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Huang C, Xu Z, Zhao Z, Yin Y, Hu Z, She Q, Mao R, Wei K, Yang H, Tang K, Lu Z. Carbon ion radiography with a composite ionization chamber detector. Appl Radiat Isot 2024; 203:111072. [PMID: 37897938 DOI: 10.1016/j.apradiso.2023.111072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 10/05/2023] [Accepted: 10/16/2023] [Indexed: 10/30/2023]
Abstract
Range uncertainty in carbon ion therapy can diminish treatment efficacy because it may cause deviation from the planned dose distribution. The precise and accurate determination of relative stopping power (RSP) maps of carbon ions in the patient is a direct solution to this problem. To obtain RSP maps in patients undergoing carbon ion radiography, our team developed a preliminary prototype of a composite ionization chamber detection (CICD) system. The CICD prototype employs synchronously gated integral electronics with the ability to measure the depth-to-dose curve and the beam profile simultaneously. Carbon ion radiography experiments were performed on hemispherical, sloped, and stepped phantoms using the Heavy Ion Medical Machine (HIMM) beam. The beam energy was 190.19 MeV/μ and the beam spot full width at half maximum (FWHM) was 7.42 mm. The radiographic image of the sloped phantom, the thickness prediction accuracy of each pixel (2 mm) is 88.25%, its absolute mean error (AME) is 1.07 mm, and the maximum absolute deviation (MAD) is 2.64 mm. The prediction accuracy of the CICD prototype is mainly affected by electronic noise, with a noise-to-signal ratio (NSR) of about 14.36 dB. Carbon ion radiography simulations were performed in this study using Geant4 software to eliminate the effect of the electronic noise. The thickness prediction accuracy is 98.54%, 98.62%, and 99.07% per pixel for hemispherical, sloped and stepped phantoms, respectively, with AME of 0.09 mm, 0.27 mm, and 0.48 mm. Carbon ion radiography utilizing the CICD prototype scheme has the ability to refine the accuracy and resolution of radiographic images, consequently establishing a scientific foundation for diminishing the effects of range uncertainty and fully exploiting the advantages of precision particle therapy.
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Affiliation(s)
- Chuan Huang
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, 730000, China; School of Nuclear Science and Technology, Lanzhou University, Lanzhou, Gansu, 730000, China
| | - Zhiguo Xu
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, 730000, China.
| | - Zulong Zhao
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, 730000, China
| | - Yongzhi Yin
- School of Nuclear Science and Technology, Lanzhou University, Lanzhou, Gansu, 730000, China
| | - Zhengguo Hu
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, 730000, China
| | - Qianshun She
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, 730000, China
| | - Ruishi Mao
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, 730000, China
| | - Kun Wei
- Wuwei Occupational College, Wuwei, Gansu, 730000, China
| | - Herun Yang
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, 730000, China
| | - Kai Tang
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, 730000, China
| | - Ziwei Lu
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, 730000, China
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Meschini G, Vai A, Barcellini A, Fontana G, Molinelli S, Mastella E, Pella A, Vitolo V, Imparato S, Orlandi E, Ciocca M, Baroni G, Paganelli C. Time-resolved MRI for off-line treatment robustness evaluation in carbon-ion radiotherapy of pancreatic cancer. Med Phys 2022; 49:2386-2395. [PMID: 35124811 PMCID: PMC9306947 DOI: 10.1002/mp.15510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 09/28/2021] [Accepted: 01/20/2022] [Indexed: 11/25/2022] Open
Abstract
PURPOSE In this study, we investigate the use of magnetic resonance imaging (MRI) for the clinical evaluation of gating treatment robustness in carbon-ion radiotherapy (CIRT) of pancreatic cancer. Indeed, MRI allows radiation-free repeated scans and fast dynamic sequences for time-resolved (TR) imaging (cine-MRI), providing information on inter- and intra-fraction cycle-to-cycle variations of respiratory motion. MRI can therefore support treatment planning and verification, overcoming the limitations of the current clinical standard, that is, four-dimensional computed tomography (4DCT), which describes an "average" breathing cycle neglecting breathing motion variability. METHODS We integrated a technique to generate a virtual CT (vCT) from 3D MRI with a method for 3D reconstruction from 2D cine-MRI, to produce TR vCTs for dose recalculations. For eight patients, the method allowed evaluating inter-fraction variations at end-exhale and intra-fraction cycle-to-cycle variability within the gating window in terms of tumor displacement and dose to the target and organs at risk. RESULTS The median inter-fraction tumor motion was in the range 3.33-12.16 mm, but the target coverage was robust (-0.4% median D95% variation). Concerning cycle-to-cycle variations, the gating technique was effective in limiting tumor displacement (1.35 mm median gating motion) and corresponding dose variations (-3.9% median D95% variation). The larger exposure of organs at risk (duodenum and stomach) was caused by inter-fraction motion, whereas intra-fraction cycle-to-cycle dose variations were limited. CONCLUSIONS This study proposed a method for the generation of TR vCTs from MRI, which enabled an off-line evaluation of gating treatment robustness and suggested its feasibility to support treatment planning of pancreatic tumors in CIRT.
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Affiliation(s)
- Giorgia Meschini
- Department of Electronics, Information and BioengineeringPolitecnico di MilanoMilanItaly
| | - Alessandro Vai
- Medical Physics UnitNational Center for Oncological Hadrontherapy (Fondazione CNAO)PaviaItaly
| | - Amelia Barcellini
- Clinical DepartmentNational Center for Oncological Hadrontherapy (Fondazione CNAO)PaviaItaly
| | - Giulia Fontana
- Clinical Bioengineering UnitNational Center for Oncological Hadrontherapy (Fondazione CNAO)PaviaItaly
| | - Silvia Molinelli
- Medical Physics UnitNational Center for Oncological Hadrontherapy (Fondazione CNAO)PaviaItaly
| | - Edoardo Mastella
- Medical Physics UnitNational Center for Oncological Hadrontherapy (Fondazione CNAO)PaviaItaly
| | - Andrea Pella
- Clinical Bioengineering UnitNational Center for Oncological Hadrontherapy (Fondazione CNAO)PaviaItaly
| | - Viviana Vitolo
- Clinical DepartmentNational Center for Oncological Hadrontherapy (Fondazione CNAO)PaviaItaly
| | - Sara Imparato
- Radiology UnitNational Center for Oncological Hadrontherapy (Fondazione CNAO)PaviaItaly
| | - Ester Orlandi
- Clinical DepartmentNational Center for Oncological Hadrontherapy (Fondazione CNAO)PaviaItaly
| | - Mario Ciocca
- Medical Physics UnitNational Center for Oncological Hadrontherapy (Fondazione CNAO)PaviaItaly
| | - Guido Baroni
- Department of Electronics, Information and BioengineeringPolitecnico di MilanoMilanItaly
- Clinical Bioengineering UnitNational Center for Oncological Hadrontherapy (Fondazione CNAO)PaviaItaly
| | - Chiara Paganelli
- Department of Electronics, Information and BioengineeringPolitecnico di MilanoMilanItaly
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Extension of RBE-weighted 4D particle dose calculation for non-periodic motion. Phys Med 2021; 91:62-72. [PMID: 34715550 DOI: 10.1016/j.ejmp.2021.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 10/01/2021] [Accepted: 10/05/2021] [Indexed: 01/02/2023] Open
Abstract
PURPOSE Highly conformal scanned Carbon Ion Radiotherapy (CIRT) might permit dose escalation and improved local control in advanced stage thoracic tumors, but is challenged by target motion. Dose calculation algorithms typically assume a periodically repeating, regular motion. To assess the effect of realistic, irregular motion, new algorithms of validated accuracy are needed. METHODS We extended an in-house treatment planning system to calculate RBE-weighted dose distributions in CIRT on non-periodic CT image sequences. Dosimetric accuracy was validated experimentally on a moving, time-resolved ionization chamber array. Log-file based dose reconstructions were compared by gamma analysis and correlation to measurements at every intermediate detector frame during delivery. The impact of irregular motion on treatment quality was simulated on a virtual 4DCT thorax phantom. Periodic motion was compared to motion with varying amplitude and period ± baseline drift. Rescanning as a mitigation strategy was assessed on all scenarios. RESULTS In experimental validation, average gamma pass rates were 99.89+-0.30% for 3%/3 mm and 88.2+-2.2% for 2%/2 mm criteria. Average correlation for integral dose distributions was 0.990±0.002. Median correlation for single 200 ms frames was 0.947±0.006. In the simulations, irregular motion deteriorated V95 target coverage to 81.2%, 76.6% and 79.0% for regular, irregular motion and irregular motion with base-line drift, respectively. Rescanning restored V95 to >98% for both scenarios without baseline drift, but not with additional baseline drift at 83.7%. CONCLUSIONS The validated algorithm permits to study the effects of irregular motion and to develop and adapt appropriate motion mitigation techniques.
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Moteabbed M, Smeets J, Hong TS, Janssens G, Labarbe R, Wolfgang JA, Bortfeld TR. Toward MR-integrated proton therapy: modeling the potential benefits for liver tumors. Phys Med Biol 2021; 66. [PMID: 34407528 DOI: 10.1088/1361-6560/ac1ef2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 08/18/2021] [Indexed: 12/25/2022]
Abstract
Magnetic resonance imaging (MRI)-integrated proton therapy (MRiPT) is envisioned to improve treatment quality for many cancer patients. However, given the availability of alternative image-guided strategies, its clinical need is yet to be justified. This study aims to compare the expected clinical outcomes of MRiPT with standard of practice cone-beam CT (CBCT)-guided PT, and other MR-guided methods, i.e. offline MR-guided PT and MR-linac, for treatment of liver tumors. Clinical outcomes were assessed by quantifying the dosimetric and biological impact of target margin reduction enabled by each image-guided approach. Planning target volume (PTV) margins were calculated using random and systematic setup, delineation and motion uncertainties, which were quantified by analyzing longitudinal MRI data for 10 patients with liver tumors. Proton treatment plans were created using appropriate PTV margins for each image-guided PT method. Photon plans with margins equivalent to MRiPT were generated to represent MR-linac. Normal tissue complication probabilities (NTCP) of the uninvolved liver were compared. We found that PTV margin can be reduced by 20% and 40% for offline MR-guided PT and MRiPT, respectively, compared with CBCT-guided PT. Furthermore, clinical target volume expansion could be largely alleviated when delineating on MRI rather than CT. Dosimetric implications included decreased equivalent mean dose of the uninvolved liver, i.e. up to 24.4 Gy and 27.3 Gy for offline MR-guided PT and MRiPT compared to CBCT-guided PT, respectively. Considering Child-Pugh score increase as endpoint, NTCP of the uninvolved liver was significantly decreased for MRiPT compared to CBCT-guided PT (up to 48.4%,p < 0.01), offline MR-guided PT (up to 12.9%,p < 0.01) and MR-linac (up to 30.8%,p < 0.05). Target underdose was possible in the absence of MRI-guidance (D90 reduction up to 4.2 Gy in 20% of cases). In conclusion, MRiPT has the potential to significantly reduce healthy liver toxicities in patients with liver tumors. It is superior to other image-guided techniques currently available.
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Affiliation(s)
- Maryam Moteabbed
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America
| | | | - Theodore S Hong
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America
| | | | - Rudi Labarbe
- Ion Beam Applications, Louvain-La-Neuve, Belguim
| | - John A Wolfgang
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America
| | - Thomas R Bortfeld
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America
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Mastella E, Mirandola A, Russo S, Vai A, Magro G, Molinelli S, Barcellini A, Vitolo V, Orlandi E, Ciocca M. High-dose hypofractionated pencil beam scanning carbon ion radiotherapy for lung tumors: Dosimetric impact of different spot sizes and robustness to interfractional uncertainties. Phys Med 2021; 85:79-86. [PMID: 33984821 DOI: 10.1016/j.ejmp.2021.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 03/18/2021] [Accepted: 05/03/2021] [Indexed: 02/08/2023] Open
Abstract
PURPOSE The robustness against setup and motion uncertainties of gated four-dimensional restricted robust optimization (4DRRO) was investigated for hypofractionated carbon ion radiotherapy (CIRT) of lung tumors. METHODS CIRT plans of 9 patients were optimized using 4DRRO strategy with 3 mm setup errors, 3% density errors and 3 breathing phases related to the gate window. The prescription was 60 Gy(RBE) in 4 fractions. Standard spots (SS) were compared to big spots (BS). Plans were recalculated on multiple 4DCTs acquired within 3 weeks from treatment simulation and rigidly registered with planning images using bone matching. Warped dose distributions were generated using deformable image registration and accumulated on the planning 4DCTs. Target coverage (D98%, D95% and V95%) and dose to lung were evaluated in the recalculated and accumulated dose distributions. RESULTS Comparable target coverage was obtained with both spot sizes (p = 0.53 for D95%). The mean lung dose increased of 0.6 Gy(RBE) with BS (p = 0.0078), still respecting the dose constraint of a 4-fraction stereotactic treatment for the risk of radiation pneumonitis. Statistically significant differences were found in the recalculated and accumulated D95% (p = 0.048 and p = 0.024), with BS showing to be more robust. Using BS, the average degradations of the D98%, D95% and V95% in the accumulated doses were -2.7%, -1.6% and -1.5%. CONCLUSIONS Gated 4DRRO was highly robust against setup and motion uncertainties. BS increased the dose to healthy tissues but were more robust than SS. The selected optimization settings guaranteed adequate target coverage during the simulated treatment course with acceptable risk of toxicity.
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Affiliation(s)
- Edoardo Mastella
- CNAO, National Center for Oncological Hadrontherapy, Strada Campeggi 53, I-27100 Pavia, Italy.
| | - Alfredo Mirandola
- CNAO, National Center for Oncological Hadrontherapy, Strada Campeggi 53, I-27100 Pavia, Italy
| | - Stefania Russo
- CNAO, National Center for Oncological Hadrontherapy, Strada Campeggi 53, I-27100 Pavia, Italy
| | - Alessandro Vai
- CNAO, National Center for Oncological Hadrontherapy, Strada Campeggi 53, I-27100 Pavia, Italy
| | - Giuseppe Magro
- CNAO, National Center for Oncological Hadrontherapy, Strada Campeggi 53, I-27100 Pavia, Italy
| | - Silvia Molinelli
- CNAO, National Center for Oncological Hadrontherapy, Strada Campeggi 53, I-27100 Pavia, Italy
| | - Amelia Barcellini
- CNAO, National Center for Oncological Hadrontherapy, Strada Campeggi 53, I-27100 Pavia, Italy
| | - Viviana Vitolo
- CNAO, National Center for Oncological Hadrontherapy, Strada Campeggi 53, I-27100 Pavia, Italy
| | - Ester Orlandi
- CNAO, National Center for Oncological Hadrontherapy, Strada Campeggi 53, I-27100 Pavia, Italy
| | - Mario Ciocca
- CNAO, National Center for Oncological Hadrontherapy, Strada Campeggi 53, I-27100 Pavia, Italy
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