Tony Lomax

A technique for calculating range spectra of charged particle beams distal to thick inhomogeneities

A method was developed for calculating range spectra of charged particles after passing through an inhomogeneous structure whose thickness was comparable to the range of the incident particles. It was shown that the spectra are strongly affected by the influence of multiple Coulomb scattering at interfaces parallel to the beam direction of two media with different relative stopping power. The calculations are in agreement with Monte Carlo simulations. The degraded Bragg peak was calculated on the basis of the computed range spectra behind the inhomogeneity interface. The method can be included into charged particle treatment planning systems where broad pencil beams are used to predict the deteriorated Bragg peak behind inhomogeneity interfaces more precisely.

Out-of-field dose studies with an anthropomorphic phantom: Comparison of X-rays and particle therapy treatments

BACKGROUND AND PURPOSE Characterization of the out-of-field dose profile following irradiation of the target with a 3D treatment plan delivered with modern techniques. METHODS An anthropomorphic RANDO phantom was irradiated with a treatment plan designed for a simulated 5 × 2 × 5 cm(3) tumor volume located in the center of the head. The experiment was repeated with all most common radiation treatment types (photons, protons and carbon ions) and delivery techniques (Intensity Modulated Radiation Therapy, passive modulation and spot scanning). The measurements were performed with active diamond detector and passive thermoluminescence (TLD) detectors to investigate the out-of-field dose both inside and outside the phantom. RESULTS The highest out-of-field dose values both on the surface and inside the phantom were measured during the treatment with 25 MV photons. In the proximity of the Planned Target Volume (PTV), the lowest lateral dose profile was observed for passively modulated protons mainly because of the presence of the collimator in combination with the chosen volume shape. In the far out-of-field region (above 100mm from the PTV), passively modulated ions were characterized by a less pronounced dose fall-off in comparison with scanned beams. Overall, the treatment with scanned carbon ions delivered the lowest dose outside the target volume. CONCLUSIONS For the selected PTV, the use of the collimator in proton therapy drastically reduced the dose deposited by ions or photons nearby the tumor. Scanning modulation represents the optimal technique for achieving the highest dose reduction far-out-of-field.

Spatial resolution of proton tomography: Methods, initial phase space and object thickness

PURPOSE Proton radiography and tomography was investigated since the early 1970s because of its low radiation dose, high density resolution and ability to image directly proton stopping power. However, spatial resolution is still a limiting factor and as a consequence experimental methods and image reconstruction should be optimized to improve position resolution. METHODS Spatial resolution of proton radiography and tomography is given by multiple Coloumb scattering (MCS) of the protons in the patient. In this paper we employ an improved MCS model to study the impact of various proton tomographic set-ups on the spatial resolution, such as different combinations of entrance and exit coordinate and angle measurements, respectively, initial particle energy and angular confusion of the incident proton field. RESULTS It was found that best spatial resolution is obtained by measuring in addition to the entrance and exit coordinates also the entrance and exit angles. However, by applying partial backprojection and by using a perfect proton fan beam a sufficient spatial resolution can be achieved with less experimental complexity (measuring only exit angles). It was also shown that it is essential to use the most probable proton trajectory to improve spatial resolution. A simple straight line connection for image reconstruction results in a spatial resolution which is not clinically sufficient. The percentage deterioration of spatial resolution due to the angular confusion of the incident proton field is less than the phase space in mrad. A clinically realistic proton beam with 10 mrad angular confusion results in a less than 10% loss of spatial resolution. CONCLUSIONS Clinically sufficient spatial resolution can be either achieved with a full measurement of entrance and exit coordinates and angles, but also by using a fan beam with small angular confusion and an exit angle measurement. It is necessary to use the most probable proton path for image reconstruction. A simple straight line connection is in general not sufficient. Increasing proton energy improves spatial resolution of an object of constant size. This should be considered in the design of proton therapy facilities.

Neutrons in active proton therapy: Parameterization of dose and dose equivalent

PURPOSE One of the essential elements of an epidemiological study to decide if proton therapy may be associated with increased or decreased subsequent malignancies compared to photon therapy is an ability to estimate all doses to non-target tissues, including neutron dose. This work therefore aims to predict for patients using proton pencil beam scanning the spatially localized neutron doses and dose equivalents. METHODS The proton pencil beam of Gantry 1 at the Paul Scherrer Institute (PSI) was Monte Carlo simulated using GEANT. Based on the simulated neutron dose and neutron spectra an analytical mechanistic dose model was developed. The pencil beam algorithm used for treatment planning at PSI has been extended using the developed model in order to calculate the neutron component of the delivered dose distribution for each treated patient. The neutron dose was estimated for two patient example cases. RESULTS The analytical neutron dose model represents the three-dimensional Monte Carlo simulated dose distribution up to 85cm from the proton pencil beam with a satisfying precision. The root mean square error between Monte Carlo simulation and model is largest for 138MeV protons and is 19% and 20% for dose and dose equivalent, respectively. The model was successfully integrated into the PSI treatment planning system. In average the neutron dose is increased by 10% or 65% when using 160MeV or 177MeV instead of 138MeV. For the neutron dose equivalent the increase is 8% and 57%. CONCLUSIONS The presented neutron dose calculations allow for estimates of dose that can be used in subsequent epidemiological studies or, should the need arise, to estimate the neutron dose at any point where a subsequent secondary tumour may occur. It was found that the neutron dose to the patient is heavily increased with proton energy.

Liquid fiducial marker applicability in proton therapy of locally advanced lung cancer

BACKGROUND AND PURPOSE We investigated the clinical applicability of a novel liquid fiducial marker (LFM) for image-guided pencil beam scanned (PBS) proton therapy (PBSPT) of locally advanced lung cancer (LALC). MATERIALS AND METHODS The relative proton stopping power (RSP) of the LFM was calculated and measured. Dose perturbations of the LFM and three solid markers, in a phantom, were measured. PBSPT treatment planning on computer tomography scans of five patients with LALC with the LFM implanted was performed with 1-3 fields. RESULTS The RSP was experimentally determined to be 1.164 for the LFM. Phantom measurements revealed a maximum relative deviation in dose of 4.8% for the LFM in the spread-out Bragg Peak, compared to 12-67% for the solid markers. Using the experimentally determined RSP, the maximum proton range error introduced by the LFM is about 1mm. If the marker was displaced at PBSPT, the maximum dosimetric error was limited to 2 percentage points for 3-field plans. CONCLUSION The dose perturbations introduced by the LFM were considerably smaller than the solid markers investigated. The RSP of the fiducial marker should be corrected in the treatment planning system to avoid errors. The investigated LFM introduced clinically acceptable dose perturbations for image-guided PBSPT of LALC.

Neutrons in proton pencil beam scanning: parameterization of energy, quality factors and RBE.

The biological effectiveness of neutrons produced during proton therapy in inducing cancer is unknown, but potentially large. In particular, since neutron biological effectiveness is energy dependent, it is necessary to estimate, besides the dose, also the energy spectra, in order to obtain quantities which could be a measure of the biological effectiveness and test current models and new approaches against epidemiological studies on cancer induction after proton therapy. For patients treated with proton pencil beam scanning, this work aims to predict the spatially localized neutron energies, the effective quality factor, the weighting factor according to ICRP, and two RBE values, the first obtained from the saturation corrected dose mean lineal energy and the second from DSB cluster induction. A proton pencil beam was Monte Carlo simulated using GEANT. Based on the simulated neutron spectra for three different proton beam energies a parameterization of energy, quality factors and RBE was calculated. The pencil beam algorithm used for treatment planning at PSI has been extended using the developed parameterizations in order to calculate the spatially localized neutron energy, quality factors and RBE for each treated patient. The parameterization represents the simple quantification of neutron energy in two energy bins and the quality factors and RBE with a satisfying precision up to 85 cm away from the proton pencil beam when compared to the results based on 3D Monte Carlo simulations. The root mean square error of the energy estimate between Monte Carlo simulation based results and the parameterization is 3.9%. For the quality factors and RBE estimates it is smaller than 0.9%. The model was successfully integrated into the PSI treatment planning system. It was found that the parameterizations for neutron energy, quality factors and RBE were independent of proton energy in the investigated energy range of interest for proton therapy. The pencil beam algorithm has been extended using the developed parameterizations in order to calculate the neutron energy, quality factor and RBE.

Design Considerations for Intensity Modulated Proton Therapy Treatment Planning

Treatment planning for intensity modulated proton therapy, IMPT, or in general with heavy charged particles, poses significant computational problems in addition to those present in treatment planning for intensity modulated X-ray therapy, IMXT. IMPT has the additional degree-of-freedom of control in depth which permits control of intensity (fluence) at a point at the elemental dose delivery component [1]. IMPT and IMXT both control the intensity of the beam across a two-dimensional field aperture. MPT, however, modulates this intensity at different energies within a single field. The IMPT computational problem is therefore an order of magnitude larger compared to IMXT, corresponding to the modulation at each energy level. In addition, dose deposition for heavy charged particles is, in general, a non-linear function of the spectral properties at that point. Thus, to be exact, conversion between RBE and energy deposition must be considered at the fundamental level.

PO-0946: A new liquid fiducial marker formulation for image-guided pencil beam scanning proton radiotherapy

Material and Methods: The hyperthermia device is equipped with double arms, operating at a radiofrequency of 434 MHz, with a water automatic superficial cooling device. For temperature measures, it is equipped with an integrated Multichannel thermometer. The antennas are designed to cover areas from 7.2 × 19.7 cm2 up to 20.7 × 28.7 cm2. The applicators geometry have been reproduced in the CAD environment with a professional software based on the FDTD processing methods. In order to identify the distribution of specific absorption power rate in different types of tissues, several simulations have been performed, varying the relative thicknesses of a model consisting of skin, fat and muscle. Working incident power has been set equal to 100 watt. Waterbolus temperature is assumed to be equal to 38 °C

TH‐E‐220‐02: Spatial Resolution of Proton Tomography: Methods, Initial Phase Space and Object Thickness

Purpose: Protonradiography and tomography was investigated in the early 1970s because of its low radiation dose, high density resolution and ability to image directly protonstopping power.Spatial resolution is still a limiting factor. therefore experimental methods and image reconstruction should be optimized to improve position resolution. Methods: Spatial resolution of protontomography is given by multiple scattering(MCS) of the protons. We employ an improved MCS model to study the impact of proton tomographic set‐ups on spatial resolution, such as different combinations of entrance and exit coordinate and angle measurements, respectively, particle energy and angular confusion of the proton field. Results: It was found that best spatial resolution is obtained by measuring in addition to the entrance and exit coordinates the entrance and exit angles. By applying partial backprojection and a perfect proton fan beam a sufficient spatial resolution can be achieved with less experimental complexity. It was also shown that it is essential to use the most probable proton trajectory to improve spatial resolution. A simple straight line connection for image reconstruction results in a spatial resolution which is not clinically sufficient. The percentage deterioration of spatial resolution due to the angular confusion of the incident proton field is less than the phase space in mrad. Conclusions: Clinically sufficient spatial resolution can be either achieved with a full measurement of entrance and exit coordinates and angles, but also by using a fan beam with small angular confusion and an exit angle measurement. It is necessary to use the most probable proton path for image reconstruction. A simple straight line connection is in general not sufficient. Increasing proton energy improves spatial resolution of an object of constant size. This should be considered in the design of proton therapy facilities.