Vadim Moskvin

Monte Carlo simulation of the Leksell Gamma Knife®: II. Effects of heterogeneous versus homogeneous media for stereotactic radiosurgery

The absence of electronic equilibrium in the vicinity of bone-tissue or air-tissue heterogeneity in the head can misrepresent deposited dose with treatment planning algorithms that assume all treatment volume as homogeneous media. In this paper, Monte Carlo simulation (PENELOPE) and measurements with a specially designed heterogeneous phantom were applied to investigate the effect of air-tissue and bone-tissue heterogeneity on dose perturbation with the Leksell Gamma Knife. The dose fall-off near the air-tissue interface caused by secondary electron disequilibrium leads to overestimation of dose by the vendor supplied treatment planning software (GammaPlan) at up to 4 mm from an interface. The dose delivered to the target area away from an air-tissue interface may be underestimated by up to 7% by GammaPlan due to overestimation of attenuation of photon beams passing through air cavities. While the underdosing near the air-tissue interface cannot be eliminated with any plug pattern, the overdosage due to under-attenuation of the photon beams in air cavities can be eliminated by plugging the sources whose beams intersect the air cavity. Little perturbation was observed next to bone-tissue interfaces. Monte Carlo results were confirmed by measurements. This study shows that the employed Monte Carlo treatment planning is more accurate for precise dosimetry of stereotactic radiosurgery with the Leksell Gamma Knife for targets in the vicinity of air-filled cavities.

150-250 MeV electron beams in radiation therapy

High-energy electron beams in the range 150-250 MeV are studied to evaluate the feasibility for radiotherapy. Monte Carlo simulation results from the PENELOPE code are presented and used to determine lateral spread and penetration of these beams. It is shown that the penumbra is comparable to photon beams at depths less than 10 cm and the practical range (Rp) of these beams is greater than 40 cm. The depth dose distribution of electron beams compares favourably with photon beams. Effects caused by nuclear reactions are evaluated, including increased dose due to neutron production and induced radioactivity resulting in an increased relative biological effectiveness (RBE) factor of < 1.03.

Monte Carlo simulation of the Leksell Gamma Knife?: I. Source modelling and calculations in homogeneous media

The Monte Carlo code PENELOPE has been used to simulate photon flux from the Leksell Gamma Knife, a precision method for treating intracranial lesions. Radiation from a single 6OCo assembly traversing the collimator system was simulated, and phase space distributions at the output surface of the helmet for photons and electrons were calculated. The characteristics describing the emitted final beam were used to build a two-stage Monte Carlo simulation of irradiation of a target. A dose field inside a standard spherical polystyrene phantom, usually used for Gamma Knife dosimetry, has been computed and compared with experimental results, with calculations performed by other authors with the use of the EGS4 Monte Carlo code, and data provided by the treatment planning system Gamma Plan. Good agreement was found between these data and results of simulations in homogeneous media. Owing to this established accuracy, PENELOPE is suitable for simulating problems relevant to stereotactic radiosurgery.

Use of the Leksell Gamma Knife for localized small field lens irradiation in rodents.

For most basic radiobiological research applications involving irradiation of small animals, it is difficult to achieve the same high precision dose distribution realized with human radiotherapy. The precision for irradiations performed with standard radiotherapy equipment is ±2 mm in each dimension, and is adequate for most human treatment applications. For small animals such as rodents, whose organs and tissue structures may be an order of magnitude smaller than those of humans, the corresponding precision required is closer to ±0.2 mm, if comparisons or extrapolations are to be made to human data. The Leksell Gamma Knife is a high precision radiosurgery irradiator, with precision in each dimension not exceeding 0.5 mm, and overall precision of 0.7 mm. It has recently been utilized to treat ocular melanoma and induce targeted lesions in the brains of small animals. This paper describes the dosimetry and a technique for performing irradiation of a single rat eye and lens with the Gamma Knife while allowing the contralateral eye and lens of the same rat to serve as the “control”. The dosimetry was performed with a phantom in vitro utilizing a pinpoint ion chamber and thermoluminescent dosimeters, and verified by Monte Carlo simulations. We found that the contralateral eye received less than 5% of the administered dose for a 15 Gy exposure to the targeted eye. In addition, after 15 Gy irradiation 15 out of 16 animals developed cataracts in the irradiated target eyes, while 0 out of 16 contralateral eyes developed cataracts over a 6-month period of observation. Experiments at 5 and 10 Gy also confirmed the lack of cataractogenesis in the contralateral eye. Our results validate the use of the Gamma Knife for cataract studies in rodents, and confirmed the precision and utility of the instrument as a small animal irradiator for translational radiobiology experiments.

Analysis of Treatment Planning Time Among Systems and Planners for Intensity-Modulated Radiation Therapy

Radiation oncology is a technologically advanced health care specialty in which numerous innovations, such as intensity-modulated radiation therapy (IMRT), require significant manpower and resources. For 3 main disease sites (prostate, head and neck, and lung), the authors investigated IMRT planning time across the United States among commonly used treatment planning systems (TPS). Treatment planning time was investigated in different components of IMRT: data transfer, contouring, beam arrangements, optimization, dose calculation, and phantom plans. The results showed significant variability among the TPS depending on the functionality and efficiency of the TPS algorithm. This study provides a road map to quantify the manpower needed and the selection of proper tools for IMRT planning and could be a model for any health care task.

Feasibility of RACT for 3D dose measurement and range verification in a water phantom

PURPOSE The objective of this study is to establish the feasibility of using radiation-induced acoustics to measure the range and Bragg peak dose from a pulsed proton beam. Simulation studies implementing a prototype scanner design based on computed tomographic methods were performed to investigate the sensitivity to proton range and integral dose. METHODS Derived from thermodynamic wave equation, the pressure signals generated from the dose deposited from a pulsed proton beam with a 1 cm lateral beam width and a range of 16, 20, and 27 cm in water using Monte Carlo methods were simulated. The resulting dosimetric images were reconstructed implementing a 3D filtered backprojection algorithm and the pressure signals acquired from a 71-transducer array with a cylindrical geometry (30 × 40 cm) rotated over 2π about its central axis. Dependencies on the detector bandwidth and proton beam pulse width were performed, after which, different noise levels were added to the detector signals (using 1 μs pulse width and a 0.5 MHz cutoff frequency/hydrophone) to investigate the statistical and systematic errors in the proton range (at 20 cm) and Bragg peak dose (of 1 cGy). RESULTS The reconstructed radioacoustic computed tomographic image intensity was shown to be linearly correlated to the dose within the Bragg peak. And, based on noise dependent studies, a detector sensitivity of 38 mPa was necessary to determine the proton range to within 1.0 mm (full-width at half-maximum) (systematic error < 150 μm) for a 1 cGy Bragg peak dose, where the integral dose within the Bragg peak was measured to within 2%. For existing hydrophone detector sensitivities, a Bragg peak dose of 1.6 cGy is possible. CONCLUSIONS This study demonstrates that computed tomographic scanner based on ionizing radiation-induced acoustics can be used to verify dose distribution and proton range with centi-Gray sensitivity. Realizing this technology into the clinic has the potential to significantly impact beam commissioning, treatment verification during particle beam therapy and image guided techniques.

Laser-plasma generated very high energy electrons in radiation therapy of the prostate

Monte Carlo simulation experiments have shown that very high energy electrons (VHEE), 150-250 MeV, have potential advantages in prostate cancer treatment over currently available electrons, photon and proton beam treatment. Small diameter VHEE beamlets can be scanned, thereby producing a finer resolution intensity modulated treatment than photon beams. VHEE beams may be delivered with greater precision and accelerators may be constructed at significantly lower cost than proton beams. A VHEE accelerator may be optimally designed using laser-plasma technology. If the accelerator is constructed to additionally produce low energy photon beams along with VHEE, real time imaging, bioprobing, and dose enhancement may be performed simultaneously. This paper describes a Monte Carlo experiment, using the parameters of the electron beam from the UCLA laser-plasma wakefield accelerator, whereby dose distributions on a human prostate are generated. The resulting dose distributions of the very high energy electrons are shown to be comparable to photon beam dose distributions. This simple experiment illustrates that the nature of the dose distribution of electrons is comparable to that of photons. However, the main advantage of electrons over photons and protons lies in the delivery and manipulation of electrons, rather than the nature of the dose distribution. This paper describes the radiation dose delivery of electrons employing technologies currently in exploration and evaluates potential benefits as compared with currently available photon and protons beams in the treatment of prostate and other cancers, commonly treated with radiation.

Very high energy electrons (50 - 250 MeV) and radiation therapy

High energy electron beams in the range 150–250 MeV are investigated to evaluate their feasibility for radiotherapy. Monte Carlo simulation results from PENELOPE code are used to determine lateral spread and penetration of these beams. It is shown that dose distribution of electron beams compare favorably with photon beams. Electromagnetic control of electron beams enables scanned intensity modulation not possible with photon beams.

Pitfalls of tungsten multileaf collimator in proton beam therapy.

PURPOSE Particle beam therapy is associated with significant startup and operational cost. Multileaf collimator (MLC) provides an attractive option to improve the efficiency and reduce the treatment cost. A direct transfer of the MLC technology from external beam radiation therapy is intuitively straightforward to proton therapy. However, activation, neutron production, and the associated secondary cancer risk in proton beam should be an important consideration which is evaluated. METHODS Monte Carlo simulation with FLUKA particle transport code was applied in this study for a number of treatment models. The authors have performed a detailed study of the neutron generation, ambient dose equivalent [H∗(10)], and activation of a typical tungsten MLC and compared with those obtained from a brass aperture used in a typical proton therapy system. Brass aperture and tungsten MLC were modeled by absorber blocks in this study, representing worst-case scenario of a fully closed collimator. RESULTS With a tungsten MLC, the secondary neutron dose to the patient is at least 1.5 times higher than that from a brass aperture. The H∗(10) from a tungsten MLC at 10 cm downstream is about 22.3 mSv/Gy delivered to water phantom by noncollimated 200 MeV beam of 20 cm diameter compared to 14 mSv/Gy for the brass aperture. For a 30-fraction treatment course, the activity per unit volume in brass aperture reaches 5.3 × 10⁴ Bq cm(-3) at the end of the last treatment. The activity in brass decreases by a factor of 380 after 24 h, additional 6.2 times after 40 days of cooling, and is reduced to background level after 1 yr. Initial activity in tungsten after 30 days of treating 30 patients per day is about 3.4 times higher than in brass that decreases only by a factor of 2 after 40 days and accumulates to 1.2 × 10⁶ Bq cm(-3) after a full year of operation. The daily utilization of the MLC leads to buildup of activity with time. The overall activity continues to increase due to (179)Ta with a half-life of 1.82 yr and thus require prolonged storage for activity cooling. The H∗(10) near the patient side of the tungsten block is about 100 μSv/h and is 27 times higher at the upstream side of the block. This would lead to an accumulated dose for therapists in a year that may exceed occupational maximum permissible dose (50 mSv/yr). The value of H∗(10) at the upstream surface of the tungsten block is about 220 times higher than that of the brass. CONCLUSIONS MLC is an efficient way for beam shaping and overall cost reduction device in proton therapy. However, based on this study, tungsten seems to be not an optimal material for MLC in proton beam therapy. Usage of tungsten MLC in clinic may create unnecessary risks associated with the secondary neutrons and induced radioactivity for patients and staff depending on the patient load. A careful selection of material for manufacturing of an optimal MLC for proton therapy is thus desired.

Monte Carlo calculation of charge-deposition depth profile in slabs irradiated by electrons

Abstract Charge-deposition distributions in finite slab absorbers irradiated by electrons have been computed by using a new Monte Carlo technique (method of trajectory rotation). The results of calculations for plane-parallel electron beams with energies from 1 to 10 MeV incident normally on slabs with thicknesses from 0.1 to 1.0 of continuous slowing-down approximation (csda) electron range are presented. Absorber materials with atomic numbers between 6 and 79 are considered. Influence of backscattering from deeper layers of the target on charge-deposition for different depths in the slab h discussed.