Configuration and validation of an analytical model predicting secondary neutron radiation in proton therapy using Monte Carlo simulations and experimental measurements

Stray neutron radiation exposures from proton therapy: physics-based analytical models of neutron spectral fluence, kerma and absorbed dose

Objective. Patients who receive proton beam therapy are exposed to unwanted stray neutrons. Stray radiations increase the risk of late effects in normal tissues, such as second cancers and cataracts, and may cause implanted devices such as pacemakers to malfunction. Compared to therapeutic beams, little attention has been paid to modeling stray neutron exposures. In the past decade, substantial progress was made to develop semiempirical models of stray neutron dose equivalent, but models to routinely calculate neutron absorbed dose and kerma are still lacking. The objective of this work was to develop a new physics based analytical model to calculate neutron spectral fluence, kerma, and absorbed dose in a water phantom. Approach. We developed the model using dosimetric data from Monte Carlo simulations and neutron kerma coefficients from the literature. The model explicitly considers the production, divergence, scattering, and attenuation of neutrons. Neutron production was modeled for 120–250 MeV proton beams impinging on a variety of materials. Fluence, kerma and dose calculations were performed in a 30 × 180 × 44 cm3 phantom at points up to 43 cm in depth and 80 cm laterally. Main Results. Predictions of the analytical model agreed reasonably with corresponding values from Monte Carlo simulations, with a mean difference in average energy deposited of 20%, average kerma coefficient of 21%, and absorbed dose to water of 49%. Significance. The analytical model is simple to implement and use, requires less configuration data that previously reported models, and is computationally fast. This model appears potentially suitable for integration in treatment planning system, which would enable risk calculations in prospective and retrospective cases, providing a powerful tool for epidemiological studies and clinical trials.

Secondary neutron dose contribution from pencil beam scanning, scattered and spatially fractionated proton therapy

The Orsay Proton therapy Center (ICPO) has a long history of intracranial radiotherapy using both double scattering (DS) and pencil beam scanning (PBS) techniques, and is actively investigating a promising modality of spatially fractionated radiotherapy using proton minibeams (pMBRT). This work provides a comprehensive comparison of the organ-specific secondary neutron dose due to each of these treatment modalities, assessed using Monte Carlo (MC) algorithms and measurements. A MC model of a universal nozzle was benchmarked by comparing the neutron ambient dose equivalent,H*(10), in the gantry room with measurements obtained using a WENDI-II counter. The secondary neutron dose was evaluated for clinically relevant intracranial treatments of patients of different ages, in which secondary neutron doses were scored in anthropomorphic phantoms merged with the patients' images. The MC calculatedH*(10) values showed a reasonable agreement with the measurements and followed the expected tendency, in which PBS yields the lowest dose, followed by pMBRT and DS. Our results for intracranial treatments show that pMBRT yielded a higher secondary neutron dose for organs closer to the target volume, while organs situated furthest from the target volume received a greater quantity of neutrons from the passive scattering beam line. To the best of our knowledge, this is the first study to compare MC secondary neutron dose estimates in clinical treatments between these various proton therapy modalities and to realistically quantify the secondary neutron dose contribution of clinical pMBRT treatments. The method established in this study will enable epidemiological studies of the long-term effects of intracranial treatments at ICPO, notably radiation-induced second malignancies.

VirtualDose-IR: a cloud-based software for reporting organ doses in interventional radiology

A cloud-based software, VirtualDose-IR (Virtual Phantoms Inc., Albany, New York, USA), designed to report organ doses and effective doses for a diverse patient population from interventional radiology (IR) procedures has been developed and tested. This software is based on a comprehensive database of Monte Carlo-generated organ dose built with a set of 21 anatomically realistic patient phantoms. The patient types included in this database are both male and female people with different ages reflecting reference adults, obese people with different BMIs and pregnant women at different gestational stages. Selectable parameters such as patient type, tube voltage, filtration thickness, beam direction, field size, and irradiation site are also considered in VirtualDose-IR. The software has been implemented using the 'Software as a Service (SaaS)' delivery concept permitting simultaneous multi-user, multi-platform access without requiring local installation. The patient doses resulting from different target sites and patient populations were reported using the VirtualDose-IR system. The patient doses under different source to surface distances (SSD) and beam angles calculated by VirtualDose-IR and Monte Carlo simulations were compared. For most organs, the dose differences between VirtualDose-IR results and Monte Carlo results were less than 0.3 mGy at 15 000 mGy * cm2 kerma-area product (KAP). The organ dose results were compared with measurement data previously reported in literatures. The doses to organs that were located within the irradiation field match closely with experimental measurement data. The differences in the effective dose values between calculated using VirtualDose-IR and those measured were less than 2.5%. The dose errors of most organs between VirtualDose-IR and literature results were less than 40%. These results validate the accuracy of organ doses reported by VirtualDose-IR. With the inclusion of pre-specified clinical IR examination parameters (such as beam direction, target location, field of view and beam quality) and the latest anatomically realistic patient phantoms in Monte Carlo simulations, VirtualDose-IR provides users with accurate dose information in order to systematically compare, evaluate, and optimize IR plans.

Implementation of planar proton minibeam radiation therapy using a pencil beam scanning system: A proof of concept study

PURPOSE

Proton minibeam radiation therapy (pMBRT) is an innovative approach that combines the advantages of minibeam radiation therapy with the more precise ballistics of protons to further reduce the side effects of radiation. One of the main challenges of this approach is the generation of very narrow proton pencil beams with an adequate dose-rate to treat patients within a reasonable treatment time (several minutes) in existing clinical facilities. The aim of this study was to demonstrate the feasibility of implementing pMBRT by combining the pencil beam scanning (PBS) technique with the use of multislit collimators. This proof of concept study of pMBRT with a clinical system is intended to guide upcoming biological experiments.

METHODS

Monte Carlo simulations (TOPAS v3.1.p2) were used to design a suitable multislit collimator to implement planar pMBRT for conventional pencil beam scanning settings. Dose distributions (depth-dose curves, lateral profiles, Peak-to-Valley Dose Ratio (PVDR) and dose-rates) for different proton beam energies were assessed by means of Monte Carlo simulations and experimental measurements in a water tank using commercial ionization chambers and a new p-type silicon diode, the IBA RAZOR. An analytical intensity-modulated dose calculation algorithm designed to optimize the weight of individual Bragg peaks composing the field was also developed and validated.

RESULTS

Proton minibeams were then obtained using a brass multislit collimator with five slits measuring 2 cm × 400 μm in width with a center-to-center distance of 4 mm. The measured and calculated dose distributions (depth-dose curves and lateral profiles) showed a good agreement. Spread-out Bragg peaks (SOBP) and homogeneous dose distributions around the target were obtained by means of intensity modulation of Bragg peaks, while maintaining spatial fractionation at shallow depths. Mean dose-rates of 0.12 and 0.09 Gy/s were obtained for one iso-energy layer and a SOBP conditions in the presence of multislit collimator.

CONCLUSIONS

This study demonstrates the feasibility of implementing pMBRT on a PBS system. It also confirms the reliability of RAZOR detector for pMBRT dosimetry. This newly developed experimental methodology will support the design of future preclinical research with pMBRT.

Independent application of an analytical model for secondary neutron equivalent dose produced in a passive-scattering proton therapy treatment unit

The purpose of this study was to independently apply an analytical model for equivalent dose from neutrons produced in a passive-scattering proton therapy treatment unit, H. To accomplish this objective, we applied the previously-published model to treatment plans of two pediatric patients. Their model accounted for neutrons generated by mono-energetic proton beams stopping in a closed aperture. To implement their model to a clinical setting, we adjusted it to account for the area of a collimating aperture, energy modulation, air gap between the treatment unit and patient, and radiation weighting factor. We used the adjusted model to estimate H per prescribed proton absorbed dose, D _Rx , for the passive-scattering proton therapy beams of two children, a 9-year-old girl and 10-year-old boy, who each received intracranial boost fields as part of their treatment. In organs and tissues at risk for radiation-induced subsequent malignant neoplasms, T, we calculated the mass-averaged H, H _T , per D _Rx . Finally, we compared H _T /D _Rx values to those of previously-published Monte Carlo (MC) simulations of these patients' fields. H _T /D _Rx values of the adjusted model deviated from the MC result for each organ on average by 20.8  ±  10.0% and 44.2  ±  17.6% for the girl and boy, respectively. The adjusted model underestimated the MC result in all T of each patient, with the exception of the girl's bladder, for which the adjusted model overestimated H _T /D _Rx by 3.1%. The adjusted model provided a better estimate of H _T /D _Rx than the unadjusted model. That is, between the two models, the adjusted model reduced the deviation from the MC result by approximately 37.0% and 46.7% for the girl and boy, respectively. We found that the previously-published analytical model, combined with adjustment factors to enhance its clinical applicability, predicted H _T /D _Rx in out-of-field organs and tissues at risk for subsequent malignant neoplasms with acceptable accuracy. This independent application demonstrated that the analytical model may be useful broadly for clinicians and researchers to calculate equivalent dose from neutrons produced externally to the patient in passive-scattering proton therapy.

Photoneutron depth dose equivalent distributions in high-energy X-ray medical accelerators by a novel position-sensitive dosimeter

PURPOSE

The purpose of this study was to; (1) investigate employing a novel position-sensitive mega-size polycarbonate (MSPC) dosimeter for photoneutron (PN) depth, profile and dose equivalent distributions studies in a multilayer polyethylene phantom in a Siemens ONCOR accelerator, and (2) develop depth dose equivalent distribution matrix data at different depths and positions of the phantom for patient PN dose equivalent determination and in particular for PN secondary cancer risk estimation.

METHODS

Position-sensitive MSPC dosimeters were successfully exposed at 9 different depths of the phantom in a 10×10cm² X-ray field. The dosimeters were processed in mega-size electrochemical chambers at optimum conditions. Each MSPC dosimeter was placed at a known phantom depth for PN depth dose equivalents and profiles on transverse, longitudinal and diagonal axes and isodose equivalent distribution studies in and out of the X-ray beam.

RESULTS

PN dose equivalent distributions at any depth showed the highest value at the beam central axis and decreases as the distance increases. PN dose equivalent at any position studied in the axes has a maximum value on the phantom surface which decreases as depth increases due to flux reduction by multi-elastic scattering interactions.

CONCLUSIONS

Extensive PN dose equivalent matrix data at different depths and positions in the phantom were determined. The position-sensitive MSPC dosimeters proved to be highly efficient for PN depth, profile and isodose equivalent distribution studies. The extensive data obtained highly assists for determining PN dose equivalent of a patient undergoing high-energy X-ray therapy and for PN secondary cancer risk estimation.

Development of a Geant4 application to characterise a prototype neutron detector based on three orthogonal 3He tubes inside an HDPE sphere

The Bonner Sphere Spectrometer (BSS) system is a well-established technique for neutron dosimetry that involves detection of thermal neutrons within a range of hydrogenous moderators. BSS detectors are often used to perform neutron field surveys in order to determine the ambient dose equivalent H*(10) and estimate health risk to personnel. There is a potential limitation of existing neutron survey techniques, since some detectors do not consider the direction of the neutron field, which can result in overly conservative estimates of dose in neutron fields. This paper shows the development of a Geant4 simulation application to characterise a prototype neutron detector based on three orthogonal ³He tubes inside a single HDPE sphere built at the Australian Nuclear Science and Technology Organisation (ANSTO). The Geant4 simulation has been validated with respect to experimental measurements performed with an Am-Be source.

A novel position-sensitive mega-size dosimeter for photoneutrons in high-energy X-ray medical accelerators

PURPOSE

A novel position-sensitive mega-size polycarbonate (MSPC) dosimeter is introduced. It provides photoneutron (PN) dose equivalent matrix of positions in and out of a beam of a high energy X-ray medical accelerator under a single exposure.

METHODS

A novel position-sensitive MSPC dosimeter was developed and applied. It has an effective etched area of 50×50cm(2), as used in this study, processed in a mega-size electrochemical etching chamber to amplify PN-induced-recoil tracks to a point viewed by the unaided eyes. Using such dosimeters, PN dose equivalents, dose equivalent profiles and isodose equivalent distribution of positions in and out of beams for different X-ray doses and field sizes were determined in a Siemens ONCOR Linac.

RESULTS

The PN dose equivalent at each position versus X-ray dose was linear up to 20Gy studied. As the field size increased, the PN dose equivalent in the beam was also increased but it remained constant at positions out of the beam up to 20cm away from the beam edge. The jaws and MLCs due to material differences and locations relative to the target produce different PN contributions.

CONCLUSIONS

The MSPC dosimeter introduced in this study is a perfect candidate for PN dosimetry with unique characteristics such as simplicity, efficiency, dose equivalent response, large size, flexibility to be bent, resembling the patient's skin, highly position-sensitive with high spatial resolution, highly insensitive to X-rays, continuity in measurements and need to a single dosimeter to obtain PN dose equivalent matrix data under a single X-ray exposure.

Identification of moisture content in tobacco plant leaves using outlier sample eliminating algorithms and hyperspectral data

Fast identification of moisture content in tobacco plant leaves plays a key role in the tobacco cultivation industry and benefits the management of tobacco plant in the farm. In order to identify moisture content of tobacco plant leaves in a fast and nondestructive way, a method involving Mahalanobis distance coupled with Monte Carlo cross validation(MD-MCCV) was proposed to eliminate outlier sample in this study. The hyperspectral data of 200 tobacco plant leaf samples of 20 moisture gradients were obtained using FieldSpc(®) 3 spectrometer. Savitzky-Golay smoothing(SG), roughness penalty smoothing(RPS), kernel smoothing(KS) and median smoothing(MS) were used to preprocess the raw spectra. In addition, Mahalanobis distance(MD), Monte Carlo cross validation(MCCV) and Mahalanobis distance coupled to Monte Carlo cross validation(MD-MCCV) were applied to select the outlier sample of the raw spectrum and four smoothing preprocessing spectra. Successive projections algorithm (SPA) was used to extract the most influential wavelengths. Multiple Linear Regression (MLR) was applied to build the prediction models based on preprocessed spectra feature in characteristic wavelengths. The results showed that the preferably four prediction model were MD-MCCV-SG (Rp(2) = 0.8401 and RMSEP = 0.1355), MD-MCCV-RPS (Rp(2) = 0.8030 and RMSEP = 0.1274), MD-MCCV-KS (Rp(2) = 0.8117 and RMSEP = 0.1433), MD-MCCV-MS (Rp(2) = 0.9132 and RMSEP = 0.1162). MD-MCCV algorithm performed best among MD algorithm, MCCV algorithm and the method without sample pretreatment algorithm in the eliminating outlier sample from 20 different moisture gradients of tobacco plant leaves and MD-MCCV can be used to eliminate outlier sample in the spectral preprocessing.

A Review of Radiotherapy-Induced Late Effects Research after Advanced Technology Treatments

The number of incident cancers and long-term cancer survivors is expected to increase substantially for at least a decade. Advanced technology radiotherapies, e.g., using beams of protons and photons, offer dosimetric advantages that theoretically yield better outcomes. In general, evidence from controlled clinical trials and epidemiology studies are lacking. To conduct these studies, new research methods and infrastructure will be needed. In the paper, we review several key research methods of relevance to late effects after advanced technology proton-beam and photon-beam radiotherapies. In particular, we focus on the determination of exposures to therapeutic and stray radiation and related uncertainties, with discussion of recent advances in exposure calculation methods, uncertainties, in silico studies, computing infrastructure, electronic medical records, and risk visualization. We identify six key areas of methodology and infrastructure that will be needed to conduct future outcome studies of radiation late effects.

An analytical model of leakage neutron equivalent dose for passively-scattered proton radiotherapy and validation with measurements

Exposure to stray neutrons increases the risk of second cancer development after proton therapy. Previously reported analytical models of this exposure were difficult to configure and had not been investigated below 100 MeV proton energy. The purposes of this study were to test an analytical model of neutron equivalent dose per therapeutic absorbed dose (H/D) at 75 MeV and to improve the model by reducing the number of configuration parameters and making it continuous in proton energy from 100 to 250 MeV. To develop the analytical model, we used previously published H/D values in water from Monte Carlo simulations of a general-purpose beamline for proton energies from 100 to 250 MeV. We also configured and tested the model on in-air neutron equivalent doses measured for a 75 MeV ocular beamline. Predicted H/D values from the analytical model and Monte Carlo agreed well from 100 to 250 MeV (10% average difference). Predicted H/D values from the analytical model also agreed well with measurements at 75 MeV (15% average difference). The results indicate that analytical models can give fast, reliable calculations of neutron exposure after proton therapy. This ability is absent in treatment planning systems but vital to second cancer risk estimation.