturbation and angular dependence, resulting in erroneous dose readings. By introducing metallic electrodes on the diamond crystals, interface phenomena between high- and low-atomic-number materials are created. Depending on the direction of the radiation field, an increased or decreased detector signal may be obtained. The small dimensions of the CVD-diamond layer and electrodes (around 100 microm and smaller) imply a higher sensitivity to the lack of charged-particle equilibrium and may cause severe interface phenomena. In the present study, we investigate the variation of energy deposition in the diamond detector for different photon-beam qualities, electrode materials and geometric configurations using the Monte Carlo code PENELOPE. The prototype detector was produced from a 50 microm thick CVD-diamond layer with 0.2 microm thick silver electrodes on both sides. The mean absorbed dose to the detectors active volume was modified in the presence of the electrodes by 1.7%, 2.1%, 1.5%, 0.6% and 0.9% for 1.25 MeV monoenergetic photons, a complete (i.e. shielded) (60)Co photon source spectrum and 6, 18 and 50 MV bremsstrahlung spectra, respectively. The shift in mean absorbed dose increases with increasing atomic number and thickness of the electrodes, and diminishes with increasing thickness of the diamond layer. From a dosimetric point of view, graphite would be an almost perfect electrode material. This study shows that, for the considered therapeutic beam qualities, the perturbation of the detector signal due to charge-collecting graphite electrodes of thicknesses between 0.1 and 700 microm is negligible within the calculation uncertainty of 0.2%.

The Clinical Value of Non-Coplanar Photon Beams in Biologically Optimized Intensity Modulated Dose Delivery on Deep-Seated Tumours

The aim of the present study is to compare the merits of different radiobiologically optimized treatment techniques using few-field planar and non-coplanar dose delivery on an advanced cancer of the cervix, with rectum and bladder as principal organs at risk. Classically, the rational for using non-coplanar beams is to minimize the overlap of beam entrance and exit regions and to find new beam directions avoiding organs at risk, in order to reduce damage to sensitive normal tissues. Two four-beam configurations have been extensively studied. The first consists of three evenly spaced coplanar beams and a fourth non-coplanar beam. A second tetrahedral-like configuration, with two symmetric non-coplanar beams at the same gantry angle and two coplanar beams, with optimized beam directions, was also tested. The present study shows that when radiobiologically optimized intensity modulated beams are applied to such a geometry, only a marginal increase in the treatment outcome can be achieved by non-coplanar beams compared to the optimal coplanar treatment. The main reason for this result is that the high dose in the beam-overlap regions is already optimally reduced by biologically optimized intensity modulation in the plane. The large number of degrees of freedom already incorporated in the treatment by the use of intensity modulation and radiobiological optimization, leads to the saturation of the benefit acquired by a further increase in the degrees of freedom with non-coplanar beams. In conclusion, the use coplanar of radiobiologically optimized intensity modulation simplifies the dose delivery, reducing the need for non-coplanar beam portals.

Target, purging magnet and electron collector design for scanned high-energy photon beams

A new method for producing very narrow and intense 50 MV bremsstrahlung beams with a half-width as low as 35 mm at a distance of 1 m from the target is presented. Such a beam is well suited for intensity modulation using scanned photon beams. An algorithm has been developed to minimize the width of the bremsstrahlung beam generated in a multilayer target by varying the individual layer thicknesses and atomic numbers under given constraints on the total target thickness and the mean energy of the transmitted electrons. Under such constraints the narrowest possible bremsstrahlung beam is obtained with a target composed of layers of monotonically increasing atomic number starting with the lowest possible value at the entrance side where the electrons impinge. It is also shown that the narrowest photon beam profile is associated with the highest possible forward photon yield. To be able to use the optimized target clinically it is desirable to be able to collect and stop all the electrons that are transmitted through the target. The electrons are most efficiently collected if they are kept close together, i.e. by minimizing the multiple scatter of the electrons and consequently the half-width of the generated bremsstrahlung beam. This is achieved by a thin low-atomic-number target. A dedicated electron stopper has been developed and integrated with the purging magnet. When the electron stopper is combined with a purging magnet, a primary photon collimator and a multileaf collimator, almost all of the transmitted electrons and their associated bremsstrahlung contamination can effectively be collected. The narrow photon beams from thin low-atomic-number targets have the additional advantage of producing the hardest and most penetrative photon spectrum possible, which is ideal for treating large deep-seated tumours.

Design of a fast multileaf collimator for radiobiological optimized IMRT with scanned beams of photons, electrons, and light ions

Intensity modulated radiation therapy is rapidly becoming the treatment of choice for most tumors with respect to minimizing damage to the normal tissues and maximizing tumor control. Today, intensity modulated beams are most commonly delivered using segmental multileaf collimation, although an increasing number of radiation therapy departments are employing dynamic multileaf collimation. The irradiation time using dynamic multileaf collimation depends strongly on the nature of the desired dose distribution, and it is difficult to reduce this time to less than the sum of the irradiation times for all individual peak heights using dynamic leaf collimation [Svensson et al., Phys. Med. Biol. 39, 37-61 (1994)]. Therefore, the intensity modulation will considerably increase the total treatment time. A more cost-effective procedure for rapid intensity modulation is using narrow scanned photon, electron, and light ion beams in combination with fast multileaf collimator penumbra trimming. With this approach, the irradiation time is largely independent of the complexity of the desired intensity distribution and, in the case of photon beams, may even be shorter than with uniform beams. The intensity modulation is achieved primarily by scanning of a narrow elementary photon pencil beam generated by directing a narrow well focused high energy electron beam onto a thin bremsstrahlung target. In the present study, the design of a fast low-weight multileaf collimator that is capable of further sharpening the penumbra at the edge of the elementary scanned beam has been simulated, in order to minimize the dose or radiation response of healthy tissues. In the case of photon beams, such a multileaf collimator can be placed relatively close to the bremsstrahlung target to minimize its size. It can also be flat and thin, i.e., only 15-25 mm thick in the direction of the beam with edges made of tungsten or preferably osmium to optimize the sharpening of the penumbra. The low height of the collimator will minimize edge scatter from glancing incidence. The major portions of the collimator leafs can then be made of steel or even aluminum, so that the total weight of the multileaf collimator will be as low as 10 kg, which may even allow high-speed collimation in real time in synchrony with organ movements. To demonstrate the efficiency of this collimator design in combination with pencil beam scanning, optimal radiobiological treatments of an advanced cervix cancer were simulated. Different geometrical collimator designs were tested for bremsstrahlung, electron, and light ion beams. With a 10 mm half-width elementary scanned photon beam and a steel collimator with tungsten edges, it was possible to make as effective treatments as obtained with intensity modulated beams of full resolution, i.e., here 5 mm resolution in the fluence map. In combination with narrow pencil beam scanning, such a collimator may provide ideal delivery of photons, electrons, or light ions for radiation therapy synchronized to breathing and other organ motions. These high-energy photon and light ion beams may allow three-dimensional in vivo verification of delivery and thereby clinical implementation of the BioArt approach using Biologically Optimized three-dimensional in vivo predictive Assay based adaptive Radiation Therapy [Brahme, Acta Oncol. 42, 123-126 (2003)].

Photon scatter kernels for intensity modulating radiation therapy filters

The most important beam property while optimizing photon therapy is the ability to modulate the intensity of the beam. The use of photon absorbers for intensity modulation of beam profiles requires special attention to be paid to the alteration of beam properties due to scatter and spectral changes, in addition to the desired intensity modulation. In this study the influence of photon scatter in high-density filters irradiated with very narrow photon pencil beams was investigated. A simple analytical relation is developed to quantify the contribution by scattered photons. A scatter kernel was derived by convolving the first Compton scatter distribution with an approximate expression for the second-order scattered photons. The calculations were validated experimentally with film dosimetry and also by using Monte Carlo simulations. Results show that the difference in photon scatter estimation by different methods is relatively small when higher order scattering is accounted for. At 6 MV x-rays the agreement is slightly better than that for 18 MV x-rays results. The simple relation presented in this paper can be used to account for the scattered photon contribution in filter optimization codes to deliver biologically or physically optimized intensity modulated treatments.