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Mairani A, Mein S, Blakely E, Debus J, Durante M, Ferrari A, Fuchs H, Georg D, Grosshans DR, Guan F, Haberer T, Harrabi S, Horst F, Inaniwa T, Karger CP, Mohan R, Paganetti H, Parodi K, Sala P, Schuy C, Tessonnier T, Titt U, Weber U. Roadmap: helium ion therapy. Phys Med Biol 2022; 67. [PMID: 35395649 DOI: 10.1088/1361-6560/ac65d3] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 04/08/2022] [Indexed: 12/16/2022]
Abstract
Helium ion beam therapy for the treatment of cancer was one of several developed and studied particle treatments in the 1950s, leading to clinical trials beginning in 1975 at the Lawrence Berkeley National Laboratory. The trial shutdown was followed by decades of research and clinical silence on the topic while proton and carbon ion therapy made debuts at research facilities and academic hospitals worldwide. The lack of progression in understanding the principle facets of helium ion beam therapy in terms of physics, biological and clinical findings persists today, mainly attributable to its highly limited availability. Despite this major setback, there is an increasing focus on evaluating and establishing clinical and research programs using helium ion beams, with both therapy and imaging initiatives to supplement the clinical palette of radiotherapy in the treatment of aggressive disease and sensitive clinical cases. Moreover, due its intermediate physical and radio-biological properties between proton and carbon ion beams, helium ions may provide a streamlined economic steppingstone towards an era of widespread use of different particle species in light and heavy ion therapy. With respect to the clinical proton beams, helium ions exhibit superior physical properties such as reduced lateral scattering and range straggling with higher relative biological effectiveness (RBE) and dose-weighted linear energy transfer (LETd) ranging from ∼4 keVμm-1to ∼40 keVμm-1. In the frame of heavy ion therapy using carbon, oxygen or neon ions, where LETdincreases beyond 100 keVμm-1, helium ions exhibit similar physical attributes such as a sharp lateral penumbra, however, with reduced radio-biological uncertainties and without potentially spoiling dose distributions due to excess fragmentation of heavier ion beams, particularly for higher penetration depths. This roadmap presents an overview of the current state-of-the-art and future directions of helium ion therapy: understanding physics and improving modeling, understanding biology and improving modeling, imaging techniques using helium ions and refining and establishing clinical approaches and aims from learned experience with protons. These topics are organized and presented into three main sections, outlining current and future tasks in establishing clinical and research programs using helium ion beams-A. Physics B. Biological and C. Clinical Perspectives.
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Affiliation(s)
- Andrea Mairani
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,National Centre of Oncological Hadrontherapy (CNAO), Medical Physics, Pavia, Italy.,Division of Molecular and Translational Radiation Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120 Heidelberg, Germany.,National Center for Radiation Research in Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany
| | - Stewart Mein
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Division of Molecular and Translational Radiation Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120 Heidelberg, Germany.,National Center for Radiation Research in Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany.,German Cancer Consortium (DKTK) Core-Center Heidelberg, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Eleanor Blakely
- Biological Systems and Engineering Division, Lawrence Berkeley National Laboratory, Berkeley, CA, United States of America
| | - Jürgen Debus
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Division of Molecular and Translational Radiation Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120 Heidelberg, Germany.,National Center for Radiation Research in Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany.,German Cancer Consortium (DKTK) Core-Center Heidelberg, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Clinical Cooperation Unit Radiation Oncology, Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Oncology (NCRO), Heidelberg University and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Marco Durante
- GSI Helmholtzzentrum für Schwerionenforschung, D-64291 Darmstadt, Germany.,Technische Universität Darmstadt, Institut für Physik Kondensierter Materie, Darmstadt, Germany
| | - Alfredo Ferrari
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Hermann Fuchs
- Division of Medical Physics, Department of Radiation Oncology, Medical University of Vienna, Austria.,MedAustron Ion Therapy Center, Wiener Neustadt, Austria
| | - Dietmar Georg
- Division of Medical Physics, Department of Radiation Oncology, Medical University of Vienna, Austria.,MedAustron Ion Therapy Center, Wiener Neustadt, Austria
| | - David R Grosshans
- The University of Texas MD Anderson cancer Center, Houston, Texas, United States of America
| | - Fada Guan
- The University of Texas MD Anderson cancer Center, Houston, Texas, United States of America.,Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, 06510, United States of America
| | - Thomas Haberer
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Semi Harrabi
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,National Center for Radiation Research in Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany.,German Cancer Consortium (DKTK) Core-Center Heidelberg, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Clinical Cooperation Unit Radiation Oncology, Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Oncology (NCRO), Heidelberg University and German Cancer Research Center (DKFZ), Heidelberg, Germany.,National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Felix Horst
- GSI Helmholtzzentrum für Schwerionenforschung, D-64291 Darmstadt, Germany
| | - Taku Inaniwa
- Department of Accelerator and Medical Physics, Institute for Quantum Medical Science, QST, 4-9-1 Anagawa, Inage-ku, Chiba 263-8555, Japan.,Medical Physics Laboratory, Division of Health Science, Graduate School of Medicine, Osaka University, 1-7 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Christian P Karger
- National Center for Radiation Research in Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany.,Department of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Radhe Mohan
- The University of Texas MD Anderson cancer Center, Houston, Texas, United States of America
| | - Harald Paganetti
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, United States of America.,Harvard Medical School, Boston, United States of America
| | - Katia Parodi
- Ludwig-Maximilians-Universität München, Department of Experimental Physics-Medical Physics, Munich, Germany
| | - Paola Sala
- Ludwig-Maximilians-Universität München, Department of Experimental Physics-Medical Physics, Munich, Germany
| | - Christoph Schuy
- GSI Helmholtzzentrum für Schwerionenforschung, D-64291 Darmstadt, Germany
| | - Thomas Tessonnier
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Uwe Titt
- The University of Texas MD Anderson cancer Center, Houston, Texas, United States of America
| | - Ulrich Weber
- GSI Helmholtzzentrum für Schwerionenforschung, D-64291 Darmstadt, Germany
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Ulrich-Pur F, Bergauer T, Burker A, Hirtl A, Irmler C, Kaser S, Pitters F, Rit S. Feasibility study of a proton CT system based on 4D-tracking and residual energy determination via time-of-flight. Phys Med Biol 2022; 67. [PMID: 35354129 DOI: 10.1088/1361-6560/ac628b] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 03/30/2022] [Indexed: 11/12/2022]
Abstract
Objective.For dose calculations in ion beam therapy, it is vital to accurately determine the relative stopping power (RSP) distribution within the treatment volume. A suitable imaging modality to achieve the required RSP accuracy is proton computed tomography (pCT), which usually uses a tracking system and a separate residual energy (or range) detector to directly measure the RSP distribution. This work investigates the potential of a novel pCT system based on a single detector technology, namely low gain avalanche detectors (LGADs). LGADs are fast 4D-tracking detectors, which can be used to simultaneously measure the particle position and time with precise timing and spatial resolution. In contrast to standard pCT systems, the residual energy is determined via a time-of-flight (TOF) measurement between different 4D-tracking stations.Approach.To show the potential of using 4D-tracking for proton imaging, we studied and optimized the design parameters for a realistic TOF-pCT system using Monte Carlo simulations. We calculated the RSP accuracy and RSP resolution inside the inserts of the CTP404 phantom and compared the results to a simulation of an ideal pCT system.Main results.After introducing a dedicated calibration procedure for the TOF calorimeter, RSP accuracies less than 0.6% could be achieved. We also identified the design parameters with the strongest impact on the RSP resolution and proposed a strategy to further improve the image quality.Significance.This comprehensive study of the most important design aspects for a novel TOF-pCT system could help guide future hardware developments and, once implemented, improve the quality of treatment planning in ion beam therapy.
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Affiliation(s)
- Felix Ulrich-Pur
- Austrian Academy of Sciences, Institute of High Energy Physics (HEPHY), Nikolsdorfer Gasse 18, A-1050 Wien, Austria
| | - Thomas Bergauer
- Austrian Academy of Sciences, Institute of High Energy Physics (HEPHY), Nikolsdorfer Gasse 18, A-1050 Wien, Austria
| | | | - Albert Hirtl
- TU Wien, Atominstitut, Stadionallee 2, A-1020 Wien, Austria
| | - Christian Irmler
- Austrian Academy of Sciences, Institute of High Energy Physics (HEPHY), Nikolsdorfer Gasse 18, A-1050 Wien, Austria
| | - Stefanie Kaser
- Austrian Academy of Sciences, Institute of High Energy Physics (HEPHY), Nikolsdorfer Gasse 18, A-1050 Wien, Austria
| | - Florian Pitters
- Austrian Academy of Sciences, Institute of High Energy Physics (HEPHY), Nikolsdorfer Gasse 18, A-1050 Wien, Austria
| | - Simon Rit
- Lyon University, INSA-Lyon, University Lyon1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR5220, U1206, France
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Relative biological effectiveness of single and split helium ion doses in the rat spinal cord increases strongly with linear energy transfer. Radiother Oncol 2022; 170:224-230. [PMID: 35367526 DOI: 10.1016/j.radonc.2022.03.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 03/16/2022] [Accepted: 03/28/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND PURPOSE Determination of the relative biological effectiveness (RBE) of helium ions as a function of linear energy transfer (LET) for single and split doses using the rat cervical spinal cord as model system for late-responding normal tissue. MATERIAL AND METHODS The rat cervical spinal cord was irradiated at four different positions within a 6 cm spread-out Bragg-peak (SOBP) (LET 2.9, 9.4, 14.4 and 20.7 keV/µm) using increasing levels of single or split doses of helium ions. Dose-response curves were determined and based on TD50-values (dose at 50% effect probability using paresis II as endpoint), RBE-values were derived for the endpoint of radiation-induced myelopathy. RESULTS With increasing LET, RBE-values increased from 1.13 ± 0.04 to 1.42 ± 0.05 (single dose) and 1.12 ± 0.03 to 1.50 ± 0.04 (split doses) as TD50-values decreased from 21.7 ± 0.3 Gy to 17.3 ± 0.3 Gy (single dose) and 30.6 ± 0.3 Gy to 22.9 ± 0.3 Gy (split doses), respectively. RBE-models (LEM I and IV, mMKM) deviated differently for single and split doses but described the RBE variation in the high-LET region sufficiently accurate. CONCLUSION This study established the LET-dependence of the RBE for late effects in the central nervous system after single and split doses of helium ions. The results extend the existing database for protons and carbon ions and allow systematic testing of RBE-models. While the RBE-values of helium were generally lower than for carbon ions, the increase at the distal edge of the Bragg-peak was larger than for protons, making detailed RBE-modeling necessary.
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Horst F, Schardt D, Iwase H, Schuy C, Durante M, Weber U. Physical characterization of 3He ion beams for radiotherapy and comparison with 4He. Phys Med Biol 2021; 66. [PMID: 33730702 DOI: 10.1088/1361-6560/abef88] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 03/17/2021] [Indexed: 12/14/2022]
Abstract
There is increasing interest in using helium ions for radiotherapy, complementary to protons and carbon ions. A large number of patients were treated with4He ions in the US heavy ion therapy project and novel4He ion treatment programs are under preparation, for instance in Germany and Japan.3He ions have been proposed as an alternative to4He ions because the acceleration of3He is technically less difficult than4He. In particular, beam contaminations have been pointed out as a potential safety issue for4He ion beams. This motivated a series of experiments with3He ion beams at Gesellschaft für Schwerionenforschung (GSI), Darmstadt. Measured3He Bragg curves and fragmentation data in water are presented in this work. Those experimental data are compared with FLUKA Monte Carlo simulations. The physical characteristics of3He ion beams are compared to those of4He, for which a large set of data became available in recent years from the preparation work at the Heidelberger Ionenstrahl-Therapiezentrum (HIT). The dose distributions (spread out Bragg peaks, lateral profiles) that can be achieved with3He ions are found to be competitive to4He dose distributions. The effect of beam contaminations on4He depth dose distribution is also addressed. It is concluded that3He ions can be a viable alternative to4He, especially for future compact therapy accelerator designs and upgrades of existing ion therapy facilities.
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Affiliation(s)
- Felix Horst
- GSI Helmholtzzentrum für Schwerionenforschung, Biophysics Department, D-64291 Darmstadt, Germany
| | - Dieter Schardt
- GSI Helmholtzzentrum für Schwerionenforschung, Biophysics Department, D-64291 Darmstadt, Germany
| | - Hiroshi Iwase
- KEK, Radiation Science, 1-1 Oho, Tsukuba, Ibaraki, 305-0801, Japan
| | - Christoph Schuy
- GSI Helmholtzzentrum für Schwerionenforschung, Biophysics Department, D-64291 Darmstadt, Germany
| | - Marco Durante
- GSI Helmholtzzentrum für Schwerionenforschung, Biophysics Department, D-64291 Darmstadt, Germany.,Technische Universität Darmstadt, Institut für Festkörperphysik, D-64289 Darmstadt, Germany
| | - Uli Weber
- GSI Helmholtzzentrum für Schwerionenforschung, Biophysics Department, D-64291 Darmstadt, Germany
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Pettersen HES, Volz L, Sølie JR, Alme J, Barnaföldi GG, Barthel R, van den Brink A, Borshchov V, Chaar M, Eikeland V, Genov G, Grøttvik O, Helstrup H, Keidel R, Kobdaj C, van der Kolk N, Mehendale S, Meric I, Harald Odland O, Papp G, Peitzmann T, Piersimoni P, Protsenko M, Ur Rehman A, Richter M, Tefre Samnøy A, Seco J, Shafiee H, Songmoolnak A, Tambave G, Tymchuk I, Ullaland K, Varga-Kofarago M, Wagner B, Xiao R, Yang S, Yokoyama H, Röhrich D. Helium radiography with a digital tracking calorimeter-a Monte Carlo study for secondary track rejection. Phys Med Biol 2021; 66:035004. [PMID: 33181502 DOI: 10.1088/1361-6560/abca03] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Radiation therapy using protons and heavier ions is a fast-growing therapeutic option for cancer patients. A clinical system for particle imaging in particle therapy would enable online patient position verification, estimation of the dose deposition through range monitoring and a reduction of uncertainties in the calculation of the relative stopping power of the patient. Several prototype imaging modalities offer radiography and computed tomography using protons and heavy ions. A Digital Tracking Calorimeter (DTC), currently under development, has been proposed as one such detector. In the DTC 43 longitudinal layers of laterally stacked ALPIDE CMOS monolithic active pixel sensor chips are able to reconstruct a large number of simultaneously recorded proton tracks. In this study, we explored the capability of the DTC for helium imaging which offers favorable spatial resolution over proton imaging. Helium ions exhibit a larger cross section for inelastic nuclear interactions, increasing the number of produced secondaries in the imaged object and in the detector itself. To that end, a filtering process able to remove a large fraction of the secondaries was identified, and the track reconstruction process was adapted for helium ions. By filtering on the energy loss along the tracks, on the incoming angle and on the particle ranges, 97.5% of the secondaries were removed. After passing through 16 cm water, 50.0% of the primary helium ions survived; after the proposed filtering 42.4% of the primaries remained; finally after subsequent image reconstruction 31% of the primaries remained. Helium track reconstruction leads to more track matching errors compared to protons due to the increased available focus strength of the helium beam. In a head phantom radiograph, the Water Equivalent Path Length error envelope was 1.0 mm for helium and 1.1 mm for protons. This accuracy is expected to be sufficient for helium imaging for pre-treatment verification purposes.
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Ying CK, Bolst D, Rosenfeld A, Guatelli S. Characterization of the Mixed Radiation Field Produced by Carbon and Oxygen Ion Beams of Therapeutic Energy: A Monte Carlo Simulation Study. J Med Phys 2020; 44:263-269. [PMID: 31908385 PMCID: PMC6936202 DOI: 10.4103/jmp.jmp_40_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 08/14/2019] [Accepted: 08/27/2019] [Indexed: 12/26/2022] Open
Abstract
Purpose: The main advantages of charged particle radiotherapy compared to conventional X-ray external beam radiotherapy are a better tumor conformality coupled with the capability of treating deep-seated radio-resistant tumors. This work investigates the possibility to use oxygen beams for hadron therapy, as an alternative to carbon ions. Materials and Methods: Oxygen ions have the advantage of a higher relative biological effectiveness (RBE) and better conformality to the tumor target. This work describes the mixed radiation field produced by an oxygen beam in water and compares it to the one produced by a therapeutic carbon ion beam. The study has been performed using Geant4 simulations. The dose is calculated for incident carbon ions with energies of 162 MeV/u and 290 MeV/u, and oxygen ions with energies of 192 MeV/u and 245 MeV/u, and hence that the range of the primary oxygen ions projectiles in water was located at the same depth as the carbon ions. Results: The results show that the benefits of oxygen ions are more pronounced when using lower energies because of a slightly higher peak-to-entrance ratio, which allows either providing higher dose in tumor target or reducing it in the surrounding healthy tissues. It is observed that, per incident particle, oxygen ions deliver higher doses than carbon ions. Conclusions: This result coupled with the higher RBE shows that it may be possible to use a lower fluence of oxygen ions to achieve the same therapeutic dose in the patient as that obtained with carbon ion therapy.
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Affiliation(s)
- C K Ying
- Oncological and Radiological Science Cluster, Advanced Medical and Dental Institute, Universiti Sains Malaysia, Kepala Batas, Pulau Pinang, Malaysia
| | - David Bolst
- Centre of Medical Radiation Physics, University of Wollongong, NSW, Australia
| | - Anatoly Rosenfeld
- Centre of Medical Radiation Physics, University of Wollongong, NSW, Australia
| | - Susanna Guatelli
- Centre of Medical Radiation Physics, University of Wollongong, NSW, Australia
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Ozoemelam I, van der Graaf E, Brandenburg S, Dendooven P. The production of positron emitters with millisecond half-life during helium beam radiotherapy. Phys Med Biol 2019; 64:235012. [PMID: 31658450 DOI: 10.1088/1361-6560/ab51c3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Therapy with helium ions is currently receiving significantly increasing interest because helium ions have a sharper penumbra than protons and undergo less fragmentation than carbon ions and thus require less complicated dose calculations. For any ion of interest in hadron therapy, the accuracy of dose delivery is limited by range uncertainties. This has led to efforts by several groups to develop in vivo verification techniques, including positron emission tomography (PET), for monitoring of the dose delivery. Beam-on PET monitoring during proton therapy through the detection of short-lived positron emitters such as 12N (T 1/2 = 11 ms), an emerging PET technique, provides an attractive option given the achievable range accuracy, minimal susceptibility to biological washout and provision of near prompt feedback. Extension of this approach to helium ions requires information on the production yield of relevant short-lived positron emitters. This study presents the first measurements of the production of short-lived positron emitters in water, graphite, calcium and phosphorus targets irradiated with 59 MeV/u 3He and 50 MeV/u 4He beams. For these targets, the most produced short-lived nuclides are 13O/12N (T 1/2 = 8.6/11 ms) on water, 13O/12N on graphite, 43Ti/41Sc/42Sc (T 1/2 = 509-680 ms) on calcium, 28P (T 1/2 = 268 ms) on phosphorus. A translation of the results from elemental targets to PMMA and representative tissues such as adipose tissue, muscle, compact and cortical bone, shows the dominance of 13O/12N in at least the first 20 s of an irradiation with 4He and somewhat longer with 3He. As the production of 13O/12N in a 3He irradiation is 3-4 times higher than in a 4He irradiation, from a statistical point of view, range verification using 13O/12N PET imaging will be about 2 times more precise for a 3He irradiation compared to a 4He irradiation.
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Mein S, Dokic I, Klein C, Tessonnier T, Böhlen TT, Magro G, Bauer J, Ferrari A, Parodi K, Haberer T, Debus J, Abdollahi A, Mairani A. Biophysical modeling and experimental validation of relative biological effectiveness (RBE) for 4He ion beam therapy. Radiat Oncol 2019; 14:123. [PMID: 31296232 PMCID: PMC6624994 DOI: 10.1186/s13014-019-1295-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 05/09/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Helium (4He) ion beam therapy provides favorable biophysical characteristics compared to currently administered particle therapies, i.e., reduced lateral scattering and enhanced biological damage to deep-seated tumors like heavier ions, while simultaneously lessened particle fragmentation in distal healthy tissues as observed with lighter protons. Despite these biophysical advantages, raster-scanning 4He ion therapy remains poorly explored e.g., clinical translational is hampered by the lack of reliable and robust estimation of physical and radiobiological uncertainties. Therefore, prior to the upcoming 4He ion therapy program at the Heidelberg Ion-beam Therapy Center (HIT), we aimed to characterize the biophysical phenomena of 4He ion beams and various aspects of the associated models for clinical integration. METHODS Characterization of biological effect for 4He ion beams was performed in both homogenous and patient-like treatment scenarios using innovative models for estimation of relative biological effectiveness (RBE) in silico and their experimental validation using clonogenic cell survival as the gold-standard surrogate. Towards translation of RBE models in patients, the first GPU-based treatment planning system (non-commercial) for raster-scanning 4He ion beams was devised in-house (FRoG). RESULTS Our data indicate clinically relevant uncertainty of ±5-10% across different model simulations, highlighting their distinct biological and computational methodologies. The in vitro surrogate for highly radio-resistant tissues presented large RBE variability and uncertainty within the clinical dose range. CONCLUSIONS Existing phenomenological and mechanistic/biophysical models were successfully integrated and validated in both Monte Carlo and GPU-accelerated analytical platforms against in vitro experiments, and tested using pristine peaks and clinical fields in highly radio-resistant tissues where models exhibit the greatest RBE uncertainty. Together, these efforts mark an important step towards clinical translation of raster-scanning 4He ion beam therapy to the clinic.
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Affiliation(s)
- Stewart Mein
- Division of Molecular and Translational Radiation Oncology, Heidelberg University Medical School, Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital (UKHD), Heidelberg, Germany
- Translational Radiation Oncology, German Cancer Consortium (DKTK) Core Center, German Cancer Research Center (DKFZ), Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Heidelberg, Germany
- Heidelberg University, Faculty of Physics, Heidelberg, Germany
| | - Ivana Dokic
- Division of Molecular and Translational Radiation Oncology, Heidelberg University Medical School, Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital (UKHD), Heidelberg, Germany
- Translational Radiation Oncology, German Cancer Consortium (DKTK) Core Center, German Cancer Research Center (DKFZ), Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Carmen Klein
- Division of Molecular and Translational Radiation Oncology, Heidelberg University Medical School, Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital (UKHD), Heidelberg, Germany
- Translational Radiation Oncology, German Cancer Consortium (DKTK) Core Center, German Cancer Research Center (DKFZ), Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Thomas Tessonnier
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital (UKHD), Heidelberg, Germany
- Centre François Baclesse, Radiation Oncology, Medical Physics Department, Caen, France
| | - Till Tobias Böhlen
- Center for Proton Therapy, Paul Scherrer Institute (PSI), Villigen, Switzerland
| | - Guiseppe Magro
- National Centre of Oncological Hadrontherapy (CNAO), Medical Physics, Pavia, Italy
| | - Julia Bauer
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital (UKHD), Heidelberg, Germany
| | - Alfredo Ferrari
- European Organization for Nuclear Research (CERN), Geneva, Switzerland
| | - Katia Parodi
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital (UKHD), Heidelberg, Germany
- Ludwig-Maximilians-Universität (LUM Munich), Munich, Germany
| | - Thomas Haberer
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital (UKHD), Heidelberg, Germany
| | - Jürgen Debus
- Division of Molecular and Translational Radiation Oncology, Heidelberg University Medical School, Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital (UKHD), Heidelberg, Germany
- Translational Radiation Oncology, German Cancer Consortium (DKTK) Core Center, German Cancer Research Center (DKFZ), Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Heidelberg, Germany
- Heidelberg University, Faculty of Physics, Heidelberg, Germany
| | - Amir Abdollahi
- Division of Molecular and Translational Radiation Oncology, Heidelberg University Medical School, Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital (UKHD), Heidelberg, Germany
- Translational Radiation Oncology, German Cancer Consortium (DKTK) Core Center, German Cancer Research Center (DKFZ), Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Andrea Mairani
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital (UKHD), Heidelberg, Germany
- National Centre of Oncological Hadrontherapy (CNAO), Medical Physics, Pavia, Italy
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Durante M, Paganetti H, Pompos A, Kry SF, Wu X, Grosshans DR. Report of a National Cancer Institute special panel: Characterization of the physical parameters of particle beams for biological research. Med Phys 2018; 46:e37-e52. [PMID: 30506898 DOI: 10.1002/mp.13324] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 10/28/2018] [Accepted: 11/05/2018] [Indexed: 12/16/2022] Open
Abstract
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.
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Affiliation(s)
- Marco Durante
- Biophysics Department, GSI Helmholtzzentrum für Schwerionenforschung and Technische Universität Darmstadt, Institute of Condensed Matter Physics, Planckstraße 1, 64291, Darmstadt, Germany
| | - Harald Paganetti
- Department of Radiation Oncology, Massachusetts General Hospital & Harvard Medical School, Boston, MA, 02114, USA
| | - Arnold Pompos
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Stephen F Kry
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Xiaodong Wu
- Department of Medical Physics, Shanghai Proton and Heavy Ion Center, Shanghai, China
| | - David R Grosshans
- Departments of Radiation and Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77054, USA
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Schuy C, Tessa CL, Horst F, Rovituso M, Durante M, Giraudo M, Bocchini L, Baricco M, Castellero A, Fioreh G, Weber U. Experimental Assessment of Lithium Hydride's Space Radiation Shielding Performance and Monte Carlo Benchmarking. Radiat Res 2018; 191:154-161. [DOI: 10.1667/rr15123.1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Christoph Schuy
- GSI Helmholtz Centre for Heavy Ion Research, Darmstadt, Germany
| | - Chiara La Tessa
- Trento Institute for Fundamental Physics and Applications (TIFPA), Povo, Italy
| | - Felix Horst
- GSI Helmholtz Centre for Heavy Ion Research, Darmstadt, Germany
| | - Marta Rovituso
- Trento Institute for Fundamental Physics and Applications (TIFPA), Povo, Italy
| | - Marco Durante
- Trento Institute for Fundamental Physics and Applications (TIFPA), Povo, Italy
| | | | | | - Marcello Baricco
- Departments of Chemistry and NIS, University of Torino, Turin, Italy
| | | | - Gianluca Fioreh
- Departments of Chemistry and NIS, University of Torino, Turin, Italy
| | - Uli Weber
- GSI Helmholtz Centre for Heavy Ion Research, Darmstadt, Germany
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11
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Volz L, Piersimoni P, Bashkirov VA, Brons S, Collins-Fekete CA, Johnson RP, Schulte RW, Seco J. The impact of secondary fragments on the image quality of helium ion imaging. Phys Med Biol 2018; 63:195016. [PMID: 30183679 PMCID: PMC6380898 DOI: 10.1088/1361-6560/aadf25] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
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.
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Affiliation(s)
- Lennart Volz
- German Cancer Research Center (DKFZ) Heidelberg, Baden-Württemberg, Germany. Department of Physics and Astronomy, Heidelberg University, Heidelberg, Baden-Württemberg, Germany. These authors contributed equally to this work
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12
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Gallas RR, Arico G, Burigo LN, Gehrke T, Jakůbek J, Granja C, Tureček D, Martišíková M. A novel method for assessment of fragmentation and beam-material interactions in helium ion radiotherapy with a miniaturized setup. Phys Med 2017; 42:116-126. [PMID: 29173904 DOI: 10.1016/j.ejmp.2017.09.126] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 08/18/2017] [Accepted: 09/13/2017] [Indexed: 10/18/2022] Open
Abstract
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.
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Affiliation(s)
- Raya R Gallas
- German Cancer Research Center (DKFZ), Division of Medical Physics in Radiation Oncology, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; National Center for Radiation Research in Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany.
| | - Giulia Arico
- German Cancer Research Center (DKFZ), Division of Medical Physics in Radiation Oncology, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; National Center for Radiation Research in Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany; Heidelberg University Hospital, Department of Radiation Oncology, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Lucas N Burigo
- German Cancer Research Center (DKFZ), Division of Medical Physics in Radiation Oncology, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; National Center for Radiation Research in Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany
| | - Tim Gehrke
- German Cancer Research Center (DKFZ), Division of Medical Physics in Radiation Oncology, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; National Center for Radiation Research in Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany; Heidelberg University Hospital, Department of Radiation Oncology, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Jan Jakůbek
- Advacam s.r.o., Na Balkáně 2075/70, 130 00 Praha 3, Czech Republic
| | - Carlos Granja
- Institute of Experimental and Applied Physics, Czech Technical University in Prague, Horská 3a/22, 12800 Prague 2, Czech Republic
| | - Daniel Tureček
- Advacam s.r.o., Na Balkáně 2075/70, 130 00 Praha 3, Czech Republic
| | - Maria Martišíková
- Heidelberg University Hospital, Department of Radiation Oncology, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; German Cancer Research Center (DKFZ), Division of Medical Physics in Radiation Oncology, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; National Center for Radiation Research in Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany
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13
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Aricò G, Gehrke T, Jakubek J, Gallas R, Berke S, Jäkel O, Mairani A, Ferrari A, Martišíková M. Investigation of mixed ion fields in the forward direction for 220.5 MeV/u helium ion beams: comparison between water and PMMA targets. ACTA ACUST UNITED AC 2017; 62:8003-8024. [DOI: 10.1088/1361-6560/aa875e] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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14
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Tessonnier T, Mairani A, Brons S, Sala P, Cerutti F, Ferrari A, Haberer T, Debus J, Parodi K. Helium ions at the heidelberg ion beam therapy center: comparisons between FLUKA Monte Carlo code predictions and dosimetric measurements. ACTA ACUST UNITED AC 2017; 62:6784-6803. [DOI: 10.1088/1361-6560/aa7b12] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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15
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Embriaco A, Bellinzona VE, Fontana A, Rotondi A. On the lateral dose profile of 4He beams in water. Phys Med 2017; 40:51-58. [PMID: 28716542 DOI: 10.1016/j.ejmp.2017.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 07/04/2017] [Accepted: 07/06/2017] [Indexed: 11/24/2022] Open
Abstract
PURPOSE We investigate the possibility to improve the accuracy of the lateral dose profile for 4He beams with a novel approach, by extending an already validated model for proton beams to heavier ions. METHODS The full Molière theory for the Coulomb multiple scattering is applied to the case of 4He beams, with a complete separation of the electromagnetic and of the nuclear contributions in the calculation of the total dose. The latter is described with only three free parameters. RESULTS The accuracy of the results compared with Monte Carlo predictions already validated with experimental data is comparable with other studies at low energy, but improves by a factor 2 at high energy. In addition the found solution is more stable with respect to (multi-) Gaussian and other parameterizations. This result makes this method of interest for applications to Treatment Planning Systems (TPS) in ion beam therapy. CONCLUSIONS We propose a model, named MONETα (MOdel of ioN dosE for Therapy for α), for the calculation of the lateral dose of 4He beams in water that allows fast and accurate dose calculations by requiring a small data base of parameters as input.
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Affiliation(s)
- A Embriaco
- Dipartimento di Fisica, Università di Pavia, Pavia, Italy; Istituto Nazionale di Fisica Nucleare, Sezione di Pavia, Pavia, Italy.
| | - V E Bellinzona
- Dipartimento di Fisica, Università di Pavia, Pavia, Italy
| | - A Fontana
- Istituto Nazionale di Fisica Nucleare, Sezione di Pavia, Pavia, Italy
| | - A Rotondi
- Dipartimento di Fisica, Università di Pavia, Pavia, Italy; Istituto Nazionale di Fisica Nucleare, Sezione di Pavia, Pavia, Italy
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16
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Hartmann B, Granja C, Jakubek J, Gehrke T, Gallas R, Pospíšil S, Jäkel O, Martišíková M. A Novel Method for Fragmentation Studies in Particle Therapy: Principles of Ion Identification. Int J Part Ther 2017; 3:439-449. [PMID: 31772994 DOI: 10.14338/ijpt-15-00003.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 03/27/2017] [Indexed: 11/21/2022] Open
Abstract
Purpose In carbon ion beam radiation therapy, fragmentation processes within the patient lead to changes in the composition of the particle field with increasing depth. Consequences are alterations of the resulting dose distribution and its biological effectiveness. To enable accurate treatment planning, the characteristics of the ion spectra resulting from fragmentation processes need to be known for various ion energies and target materials. In this work, we present a novel method for ion type identification using a small and highly flexible setup based on a single detector and designed to simplify measurements and overcome current shortages in available fragmentation data. Materials and Methods The presented approach is based on the pixelated, semiconductor detector Timepix. The large number of pixels with small pitch, all individually calibrated for energy deposition, enables detection and visualization of single particle tracks. For discrimination among different ion species, the pattern recognition analysis of the detector signal is used. Fragmentation spectra resulting from a primary carbon ion beam at various depths of tissue-equivalent material were studied to identify different ion species in mixed particle fields. The performance of the method was evaluated quantitatively using reference data from an established technique. Results All ion species resulting from carbon ion fragmentation in tissue-equivalent material could be separated. For measurements behind a 158-mm-thick water tank, the relative fractions of H, He, Be, and B ions detected agreed with corresponding reference data within the limits of uncertainty. For the relatively rare lithium ions, the agreement was within 2.3 Δref (uncertainty of reference). Conclusion For designated configurations, the presented ion type identification method enables studies of therapeutic carbon ion beams with a simple, small, and configurable detection setup. The technique is promising to enable online fragmentation studies over a wide range of beam and target parameters in the future.
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Affiliation(s)
- Bernadette Hartmann
- Clinic for Radiation Oncology and Radiation Therapy, Heidelberg University Hospital, Heidelberg, Germany.,Department of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany
| | - Carlos Granja
- Institute of Experimental and Applied Physics (IEAP), Czech Technical University, Prague, Czech Republic
| | - Jan Jakubek
- Institute of Experimental and Applied Physics (IEAP), Czech Technical University, Prague, Czech Republic
| | - Tim Gehrke
- Clinic for Radiation Oncology and Radiation Therapy, Heidelberg University Hospital, Heidelberg, Germany.,Department of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany
| | - Raya Gallas
- Department of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany
| | - Stanislav Pospíšil
- Institute of Experimental and Applied Physics (IEAP), Czech Technical University, Prague, Czech Republic
| | - Oliver Jäkel
- Department of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany.,Heidelberg Ion-Beam Therapy Center (HIT), Heidelberg, Germany
| | - Mária Martišíková
- Clinic for Radiation Oncology and Radiation Therapy, Heidelberg University Hospital, Heidelberg, Germany.,Department of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany
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Durante M, Orecchia R, Loeffler JS. Charged-particle therapy in cancer: clinical uses and future perspectives. Nat Rev Clin Oncol 2017; 14:483-495. [DOI: 10.1038/nrclinonc.2017.30] [Citation(s) in RCA: 241] [Impact Index Per Article: 34.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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