External dosimetry audit for quality assurance of carbon-ion radiation therapy clinical trials

Commissioning a newly developed treatment planning system, VQA Plan, for fast-raster scanning of carbon-ion beams

In this study, we report our experience in commissioning a commercial treatment planning system (TPS) for fast-raster scanning of carbon-ion beams. This TPS uses an analytical dose calculation algorithm, a pencil-beam model with a triple Gaussian form for the lateral-dose distribution, and a beam splitting algorithm to consider lateral heterogeneity in a medium. We adopted the mixed beam model as the relative biological effectiveness (RBE) model for calculating the RBE values of the scanned carbon-ion beam. To validate the modeled physical dose, we compared the calculations with measurements of various relevant quantities as functions of the field size, range and width of the spread-out Bragg peak (SOBP), and depth–dose and lateral-dose profiles for a 6-mm SOBP in water. To model the biological dose, we compared the RBE calculated with the newly developed TPS to the RBE calculated with a previously validated TPS that is in clinical use and uses the same RBE model concept. We also performed patient-specific measurements to validate the dose model in clinical situations. The physical beam model reproduces the measured absolute dose at the center of the SOBP as a function of field size, range, and SOBP width and reproduces the dose profiles for a 6-mm SOBP in water. However, the profiles calculated for a heterogeneous phantom have some limitations in predicting the carbon-ion-beam dose, although the biological doses agreed well with the values calculated by the validated TPS. Using this dose model for fast-raster scanning, we successfully treated more than 900 patients from October 2018 to October 2020, with an acceptable agreement between the TPS-calculated and measured dose distributions. We conclude that the newly developed TPS can be used clinically with the understanding that it has limited accuracies for heterogeneous media.

Evaluation of radiophotoluminescent glass dosimeter response for therapeutic spot scanning proton beam: suggestion of linear energy transfer-based correction

A radiophotoluminescent glass dosimeter (RGD) is used for a postal audit of a photon beam because of its various excellent characteristics. However, it has not been used for scanning proton beams because its response characteristics have not been verified. In this study, the response of RGD to scanning protons was investigated to develop a dosimetry protocol using the linear energy transfer (LET)‐based correction factor. The responses of RGD to four maximum‐range‐energy‐pattern proton beams were verified by comparing it with ionization chamber (IC) dosimetry. The LET at each measurement depth was calculated via Monte Carlo (MC) simulation. The LET correction factor (kLETRGD) was the ratio between the uncorrected RGD dose (DrawRGD) and the IC dose at each measurement depth. kLETRGD can be represented as a function of LET using the following equation: kLETRGDLET=‐0.035LET+1.090. DrawRGD showed a linear under‐response with increasing LET, and the maximum dose difference between the IC dose and DrawRGD was 15.2% at an LET of 6.07 keV/μm. The LET‐based correction dose (DLETRGD) conformed within 3.6% of the IC dose. The mean dose difference (±SD) of DrawRGD and DLETRGD was –2.5 ± 6.9% and 0.0 ± 1.6%, respectively. To achieve accurate dose verification for scanning proton beams using RGD, we derived a linear regression equation based on LET. The results show that with appropriate LET correction, RGD can be used for dose verification of scanning proton beams.

Technical Note: Reconstruction of physical and biological dose distributions of carbon-ion beam through deconvolution of longitudinal dosimeter responses

PURPOSE

This is a theoretical simulation study for proof of concept of radiochromic film dosimetry to measure physical and biological doses without plan-based quenching correction for patient-specific quality assurance of carbon-ion radiotherapy.

METHODS

We took a layer-stacking carbon-ion beam comprised of range-shifted beamlets. The dosimeter response was simulated according to an experimental quenching model. The beam model followed a treatment planning system. The beam was decomposed into finely arranged beamlets with weights estimated by deconvolution of longitudinal dosimeter responses. The distributions of physical and biological doses were reconstructed from the estimated weights and were compared with the plan. We also evaluated the sensitivity to measurement errors and to erratic delivery with an undelivered beamlet.

RESULTS

The reconstructed physical and biological doses accurately reproduced the simulated delivery with errors approximately corresponding to the measurement errors. The erratic beam delivery was easily detectable by comparison of biological dose distribution to the plan.

CONCLUSIONS

We have developed a method to measure physical and biological doses by longitudinal dosimetry of quenched response without using plan data. The method only involves a general optimization algorithm, a radiobiology model, and experimental beamlet data, and requires no extra corrections. Theoretically, this approach is applicable to various dosimeters and to proton and ion beams of any delivery method, regardless of quenching or biological effectiveness.