Benchmarking nuclear models of FLUKA and GEANT4 for carbon ion therapy

Linear Energy Transfer Measurements and Estimation of Relative Biological Effectiveness in Proton and Helium Ion Beams Using Fluorescent Nuclear Track Detectors

PURPOSE

Our objective was to develop a methodology for assessing the linear energy transfer (LET) and relative biological effectiveness (RBE) in clinical proton and helium ion beams using fluorescent nuclear track detectors (FNTDs).

METHODS AND MATERIALS

FNTDs were exposed behind solid water to proton and helium (4He) ion spread-out Bragg peaks. Detectors were imaged with a confocal microscope, and the LET spectra were derived from the fluorescence intensity. The track- and dose-averaged LET (LETF and LETD, respectively) were calculated from the LET spectra. LET measurements were used as input on RBE models to estimate the RBE. Human alveolar adenocarcinoma cells (A549) were exposed at the same positions as the FNTDs. The RBE was calculated from the resulting survival curves. All measurements were compared with Monte Carlo simulations.

RESULTS

For protons, average relative differences between measurements and simulations were 6% and 19% for LETF and LETD, respectively. For helium ions, the same differences were 11% for both quantities. The position of the experimental LET spectra primary peaks agreed with the simulations within 9% and 14% for protons and helium ions, respectively. For the RBE models using LETD as input, FNTD-based RBE values ranged from 1.02 ± 0.01 to 1.25 ± 0.04 and from 1.08 ± 0.09 to 2.68 ± 1.26 for protons and helium ions, respectively. The average relative differences between these values and simulations were 2% and 4%. For A549 cells, the RBE ranged from 1.05 ± 0.07 to 1.47 ± 0.09 and from 0.89 ± 0.06 to 3.28 ± 0.20 for protons and helium ions, respectively. Regarding the RBE-weighted dose (2.0 Gy at the spread-out Bragg peak), the differences between simulations and measurements were below 0.10 Gy.

CONCLUSIONS

This study demonstrates for the first time that FNTDs can be used to perform direct LET measurements and to estimate the RBE in clinical proton and helium ion beams.

The influence of different versions of FLUKA and GEANT4 on the calculation of response functions of ionization chambers in clinical proton beams

Objective.To investigate the influence of different versions of the Monte Carlo codesgeant4 andflukaon the calculation of overall response functionsfQof air-filled ionization chambers in clinical proton beams.Approach. fQfactors were calculated for six plane-parallel and four cylindrical ionization chambers withgeant4 andfluka. These factors were compared to already published values that were derived using older versions of these codes.Main results.Differences infQfactors calculated with different versions of the same Monte Carlo code can be up to ∼1%. Especially forgeant4, the updated version leads to a more pronounced dependence offQon proton energy and to smallerfQfactors for high energies.Significance.Different versions of the same Monte Carlo code can lead to differences in the calculation offQfactors of up to ∼1% without changing the simulation setup, transport parameters, ionization chamber geometry modeling, or employed physics lists. These findings support the statement that the dominant contributor to the overall uncertainty of Monte Carlo calculatedfQfactors are type-B uncertainties.

A torus source and its application for non-primary radiation evaluation

Objective. Non-primary radiation doses to normal tissues from proton therapy may be associated with an increased risk of secondary malignancies, particularly in long-term survivors. Thus, a systematic method to evaluate if the dose level of non-primary radiation meets the IEC standard requirements is needed.Approach. Different from the traditional photon radiation therapy system, proton therapy systems are composed of several subsystems in a thick bunker. These subsystems are all possible sources of non-primary radiation threatening the patient. As a case study, 7 sources in the P-Cure synchrotron-based proton therapy system are modeled in Monte Carlo (MC) code: tandem injector, injection, synchrotron ring, extraction, beam transport line, scanning nozzle and concrete reflection/scattering. To accurately evaluate the synchrotron beam loss and non-primary dose, a new model called the torus source model is developed. Its parametric equations define the position and direction of the off-orbit particle bombardment on the torus pipe shell in the Cartesian coordinate system. Non-primary doses are finally calculated by several FLUKA simulations.Main results. The ratios of summarized non-primary doses from different sources to the planned dose of 2 Gy are all much smaller than the IEC requirements in both the 15-50 cm and 50-200 cm regions. Thus, the P-Cure synchrotron-based proton therapy system is clean and patient-friendly, and there is no need an inner shielding concrete between the accelerator and patient.Significance. Non-primary radiation dose level is a very important indicator to evaluate the quality of a PT system. This manuscript provides a feasible MC procedure for synchrotron-based proton therapy with new beam loss model. Which could help people figure out precisely whether this level complies with the IEC standard before the system put into clinical treatment. What' more, the torus source model could be widely used for bending magnets in gantries and synchrotrons to evaluate non-primary doses or other radiation doses.

Validation of the relative biological effectiveness of active-energy scanning carbon-ion radiotherapy on a commercial treatment planning system with a microdosimetic kinetic model

BACKGROUND

The study objective was to validate the relative biological effectiveness (RBE) calculated by the modified microdosimetric kinetic model in RayStation (Ray-MKM) for active-energy scanning carbon-ion radiotherapy.

METHODS

The Ray-MKM was benchmarked using a spread-out Bragg-peak (SOBP) plan, which was suggested in literature from the National Institute of Radiobiological Science (NIRS) in Japan. The residual RBE differences from the MKM at NIRS (NIRS-MKM) were derived using several SOBP plans with different ranges, SOBP widths, and prescriptions. To investigate the origins of the differences, we compared the saturation-corrected dose-mean specific energy [Formula: see text] of the aforementioned SOBPs. Furthermore, we converted the RBE-weighted doses with the Ray-MKM to those with local effect model I (LEM doses). The purpose was to investigate whether the Ray-MKM could reproduce the RBE-weighted conversion study.

RESULTS

The benchmark determined the value of the clinical dose scaling factor, [Formula: see text], as 2.40. The target mean RBE deviations between the Ray-MKM and NIRS-MKM were median: 0.6 (minimum: 0.0 to maximum: 1.69) %. The [Formula: see text] difference in-depth led to the RBE difference in-depth and was remarkable at the distal end. The converted LEM doses from the Ray-MKM doses were comparable (the deviation being - 1.8-0.7%) to existing literature.

CONCLUSION

This study validated the Ray-MKM based on our active-energy scanning carbon-ion beam via phantom studies. The Ray-MKM could generate similar RBEs as the NIRS-MKM after benchmarking. Analysis based on [Formula: see text] indicated that the different beam qualities and fragment spectra caused the RBE differences. Since the absolute dose differences at the distal end were small, we neglected them. Furthermore, each centre may determine its centre-specific [Formula: see text] based on this approach.

A Geant4 shielding design for the first US carbon multi-ion hybrid synchrotron facility

The Mayo Clinic Florida Integrated Oncology Building will be the home of the first spot-scanning only carbon/proton hybrid therapy system by Hitachi, Ltd. It will provide proton beams up to kinetic energies of 230 MeV and carbon beams up to 430 MeV n^-1for clinical deployment. To provide adequate radiation protection, the Geant4 (v10.6) Monte Carlo toolkit was utilized to quantify the ambient dose equivalent at a 10 mm depth (H*(10)) for photons and neutrons. To perform accurate calculations of the ambient dose equivalent, three-dimensional computer-aided design files of the entire planned facility were imported into Geant4, as well as certain particle system components such as the bending magnets, fast Faraday cup, and gantry. Particle fluence was scored using 60 cm diameter spheres, which were strategically placed throughout areas of interests. Analytical calculations were performed as first-pass design checks. Major shielding slabs were optimized using Geant4 simulations iteratively, with more than 20 alternative designs evaluated within Geant4. The 430 MeV n^-1carbon beams played the most significant role in concrete thickness Requirements. The primary wall thickness for the carbon fixed beam room is 4 meters. The presence of the proton gantry structure in the simulation caused the ambient dose equivalent to increase by around 67% at the maze entrance, but a decrease in the high energy beam transport corridor. All shielding primary and secondary goals for clinical operations were met per state regulation and national guidelines.

The role of Monte Carlo simulation in understanding the performance of proton computed tomography

Proton computed tomography (pCT) is a promising tomographic imaging modality allowing direct reconstruction of proton relative stopping power (RSP) required for proton therapy dose calculation. In this review article, we aim at highlighting the role of Monte Carlo (MC) simulation in pCT studies. After describing the requirements for performing proton computed tomography and the various pCT scanners actively used in recent research projects, we present an overview of available MC simulation platforms. The use of MC simulations in the scope of investigations of image reconstruction, and for the evaluation of optimal RSP accuracy, precision and spatial resolution omitting detector effects is then described. In the final sections of the review article, we present specific applications of realistic MC simulations of an existing pCT scanner prototype, which we describe in detail.

Monte Carlo-derived ionization chamber correction factors in therapeutic carbon ion beams

The accuracy of electromagnetic transport in the GEANT4 Monte Carlo (MC) code was investigated for carbon ion beams and ionization chamber (IC)-specific beam quality correction factors were calculated. This work implemented a Fano cavity test for carbon ion beams in the 100-450 MeV/u energy range to assess the accuracy of the default electromagnetic physics parameters. TheUrbanand theWentzel-VImultiple Coulomb scattering models were evaluated and the impact ofmaxStep,dRover,andfinal rangeparameters on the accuracy of the transport algorithm was investigated. The optimal production thresholds for an accurate calculation offQvalues, which is the product of the water-to-air stopping power ratio and the IC-specific perturbation correction factor, were also studied. ThefQcorrection factors were calculated for a cylindrical and a parallel-plate IC using carbon ions in the 150-450 MeV/u energy range. Modifying the default electromagnetic physics parameters resulted in a maximum deviation from theory of 0.3%. Therefore, the default EM parameters were used for the remainder of this work. ThefQfactors were found to converge for both ICs with decreasing production threshold distance below 5μm. ThefQvalues obtained in this work agreed with the TRS-398 stopping power ratios and other previously reported results within uncertainty. This study highlights an accurate MC-based technique to calculate the combined stopping power ratio and the perturbation correction factor for any IC in carbon ion beams.

Monte Carlo methods for device simulations in radiation therapy

Monte Carlo (MC) simulations play an important role in radiotherapy, especially as a method to evaluate physical properties that are either impossible or difficult to measure. For example, MC simulations (MCSs) are used to aid in the design of radiotherapy devices or to understand their properties. The aim of this article is to review the MC method for device simulations in radiation therapy. After a brief history of the MC method and popular codes in medical physics, we review applications of the MC method to model treatment heads for neutral and charged particle radiation therapy as well as specific in-room devices for imaging and therapy purposes. We conclude by discussing the impact that MCSs had in this field and the role of MC in future device design.

Monte Carlo calculation of beam quality correction factors in proton beams using FLUKA

Purpose.To provide Monte Carlo calculated beam quality correction factors (k_Q) for monoenergetic proton beams using the Monte Carlo codefluka.Materials and methods.The Monte Carlo codeflukawas used to calculate the dose absorbed in a water-filled reference volume and the air-filled cavities of six plane-parallel and four cylindrical ionization chambers. The chambers were positioned at the entrance region of monoenergetic proton beams with energies between 60 and 250 MeV. Based on these dose values,f_Qas well ask_Qfactors were calculated whilefQ0factors were taken from Andreoet al(2020Phys. Med. Biol.65095011).Results. k_Qfactors calculated in this work were found to agree with experimentally determinedk_Qfactors on the 1%-level, with only two exceptions with deviations of 1.4% and 1.9%. The comparison off_Qfactors calculated usingflukawithf_Qfactors calculated using the Monte Carlo codesgeant4 andpenhshowed a general good agreement for low energies, while differences for higher energies were pronounced. For high energies, in most cases the Monte Carlo codesflukaandgeant4 lead to comparable results while thef_Qfactors calculated withpenhare larger.Conclusion.flukacan be used to calculatek_Qfactors in clinical proton beams. The divergence of Monte Carlo calculatedk_Qfactors for high energies suggests that the role of nuclear interaction models implemented in the different Monte Carlo codes needs to be investigated in more detail.

What can space radiation protection learn from radiation oncology?

Protection from cosmic radiation of crews of long-term space missions is now becoming an urgent requirement to allow a safe colonization of the moon and Mars. Epidemiology provides little help to quantify the risk, because the astronaut group is small and as yet mostly involved in low-Earth orbit mission, whilst the usual cohorts used for radiation protection on Earth (e.g. atomic bomb survivors) were exposed to a radiation quality substantially different from the energetic charged particle field found in space. However, there are over 260,000 patients treated with accelerated protons or heavier ions for different types of cancer, and this cohort may be useful for quantifying the effects of space-like radiation in humans. Space radiation protection and particle therapy research also share the same tools and devices, such as accelerators and detectors, as well as several research topics, from nuclear fragmentation cross sections to the radiobiology of densely ionizing radiation. The transfer of the information from the cancer radiotherapy field to space is manifestly complicated, yet the two field should strengthen their relationship and exchange methods and data.

Report on G4-Med, a Geant4 benchmarking system for medical physics applications developed by the Geant4 Medical Simulation Benchmarking Group

BACKGROUND

Geant4 is a Monte Carlo code extensively used in medical physics for a wide range of applications, such as dosimetry, micro- and nanodosimetry, imaging, radiation protection, and nuclear medicine. Geant4 is continuously evolving, so it is crucial to have a system that benchmarks this Monte Carlo code for medical physics against reference data and to perform regression testing.

AIMS

To respond to these needs, we developed G4-Med, a benchmarking and regression testing system of Geant4 for medical physics.

MATERIALS AND METHODS

G4-Med currently includes 18 tests. They range from the benchmarking of fundamental physics quantities to the testing of Monte Carlo simulation setups typical of medical physics applications. Both electromagnetic and hadronic physics processes and models within the prebuilt Geant4 physics lists are tested. The tests included in G4-Med are executed on the CERN computing infrastructure via the use of the geant-val web application, developed at CERN for Geant4 testing. The physical observables can be compared to reference data for benchmarking and to results of previous Geant4 versions for regression testing purposes.

RESULTS

This paper describes the tests included in G4-Med and shows the results derived from the benchmarking of Geant4 10.5 against reference data.

DISCUSSION

Our results indicate that the Geant4 electromagnetic physics constructor G4EmStandardPhysics_option4 gives a good agreement with the reference data for all the tests. The QGSP_BIC_HP physics list provided an overall adequate description of the physics involved in hadron therapy, including proton and carbon ion therapy. New tests should be included in the next stage of the project to extend the benchmarking to other physical quantities and application scenarios of interest for medical physics.

CONCLUSION

The results presented and discussed in this paper will aid users in tailoring physics lists to their particular application.

Rapid effective dose calculation for raster-scanning 4He ion therapy with the modified microdosimetric kinetic model (mMKM)

PURPOSE

To develop and verify effective dose (D_RBE) calculation in ⁴He ion beam therapy based on the modified microdosimetric kinetic model (mMKM) and evaluate the bio-sensitivity of mMKM-based plans to clinical parameters using a fast analytical dose engine.

METHODS

Mixed radiation field particle spectra (MRFS) databases have been generated with Monte-Carlo (MC) simulations for ⁴He-ion beams. Relative biological effectiveness (RBE) and D_RBE calculation using MRFS were established within a fast analytical engine. Spread-out Bragg-Peaks (SOBPs) in water were optimized for two dose levels and two tissue types with photon linear-quadratic model parameters α_ph, β_ph, and (α/β)_ph to verify MRFS-derived database implementation against computations with MC-generated mixed-field α and β databases. Bio-sensitivity of the SOBPs was investigated by varying absolute values of β_ph, while keeping (α/β)_ph constant. Additionally, dose, dose-averaged linear energy transfer, and bio-sensitivity were investigated for two patient cases.

RESULTS

Using MRFS-derived databases, dose differences ≲2% in the plateau and SOBP are observed compared to computations with MC-generated databases. Bio-sensitivity studies show larger deviations when altering the absolute β_ph value, with maximum D_50% changes of ~5%, with similar results for patient cases. Bio-sensitivity analysis indicates a greater impact on D_RBE varying (α/β)_ph than β_ph in mMKM.

CONCLUSIONS

The MRSF approach yielded negligible differences in the target and small differences in the plateau compared to MC-generated databases. The presented analyses provide guidance for proper implementation of RBE-weighted ⁴He ion dose prescription and planning with mMKM. The MRFS-D_RBE calculation approach using mMKM will be implemented in a clinical treatment planning system.

Impact of charge collection efficiency and electronic noise on the performance of solid-state 3D microdetectors

Microdosimetry has been traditionally performed through gaseous proportional counters, although in recent years different solid-state microdosimeters have been proposed and constructed for this task. In this paper, we analyze the response of solid-state devices of micrometric size with no intrinsic gain developed by CNM-CSIC (Spain). There are two major aspects of the operation of these devices that affect the reconstruction of the probability distributions and momenta of stochastic quantities related to microdosimetry. For micrometric volumes, the drift and diffusion of the charge carriers gives rise to a partial charge collection efficiency in the peripheral region of the depleted volume. This effect produces a perturbation of the reconstructed pulse height (i.e. imparted energy) distributions with respect to the actual microdosimetric distributions. The relevance of this deviation depends on the size, geometry and operating conditions of the device. On the other hand, the electronic noise from the single-event readout set-up poses a limit on the minimum detectable lineal energy when the microdosimeter size is reduced. This article addresses these issues to provide a framework on the physical constraints for the design and operation of solid-state microdosimeters.

Preliminary results in using Deep Learning to emulate BLOB, a nuclear interaction model

PURPOSE

A reliable model to simulate nuclear interactions is fundamental for Ion-therapy. We already showed how BLOB ("Boltzmann-Langevin One Body"), a model developed to simulate heavy ion interactions up to few hundreds of MeV/u, could simulate also ¹²C reactions in the same energy domain. However, its computation time is too long for any medical application. For this reason we present the possibility of emulating it with a Deep Learning algorithm.

METHODS

The BLOB final state is a Probability Density Function (PDF) of finding a nucleon in a position of the phase space. We discretised this PDF and trained a Variational Auto-Encoder (VAE) to reproduce such a discrete PDF. As a proof of concept, we developed and trained a VAE to emulate BLOB in simulating the interactions of ¹²C with ¹²C at 62 MeV/u. To have more control on the generation, we forced the VAE latent space to be organised with respect to the impact parameter (b) training a classifier of b jointly with the VAE.

RESULTS

The distributions obtained from the VAE are similar to the input ones and the computation time needed to use the VAE as a generator is negligible.

CONCLUSIONS

We show that it is possible to use a Deep Learning approach to emulate a model developed to simulate nuclear reactions in the energy range of interest for Ion-therapy. We foresee the implementation of the generation part in C++ and to interface it with the most used Monte Carlo toolkit: Geant4.

Comparison of penh, fluka, and Geant4/topas for absorbed dose calculations in air cavities representing ionization chambers in high-energy photon and proton beams

PURPOSE

The purpose of this work is to analyze whether the Monte Carlo codes penh, fluka, and geant4/topas are suitable to calculate absorbed doses andf Q / f Q 0 ratios in therapeutic high-energy photon and proton beams.

METHODS

We used penh, fluka, geant4/topas, and egsnrc to calculate the absorbed dose to water in a reference water cavity and the absorbed dose to air in two air cavities representative of a plane-parallel and a cylindrical ionization chamber in a 1.25 MeV photon beam and a 150 MeV proton beam - egsnrc was only used for the photon beam calculations. The physics and transport settings in each code were adjusted to simulate the particle transport as detailed as reasonably possible. From these absorbed doses, f Q 0 factors, f Q factors, andf Q / f Q 0 ratios (which are the basis of Monte Carlo calculated beam quality correction factors k Q , Q 0 ) were calculated and compared between the codes. Additionally, we calculated the spectra of primary particles and secondary electrons in the reference water cavity, as well as the integrated depth-dose curve of 150 MeV protons in water.

RESULTS

The absorbed doses agreed within 1.4% or better between the individual codes for both the photon and proton simulations. The f Q 0 and f Q factors agreed within 0.5% or better for the individual codes for both beam qualities. The resultingf Q / f Q 0 ratios for 150 MeV protons agreed within 0.7% or better. For the 1.25 MeV photon beam, the spectra of photons and secondary electrons agreed almost perfectly. For the 150 MeV proton simulation, we observed differences in the spectra of secondary protons whereas the spectra of primary protons and low-energy delta electrons also agreed almost perfectly. The first 2 mm of the entrance channel of the 150 MeV proton Bragg curve agreed almost perfectly while for greater depths, the differences in the integrated dose were up to 1.5%.

CONCLUSION

penh, fluka, and geant4/topas are capable of calculating beam quality correction factors in proton beams. The differences in the f Q 0 and f Q factors between the codes are 0.5% at maximum. The differences in thef Q / f Q 0 ratios are 0.7% at maximum.

Comparative study of alternative Geant4 hadronic ion inelastic physics models for prediction of positron-emitting radionuclide production in carbon and oxygen ion therapy

The distribution of fragmentation products predicted by Monte Carlo simulations of heavy ion therapy depend on the hadronic physics model chosen in the simulation. This work aims to evaluate three alternative hadronic inelastic fragmentation physics options available in the Geant4 Monte Carlo radiation physics simulation framework to determine which model most accurately predicts the production of positron-emitting fragmentation products observable using in-beam PET imaging. Fragment distributions obtained with the BIC, QMD, and INCL + + physics models in Geant4 version 10.2.p03 are compared to experimental data obtained at the HIMAC heavy-ion treatment facility at NIRS in Chiba, Japan. For both simulations and experiments, monoenergetic beams are applied to three different block phantoms composed of gelatin, poly(methyl methacrylate) and polyethylene. The yields of the positron-emitting nuclei ¹¹C, ¹⁰C and ¹⁵O obtained from simulations conducted with each model are compared to the experimental yields estimated by fitting a multi-exponential radioactive decay model to dynamic PET images using the normalised mean square error metric in the entrance, build up/Bragg peak and tail regions. Significant differences in positron-emitting fragment yield are observed among the three physics models with the best overall fit to experimental ¹²C and ¹⁶O beam measurements obtained with the BIC physics model.

Prediction of positron emitter distributions for range monitoring in carbon ion therapy: an analytical approach

Range verification is one of the most relevant tasks in ion beam therapy. In the case of carbon ion therapy, positron emission tomography (PET) is the most widely used method for this purpose, which images the [Formula: see text]-activation following nuclear interactions of the ions with the tissue nuclei. Since the positron emitter activity profile is not directly proportional to the dose distribution, until today only its comparison to a prediction of the PET profile allows for treatment verification. Usually, this prediction is obtained from time-consuming Monte Carlo simulations of high computational effort, which impacts the clinical workflow. To solve this issue in proton therapy, a convolution approach was suggested to predict positron emitter activity profiles from depth dose distributions analytically. In this work, we introduce an approach to predict positron emitter distributions from depth dose profiles in carbon ion therapy. While the distal fall-off position of the positron emitter profile is predicted from a convolution approach similar to the one suggested for protons, additional analytical functions are introduced to describe the characteristics of the positron emitter distribution in tissue. The feasibility of this approach is demonstrated with monoenergetic depth dose profiles and spread out Bragg peaks in homogeneous and heterogeneous phantoms. In all cases, the positron emitter profile is predicted with high precision and the distal fall-off position is reproduced with millimeter accuracy.

Report of a National Cancer Institute special panel: Characterization of the physical parameters of particle beams for biological research

PURPOSE

To define the physical parameters needed to characterize a particle beam in order to allow intercomparison of different experiments performed using different ions at the same facility and using the same ion at different facilities.

METHODS

At the request of the National Cancer Institute (NCI), a special panel was convened to review the current status of the field and to provide suggested metrics for reporting the physical parameters of particle beams to be used for biological research. A set of physical parameters and measurements that should be performed by facilities and understood and reported by researchers supported by NCI to perform pre-clinical radiobiology and medical physics of heavy ions were generated.

RESULTS

Standard measures such as radiation delivery technique, beam modifiers used, nominal energy, field size, physical dose and dose rate should all be reported. However, more advanced physical measurements, including detailed characterization of beam quality by microdosimetric spectrum and fragmentation spectra, should also be established and reported. Details regarding how such data should be incorporated into Monte Carlo simulations and the proper reporting of simulation details are also discussed.

CONCLUSIONS

In order to allow for a clear relation of physical parameters to biological effects, facilities and researchers should establish and report detailed physical characteristics of the irradiation beams utilized including both standard and advanced measures. Biological researchers are encouraged to actively engage facility staff and physicists in the design and conduct of experiments. Modeling individual experimental setups will allow for the reporting of the uncertainties in the measurement or calculation of physical parameters which should be routinely reported.

Computational models and tools

In this chapter, we describe two different methods, analytical (pencil beam) algorithms and Monte Carlo simulations, used to obtain the intended dose distributions in patients and evaluate their strengths and shortcomings. We discuss the difference between the prescribed physical dose and the biologically effective dose, the relative biological effectiveness (RBE) between ions and photons and the dependence of RBE on the linear energy transfer (LET). Lastly, we show how LET- or RBE-based optimization can be used to improve treatment plans and explore how the availability of multimodality ion beam facilities can be used to design a tumor-specific optimal treatment.

Experimental validation of the FLUKA Monte Carlo code for dose and [Formula: see text]-emitter predictions of radioactive ion beams

In the context of hadrontherapy, whilst ions are capable of effectively destroying radio resistant, deep seated tumors, their treatment localization must be well assessed to ensure the sparing of surrounding healthy tissue and treatment effectiveness. Thus, range verification techniques, such as online positron-emission-tomography (PET) imaging, hold great potential in clinical practice, providing information on the in vivo beam range and consequent tumor targeting. Furthermore, [Formula: see text] emitting radioactive ions can be an asset in online PET imaging, depending on their half-life, compared to their stable counterparts. It is expected that using these radioactive ions the signal obtained by a PET apparatus during beam delivery will be greatly increased, and exhibit a better correlation to the Bragg Peak. To this end, FLUKA Monte Carlo particle transport and interaction code was used to evaluate, in terms of annihilation events at rest and dose, the figure of merit in using [Formula: see text] emitter, radioactive ion beams (RI [Formula: see text]). For this purpose, the simulation results were compared with experimental data obtained with an openPET prototype in various online PET acquisitions at the Heavy Ion Medical Accelerator in Chiba (HIMAC), in collaboration with colleagues from the National Institute of Radiological Sciences' (NIRS) Imaging Physics Team. The dosimetry performance evaluation with FLUKA benefits from its recent developments in fragmentation production models. The present work estimated that irradiations with RI [Formula: see text], produced via projectile fragmentation and their signal acquisition with state-of-the-art PET scanner, lead to nearly a factor of two more accurate definition of the signals' peak position. In addition to its more advantageous distribution shape, it was observed at least an order magnitude higher signal acquired from ¹¹C and ¹⁵O irradiations, with respect to their stable counterparts.

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.

MICRODOSIMETRIC SIMULATIONS OF CARBON IONS USING THE MONTE CARLO CODE FLUKA

Therapeutic carbon ion beams produce a complex and variable radiation field that changes along the penetration depth due to the high density of energy loss along the particle track together with the secondary particles produced by nuclear fragmentation reactions. An accurate physical characterisation of such complex mixed-radiation fields can be performed by measuring microdosimetric spectra with mini tissue-equivalent proportional counters (mini-TEPCs), which are one of the most accurate devices used in experimental microdosimetry. Numerical calculations with Monte Carlo codes such as FLUKA can be used to supplement experimental microdosimetric measurements performed with TEPCs, but the nuclear cross sections and fragmentation models need to be benchmarked with experimental data for different energies and scenarios. The aim of this work is to compare experimental carbon microdosimetric data measured with the mini TEPC with calculated microdosimetry spectra obtained with FLUKA for 12C ions of 189.5 MeV/u in the Bragg peak region.

Benchmarking of PHITS for Carbon Ion Therapy

Purpose

Up to now, carbon ions have shown the most favorable physical and radiobiological properties for radiation therapy of, for example, deep-seated radioresistant tumors. However, when carbon ions penetrate matter, they undergo inelastic nuclear reactions that give rise to secondary fragments contributing to the dose in the healthy tissue. This can cause damage to radiosensitive organs at risk when they are located in the vicinity of the tumor. Therefore, predictions of the yields and angular distributions of the secondary fragments are needed to be able to estimate the resulting biological effects in both the tumor region and the healthy tissues. This study presents the accuracy of simulations of therapeutic carbon ion beams with water, with the 3D MC (Monte Carlo) general purpose particle and ion transport code PHITS.

Materials and Methods

Simulations with PHITS of depth-dose distributions, beam attenuation, fragment yields, and fragment angular distributions from interactions of therapeutic carbon ion beams with water are compared to published measurements performed at Gesellschaft für Schwerionen Forschung (GSI).

Results

The results presented in this study demonstrate that PHITS simulations of therapeutic carbon ion beams in water show overall a good agreement with measurements performed at GSI; for example, for light ions like H and He, simulations agree within about 10%. However, there is still a need to further improve the calculations of fragment yields, especially for underproduction of Li of up to 50%, by improving the nucleus-nucleus cross-section models.

Conclusion

The simulated data are clinically acceptable but there is still a need to further improve the models in the transport code PHITS. More reliable experimental data are therefore needed.

A novel method for assessment of fragmentation and beam-material interactions in helium ion radiotherapy with a miniaturized setup

Radiotherapy with protons and carbon ions enables to deliver dose distributions of high conformation to the target. Treatment with helium ions has been suggested due to their physical and biological advantages. A reliable benchmarking of the employed physics models with experimental data is required for treatment planning. However, experimental data for helium interactions is limited, in part due to the complexity and large size of conventional experimental setups. We present a novel method for the investigation of helium interactions with matter using miniaturized instrumentation based on highly integrated pixel detectors. The versatile setup consisted of a monitoring detector in front of the PMMA phantom of varying thickness and a detector stack for investigation of outgoing particles. The ion type downstream from the phantom was determined by high-resolution pattern recognition analysis of the single particle signals in the pixelated detectors. The fractions of helium and hydrogen ions behind the used targets were determined. As expected for the stable helium nucleus, only a minor decrease of the primary ion fluence along the target depth was found. E.g. the detected fraction of hydrogen ions on axis of a 220MeV/u ⁴He beam was below 6% behind 24.5cm of PMMA. Monte-Carlo simulations using Geant4 reproduce the experimental data on helium attenuation and yield of helium fragments qualitatively, but significant deviations were found for some combinations of target thickness and beam energy. The presented method is promising to contribute to the reduction of the uncertainty of treatment planning for helium ion radiotherapy.

Benchmarking GATE/Geant4 for 16O ion beam therapy

Oxygen ([Formula: see text]) ions are a potential alternative to carbon ions in ion beam therapy. Their enhanced linear energy transfer indicates a higher relative biological effectiveness and a reduced oxygen enhancement ratio. Due to the limited availability of [Formula: see text] ion beams, Monte Carlo (MC) transport codes are important research tools for investigating their potential. The purpose of this study was to validate GATE/Geant4 for [Formula: see text] ion beam therapy using experimental data from literature. Five hadron physics lists and two electromagnetic options were benchmarked against measured depth dose distributions (DDDs) and charge-changing cross sections. The simulated beam ranges deviated by less than 0.5% for all physics configurations and only a few points exceeded the gamma index criterion (2%/1 mm). However, the simulated partial charge-changing cross sections deviated considerably for some hadron physics configurations. Best agreement with the experimental values was obtained with the quantum molecular dynamics model (QMD), and we therefore suggest using this model in Geant4 to accurately describe the fragmentation of [Formula: see text] ion beams into lighter fragments ([Formula: see text]).

Measurements and simulations of microscopic damage to DNA in water by 30 keV electrons: A general approach applicable to other radiation sources and biological targets

The determination of the microscopic dose-damage relationship for DNA in an aqueous environment is of a fundamental interest for dosimetry and applications in radiation therapy and protection. We combine geant4 particle-scattering simulations in water with calculations concerning the movement of biomolecules to obtain the energy deposit in the biologically relevant nanoscopic volume. We juxtaposition these results to the experimentally determined damage to obtain the dose-damage relationship at a molecular level. This approach is tested for an experimentally challenging system concerning the direct irradiation of plasmid DNA (pUC19) in water with electrons as primary particles. Here a microscopic target model for the plasmid DNA based on the relation of lineal energy and radiation quality is used to calculate the effective target volume. It was found that on average fewer than two ionizations within a 7.5-nm radius around the sugar-phosphate backbone are sufficient to cause a single strand break, with a corresponding median lethal energy deposit being E_{1/2}=6±4 eV. The presented method is applicable for ionizing radiation (e.g., γ rays, x rays, and electrons) and a variety of targets, such as DNA, proteins, or cells.

Radial dose distributions from carbon ions of therapeutic energies calculated with Geant4-DNA

We report on radial dose distributions [Formula: see text] for carbon ions calculated with Geant4-DNA code. These distributions characterize ion tracks on a nanoscale and are important for understanding the biological effects of ion beams. We present data for carbon ion beams in the energy range from 20 to 400 MeV u^-1. To approximate the Monte Carlo results, we developed a simple formula that combines the well-known inverse square distance dependence with a factor correcting [Formula: see text] for small [Formula: see text]. The proposed formula can be used to calculate [Formula: see text] for any energy within the above range and for distances [Formula: see text] from 1 nm to 2 μm with a maximum error not exceeding 14%. This range of distances corresponds to a dose range of over seven orders of magnitude. Differences between our results and those of previously published analytical models are discussed.

Fluence correction factor for graphite calorimetry in a clinical high-energy carbon-ion beam

The aim of this work is to develop and adapt a formalism to determine absorbed dose to water from graphite calorimetry measurements in carbon-ion beams. Fluence correction factors, [Formula: see text], needed when using a graphite calorimeter to derive dose to water, were determined in a clinical high-energy carbon-ion beam. Measurements were performed in a 290 MeV/n carbon-ion beam with a field size of 11  ×  11 cm², without modulation. In order to sample the beam, a plane-parallel Roos ionization chamber was chosen for its small collecting volume in comparison with the field size. Experimental information on fluence corrections was obtained from depth-dose measurements in water. This procedure was repeated with graphite plates in front of the water phantom. Fluence corrections were also obtained with Monte Carlo simulations through the implementation of three methods based on (i) the fluence distributions differential in energy, (ii) a ratio of calculated doses in water and graphite at equivalent depths and (iii) simulations of the experimental setup. The [Formula: see text] term increased in depth from 1.00 at the entrance toward 1.02 at a depth near the Bragg peak, and the average difference between experimental and numerical simulations was about 0.13%. Compared to proton beams, there was no reduction of the [Formula: see text] due to alpha particles because the secondary particle spectrum is dominated by projectile fragmentation. By developing a practical dose conversion technique, this work contributes to improving the determination of absolute dose to water from graphite calorimetry in carbon-ion beams.

Evaluation of the water-equivalence of plastic materials in low- and high-energy clinical proton beams

The aim of this work was to evaluate the water-equivalence of new trial plastics designed specifically for light-ion beam dosimetry as well as commercially available plastics in clinical proton beams. The water-equivalence of materials was tested by computing a plastic-to-water conversion factor, [Formula: see text]. Trial materials were characterized experimentally in 60 MeV and 226 MeV un-modulated proton beams and the results were compared with Monte Carlo simulations using the FLUKA code. For the high-energy beam, a comparison between the trial plastics and various commercial plastics was also performed using FLUKA and Geant4 Monte Carlo codes. Experimental information was obtained from laterally integrated depth-dose ionization chamber measurements in water, with and without plastic slabs with variable thicknesses in front of the water phantom. Fluence correction factors, [Formula: see text], between water and various materials were also derived using the Monte Carlo method. For the 60 MeV proton beam, [Formula: see text] and [Formula: see text] factors were within 1% from unity for all trial plastics. For the 226 MeV proton beam, experimental [Formula: see text] values deviated from unity by a maximum of about 1% for the three trial plastics and experimental results showed no advantage regarding which of the plastics was the most equivalent to water. Different magnitudes of corrections were found between Geant4 and FLUKA for the various materials due mainly to the use of different nonelastic nuclear data. Nevertheless, for the 226 MeV proton beam, [Formula: see text] correction factors were within 2% from unity for all the materials. Considering the results from the two Monte Carlo codes, PMMA and trial plastic #3 had the smallest [Formula: see text] values, where maximum deviations from unity were 1%, however, PMMA range differed by 16% from that of water. Overall, [Formula: see text] factors were deviating more from unity than [Formula: see text] factors and could amount to a few percent for some materials.

Production of the PET isotope 11C in hadron therapy via neutron knockout

PURPOSE

Positron emitting isotopes such as ¹¹C and ¹⁰C can be used for vital dose verification in hadron therapy. These isotopes are produced when the high energy ¹²C primary beam particles undergo nuclear reactions within the patient.

METHODS

We discuss a model for calculating cross sections for the production ¹¹C in ¹²C+¹²C collisions, applicable at hadron therapy energies.

RESULTS

Good agreement with the available cross section measurements is found for ¹²C(-1n), though more detailed, systematic measurements would be very valuable.

CONCLUSIONS

Nuclear structure plays a crucial role in the reactions of light nuclei, particularly when those reactions are peripheral and involve only a few nucleons. For such reactions, nuclear structure has a strong influence on the energy and angular distribution of the cross section, and is an important consideration for reliable dose verification using ¹¹C in hadron therapy.

Nuclear physics in particle therapy: a review

Charged particle therapy has been largely driven and influenced by nuclear physics. The increase in energy deposition density along the ion path in the body allows reducing the dose to normal tissues during radiotherapy compared to photons. Clinical results of particle therapy support the physical rationale for this treatment, but the method remains controversial because of the high cost and of the lack of comparative clinical trials proving the benefit compared to x-rays. Research in applied nuclear physics, including nuclear interactions, dosimetry, image guidance, range verification, novel accelerators and beam delivery technologies, can significantly improve the clinical outcome in particle therapy. Measurements of fragmentation cross-sections, including those for the production of positron-emitting fragments, and attenuation curves are needed for tuning Monte Carlo codes, whose use in clinical environments is rapidly increasing thanks to fast calculation methods. Existing cross sections and codes are indeed not very accurate in the energy and target regions of interest for particle therapy. These measurements are especially urgent for new ions to be used in therapy, such as helium. Furthermore, nuclear physics hardware developments are frequently finding applications in ion therapy due to similar requirements concerning sensors and real-time data processing. In this review we will briefly describe the physics bases, and concentrate on the open issues.

Induced radioactivity of a GSO scintillator by secondary fragments in carbon ion therapy and its effects on in-beam OpenPET imaging

The accumulation of induced radioactivity within in-beam PET scanner scintillators is of concern for its long-term clinical usage in particle therapy. To estimate the effects on OpenPET which we are developing for in-beam PET based on GSOZ (Zi doped Gd2SiO5), we measured the induced radioactivity of GSO activated by secondary fragments in a water phantom irradiation by a (12)C beam with an energy of 290 MeV u(-1). Radioisotopes of Na, Ce, Eu, Gd, Nd, Pm and Tb including positron emitters were observed in the gamma ray spectra of the activated GSO with a high purity Ge detector and their absolute radioactivities were calculated. We used the Monte Carlo simulation platform, Geant4 in which the observed radioactivity was assigned to the scintillators of a precisely reproduced OpenPET and the single and coincidence rates immediately after one treatment and after one-year usage were estimated for the most severe conditions. Comparing the highest coincidence rate originating from the activated scintillators (background) and the expected coincidence rate from an imaging object (signal), we determined the expected signal-to-noise ratio to be more than 7 within 3 min and more than 10 within 1 min from the scan start time. We concluded the effects of scintillator activation and their accumulation on the OpenPET imaging were small and clinical long-term usage of the OpenPET was feasible.

The FLUKA Code: An Accurate Simulation Tool for Particle Therapy

Monte Carlo (MC) codes are increasingly spreading in the hadrontherapy community due to their detailed description of radiation transport and interaction with matter. The suitability of a MC code for application to hadrontherapy demands accurate and reliable physical models capable of handling all components of the expected radiation field. This becomes extremely important for correctly performing not only physical but also biologically based dose calculations, especially in cases where ions heavier than protons are involved. In addition, accurate prediction of emerging secondary radiation is of utmost importance in innovative areas of research aiming at in vivo treatment verification. This contribution will address the recent developments of the FLUKA MC code and its practical applications in this field. Refinements of the FLUKA nuclear models in the therapeutic energy interval lead to an improved description of the mixed radiation field as shown in the presented benchmarks against experimental data with both (4)He and (12)C ion beams. Accurate description of ionization energy losses and of particle scattering and interactions lead to the excellent agreement of calculated depth-dose profiles with those measured at leading European hadron therapy centers, both with proton and ion beams. In order to support the application of FLUKA in hospital-based environments, Flair, the FLUKA graphical interface, has been enhanced with the capability of translating CT DICOM images into voxel-based computational phantoms in a fast and well-structured way. The interface is capable of importing also radiotherapy treatment data described in DICOM RT standard. In addition, the interface is equipped with an intuitive PET scanner geometry generator and automatic recording of coincidence events. Clinically, similar cases will be presented both in terms of absorbed dose and biological dose calculations describing the various available features.

Dose and linear energy transfer distributions of primary and secondary particles in carbon ion radiation therapy: A Monte Carlo simulation study in water

The factors influencing carbon ion therapy can be predicted from accurate knowledge about the production of secondary particles from the interaction of carbon ions in water/tissue-like materials, and subsequently the interaction of the secondary particles in the same materials. The secondary particles may have linear energy transfer (LET) values that potentially increase the relative biological effectiveness of the beam. Our primary objective in this study was to classify and quantify the secondary particles produced, their dose averaged LETs, and their dose contributions in the absorbing material. A 1 mm diameter carbon ion pencil beam with energies per nucleon of 155, 262, and 369 MeV was used in a geometry and tracking 4 Monte Carlo simulation to interact in a 27 L water phantom containing 3000 rectangular detector voxels. The dose-averaged LET and the dose contributions of primary and secondary particles were calculated from the simulation. The results of the simulations show that the secondary particles that contributed a major dose component had LETs <100 keV/µm. The secondary particles with LETs >600 keV/µm contributed only <0.3% of the dose.