The potential of mixed carbon-helium beams for online treatment verification: a simulation and treatment planning study

Objective.Recently, a new and promising approach for range verification was proposed. This method requires the use of two different ion species. Due to their equal magnetic rigidity, fully ionized carbon and helium ions can be simultaneously accelerated in accelerators like synchrotrons. At sufficiently high treatment energies, helium ions can exit the patient distally, reaching approximately three times the range of carbon ions at an equal energy per nucleon. Therefore, the proposal involves adding a small helium fluence to the carbon ion beam and utilizing helium as an online range probe during radiation therapy. This work aims to develop a software framework for treatment planning and motion verification in range-guided radiation therapy using mixed carbon-helium beams.Approach.The developed framework is based on the open-source treatment planning toolkit matRad. Dose distributions and helium radiographs were simulated using the open-source Monte Carlo package TOPAS. Beam delivery system parameters were obtained from the Heidelberg Ion Therapy Center, and imaging detectors along with reconstruction were facilitated by ProtonVDA. Methods for reconstructing the most likely patient positioning error scenarios and the motion phase of 4DCT are presented for prostate and lung cancer sites.Main results.The developed framework provides the capability to calculate and optimize treatment plans for mixed carbon-helium ion therapy. It can simulate the treatment process and generate helium radiographs for simulated patient geometry, including small beam views. Furthermore, motion reconstruction based on these radiographs seems possible with preliminary validation.Significance.The developed framework can be applied for further experimental work with the promising mixed carbon-helium ion implementation of range-guided radiotherapy. It offers opportunities for adaptation in particle therapy, improving dose accumulation, and enabling patient anatomy reconstruction during radiotherapy.

Energy painting: helium-beam radiography with thin detectors and multiple beam energies

Objective.Compact ion imaging systems based on thin detectors are a promising prospect for the clinical environment since they are easily integrated into the clinical workflow. Their measurement principle is based on energy deposition instead of the conventionally measured residual energy or range. Therefore, thin detectors are limited in the water-equivalent thickness range they can image with high precision. This article presents ourenergy paintingmethod, which has been developed to render high precision imaging with thin detectors feasible even for objects with larger, clinically relevant water-equivalent thickness (WET) ranges.Approach.A detection system exclusively based on pixelated silicon Timepix detectors was used at the Heidelberg ion-beam therapy center to track single helium ions and measure their energy deposition behind the imaged object. Calibration curves were established for five initial beam energies to relate the measured energy deposition to WET. They were evaluated regarding their accuracy, precision and temporal stability. Furthermore, a 60 mm × 12 mm region of a wedge phantom was imaged quantitatively exploiting the calibrated energies and five different mono-energetic images. These mono-energetic images were combined in a pixel-by-pixel manner by averaging the WET-data weighted according to their single-ion WET precision (SIWP) and the number of contributing ions.Main result.A quantitative helium-beam radiograph of the wedge phantom with an average SIWP of 1.82(5) % over the entire WET interval from 150 mm to 220 mm was obtained. Compared to the previously used methodology, the SIWP improved by a factor of 2.49 ± 0.16. The relative stopping power value of the wedge derived from the energy-painted image matches the result from range pullback measurements with a relative deviation of only 0.4 %.Significance.The proposed method overcomes the insufficient precision for wide WET ranges when employing detection systems with thin detectors. Applying this method is an important prerequisite for imaging of patients. Hence, it advances detection systems based on energy deposition measurements towards clinical implementation.

MC TRIM Algorithm in Mandibula Phantom in Helium Therapy

Helium ion beam therapy, one of the particle therapies developed and studied in the 1950s for cancer treatment, resulted in clinical trials starting at Lawrence Berkeley National Laboratory in 1975. While proton and carbon ion therapies have been implemented in research institutions and hospitals globally after the end of the trials, progress in comprehending the physical, biological, and clinical findings of helium ion beam therapy has been limited, particularly due to its limited accessibility. Ongoing efforts aim to establish programs that evaluate the use of helium ion beams for clinical and research purposes, especially in the treatment of sensitive clinical cases. Additionally, helium ions have superior physical properties to proton beams, such as lower lateral scattering and larger LET. Moreover, they exhibit similar physical characteristics to carbon, oxygen, and neon ions, which are all used in heavy ion therapy. However, they demonstrate a sharper lateral penumbra with a lower radiobiological absence of certainties and lack the degradation of variations in dose distributions caused by excessive fragmenting of heavier-ion beams, especially at greater depths of penetration. In this context, the status and the prospective advancements of helium ion therapy are examined by investigating ionization, recoil, and lateral scattering values using MC TRIM algorithms in mandible plate phantoms designed from both tissue and previously studied biomaterials, providing an overview for dental cancer treatment. An average difference of 1.9% in the Bragg peak positions and 0.211 mm in lateral scattering was observed in both phantoms. Therefore, it is suggested that the 4He ion beam can be used in the treatment of mandibular tumors, and experimental research is recommended using the proposed biomaterial mandible plate phantom.

Roadmap: helium ion therapy

Helium ion beam therapy for the treatment of cancer was one of several developed and studied particle treatments in the 1950s, leading to clinical trials beginning in 1975 at the Lawrence Berkeley National Laboratory. The trial shutdown was followed by decades of research and clinical silence on the topic while proton and carbon ion therapy made debuts at research facilities and academic hospitals worldwide. The lack of progression in understanding the principle facets of helium ion beam therapy in terms of physics, biological and clinical findings persists today, mainly attributable to its highly limited availability. Despite this major setback, there is an increasing focus on evaluating and establishing clinical and research programs using helium ion beams, with both therapy and imaging initiatives to supplement the clinical palette of radiotherapy in the treatment of aggressive disease and sensitive clinical cases. Moreover, due its intermediate physical and radio-biological properties between proton and carbon ion beams, helium ions may provide a streamlined economic steppingstone towards an era of widespread use of different particle species in light and heavy ion therapy. With respect to the clinical proton beams, helium ions exhibit superior physical properties such as reduced lateral scattering and range straggling with higher relative biological effectiveness (RBE) and dose-weighted linear energy transfer (LET_d) ranging from ∼4 keVμm^-1to ∼40 keVμm^-1. In the frame of heavy ion therapy using carbon, oxygen or neon ions, where LET_dincreases beyond 100 keVμm^-1, helium ions exhibit similar physical attributes such as a sharp lateral penumbra, however, with reduced radio-biological uncertainties and without potentially spoiling dose distributions due to excess fragmentation of heavier ion beams, particularly for higher penetration depths. This roadmap presents an overview of the current state-of-the-art and future directions of helium ion therapy: understanding physics and improving modeling, understanding biology and improving modeling, imaging techniques using helium ions and refining and establishing clinical approaches and aims from learned experience with protons. These topics are organized and presented into three main sections, outlining current and future tasks in establishing clinical and research programs using helium ion beams-A. Physics B. Biological and C. Clinical Perspectives.

Experimental helium-beam radiography with a high-energy beam: Water-equivalent thickness calibration and first image-quality results

PURPOSE

A clinical implementation of ion-beam radiography (iRad) is envisaged to provide a method for on-couch verification of ion-beam treatment plans. The aim of this work is to introduce and evaluate a method for quantitative water-equivalent thickness (WET) measurements for a specific helium-ion imaging system for WETs that are relevant for imaging thicker body parts in the future.

METHODS

Helium-beam radiographs (αRads) are measured at the Heidelberg Ion-beam Therapy Center (HIT) with an initial beam energy of 239.5 MeV/ u. An imaging system based on three pairs of thin silicon pixel detectors is used for ion path reconstruction and measuring the energy deposition (dE) of each particle behind the object to be imaged. The dE behind homogeneous plastic blocks is related to their well-known WETs between 280.6mm and 312.6 mm with a calibration curve that is created by fitting the measured data points. The quality of the quantitative WET measurements is determined by the uncertainty of the measured WET of a single ion (single-ion WET precision) and the deviation of a measured WET value to the well-known WET (WET accuracy). Subsequently, the fitted calibration curve is applied to an energy deposition radiograph of a phantom with a complex geometry. The spatial resolution (modulation transfer function at 10% (MTF_10% )) and WET accuracy (mean absolute percentage difference (MAPD)) of the WET map, are determined.

RESULTS

In the optimal imaging WET-range from ∼  280 mm to 300 mm, the fitted calibration curve reached a mean single-ion WET precision of 1.55 ± 0.00%. Applying the calibration to an ion radiograph (iRad) of a more complex WET distribution, the spatial resolution was determined to be MTF_10% = 0.49 ± 0.03 lp/mm and the WET accuracy was assessed as MAPD to 0.21%.

CONCLUSIONS

Using a beam energy of 239.5MeV/ u and the proposed calibration procedure, quantitative αRads of WETs between ∼  280mm to 300 mm can be measured and show high potential for clinical use. The proposed approach with the resulting image qualities encourages further investigation towards the clinical application of helium-beam radiography. This article is protected by copyright. All rights reserved.

The accuracy of helium ion CT based particle therapy range prediction: an experimental study comparing different particle and x-ray CT modalities

This work provides a quantitative assessment of helium ion CT (HeCT) for particle therapy treatment planning. For the first time, HeCT based range prediction accuracy in a heterogeneous tissue phantom is presented and compared to single-energy x-ray CT (SECT), dual-energy x-ray CT (DECT) and proton CT (pCT). HeCT and pCT scans were acquired using the US pCT collaboration prototype particle CT scanner at the Heidelberg Ion-Beam Therapy Center. SECT and DECT scans were done with a Siemens Somatom Definition Flash and converted to RSP. A Catphan CTP404 module was used to study the RSP accuracy of HeCT. A custom phantom of 20 cm diameter containing several tissue equivalent plastic cubes was used to assess the spatial resolution of HeCT and compare it to DECT. A clinically realistic heterogeneous tissue phantom was constructed using cranial slices from a pig head placed inside a cylindrical phantom (ø150 mm). A proton beam (84.67 mm range) depth-dose measurement was acquired using a stack of GafchromicTM EBT-XD films in a central dosimetry insert in the phantom. CT scans of the phantom were acquired with each modality, and proton depth-dose estimates were simulated based on the reconstructions. The RSP accuracy of HeCT for the plastic phantom was found to be 0.3 ± 0.1%. The spatial resolution for HeCT of the cube phantom was 5.9 ± 0.4 lp cm-1for central, and 7.6 ± 0.8 lp cm-1for peripheral cubes, comparable to DECT spatial resolution (7.7 ± 0.3 lp cm-1and 7.4 ± 0.2 lp cm-1, respectively). For the pig head, HeCT, SECT, DECT and pCT predicted range accuracy was 0.25%, -1.40%, -0.45% and 0.39%, respectively. In this study, HeCT acquired with a prototype system showed potential for particle therapy treatment planning, offering RSP accuracy, spatial resolution, and range prediction accuracy comparable to that achieved with a commercial DECT scanner. Still, technical improvements of HeCT are needed to enable clinical implementation.

Investigating particle track topology for range telescopes in particle radiography using convolutional neural networks

BACKGROUND

Proton computed tomography (pCT) and radiography (pRad) are proposed modalities for improved treatment plan accuracy and in situ treatment validation in proton therapy. The pCT system of the Bergen pCT collaboration is able to handle very high particle intensities by means of track reconstruction. However, incorrectly reconstructed and secondary tracks degrade the image quality. We have investigated whether a convolutional neural network (CNN)-based filter is able to improve the image quality.

MATERIAL AND METHODS

The CNN was trained by simulation and reconstruction of tens of millions of proton and helium tracks. The CNN filter was then compared to simple energy loss threshold methods using the Area Under the Receiver Operating Characteristics curve (AUROC), and by comparing the image quality and Water Equivalent Path Length (WEPL) error of proton and helium radiographs filtered with the same methods.

RESULTS

The CNN method led to a considerable improvement of the AUROC, from 74.3% to 97.5% with protons and from 94.2% to 99.5% with helium. The CNN filtering reduced the WEPL error in the helium radiograph from 1.03 mm to 0.93 mm while no improvement was seen in the CNN filtered pRads.

CONCLUSION

The CNN improved the filtering of proton and helium tracks. Only in the helium radiograph did this lead to improved image quality.

Statistical limitations in ion imaging

In this study, we investigated the capacity of various ion beams available for radiotherapy to produce high quality relative stopping power map acquired from energy-loss measurements. The image quality metrics chosen to compare the different ions were signal-to-noise ratio (SNR) as a function of dose and spatial resolution. Geant4 Monte Carlo simulations were performed for: hydrogen, helium, lithium, boron and carbon ion beams crossing a 20 cm diameter water phantom to determine SNR and spatial resolution. It has been found that protons possess a significantly larger SNR when compared with other ions at a fixed range (up to 36% higher than helium) due to the proton nuclear stability and low dose per primary. However, it also yields the lowest spatial resolution against all other ions, with a resolution lowered by a factor 4 compared to that of carbon imaging, for a beam with the same initial range. When comparing for a fixed spatial resolution of 10 lp cm⁻¹, carbon ions produce the highest image quality metrics with proton ions producing the lowest. In conclusion, it has been found that no ion can maximize all image quality metrics simultaneously and that a choice must be made between spatial resolution, SNR, and dose.

The impact of path estimates in iterative ion CT reconstructions for clinical-like cases

Ion computed tomography (CT) promises to mitigate range uncertainties inherent in the conversion of x-ray Hounsfield units into ion relative stopping power (RSP) for ion beam therapy treatment planning. To improve accuracy and spatial resolution of ion CT by accounting for statistical multiple Coulomb scattering deflection of the ion trajectories from a straight line path (SLP), the most likely path (MLP) and the cubic spline path (CSP) have been proposed. In this work, we use FLUKA Monte Carlo simulations to investigate the impact of these path estimates in iterative tomographic reconstruction algorithms for proton, helium and carbon ions. To this end the ordered subset simultaneous algebraic reconstruction technique was used and coupled with a total variation superiorization (TVS). We evaluate the image quality and dose calculation accuracy in proton therapy treatment planning of cranial patient anatomies. CSP and MLP generally yielded nearly equal image quality with an average RSP relative error improvement over the SLP of 0.6%, 0.3% and 0.3% for proton, helium and carbon ion CT, respectively. Bone and low density materials have been identified as regions of largest enhancement in RSP accuracy. Nevertheless, only minor differences in dose calculation results were observed between the different models and relative range errors of better than 0.5% were obtained in all cases. Largest improvements were found for proton CT in complex scenarios with strong heterogeneities along the beam path. The additional TVS provided substantially reduced image noise, resulting in improved image quality in particular for soft tissue regions. Employing the CSP and MLP for iterative ion CT reconstructions enabled improved image quality over the SLP even in realistic and heterogeneous patient anatomy. However, only limited benefit in dose calculation accuracy was obtained even though an ideal detector system was simulated.

Helium radiography with a digital tracking calorimeter-a Monte Carlo study for secondary track rejection

Radiation therapy using protons and heavier ions is a fast-growing therapeutic option for cancer patients. A clinical system for particle imaging in particle therapy would enable online patient position verification, estimation of the dose deposition through range monitoring and a reduction of uncertainties in the calculation of the relative stopping power of the patient. Several prototype imaging modalities offer radiography and computed tomography using protons and heavy ions. A Digital Tracking Calorimeter (DTC), currently under development, has been proposed as one such detector. In the DTC 43 longitudinal layers of laterally stacked ALPIDE CMOS monolithic active pixel sensor chips are able to reconstruct a large number of simultaneously recorded proton tracks. In this study, we explored the capability of the DTC for helium imaging which offers favorable spatial resolution over proton imaging. Helium ions exhibit a larger cross section for inelastic nuclear interactions, increasing the number of produced secondaries in the imaged object and in the detector itself. To that end, a filtering process able to remove a large fraction of the secondaries was identified, and the track reconstruction process was adapted for helium ions. By filtering on the energy loss along the tracks, on the incoming angle and on the particle ranges, 97.5% of the secondaries were removed. After passing through 16 cm water, 50.0% of the primary helium ions survived; after the proposed filtering 42.4% of the primaries remained; finally after subsequent image reconstruction 31% of the primaries remained. Helium track reconstruction leads to more track matching errors compared to protons due to the increased available focus strength of the helium beam. In a head phantom radiograph, the Water Equivalent Path Length error envelope was 1.0 mm for helium and 1.1 mm for protons. This accuracy is expected to be sufficient for helium imaging for pre-treatment verification purposes.

In vivo range verification in particle therapy

Exploitation of the full potential offered by ion beams in clinical practice is still hampered by several sources of treatment uncertainties, particularly related to the limitations of our ability to locate the position of the Bragg peak in the tumor. To this end, several efforts are ongoing to improve the characterization of patient position, anatomy, and tissue stopping power properties prior to treatment as well as to enable in vivo verification of the actual dose delivery, or at least beam range, during or shortly after treatment. This contribution critically reviews methods under development or clinical testing for verification of ion therapy, based on pretreatment range and tissue probing as well as the detection of secondary emissions or physiological changes during and after treatment, trying to disentangle approaches of general applicability from those more specific to certain anatomical locations. Moreover, it discusses future directions, which could benefit from an integration of multiple modalities or address novel exploitation of the measurable signals for biologically adapted therapy.

The impact of secondary fragments on the image quality of helium ion imaging

Single-event ion imaging enables the direct reconstruction of the relative stopping power (RSP) information required for ion-beam therapy. Helium ions were recently hypothesized to be the optimal species for such technique. The purpose of this work is to investigate the effect of secondary fragments on the image quality of helium CT (HeCT) and to assess the performance of a prototype proton CT (pCT) scanner when operated with helium beams in Monte Carlo simulations and experiment. Experiments were conducted installing the U.S. pCT consortium prototype scanner at the Heidelberg Ion-Beam Therapy Center (HIT). Simulations were performed with the scanner using the TOPAS toolkit. HeCT images were reconstructed for a cylindrical water phantom, the CTP404 (sensitometry), and the CTP528 (line-pair) [Formula: see text] ® modules. To identify and remove individual events caused by fragmentation, the multistage energy detector of the scanner was adapted to function as a [Formula: see text] telescope. The use of the developed filter eliminated the otherwise arising ring artifacts in the HeCT reconstructed images. For the HeCT reconstructed images of a water phantom, the maximum RSP error was improved by almost a factor 8 with respect to unfiltered images in the simulation and a factor 10 in the experiment. Similarly, for the CTP404 module, the mean RSP accuracy improved by a factor 6 in both the simulation and the experiment when the filter was applied (mean relative error 0.40% in simulation, 0.45% in experiment). In the evaluation of the spatial resolution through the CTP528 module, the main effect of the filter was noise reduction. For both simulated and experimental images the spatial resolution was  ∼4 lp cm-1. In conclusion, the novel filter developed for secondary fragments proved to be effective in improving the visual quality and RSP accuracy of the reconstructed images. With the filter, the pCT scanner is capable of accurate HeCT imaging.

Helium ion beam imaging for image guided ion radiotherapy

BACKGROUND

Ion beam radiotherapy provides potential for increased dose conformation to the target volume. To translate it into a clinical advantage, it is necessary to guarantee a precise alignment of the actual internal patient geometry with the treatment beam. This is in particular challenging for inter- and intrafractional variations, including movement. Ion beams have the potential for a high sensitivity imaging of the patient geometry. However, the research on suitable imaging methods is not conclusive yet. Here we summarize the research activities within the "Clinical research group heavy ion therapy" funded by the DFG (KFO214). Our aim was to develop a method for the visualization of a 1 mm thickness difference with a spatial resolution of about 1 mm at clinically applicable doses.

METHODS

We designed and built a dedicated system prototype for ion radiography using exclusively the pixelated semiconductor technology Timepix developed at CERN. Helium ions were chosen as imaging radiation due to their decreased scattering in comparison to protons, and lower damaging potential compared to carbon ions. The data acquisition procedure and a dedicated information processing algorithm were established. The performance of the method was evaluated at the ion beam therapy facility HIT in Germany with geometrical phantoms. The quality of the images was quantified by contrast-to-noise ratio (CNR) and spatial resolution (SR) considering the imaging dose.

RESULTS

Using the unique method for single ion identification, degradation of the images due to the inherent contamination of the outgoing beam with light secondary fragments (hydrogen) was avoided. We demonstrated experimentally that the developed data processing increases the CNR by 350%. Consideration of the measured ion track directions improved the SR by 150%. Compared to proton radiographs at the same dose, helium radiographs exhibited 50% higher SR (0.56 ± 0.04lp/mm vs. 0.37 ± 0.02lp/mm) at a comparable CNR in the middle of the phantom. The clear visualization of the aimed inhomogeneity at a diagnostic dose level demonstrates a resolution of 0.1 g/cm2 or 0.6% in terms of water-equivalent thickness.

CONCLUSIONS

We developed a dedicated method for helium ion radiography, based exclusively on pixelated semiconductor detectors. The achievement of a clinically desired image quality in simple phantoms at diagnostic dose levels was demonstrated experimentally.