Useful island block geometries of a passive intensity modulator used for intensity-modulated bolus electron conformal therapy

Dosimetric validation of intensity-modulated bolus electron conformal therapy planning and delivery using an anthropomorphic cylindrical head phantom

PURPOSE

This work investigated the dosimetric accuracy of the intensity-modulated bolus electron conformal therapy (IM-BECT) planning and delivery process using the decimal ElectronRT (eRT) treatment planning system.

METHODS

An IM-BECT treatment plan was designed using eRT for a cylindrical, anthropomorphic retromolar trigone phantom. Treatment planning involved specification of beam parameters and design of a variable thickness wax bolus and Passive Radiotherapy Intensity Modulator for Electrons (PRIME) device, which was comprised of 33 tungsten island blocks of discrete diameters from 0.158 to 0.223 cm (Intensity Reduction Factors from 0.937 to 0.875, respectively) inside a 10.1 × 6.7 cm2 copper cutout. For comparison of calculation accuracy, a BECT plan was generated by copying the IM-BECT plan and removing the intensity modulation. For both plans, a 16 MeV electron beam was used with 104.7 cm source-to-surface distance to bolus. In-phantom TLD-100 measurements (N = 47) were compared with both eRT planned dose distributions, which used the pencil beam redefinition algorithm with modifications for passive electron intensity modulation (IM-PBRA). Dose difference and distance to agreement (DTA) metrics were computed for each measurement point.

RESULTS

Comparison of measured dose distributions with planned dose distributions yielded dose differences (calculated minus measured) characterized by a mean and standard deviation of -0.36% ± 1.64% for the IM-BECT plan, which was similar to -0.36% ± 1.90% for the BECT plan. All dose measurements were within 5% of the planned dose distribution, with both the BECT and IM-BECT measurement sets having 46/47 (97.8%) points within 3% or within 3 mm of the respective treatment plans.

CONCLUSIONS

It was found that the IM-BECT treatment plan generated using eRT was sufficiently accurate for clinical use when compared to TLD measurements in a cylindrical, anthropomorphic phantom, and was similarly accurate to the BECT treatment plan in the same phantom.

Factory quality assurance of passive radiotherapy intensity modulators for electrons using kilovoltage x-ray imaging

PURPOSE

This work developed an x-ray-based method for performing factory quality assurance (QA) of Passive Radiotherapy Intensity Modulators for Electrons (PRIME) device fabrication. This method measures errors in position, diameter, and orientation of cylindrical island blocks on a hexagonal grid that comprises PRIME devices and the impact of such errors on the underlying intensity distribution.

METHODS

X-ray images were acquired of six PRIME devices, which modeled three error cases (small random, large random, and systematic errors) for two island block diameters (0.158 and 0.352 cm). Island blocks in each device, 0.6 cm long tungsten cylinders of constant diameter, were spaced 0.6 cm on a hexagonal grid over approximately 8 cm square. Using a 50 kVp x-ray image, each island block projected a racetrack, whose perimeter was fit to a function that allowed determination of its position, diameter, and angular orientation (θ, ϕ). These measured parameters were input into a pencil beam algorithm (PBA) dose calculation performed in water (16 MeV, SSD = 103 cm) for each device. PBA calculated intensity distributions using measured and planned (exact) island block parameters were compared.

RESULTS

Θ distributions for the 0.158 and 0.352 cm devices were nearly identical for each error case, with θ values for most island blocks being within 3.2°, 8.5°, and 7.5° for the small random, large random, and systematic error PRIME devices, respectively. Corresponding intensity differences between using measured and planned island block parameters were within 1.0% and 2.8% (small random), 2.2% and 4.8% (large random), and 3.2% and 6.7% (systematic) for the 0.158 and 0.352 cm devices, respectively.

CONCLUSION

This approach provides a viable and economical method for factory QA of fabricated PRIME devices by determining errors in their planned intensity distribution from which their quality can be assessed prior to releasing to the customer.

Modeling scatter through sides of island blocks used for intensity-modulated bolus electron conformal therapy

PURPOSE

Passive Radiotherapy Intensity Modulators for Electrons (PRIME) devices are comprised of cylindrical tungsten island blocks imbedded in a machinable foam slab within the patient's cutout. Intensity-modulated bolus electron conformal therapy (IM-BECT) uses PRIME devices to reduce dose heterogeneity caused by the irregular bolus surface. Heretofore, IM-BECT dose calculations used the pencil beam redefinition algorithm (PBRA) assuming perfect collimation. This study investigates modeling electron scatter into and out the sides of island blocks.

METHODS

Dose distributions were measured in a water phantom at 7, 13, and 20 MeV for devices having nominal intensity reduction factors of 1.000 (foam only), 0.937, 0.812, and 0.688, corresponding to nominal island block diameters (d_nom ) of 0.158, 0.273, and 0.352 cm, respectively. Pencil beam theory derived an effective diameter (d_IS ) to account for in-scattered electrons as a function of d_nom and beam energy (E_p,0 ). However, for out-scattered electrons, an effective diameter (d_mod ) was estimated by best fitting measured data.

RESULTS

In the modulated region (under island blocks, depth < R₉₀ ), modified PBRA-calculated dose distributions showed 2%/2 mm passing rates for d_nom  = 0.158, 0.273, and 0.352 cm of (100%, 100%, 100%) at 7 MeV, (100%, 100%, 93.5%) at 13 MeV, and (99.8%, 85.4%, and 71.5%) at 20 MeV. The largest dose differences (≤ 6%) occurred at the highest energy (20 MeV), largest d_nom , shallowest depths (≤ 2 cm), and on central axis.

CONCLUSIONS

An equation for modeling island block scatter, d_mod (d_nom , E_p,0 ), has been developed for use in the PBRA, insignificantly impacting calculation time. Although inaccuracy sometimes exceeded our 2%/2 mm criteria, it could be clinically acceptable, as superficial dose differences often fall inside the bolus. Also, patient PRIME devices are expected to have fewer large diameter island blocks than did test devices. Inaccuracies are attributed to out-scattered electrons having energy spectra different than the primary beams.

Treatment planning for Flash radiotherapy: general aspects and applications to proton beams

The increased radioresistence of healthy tissues when irradiated at very high dose rates (known as the Flash effect) is a radiobiological mechanism that is currently investigated in order to increase the therapeutic ratio of radiotherapy treatments. To maximize the benefits of the clinical application of Flash, a patient-specific balance between different properties of the dose distribution should be found, i.e. Flash needs to be one of the variables considered in treatment planning. We investigated the Flash potential of three proton therapy planning and beam delivery techniques, each on a different anatomical region. Based on a set of beam delivery parameters, on hypotheses on the dose and dose rate thresholds needed for the Flash effect to occur, and on two definitions of Flash dose rate, we generated exemplary illustrations of the capabilities of current proton therapy equipment to generate Flash dose distributions. All techniques investigated could both produce dose distributions comparable with a conventional proton plan and reach the Flash regime, to an extent that was strongly dependent on the dose per fraction and the Flash dose threshold. The beam current, Flash dose rate threshold and dose rate definition typically had a more moderate effect on the amount of Flash dose in normal tissue. A systematic estimation of the impact of Flash on different patient anatomies and treatment protocols is possible only if Flash-specific treatment planning features become readily available. Planning evaluation tools such as a voxel-based dose delivery time structure, and the inclusion in the optimization cost function of parameters directly associated with Flash (e.g. beam current, spot delivery sequence and scanning speed), are needed to generate treatment plans that are taking full advantage of the potential benefits of the Flash effect. This article is protected by copyright. All rights reserved.