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Franciosini G, Carlotti D, Cattani F, De Gregorio A, De Liso V, De Rosa F, Di Francesco M, Di Martino F, Felici G, Pensavalle JH, Leonardi MC, Marafini M, Muscato A, Paiar F, Patera V, Poortmans P, Sciubba A, Schiavi A, Toppi M, Traini G, Trigilio A, Sarti A. IOeRT conventional and FLASH treatment planning system implementation exploiting fast GPU Monte Carlo: The case of breast cancer. Phys Med 2024; 121:103346. [PMID: 38608421 DOI: 10.1016/j.ejmp.2024.103346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 03/13/2024] [Accepted: 04/01/2024] [Indexed: 04/14/2024] Open
Abstract
Partial breast irradiation for the treatment of early-stage breast cancer patients can be performed by means of Intra Operative electron Radiation Therapy (IOeRT). One of the main limitations of this technique is the absence of a treatment planning system (TPS) that could greatly help in ensuring a proper coverage of the target volume during irradiation. An IOeRT TPS has been developed using a fast Monte Carlo (MC) and an ultrasound imaging system to provide the best irradiation strategy (electron beam energy, applicator position and bevel angle) and to facilitate the optimisation of dose prescription and delivery to the target volume while maximising the organs at risk sparing. The study has been performed in silico, exploiting MC simulations of a breast cancer treatment. Ultrasound-based input has been used to compute the absorbed dose maps in different irradiation strategies and a quantitative comparison between the different options was carried out using Dose Volume Histograms. The system was capable of exploring different beam energies and applicator positions in few minutes, identifying the best strategy with an overall computation time that was found to be completely compatible with clinical implementation. The systematic uncertainty related to tissue deformation during treatment delivery with respect to imaging acquisition was taken into account. The potential and feasibility of a GPU based full MC TPS implementation of IOeRT breast cancer treatments has been demonstrated in-silico. This long awaited tool will greatly improve the treatment safety and efficacy, overcoming the limits identified within the clinical trials carried out so far.
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Affiliation(s)
- G Franciosini
- Sapienza, University of Rome, Department of Scienze di Base e Applicate all'Ingegneria, Rome, Italy; National Institute of Nuclear Physics, INFN, Section of Rome I, Rome, Italy
| | - D Carlotti
- Operative Research Unit of Radiation Oncology, Fondazione Policlinico Universitatio Campus-Bio Medico, Rome, Italy
| | - F Cattani
- Unit of Medical Physics, European Institute of Oncology IRCCS, Milan, Italy
| | - A De Gregorio
- National Institute of Nuclear Physics, INFN, Section of Rome I, Rome, Italy; Sapienza, University of Rome, Department of Physics, Rome, Italy
| | - V De Liso
- S.I.T. Sordina IORT Technologies S.p.A, Aprilia, Italy
| | - F De Rosa
- Sapienza, University of Rome, Department of Scienze di Base e Applicate all'Ingegneria, Rome, Italy
| | | | - F Di Martino
- Centro Pisano Multidisciplinare sulla Ricerca e Implementazione Clinica della Flash Radiotherapy (CPFR), Pisa, Italy; University of Pisa, Department of Physics, Pisa, Italy; Azienda Ospedaliero Universitaria Pisa (AOUP), Fisica Sanitaria, Pisa, Italy; National Institute of Nuclear Physics, INFN, Section of Pisa, Pisa, Italy
| | - G Felici
- S.I.T. Sordina IORT Technologies S.p.A, Aprilia, Italy
| | - J Harold Pensavalle
- S.I.T. Sordina IORT Technologies S.p.A, Aprilia, Italy; Centro Pisano Multidisciplinare sulla Ricerca e Implementazione Clinica della Flash Radiotherapy (CPFR), Pisa, Italy; National Institute of Nuclear Physics, INFN, Section of Pisa, Pisa, Italy
| | - M C Leonardi
- Division of Radiation Oncology, European Institute of Oncology IRCCS, Milan, Italy
| | - M Marafini
- National Institute of Nuclear Physics, INFN, Section of Rome I, Rome, Italy; Museo Storico della Fisica e Centro Studi e Ricerche "E. Fermi", Rome, Italy
| | - A Muscato
- National Institute of Nuclear Physics, INFN, Section of Rome I, Rome, Italy; Specialty School of Medical Physics, La Sapienza University of Rome, Rome, Italy
| | - F Paiar
- Centro Pisano Multidisciplinare sulla Ricerca e Implementazione Clinica della Flash Radiotherapy (CPFR), Pisa, Italy; Azienda Ospedaliero Universitaria Pisa (AOUP), Fisica Sanitaria, Pisa, Italy
| | - V Patera
- Sapienza, University of Rome, Department of Scienze di Base e Applicate all'Ingegneria, Rome, Italy; National Institute of Nuclear Physics, INFN, Section of Rome I, Rome, Italy
| | - P Poortmans
- Department of Radiation Oncology, Iridium Netwerk, Antwerp, Belgium; University of Antwerp, Faculty of Medicine and Health Sciences, Antwerp, Belgium
| | - A Sciubba
- Sapienza, University of Rome, Department of Scienze di Base e Applicate all'Ingegneria, Rome, Italy; National Institute of Nuclear Physics, INFN, Frascati National Laboratories (LNF), Rome, Italy
| | - A Schiavi
- Sapienza, University of Rome, Department of Scienze di Base e Applicate all'Ingegneria, Rome, Italy; National Institute of Nuclear Physics, INFN, Section of Rome I, Rome, Italy
| | - M Toppi
- Sapienza, University of Rome, Department of Scienze di Base e Applicate all'Ingegneria, Rome, Italy; National Institute of Nuclear Physics, INFN, Section of Rome I, Rome, Italy
| | - G Traini
- National Institute of Nuclear Physics, INFN, Section of Rome I, Rome, Italy
| | - A Trigilio
- Sapienza, University of Rome, Department of Physics, Rome, Italy; National Institute of Nuclear Physics, INFN, Frascati National Laboratories (LNF), Rome, Italy
| | - A Sarti
- Sapienza, University of Rome, Department of Scienze di Base e Applicate all'Ingegneria, Rome, Italy; National Institute of Nuclear Physics, INFN, Section of Rome I, Rome, Italy.
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Pouyanrad Z, Shamsaei Zafarghandi M, Setayeshi S. A Novel Treatment Planning Design for Intraoperative Electron Radiation Therapy (IOERT) using an Electronic Board. J Biomed Phys Eng 2024; 14:119-128. [PMID: 38628890 PMCID: PMC11016823 DOI: 10.31661/jbpe.v0i0.2109-1405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 05/19/2022] [Indexed: 04/19/2024]
Abstract
Background Intraoperative Irradiation Therapy (IORT) refers to the delivery of radiation during surgery and needs the computed- thickness of the target as one of the most significant factors. Objective This paper aimed to compute target thickness and design a radiation pattern distributing the irradiation uniformly throughout the target. Material and Methods The Monte Carlo code was used to simulate the experimental setup in this simulation study. The electron flux variations on an electronic board's metallic layer were studied for different thicknesses of the target tissue and validated with experimental data of the electronic board. Results Based on the electron number for different Poly Methyl Methacrylate (PMMA) phantom thicknesses at various energies, 6 MeV electrons are suitable to determine the target thickness. Uniformity in radiation and corresponding time for each target were investigated. The iso-dose and percentage depth dose curves show that higher energies are suitable for treatment and distribute uniform radiation throughout the target. Increasing the phantom thickness leads to rising radiation time based on the radiation time corresponding to these energies. The tissue thickness of each section is determined, and the radiation time is managed by scanning the target. Conclusion Calculation of the thickness of the remaining tissue and irradiation time are needed after incomplete tumor removal in IORT for various remaining tissues. The patients should be protected from overexposure to uniform irradiation of tissues since the radiation dose is prescribed and checked by an oncologist.
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Affiliation(s)
- Zahra Pouyanrad
- Department of Energy Engineering and Physics, Amirkabir University of Technology, Tehran, Iran
| | | | - Saeed Setayeshi
- Department of Energy Engineering and Physics, Amirkabir University of Technology, Tehran, Iran
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Baghani HR, Robatjazi M. Evaluating the induced photon contamination by different breast IOERT shields using Monte Carlo simulation. J Appl Clin Med Phys 2023; 24:e14098. [PMID: 37461859 PMCID: PMC10647956 DOI: 10.1002/acm2.14098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/25/2023] [Accepted: 07/05/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Avoiding the underlying healthy tissue over-exposure during breast intraoperative electron radiotherapy (IOERT) is owing to the use of some dedicated radioprotection disks during patient irradiation. The originated contaminant photons from some widely used double-layered shielding disks including PMMA+Cu, PTFE+steel, and Al+Pb configurations during the breast IOERT have been evaluated through a Monte Carlo (MC) simulation approach. METHODS Produced electron beam with energies of 6, 8, 10, and 12 MeV by a validated MC model of Liac12 dedicated IOERT accelerator was used for disk irradiations. Each of above-mentioned radioprotection disks was simulated inside a water phantom, so that the upper disk surface was positioned at R90 depth of each considered electron energy. Simulations were performed by MCNPX (version 2.6.0) MC code. Then, the energy spectra of the contaminant photons at different disk surfaces (upper, middle, and lower one) and relevant contaminant dose beneath the studied disks were determined and compared. RESULTS None of studied shielding disks show significant photon contamination up to 10 MeV electron energy, so that the induced photon dose by the contaminant X-rays was lower than those observed in the disk absence under the same conditions. In return, the induced photon dose at a close distance to the lower disk surface exceeded from calculated values in the disk absence at 12 MeV electron energy. The best performance in contaminant dose reduction at the energy range of 6-10 MeV belonged to the Al+Pb disk, while the PMMA+Cu configuration showed the best performance in this regard at 12 MeV energy. CONCLUSION Finally, it can be concluded that all studied shielding disks not only don't produce considerable photon contamination but also absorb the originated X-rays from electron interactions with water at the electron energy range of 6-10 MeV. The only concern is related to 12 MeV energy where the induced photon dose exceeds the dose values in the disk absence. Nevertheless, the administered dose by contaminant photons to underlying healthy tissues remains beneath the tolerance dose level by these organs at the entire range of studied electron energies.
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Affiliation(s)
| | - Mostafa Robatjazi
- Medical Physics and Radiological Sciences DepartmentSabzevar University of Medical SciencesSabzevarIran
- Non‐communicable Disease Research CenterSabzevar University of Medical SciencesSabzevarIran
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Tavallaie M, Hariri Tabrizi S, Heidarloo N. Implementation of pencil beam redefinition algorithm (PBRA) for intraoperative electron radiation therapy (IOERT) treatment planning. Phys Med 2022; 104:32-42. [PMID: 36356502 DOI: 10.1016/j.ejmp.2022.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 09/01/2022] [Accepted: 10/22/2022] [Indexed: 11/11/2022] Open
Abstract
PURPOSE Similar to other radiation therapy techniques, intraoperative electron radiation therapy (IOERT) can benefit from an online treatment planning system (TPS). Among all the analytical electron dose calculation algorithms, pencil beam redefinition algorithm (PBRA) has shown an acceptable accuracy in inhomogeneities. The input dataset for PBRA includes electron planar fluence, mean direction and root mean square (RMS) spread about the mean direction which had been introduced based on the conventional linear accelerator geometry in former studies. Herein, three methods for implementing PBRA for IOERT system are presented. METHODS The initialization parameters were identified using Monte Carlo (MC) simulation of a dedicated IOERT system equipped with a cylindrical 10 cm applicator, irradiating a water phantom. Phase space distribution of electrons was recorded on a plane below the applicator. The input dataset was extracted for 2 × 2 mm2 pixels and energy bin width of 1 MeV. RESULTS PBRA was implemented with three initialization methods and compared to MC. The 3D gamma analysis of the algorithm with the Formula method, which was in best agreement with MC in a simple water phantom, showed passing rates of more than 99 % for all nominal energies and it was 97.1 % for 8 MeV in the presence of protecting disk and irregular surface. Implementing PBRA on CUDA C++ resulted in 5 s run time for 8 MeV nominal energy in a water phantom. CONCLUSIONS The agreement between PBRA dose calculation and MC is promising for the development of an intraoperative TPS for IOERT.
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Affiliation(s)
- Mina Tavallaie
- Department of Medical Radiation Engineering, Shahid Beheshti University, Tehran, Iran.
| | - Sanaz Hariri Tabrizi
- Department of Medical Radiation Engineering, Shahid Beheshti University, Tehran, Iran.
| | - Nematollah Heidarloo
- Department of Medical Radiation Engineering, Shahid Beheshti University, Tehran, Iran
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Lashkari S, Baghani HR, Tavakoli MB, Mahdavi SR. An inter-comparison between accuracy of EGSnrc and MCNPX Monte Carlo codes in dosimetric characterization of intraoperative electron beam. Comput Biol Med 2020; 128:104113. [PMID: 33197735 DOI: 10.1016/j.compbiomed.2020.104113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/20/2020] [Accepted: 11/05/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Ionometric dosimetry in IOERT is a complicated process, due to the sophisticated beam setup and the necessity for dedicated protocols for ion chamber response correction. On the other hand, the Monte Carlo (MC) technique can easily overcome such limitations and be considered as an alternative dosimetry approach. This paper presents a comparative analysis of two widely used MC codes, EGSnrc and MCNPX, for intraoperative electron beam dosimetry. METHOD The head of LIAC12, a dedicated IOERT accelerator, was modeled by both mentioned MC codes. Then, the percentage depth dose (PDD) curves, transverse dose profiles (TDPs), and output factor (OF) values were accordingly calculated within the water phantom. To realize the accuracy of MC codes in dosimetric characterization of intraoperative electron beam, their results were finally compared with those measured by corresponding ionometric dosimetry for all forms of electron energy/applicator size. RESULTS A good agreement was observed between the simulated and measured PDDs/TDPs for both considered MC codes, such that the calculated gamma index values were always lower than unity for both considered MC codes. Nevertheless, the lower gamma index values were found in the case of the EGSnrc code. The maximum difference between the measured and calculated OF was obtained as 2.3% and 3.1% for EGSnrc and MCNPX code, respectively. CONCLUSIONS Although both studied MC codes showed compatible results with the measured ones, EGSnrc code has superior accuracy in this regard and can be considered as a more reliable toolkit in Monte Carlo-based commissioning of dedicated IOERT accelerators.
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Affiliation(s)
- Sara Lashkari
- Department of Medical Physics and Medical Engineering, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Mohammad Bagher Tavakoli
- Department of Medical Physics and Medical Engineering, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Seyed Rabi Mahdavi
- Medical Physics Department, Iran University of Medical Sciences, Tehran, Iran
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Baghani HR, Robatjazi M, Mahdavi SR, Nafissi N, Akbari ME. Breast intraoperative electron radiotherapy: Image-based setup verification and in-vivo dosimetry. Phys Med 2019; 60:37-43. [PMID: 31000084 DOI: 10.1016/j.ejmp.2019.03.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 02/25/2019] [Accepted: 03/19/2019] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION Single fraction nature of intraoperative radiotherapy highly demands a quality assurance procedure to qualify both beam setup and treatment delivery. The aim of this study is to evaluate the treatment setup during breast intraoperative electron radiotherapy (IOERT) and in-vivo dose delivery verification. MATERIALS AND METHODS Twenty-five breast cancer patients were enrolled and setup verification for each case was performed using C-arm imaging. The received dose by surface and distal end of target was measured by EBT2 film. The significance level of difference between obtained dosimetry results and predicted ones was evaluated by the T statistical test. RESULTS Acquired C-arm images in two different oblique views revealed any misalignment between the applicator and shielding disk. The mean difference between the measured surface dose and expected one was 1.8% ± 1.2 (p = 0.983) while a great disagreement, 11.1% ± 1.5 (p < 0.001), was observed between the measured distal end dose and expected one. This discrepancy is mainly correlated to the backscattering effect from the shielding disk. Target depth nonuniformities can also contribute to this remarkable difference. CONCLUSION Employing the intraoperative imaging for IOERT setup verification can considerably improve the treatment quality. Therefore, it is suggested to implement this imaging procedure as a part of treatment quality assurance. Favorable agreement between the predicted and measured surface doses demonstrates the applicability of EBT2 film for dose delivery verification. The results of in-vivo dosimetry showed that the electron backscattering from employed shielding disk can affect the received dose by the distal end of tumor bed.
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Affiliation(s)
- Hamid Reza Baghani
- Physics Department, Hakim Sabzevari University, Shohada-e Hastei Blvd, P.O. 9617976487, Sabzevar, Iran.
| | - Mostafa Robatjazi
- Department of Medical Physics and Radiological Sciences, Sabzevar University of Medical Sciences, Shohada-e Hastei Blvd, Sabzevar University of Medical Sciences Campus, P.O. 9617913112, Sabzevar, Iran; Vasei Radiotherapy & Oncology Center, Vasei Hospital, P.O. 9617913113, Sabzevar, Iran.
| | - Seied Rabi Mahdavi
- Department of Medical Physics, Iran University of Medical Sciences. Hemmat Exp. Way, Faculty of Medicine, P.O. 14496141525, Tehran, Iran
| | - Nahid Nafissi
- Department of Breast Surgery, Iran University of Medical Sciences. Hemmat Exp. Way, Faculty of Medicine, P.O. 14496141525, Tehran, Iran
| | - Mohammad Esmail Akbari
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Shohadaye Tajrrish Hospital, Tajrish Sq., P.O. 19996 14414, Tehran, Iran
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Breast intraoperative radiotherapy: a review of available modalities, dedicated machines and treatment procedure. JOURNAL OF RADIOTHERAPY IN PRACTICE 2018. [DOI: 10.1017/s146039691800033x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
AbstractBackgroundBreast intraoperative radiotherapy (IORT) is a partial irradiation technique that delivers a single fraction of radiation dose to the tumour bed during surgery. The use of this technique is increasing (especially in the Middle East), and therefore, it is essential to have a comprehensive approach to this treatment modality. The aim of this study is to conduct a literature review on available IORT modalities during breast irradiation as well as dedicated IORT machines and associated treatment procedures. The main IORT trials and corresponding clinical outcomes are also studied.Materials and MethodsA computerised search was performed through MEDLINE, PubMed, PubMed Central, ISI web of knowledge and reference list of related articles.ResultsIORT is now feasible through using two main modalities, including low-kilovolt IORT and intraoperative electron radiotherapy (IOERT). The dedicated machines employed and treatment procedure for mentioned modalities are quite different. The outcomes of implemented clinical trials showed that IORT is not inferior to external beam radiotherapy (EBRT) in specifically selected and well-informed patients and can be considered as an alternative to EBRT.ConclusionAlthough the clinical outcomes of introduced IORT methods are comparable, but based on the review results, it could be said that IOERT is the most effective technical method, in view of the treatment time and dose uniformity concepts. The popularity of IORT is mainly due to the distinguished obtained results during breast cancer treatment. Despite the presence of some technical challenges, it is expected that the IORT technique will become more widespread in the immediate future.
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