Use of Monte Carlo computation in benchmarking radiotherapy treatment planning system algorithms

Development of a TOPAS Monte Carlo (MC) model extension to simulate the automatic exposure control function of a C-arm CBCT

PURPOSE

Accurate simulation of organ doses in C-arm CBCT is critical for estimating personalised patient dosimetry. However, system complexities such as automatic exposure control (AEC) and the incorporation of DICOM images into simulations are challenging. The aim of this study was to develop a model for mimicking the operation of an AEC system, which maintains a constant dose to the detector through mA modulation in order to facilitate more accurate MC dosimetry models for C-arm CBCT.

METHODS

A Siemens Artis Q Interventional Radiology (IR) C-arm system [Siemens, Erlangen, Germany] was modelled in TOol for PArticle Simulation (TOPAS) by incorporating system specifications such as rotational speed, number of projections and exam protocol parameters. A novel threshold scorer, AECScorer, was developed to model the AEC functionality. MC simulations were performed using a variety of imaged volumes including a CTDI phantom, an anthropomorphic phantom and a patient DICOM dataset.

RESULTS

The AECScorer extension provides a framework for a conditional scoring function within TOPAS which allows for the simulation of an AEC system. The AECScorer successfully equalises the dose to the detector for simple phantoms and DICOM imaging datasets by adjusting the number of histories simulated at each CBCT projection. This AECSCorer tool is applicable to other medical imaging systems requiring AEC simulation.

CONCLUSIONS

We demonstrate a novel threshold scorer in TOPAS for a C-arm CBCT setup. The presented AECScorer is the first step towards providing a system-, patient- and protocol-specific dose estimates from CBCT dosimetry applications.

Determination and validation of the initial beam parameters of Elekta Agility collimator head by Monte Carlo simulations

The availability of geometrical, physical, and initial beam parameters for Monte Carlo (MC) simulations of the Elekta Agility collimator head has become very difficult due to the proprietary nature of this data. This study presents strategies to independently determine the geometrical and physical properties of the components and initial beam parameters of the Agility collimator head for full beam simulations and postulates a benchmarking process using the EGSnrc MC toolkit. Target material of W (90%) and Re (10%) of 0.09 cm thickness, flattening filter of 1.77 cm thick stainless steel placed on 0.5 cm Al disc, and primary and secondary collimators of Tungsten alloy have been found to best fit the Agility head. The initial beam energy of 6.0 MeV with a radial distribution given as full-width half maxima (FWHM) of 0.301 cm (crossline) × 0.201 cm (inline) for 6 MV beam with a mean angular spread of 1.34° has been found best fitting the model. Variations of 0.29% and 0.59% have been noted in the measured and calculated values of TPR_20,10 and D₁₀ respectively. More than 90% dose points for all simulations passed the 2D gamma criteria of 3% DD, 3 mm DTA. This MC model of the Agility head can be used for dose calculation and validation of advanced treatment techniques.

A comparison of physical and dosimetric properties of lung substitute materials

PURPOSE

The need for an accurate estimate of absorbed doses within and around irradiated thorax tissues necessitates the use of carefully selected materials from which phantoms are constructed. A lung substitute is more difficult to establish mostly due to its low physical density. Although many researchers have used cork as a lung substitute, very little research data address cork's characteristics to determine which type of cork is optimal as a substitute for lung tissue.

METHODS

Natural cork, composition cork, rubber cork, ATOM, RANDO, and a reference lung material (ICRU-44 lung tissue) were investigated to establish comparisons of physical properties. Following the determination of the respective physical properties, the dose distributions from 6 MV photon beams in water/lung substitute/water phantoms were assessed using the Monte Carlo method. Physical and electron densities affecting the dose distributions through lung tissues in different field size conditions were investigated.

RESULTS

The physical properties (physical density, electronic density, and effective atomic number) of the composition cork are the most similar to those of the ICRU-44 lung, and the CT number of the composition cork is very similar to that of humans aged 30-60. PDD of the composition cork and the RANDO phantom are the most comparable to that of ICRU-44 lung in 1 × 1 cm(2) field size due to the combined properties of physical density (PD) and electron density per gram (EDG) of the studied lung materials. PD and EDG affect the lung dose primarily in small field size. The effects of PD are minimal in large fields, having a more rapid lateral electron equilibrium. EDG dominates PDD pattern in lung material when large fields are applied. Combined effects of PD and EDG are nonlinear for all field sizes.

CONCLUSIONS

The composition cork is the preferred lung substitute based on physical and dosimetric properties.

Differential dose volume histograms of Gamma knife in the presence of inhomogeneities using MRI-polymer gel dosimetry and MC simulation

Polymer gel dosimeters offer a practical solution to 3D dose verification for conventional radiotherapy as well as intensity-modulated and stereotactic radiotherapy. In this study, EGSnrc calculated and PAGAT polymer gel dosimeter measured dose volume histograms (DVHs) for single-shot irradiations of the Gamma Knife (GK) unit were used to investigate the effects of the presence of inhomogeneities on 3D dose distribution. The head phantom was a custom-built 16 cm diameter Plexiglas sphere. Inside the phantom, there is a cubic cutout for inserting the gel vials and another cutout for inserting the inhomogeneities. Following irradiation with the GK unit, the polymer gel phantoms were scanned with a 1.5 T MRI scanner. Comparing the results of measurement in homogeneous and heterogeneous phantoms revealed that inserting inhomogeneities inside the homogeneous phantom did not cause considerable disturbances on dose distribution in irradiation with 8 mm collimator within low isodose levels (< 50%), which is essential for the dose sparing of sensitive structures. The results of simulation for homogeneous and inhomogeneous phantoms in irradiation with 18 mm collimator of the GK unit showed 23.24% difference in DVH within 90%-100% relative isodose level and also revealed that a significant part of the target (28.56%) received relative doses higher than the maximum dose, which exceeds the acceptance criterion (5%). Based on these results it is concluded that the presence of inhomogeneities inside the phantom can cause considerable errors in dose calculation within high isodose levels with respect to LGP prediction which assumes that the target is a homogeneous material. Moreover, it is demonstrated that the applied MC code is an accurate and stand-alone tool for 3D evaluation of dose distribution in irradiation with the GK unit, which can provide important, 3D plan evaluation criteria used in clinical practice.

Evaluation of the analytical anisotropic algorithm in an extreme water-lung interface phantom using Monte Carlo dose calculations

Our study compares the performance of the analytical anisotropic algorithm (AAA), a new superposition–convolution algorithm recently implemented in the Eclipse (Varian Medical Systems, Palo Alto, CA) Integrated Treatment Planning System (TPS), to that of the pencil beam convolution (PBC) algorithm in an extreme (C‐shaped, horizontal and vertical boundaries) water–lung interface phantom. Monte Carlo (MC) calculated dose distributions for a variety of clinical beam configurations at nominal energies of 6‐MV and 18‐MV are used as benchmarks in the comparison. Dose profiles extracted at three depths (4, 10, and 16 cm), two‐dimensional (2D) maps of the dose differences, and dose difference statistics are used to quantify the accuracy of both photon‐dose calculation algorithms. Results show that the AAA is considerably more accurate than the PBC, with the standard deviation of the dose differences within a region encompassing the lung block reduced by a factor of 2 and more. Confidence limits with the AAA were 4% or less for all beam configurations investigated; with the PBC, confidence limits ranged from 3.5% to 11.2%. Finally, AAA calculations for the small 4×4 18‐MV beam, which is poorly modeled by PBC (dose differences as high as 16.1%), provided the same accuracy as the PBC model of the 6‐MV beams commonly acceptable in clinical situations.

PACS number: 87.53.Bn

Monte Carlo dosimetric evaluation of high energy vs low energy photon beams in low density tissues

BACKGROUND AND PURPOSE

Low megavoltage photon beams are often the treatment choice in radiotherapy when low density heterogeneities are involved, because higher energies show some undesirable dosimetric effects. This work is aimed at investigating the effects of different energy selection for low density tissues.

PATIENTS AND METHODS

BEAMnrc was used to simulate simple treatment set-ups in a simple and a CT reconstructed lung phantom and an air-channel phantom. The dose distribution of 6, 15 and 20 MV photon beams was studied using single, AP/PA and three-field arrangements.

RESULTS

Our results showed no significant changes in the penumbra width in lung when a pair of opposed fields were used. The underdosage at the anterior/posterior tumor edge caused by the dose build-up at the lung-tumor interface reached 7% for a 5 x 5 cm AP/PA set-up. Shrinkage of the 90% isodose volume was noticed for the same set-up, which could be rectified by adding a lateral field. For the CT reconstructed phantom, the AP/PA set-up offered better tumor coverage when lower energies were used but for the three field set-up, higher energies resulted to better sparing of the lung tissue. For the air-channel set-up, adding an opposed field reduced the penumbra width. Using higher energies resulted in a 7% cold spot around the air-tissue interface for a 5 x 5 cm field.

CONCLUSIONS

The choice of energy for treatment in the low density areas is not a straightforward decision but depends on a number of parameters such as the beam set-up and the dosimetric criteria. Updated calculation algorithms should be used in order to be confident for the choice of energy of treatment.

A Monte Carlo multiple source model applied to radiosurgery narrow photon beams

Monte Carlo (MC) methods are nowadays often used in the field of radiotherapy. Through successive steps, radiation fields are simulated, producing source Phase Space Data (PSD) that enable a dose calculation with good accuracy. Narrow photon beams used in radiosurgery can also be simulated by MC codes. However, the poor efficiency in simulating these narrow photon beams produces PSD whose quality prevents calculating dose with the required accuracy. To overcome this difficulty, a multiple source model was developed that enhances the quality of the reconstructed PSD, reducing also the time and storage capacities. This multiple source model was based on the full MC simulation, performed with the MC code MCNP4C, of the Siemens Mevatron KD2 (6 MV mode) linear accelerator head and additional collimators. The full simulation allowed the characterization of the particles coming from the accelerator head and from the additional collimators that shape the narrow photon beams used in radiosurgery treatments. Eight relevant photon virtual sources were identified from the full characterization analysis. Spatial and energy distributions were stored in histograms for the virtual sources representing the accelerator head components and the additional collimators. The photon directions were calculated for virtual sources representing the accelerator head components whereas, for the virtual sources representing the additional collimators, they were recorded into histograms. All these histograms were included in the MC code, DPM code and using a sampling procedure that reconstructed the PSDs, dose distributions were calculated in a water phantom divided in 20000 voxels of 1 x 1 x 5 mm3. The model accurately calculates dose distributions in the water phantom for all the additional collimators; for depth dose curves, associated errors at 2sigma were lower than 2.5% until a depth of 202.5 mm for all the additional collimators and for profiles at various depths, deviations between measured and calculated values were less than 2.5% or 1 mm.

Application of GEANT4radiation transport toolkit to dose calculations in anthropomorphic phantoms

In this paper, we present a novel implementation of a dose calculation application, based on the GEANT4 Monte Carlo toolkit. Validation studies were performed with an homogeneous water phantom and an Alderson-Rando anthropomorphic phantom both irradiated with high-energy photon beams produced by a clinical linear accelerator. As input, this tool requires computer tomography images for automatic codification of voxel-based geometries and phase-space distributions to characterize the incident radiation field. Simulation results were compared with ionization chamber, thermoluminescent dosimetry data and commercial treatment planning system calculations. In homogeneous water phantom, overall agreement with measurements were within 1-2%. For anthropomorphic simulated setups (thorax and head irradiation) mean differences between GEANT4 and TLD measurements were less than 2%. Significant differences between GEANT4 and a semi-analytical algorithm implemented in the treatment planning system, were found in low-density regions, such as air cavities with strong electronic disequilibrium.

Investigation of photon beam models in heterogeneous media of modern radiotherapy

This study investigates the performance of photon beam models in dose calculations involving heterogeneous media in modern radiotherapy. Three dose calculation algorithms implemented in the CMS FOCUS treatment planning system have been assessed and validated using ionization chambers, thermoluminescent dosimeters (TLDs) and film. The algorithms include the multigrid superposition (MGS) algorithm, fast Fourier Transform Convolution (FFTC) algorithm and Clarkson algorithm. Heterogeneous phantoms used in the study consist of air cavities, lung analogue and an anthropomorphic phantom. Depth dose distributions along the central beam axis for 6 MV and 10 MV photon beams with field sizes of 5 cm x 5 cm and 10 cm x 10 cm were measured in the air cavity phantoms and lung analogue phantom. Point dose measurements were performed in the anthropomorphic phantom. Calculated results with three dose calculation algorithms were compared with measured results. In the air cavity phantoms, the maximum dose differences between the algorithms and the measurements were found at the distal surface of the air cavity with a 10 MV photon beam and a 5 cm x 5 cm field size. The differences were 3.8%. 24.9% and 27.7% for the MGS. FFTC and Clarkson algorithms. respectively. Experimental measurements of secondary electron build-up range beyond the air cavity showed an increase with decreasing field size, increasing energy and increasing air cavity thickness. The maximum dose differences in the lung analogue with 5 cm x 5 cm field size were found to be 0.3%. 4.9% and 6.9% for the MGS. FFTC and Clarkson algorithms with a 6 MV photon beam and 0.4%. 6.3% and 9.1% with a 10 MV photon beam, respectively. In the anthropomorphic phantom, the dose differences between calculations using the MGS algorithm and measurements with TLD rods were less than +/-4.5% for 6 MV and 10 MV photon beams with 10 cm x 10 cm field size and 6 MV photon beam with 5 cm x 5 cm field size, and within +/-7.5% for 10 MV with 5 cm x 5 cm field size, respectively. The FFTC and Clarkson algorithms overestimate doses at all dose points in the lung of the anthropomorphic phantom. In conclusion, the MGS is the most accurate dose calculation algorithm of investigated photon beam models. It is strongly recommended for implementation in modern radiotherapy with multiple small fields when heterogeneous media are in the treatment fields.

Analysis of the penumbra enlargement in lung versus the Quality Index of photon beams: A methodology to check the dose calculation algorithm

It is well known that considerable underdosage can occur at the edges of a tumor inside the lung because of the degradation of penumbra due to lack of lateral electronic equilibrium. Although present even at smaller energies, this phenomenon is more pronounced for higher energies. Apart from Monte Carlo calculation, most of the existing Treatment Planning Systems (TPSs) cannot deal at all, or with acceptable accuracy, with this effect. A methodology has been developed for assessing the dose calculation algorithms in the lung region where lateral electronic disequilibrium exists, based on the Quality Index (QI) of the incident beam. A phantom, consisting of layers of polystyrene and lung material, has been irradiated using photon beams of 4, 6, 15, and 20 MV. The cross-plane profiles of each beam for 5x5, 10x10, and 25x10 fields have been measured at the middle of the phantom with the use of films. The penumbra (20%-80%) and fringe (50%-90%) enlargement was measured and the ratio of the widths for the lung to that of polystyrene was defined as the Correction Factor (CF). Monte Carlo calculations in the two phantoms have also been performed for energies of 6, 15, and 20 MV. Five commercial TPS's algorithms were tested for their ability to predict the penumbra and fringe enlargement. A linear relationship has been found between the QI of the beams and the CF of the penumbra and fringe enlargement for all the examined fields. Monte Carlo calculations agree very well (less than 1% difference) with the film measurements. The CF values range between 1.1 for 4 MV (QI 0.620) and 2.28 for 20 MV (QI 0.794). Three of the tested TPS's algorithms could not predict any enlargement at all for all energies and all fields and two of them could predict the penumbra enlargement to some extent. The proposed methodology can help any user or developer to check the accuracy of its algorithm for lung cases, based on a simple phantom geometry and the QI of the incident beam. This check is very important especially when higher energies are used, as the inaccuracies in existing algorithms can lead to an incorrect choice of energy for lung treatment and consequently to a failure in tumor control.

Basic dosimetry of radiosurgery narrow beams using Monte Carlo simulations: A detailed study of depth of maximum dose

In radiosurgery narrow photon beams, the depth of maximum dose d(max), in the beam central axis increases as the size of the additional collimator increases. This behavior is the opposite of what is observed in radiotherapy conventional beams. To understand this effect, experimental depth dose curves of the additional collimators were obtained for a Siemens KD2 linear accelerator in 6 MV photon mode and the shift of d(max) varied from 11.0 +/- 0.6 mm for the 5 mm collimator to 14.5 +/- 0.6 mm for the 23 mm collimator. Monte Carlo simulations showed that the photons that had no interactions in the additional collimators, contributing more than 90% to the total dose in water, were responsible for the shift in d(max). Monte Carlo simulations also showed that electrons originated from these photons and contributing to the dose deposit in water in the beam central axis could be divided in two groups: those that deposit energy far away from their point of origin (the point of the first photon collision in water) and those that deposit energy locally (originated at more than one photon collision in water). Applying a simplified model based on the fact that the photons originating Compton electrons (at the first and subsequent collisions) have similar characteristics in air for all the additional collimators, it was shown that these electrons were also responsible for the shift of d(max) in the beam central axis. Finally, it was shown that the changes in the initial gradients of the depth dose curves of the additional collimators were mainly due to electrons originated from the first photon collision in water.

Experimental verification of convolution/superposition photon dose calculations for radiotherapy treatment planning

This work describes an experimental verification of the two-photon dose calculation engines available on the Helax-TMS (version 6.1) commercial radiotherapy treatment planning system. The performance of the pencil beam convolution and the collapsed cone superposition algorithms was examined for 4, 6, 15 MV beams, under a range of clinically relevant irradiation geometries. Comparisons against measurements were carried out in terms of absolute dose, thus assessment of the accuracy of monitor unit (MU) calculations was also carried out. Results show that both algorithms agree with measurement to acceptable tolerance levels in most cases in homogeneous water-equivalent media irradiated under full scatter conditions. The collapsed cone algorithm slightly overestimates the penumbra width and this is mainly due to discretization effects of the fluence matrix. The accuracy of this algorithm strongly depends on the resolution of the patient density matrix. It is recommended that the density matrix voxel size used for dose calculations is less than 5 x 5 x 5 mm3. The dose in media irradiated under missing tissue geometry, or in the presence of low or high-density heterogeneities, is modelled best with the collapsed cone algorithm. This is of particular clinical interest in treatment planning of the breast and of the thorax. For these treatment sites, a retrospective study of treatment plans indicated in certain cases significant overestimation of the dose to the planning target volume when using the pencil beam convolution model.

[Results of the DGMP survey on radiotherapy planning systems]

The present paper presents the results of a survey on radiotherapy-treatment planning systems conducted in the summer of 2000. A total of 263 questionnaires of 108 German, 6 Austrian, and 4 Swiss radiotherapy clinics or practices have been evaluated. Most treatment planning systems are used for teletherapy, with nearly all sites using at least one commercial system. The planning systems are mostly networked with CT, partially also with MRI, simulator and R&V systems of the treatment equipment. For brachytherapy planning, usually orthogonal X-ray images are used, but some systems allow already the use of CT data as well. Stereotactic planning dominates the specialized treatment planning, followed by total body irradiation techniques. Commercial systems are well established for stereotactic planning systems, whereas in-house systems are still predominant for total body irradiation. In-house systems predominate also in the case of simple treatment planning systems and plausibility check programs. These simpler dose-calculation programs usually offer variable degrees of correction options.

Monte Carlo dose verification for intensity-modulated arc therapy

Intensity-modulated arc therapy (IMAT), a technique which combines beam rotation and dynamic multileaf collimation, has been implemented in our clinic. Dosimetric errors can be created by the inability of the planning system to accurately account for the effects of tissue inhomogeneities and physical characteristics of the multileaf collimator (MLC). The objective of this study is to explore the use of Monte Carlo (MC) simulation for IMAT dose verification. The BEAM/DOSXYZ Monte Carlo system was implemented to perform dose verification for the IMAT treatment. The implementation includes the simulation of the linac head/MLC (Elekta SL20), the conversion of patient CT images and beam arrangement for 3D dose calculation, the calculation of gantry rotation and leaf motion by a series of static beams and the development of software to automate the entire MC process. The MC calculations were verified by measurements for conventional beam settings. The agreement was within 2%. The IMAT dose distributions generated by a commercial forward planning system (RenderPlan. Elekta) were compared with those calculated by the MC package. For the cases studied, discrepancies of over 10% were found between the MC and the RenderPlan dose calculations. These discrepancies were due in part to the inaccurate dose calculation of the RenderPlan system. The computation time for the IMAT MC calculation was in the range of 20-80 min on 15 Pentium-Ill computers. The MC method was also useful in verifying the beam apertures used in the IMAT treatments.