Diamond based integrated detection system for dosimetric and microdosimetric characterization of radiotherapy ion beams

BACKGROUND

Ion beam therapy allows for a substantial sparing of normal tissues and higher biological efficacy. Synthetic single crystal diamond is a very good material to produce high-spatial-resolution and highly radiation hard detectors for both dosimetry and microdosimetry in ion beam therapy.

PURPOSE

The aim of this work is the design, fabrication and test of an integrated waterproof detector based on synthetic single crystal diamond able to simultaneously perform dosimetric and microdosimetric characterization of clinical ion beams.

METHODS

The active elements of the integrated diamond device, that is, dosimeter and microdosimeter, were both realized in a Schottky diode configuration featured by different area, thickness, and shape by means of photolithography technologies for the selective growth of intrinsic and boron-doped CVD diamond. The cross-section of the sensitive volume of the dosimetric element is 4 mm2 and 1 μm-thick, while the microdosimetric one has an active cross-sectional area of 100 × 100 μm2 and a thickness of about 6.2 μm. The dosimetric and microdosimetric performance of the developed device was assessed at different depths in a water phantom at the MedAustron ion beam therapy facility using a monoenergetic uniformly scanned carbon ion beam of 284.7 MeV/u and proton beam of 148.7 MeV. The particle flux in the region of the microdosimeter was 6·107  cm2 /s for both irradiation fields. At each depth, dose and dose distributions in lineal energy were measured simultaneously and the dose mean lineal energy values were then calculated. Monte Carlo simulations were also carried out by using the GATE-Geant4 code to evaluate the relative dose, dose averaged linear energy transfer (LETd ), and microdosimetric spectra at various depths in water for the radiation fields used, by considering the contribution from the secondary particles generated in the ion interaction processes as well.

RESULTS

Dosimetric and microdosimetric quantities were measured by the developed prototype with relatively low noise (∼2 keV/μm). A good agreement between the measured and simulated dose profiles was found, with discrepancies in the peak to plateau ratio of about 3% and 4% for proton and carbon ion beams respectively, showing a negligible LET dependence of the dosimetric element of the device. The microdosimetric spectra were validated with Monte Carlo simulations and a good agreement between the spectra shapes and positions was found. Dose mean lineal energy values were found to be in close agreement with those reported in the literature for clinical ion beams, showing a sharp increase along the Bragg curve, being also consistent with the calculated LETd for all depths within the experimental error of 10%.

CONCLUSIONS

The experimental indicate that the proposed device can allow enhanced dosimetry in particle therapy centers, where the absorbed dose measurement is implemented by the microdosimetric characterization of the radiation field, thus providing complementary results. In addition, the proposed device allows for the reduction of the experimental uncertainties associated with detector positioning and could facilitate the partial overcoming of some drawbacks related to the low sensitivity of diamond microdosimeters to low LET radiation.

First microdosimetric measurements with a tissue-equivalent proportional counter at the MedAustron ion-beam therapy facility

The aim of this work is to present the first microdosimetric spectra measured with a miniaturised tissue-equivalent proportional counter in the clinical environment of the MedAustron ion-beam therapy facility. These spectra were gathered with a 62.4-MeV proton beam and have been compared with microdosimetric spectra measured in the 62-MeV clinical proton beam of the CATANA beam line. Monte Carlo simulations were performed using the Geant4 toolkit GATE and a fully commissioned clinical beam line model. Finally, similarities and discrepancies of the measured data to simulations based on a simple and complex detector geometry are discussed.

3D printed 2D range modulators preserve radiation quality on a microdosimetric scale in proton and carbon ion beams

INTRODUCTION

Particle therapy using pencil beam scanning (PBS) faces large uncertain- ties related to ranges and target motion. One possibility to improve existing mitigation strategies is a 2D range modulator (2DRM). A 2DRM offers faster irradiation times by reducing the number of layers and spots needed to create a spread-out Bragg peak. We have investigated the impact of 2DRM on microdosimetric spectra measured in proton and carbon ion beams.

MATERIALS AND METHODS

Two 2DRMs were designed and 3D printed, one for. 124.7 MeV protons and one for 238.6 MeV/u carbon ions. Their dosimetric validation was performed using Roos and PinPoint ionization chamber and EBT3 films. Monte Carlo simulations were done using GATE. A silicon-based solid-state microdosimeter was used to collect pulse-height spectra along three depths for two irradiation modalities, PBS and a single central beam.

RESULTS

For both particle types, the original pin design had to be optimized via GATE simulations. The difference between the R80 of the simulated and measured depth dose curve was 0.1 mm. The microdosimetric spectra collected with the two irradiation modalities overlap well. Their mean lineal energy values differ over all positions by 5.2 % for the proton 2DRM and 2.1 % for the carbon ion 2DRM.

CONCLUSION

Radiation quality in terms of lineal energy was independent of the irradiation method. This supports the current approach in reference dosimetry, where the residual range is chosen as a beam quality index to select stopping power ratios.

State-of-the-art and potential of experimental microdosimetry in ion-beam therapy

In radiotherapy, radiation-quality should be an expression of the biological and physical characteristics of ionizing radiation such as spatial distribution of ionization or energy deposition. Linear energy transfer (LET) and lineal energy (y) are two descriptors used to quantify the radiation quality. These two quantities are connected and exhibit similar features. In ion-beam therapy (IBT), lineal energy can be measured with microdosimeters, which are specifically designed to cope with the high fluence of particles in clinical beams, while the quantification of LET is generally based on calculations. In pre-clinical studies, microdosimetric spectra are used for the indirect determination of relative biological effectiveness (RBE), e.g., using the microdosimetric kinetic model (MKM) or biophysical response functions. In this context it is important to consider saturation effects, which occur when the highest values of y become less biologically relevant compared to the relative contribution they make to the physical dose. Recent clinical data suggests that local tumor control and normal tissue effects can be linked to macroscopic and microscopic dosimetry parameters. In particular, positive clinical outcomes have been correlated to the highest LET values in the density distribution, and there is no evident link to the saturation discussed above. A systematic collection of microdosimetric information in combination with clinical data in retrospective studies may clarify the role of radiation quality at the highest LET. In the clinical setting, microdosimetry is not widely used yet, despite its potential to be linked with LET by experimentally-determined y values. Through this connection, both play an important role in complex therapy techniques such as intensity modulated particle therapy (IMPT), LET-painting and multi-ion optimization. This review summarizes the current state of microdosimetry for IBT and its potential, as well as research and development needed to make experimental microdosimetry a mature procedure in a clinical context.

On the measurement uncertainty of microdosimetric quantities using diamond and silicon microdosimeters in carbon-ion beams

PURPOSE

The purpose of this paper is to compare the response of two different types of solid-state microdosimeters, that is, silicon and diamond, and their uncertainties. A study of the conversion of silicon microdosimetric spectra to the diamond equivalent for microdosimeters with different geometry of the sensitive volumes is performed, including the use of different stopping power databases.

METHOD

Diamond and silicon microdosimeters were irradiated under the same conditions, aligned at the same depth in a carbon-ion beam at the MedAustron ion therapy center. In order to estimate the microdosimetric quantities, the readout electronic linearity was investigated with three different methods, that is, the first being a single linear regression, the second consisting of a double linear regression with a channel transition and last a multiple linear regression by splitting the data into odd and even groups. The uncertainty related to each of these methods was estimated as well. The edge calibration was performed using the intercept with the horizontal axis of the tangent through the inflection point of the Fermi function approximation multi-channel analyzer spectrum. It was assumed that this point corresponds to the maximum energy difference of particle traversing the sensitive volume (SV) for which the residual range difference in the continuous slowing down approximation is equal to the thickness of the SV of the microdosimeter. Four material conversion methods were explored, the edge method, the density method, the maximum-deposition energy method and the bin-by-bin transformation method. The uncertainties of the microdosimetric quantities resulting from the linearization, the edge calibration and the detectors thickness were also estimated.

RESULTS

It was found that the double linear regression had the lowest uncertainty for both microdosimeters. The propagated standard (k = 1) uncertainties on the frequency-mean lineal energy y ¯ F ${\bar{y}}_{\rm{F}}$ and the dose-mean lineal energy y ¯ D ${\bar{y}}_{\rm{D}}$ values from the marker point, in the spectra, in the plateau were 0.1% and 0.2%, respectively, for the diamond microdosimeter, whilst for the silicon microdosimeter data converted to diamond, the uncertainty was estimated to be 0.1%. In the range corresponding to the 90% of the amplitude of the Bragg Peak at the distal part of the Bragg curve (R₉₀ ) the uncertainty was found to be 0.1%. The uncertainty propagation from the stopping power tables was estimated to be between 5% and 7% depending on the method. The uncertainty on the y ¯ F ${\bar{y}}_{\rm{F}}$ and y ¯ D ${\bar{y}}_{\rm{D}}$ coming from the thickness of the detectors varied between 0.3% and 0.5%.

CONCLUSION

This article demonstrate that the linearity of the readout electronics affects the microdosimetric spectra with a difference in y ¯ F ${\bar{y}}_{\rm{F}}$ values between the different linearization methods of up to 17.5%. The combined uncertainty was dominated by the uncertainty of stopping power on the edge.

Development of a new microdosimetric biological weighting function for the RBE10 assessment in case of the V79 cell line exposed to ions from 1H to 238U

An improved biological weighting function (IBWF) is proposed to phenomenologically relate microdosimetric lineal energy probability density distributions with the relative biological effectiveness (RBE) for the in vitro clonogenic cell survival (surviving fraction = 10%) of the most commonly used mammalian cell line, i.e. the Chinese hamster lung fibroblasts (V79). The IBWF, intended as a simple and robust tool for a fast RBE assessment to compare different exposure conditions in particle therapy beams, was determined through an iterative global-fitting process aimed to minimize the average relative deviation between RBE calculations and literature in vitro data in case of exposure to various types of ions from ¹H to ²³⁸U. By using a single particle- and energy- independent function, it was possible to establish an univocal correlation between lineal energy and clonogenic cell survival for particles spanning over an unrestricted linear energy transfer range of almost five orders of magnitude (0.2 keV µm^-1 to 15 000 keV µm^-1 in liquid water). The average deviation between IBWF-derived RBE values and the published in vitro data was ∼14%. The IBWF results were also compared with corresponding calculations (in vitro RBE₁₀ for the V79 cell line) performed using the modified microdosimetric kinetic model (modified MKM). Furthermore, RBE values computed with the reference biological weighting function (BWF) for the in vivo early intestine tolerance in mice were included for comparison and to further explore potential correlations between the BWF results and the in vitro RBE as reported in previous studies. The results suggest that the modified MKM possess limitations in reproducing the experimental in vitro RBE₁₀ for the V79 cell line in case of ions heavier than ²⁰Ne. Furthermore, due to the different modelled endpoint, marked deviations were found between the RBE values assessed using the reference BWF and the IBWF for ions heavier than ²H. Finally, the IBWF was unchangingly applied to calculate RBE values by processing lineal energy density distributions experimentally measured with eight different microdosimeters in 19 ¹H and ¹²C beams at ten different facilities (eight clinical and two research ones). Despite the differences between the detectors, irradiation facilities, beam profiles (pristine or spread out Bragg peak), maximum beam energy, beam delivery (passive or active scanning), energy degradation system (water, PMMA, polyamide or low-density polyethylene), the obtained IBWF-based RBE trends were found to be in good agreement with the corresponding ones in case of computer-simulated microdosimetric spectra (average relative deviation equal to 0.8% and 5.7% for ¹H and ¹²C ions respectively).

MICRODOSIMETRY OF CLINICAL ION BEAMS: CONVERTING SPECTRA FROM DIAMOND SLAB TO WATER OF DIFFERENT SHAPES

Microdosemeters are frequently used today to specify the radiation quality in the framework of ion-beam therapy. The heterogeneity of the detector shapes and the materials limits the possibility of comparing directly spectra and mean lineal energies. A method was recently studied to convert the spectra obtained with unidirectional ion beams in slab detectors to those obtained with detectors of different in shape and material. The method is based on the observation that the lineal-energy spectra of slab detector, in a restricted energy interval, approximate the Linear Energy Transfer distributions at corresponding material and particle type and energies. In this study, the experimental spectra collected with a slab diamond detector are converted to the spectra that would be obtained using water detectors of spherical and cylindrical shapes.

Concepts and terms for dose/volume parameters in carbon-ion radiotherapy: Conclusions of the ULICE taskforce

PURPOSE

The Union of Light Ion Centers in Europe (ULICE) program addressed the need for uniting scientific results for carbon-ion radiation therapy obtained by several institutions worldwide in different fields of excellence, and translating them into a real benefit to the community. Particularly, the concepts for dose/volume parameters developed in photon radiotherapy cannot be extrapolated to high linear energy transfer particles.

METHODS AND MATERIALS

The ULICE-WP2 taskforce included radiation oncologists involved in carbon-ion radiation therapy and International Commission on Radiation Units and Measurements, radiation biologists, expert physicists in the fields of carbon-ion radiation therapy, microdosimetry, biological modeling and image-guided radiotherapy. Consensual reports emerged from multiple discussions within both the restricted group and the wider ULICE community. Public deliverables were produced and disseminated to the European Commission.

RESULTS

Here we highlight the disparity in practices between treating centers, then address the main topics to finally elaborate specific recommendations. Although it appears relatively simple to add geometrical margins around the clinical target volume to obtain the planning target volume as performed in photon radiotherapy, this procedure is not appropriate for carbon-ion radiation therapy. Due to the variation of the radiation quality in depth, there is no generic relative biological effectiveness value for carbon-ions outside of an isolated point, for a given fractionation and specific experimental conditions. Absorbed dose and "equieffective dose" for specified conditions must always be reported.

CONCLUSIONS

This work contributed to the development of standard operating procedures for carbon-ion radiation therapy clinical trials. These procedures are now being applied, particularly in the first phase III international, multicenter trial (PHRC Étoile).

Radiation quality and ion-beam therapy: understanding the users' needs

Ion-beam therapy faces a growing demand of tools able to map radiation quality within the irradiated volume. Although analytical computations and simulations provide useful estimations of dose and radiation quality, the direct measure of those parameters would improve ion-beam therapy in particular when deep-seated tumours are irradiated, tissue composition and density are variable or organs at risk are near the tumour. Several ion-beam therapy facilities are studying detectors and procedures for measuring the radiation quality on a microdosimetric as well as a nanodosimetric scale. Simplicity and miniaturisation of the devices are essential for measurements first in phantoms and thereafter during therapy, particularly for intra-cavity detectors. MedAustron is studying solid-state detectors based on a single crystal chemical vapour deposition diamond. In collaboration with Italian National Institute for Nuclear Physics (INFN), Tor Vergata and Legnaro; INFN-microdosimetry and track structure project; Austrian Institute of Technology, Vienna; and Italian National agency for new technologies, energy and sustainable economic development, Rome, prototypes have been developed to characterise radiation quality in sizes equivalent to one micrometre of biological tissue.

Introduction to the EC's Marie Curie Initial Training Network (MC-ITN) project: Particle Training Network for European Radiotherapy (PARTNER)

PARTNER (Particle Training Network for European Radiotherapy) is a project funded by the European Commission's Marie Curie-ITN funding scheme through the ENLIGHT Platform for 5.6 million Euro. PARTNER has brought together academic institutes, research centres and leading European companies, focusing in particular on a specialized radiotherapy (RT) called hadron therapy (HT), interchangeably referred to as particle therapy (PT). The ultimate goal of HT is to deliver more effective treatment to cancer patients leading to major improvement in the health of citizens. In Europe, several hundred million Euro have been invested, since the beginning of this century, in PT. In this decade, the use of HT is rapidly growing across Europe, and there is an urgent need for qualified researchers from a range of disciplines to work on its translational research. In response to this need, the European community of HT, and in particular 10 leading academic institutes, research centres, companies and small and medium-sized enterprises, joined together to form the PARTNER consortium. All partners have international reputations in the diverse but complementary fields associated with PT: clinical, radiobiological and technological. Thus the network incorporates a unique set of competencies, expertise, infrastructures and training possibilities. This paper describes the status and needs of PT research in Europe, the importance of and challenges associated with the creation of a training network, the objectives, the initial results, and the expected long-term benefits of the PARTNER initiative.

Piloting the use of 2D barcode and patient safety-software in an Australian tertiary hospital setting

OBJECTIVES

Errors in administration of blood products can lead to poor patient outcomes including fatal ABO incompatible transfusions. This pilot study sought to establish whether the use of two-dimensional (2D) barcode technology combined with patient identification software designed to assist in blood administration improves the bedside administration of transfusions in an Australian tertiary hospital.

STUDY DESIGN AND METHODS

The study was conducted in a Haematology/Oncology Day Clinic of a major metropolitan hospital, to evaluate the use of 2D barcode technology and patient safety-software and hand-held PDAs to assist nursing staff in patient identification and blood administration. Comparative audits were conducted before and after the technology's implementation.

RESULTS

The preimplementation transfusion practice audits demonstrated a poor understanding of the blood checking process, with focus on the product rather than patient identification. Following the implementation of 2D barcode technology and patient safety-software, there was significant improvement in administration practice. Positive, verbal patient identification improved from 57% (51/90) to 94% (75/80). Similarly, the cross-referencing of the patient's identification with the patient's wristband improved from 36% (32/90) to 94% (75/80), and the cross-referencing of patient ID on the compatibility tag to wristbands improved from 48% (43/90) to 99% (79/80). Importantly, the 2D barcode technology and patient safety-software saw 100% (80/80) of checks being conducted at the patient bedside, compared with 76% (68/90) in the preimplementation audits.

CONCLUSION

This pilot study demonstrates that 2D barcode technology and patient safety-software significantly improves the bedside check of patient and blood product identification in an Australian setting.

A 'dangerous' group O donor: severe hemolysis in all recipients of organs from a donor with multiple red cell alloantibodies

Alloimmune hemolysis is a recognized but infrequent complication of solid organ transplantation, particularly where there is incompatibility within the ABO blood group system. We describe severe hemolysis due to passenger lymphocyte syndrome (PLS) in all three recipients of organs from a single donor with multiple red cell (RC) alloantibodies. The first patient, a liver transplant recipient, required augmentation of immunosuppression to treat immune hemolysis due to anti-B, -D, -C and -Cellano (k). This is the first description of PLS caused by alloantibody to the high incidence RC antigen, k. The two single lung transplant recipients developed hemolysis due to anti-D. Both required escalation of immunosuppression and early transfusion support. Three months posttransplant, all three patients have ongoing evidence of compensated hemolysis. This series highlights the potential for severe non-ABO-mediated immune hemolysis following solid organ transplantation. A positive donor RC antibody screen should prompt careful monitoring of organ recipients for hemolysis.

Mini-TEPCs for radiation therapy

A mini-tissue-equivalent proportional-counter (TEPC) has been constructed to study the possibility to manufacture mini-counters without field-shaping tubes for radiation therapy. The mini-TEPC can be assembled with and without field-shaping tubes. It can be equipped with a mini-alpha source for a precise lineal energy calibration. After the positive conclusions of this study, a slim TEPC has been designed and constructed. The slim TEPC has an external diameter of only 2.7 mm. It has been tested with therapeutic proton beams and gamma ray sources.

Nanodosimetric measurements with an avalanche confinement TEPC

This paper illustrates a tissue-equivalent proportional counter designed to have high gas gain and good energy resolution at nanometric simulated site sizes. Microdosimetric neutron and gamma spectra were measured in dimethyl ether and in propane-based tissue-equivalent gas mixture down to 35 nm. The comparison of experimental data with the results of Monte Carlo calculations shows a satisfactory agreement.

Microdosimetric analysis of radiation from a clinical mammography machine using realistic breast phantoms and a miniature proportional counter

We have measured the microdosimetric spectra of a Senographe 600T mammography machine employing an Mo target with 0.8 mm Be inherent filtration and 0.03 mm Mo added filtration, giving a half-value layer of 0.35 mm A1 at 28 kVp. In all of our measurements a large collimator producing a 24 cm x 30 cm field at 65 cm was used. Two different phantom compositions differing in the ratio of adipose to fibroglandular tissue were compared, using simulated breast material from Nuclear Associates. Spectra were taken at various depths and locations in simulated breasts of 3.4 and 5 cm thickness. The detector used was a miniature proportional counter having outer dimensions of 5 cm x 1.8 cm diameter, with a sensitive volume 0.5 mm x 0.5 mm. The small dimensions of the counter and the cavity allowed total embedding in the breast material with minimal disturbance of the photon and secondary electron spectrum. Our results show that there can be changes in the radiation quality amounting to as much as 17% (as measured by the dose mean lineal energy. yD) between breasts of different thickness, at the same relative position within the breast. There is little difference due to breast composition.

Preoperative autologous blood donation. Linkage of the public and private hospital sectors

OBJECTIVE

To evaluate the safety and efficacy of a preoperative autologous blood donation (PABD) program with liberal patient exclusion criteria.

DESIGN

Prospective patient accrual from September 1990 to May 1992.

SETTING

A PABD program in a public tertiary care hospital linked with a specialist orthopaedic practice in a private hospital.

PATIENTS

One hundred and twenty patients consecutively scheduled for orthopaedic surgery were referred for PABD. There were 77 women (median age, 63 years) and 43 men (median age, 62 years). One-third of patients were 70 or more years old. Coexistent medical disease, mainly cardiovascular, was present in 46% of patients and 3% were excluded because of coexisting morbidity. Total hip or total knee replacement was performed in a private hospital with intraoperative or postoperative blood salvage in 37% of the patients.

OUTCOME MEASURES

Adverse effects of PABD, autologous blood collected and used and homologous blood transfused.

RESULTS

One hundred and sixteen patients donated 267 units of autologous blood. In 70 patients undergoing total hip replacement, 78% donated three and 20% donated two units, with 95% of autologous blood being used. In 38 patients undergoing total knee replacement, 42% donated two units and 55% donated one unit, with 87% of autologous blood being transfused. Seventy-eight per cent of all patients only received autologous blood. In the remaining patients, homologous blood use was confined to two units or less in 80%. Hypotensive episodes associated with phlebotomy occurred in 3% of patients, and 13% of patients had preoperative haemoglobin levels ranging from 85-100 g/L without adverse clinical effects.

CONCLUSION

A hospital-based PABD program with less strict patient exclusion criteria does not prejudice the clinical status of the donors. Its linkage to private hospitals can significantly reduce the use of homologous blood in selected elective surgery.