Study of the responses and calibration procedures of neutron and gamma area and environmental detectors for use in proton therapy

Benchmarking of stray neutron fields produced by synchrocyclotrons and synchrotrons in compact protontherapy centers (CPTC) using MCNP6 Monte Carlo code

Proton therapy is an external radiotherapy using proton beams with energies between 70 and 230 MeV to treat some type of tumours with outstanding benefits, due to its energy transfer plot. There is a growing demand of facilities taking up small spaces and Compact Proton Therapy Centers (CPTC), with one or two treatment rooms, supposing the technical response of manufacturers to this request. A large amount of stray radiation is yielded in the interaction of proton beam used in therapy, neutrons mainly, hence, optimal design of shielding and verifications must be carried out in commissioning phases. Currently, almost 50 proton centers are under construction and start up in several countries, including ten in Spain. In the present work the effectiveness of shielding in two CPTC was verified with the Monte Carlo code MCNP6 by calculating the ambient dose equivalent, H*(10) due to secondary neutrons, outside the enclosures and walls of the center. The facilities modelled were the two centers currently operating in Spain, the first, since December 2019, with a superconductor synchrocyclotron, and the second, since March 2020, with a compact synchrotron. The geometry and materials are based on dimensions proposed a priori by the vendors, therefore, the paper is focused on check the suitability of the materials and thickness of the walls of the centers. Several models of the radiation sources were simulated, starting from a conservative assumptions, followed by more realistic scenarios. In all cases, the results reached for the ambient dose equivalent, H*(10), were below 1 mSv/year, which is the legal limit considered for the public in international references. Finally, considering that the recent ICRU Report 95 proposes changes in the operational quantities, the dose outside shieldingt has been evaluated in terms of the new next area surveillance quantity, H*, known as ambient dose, in the process of implementation.

30 years of ocular proton therapy, the Nice view

PURPOSE

Radiotherapy with protons (PT) is a standard treatment of ocular tumors. It achieves excellent tumor control, limited toxicities, and the preservation of important functional outcomes, such as vision. Although PT may appear as one homogenous technique, it can be performed using dedicated ocular passive scattering PT or, increasingly, Pencil Beam Scanning (PBS), both with various degrees of patient-oriented customization.

MATERAIAL AND METHODS

MEDICYC PT facility of Nice are detailed with respect to their technical, dosimetric, microdosimetric and radiobiological, patient and tumor-customization process of PT planning and delivery that are key. 6684 patients have been treated for ocular tumors (1991-2020). Machine characteristics (accelerator, beam line, beam monitoring) allow efficient proton extraction, high dose rate, sharp lateral and distal penumbrae, and limited stray radiation in comparison to beam energy reduction and subsequent straggling with high-energy PBS PT. Patient preparation before PT includes customized setup and image-guidance, CT-based planning, and ocular PT software modelling of the patient eye with integration of beam modifiers. Clinical reports have shown excellent tumor control rates (∼95%), vision preservation and limited toxicity rates (papillopathy, retinopathy, neovascular glaucoma, dry eye, madarosis, cataract).

RESULTS

Although demanding, dedicated ocular PT has proven its efficiency in achieving excellent tumor control, OAR sparing and patient radioprotection. It is therefore worth adaptations of the equipments and practice.

CONCLUSIONS

Some of these adaptations can be transferred to other PT centers and should be acknowledeged when using non-PT options.

Ocular proton therapy, pencil beam scanning high energy proton therapy or stereotactic radiotherapy for uveal melanoma; an in silico study

PURPOSE

In radiotherapy, the dose and volumes of the irradiated normal tissues is correlated to the complication rate. We assessed the performances of low-energy proton therapy (ocular PT) with eye-dedicated equipment, high energy PT with pencil-beam scanning (PBS) or CyberKnife^R  -based stereotactic irradiation (SBRT).

MATERIAL AND METHODS

CT-based comparative dose distribution between external beam radiotherapy techniques was assessed using an anthropomorphic head phantom. The prescribed dose was 60Gy_RBE in 4 fractions to a typical posterior pole uveal melanoma. Clinically relevant structures were delineated, and doses were calculated using radiotherapy treatment planning softwares and measured using Gafchromic dosimetry films inserted at the ocular level.

RESULTS

Precision was significantly better with ocular PT than both PBS or SBRT in terms of beam penumbra (80%-20%: laterally 1.4 vs. ≥10mm, distally 0.8 vs. ≥2.5mm). Ocular PT duration was shorter, allowing eye gating and lid sparing more easily. Tumor was excellent with all modalities, but ocular PT resulted in more homogenous and conformal dose compared to PBS or SBRT. The maximal dose to ocular/orbital structures at risk was smaller and often null with ocular PT compared to other modalities. Mean dose to ocular/orbital structures was also lower with ocular PT. Structures like the lids and lacrimal punctum could be preserved with ocular PT using gaze orientation and lid retractors, which is easier to implement clinically than with the other modalities. The dose to distant organs was null with ocular PT and PBS, in contrast to SBRT.

CONCLUSIONS

ocular PT showed significantly improved beam penumbra, shorter treatment delivery time, better dose homogeneity, and reduced maximal/mean doses to critical ocular structures compared with other current external beam radiation modalities. Similar comparisons may be warranted for other tumor presentations.

Determination of the uncertainties associated to the use of different nuclear data libraries in the analysis of extended-range rem-meters

In proton therapy centers stray neutron radiation of up to 230-250 MeV is yielded by (p, Xn) nuclear reactions. To monitor ambient dose in such facilities, extended-range rem-meters are needed. The aim of this project was to characterize the response of two extended-range rem-meters, WENDI-II and LUPIN-II, by Monte Carlo methods, for energies ranging from 10^-9 MeV up to 230 MeV. Different nuclear data libraries (ENDF/B-VII.1, TENDL2017, TENDL2019, JEFF-3.3) have been used, determining the uncertainties associated with the application of the libraries in the calculation of the response functions of both monitors. The differences found are very significant at energies around 150-200 MeV. This is an issue for predicting by Monte Carlo methods the response of these instruments at high energies. The results point to the necessity of testing experimentally the response of rem-meters at 150 MeV-200 MeV neutron beams.

[Measurement of out-of-field dose to the uterus during proton therapy of the head and neck]

The decision to irradiate during pregnancy is based on a risk benefit compromise of two kinds: maternal risk and fetal risk. The aim of this work is to determine the foetal risk, and uterine dose measurement in proton therapy. Foetal exposure during treatment is linked to two sources: the treatment phase, and the repositioning phase. An Alderson-Rando anthropomorphic ghost (170cm, 74kg) was positioned on the table in the treatment position. A tissue-equivalent proportional counter (TEPC), adapted to the analysis of complex radiation fields (neutron and photonics), was used to determine the irradiation related to the treatment phase. An AT1123 radiation survey meter was used to measure photons generated by X-ray radiation. I dosimetry was proposed using radio-photoluminescent dosimeters, allowing for a daily check of the dose received in the uterus. The treatment phase produces higher uterine doses than the positioning phase, but these remain very low. The equivalent dose received in the uterus for the entire treatment is estimated at 840 μSv. Using a methodology for measuring the out-of-field dose with pencil beam scanning proton therapy, the foetal dose in the first trimester was well below the acceptance dose of 100 mGy determined by the International Commission on Radiological Protection.