A quantitative assessment of Geant4 for predicting the yield and distribution of positron-emitting fragments in ion beam therapy

PURPOSE

To compare the accuracy with which different hadronic inelastic physics models across ten Geant4 Monte Carlo simulation toolkit versions can predict positron-emitting fragments produced along the beam path during carbon and oxygen ion therapy. Materials and Methods: Phantoms of polyethylene, gelatin or poly(methyl methacrylate) were irradiated with monoenergetic carbon and oxygen ion beams. Post-irradiation, 4D PET images were acquired and parent11C,10C and15O radionuclides contributions in each voxel were determined from the extracted time activity curves. Next, the experimental configurations were simulated in Geant4 Monte Carlo versions 10.0 to 11.1, with three different fragmentation models - binary ion cascade (BIC), quantum molecular dynamics (QMD) and the Liege intranuclear cascade (INCL++) - 30 model-version combinations. Total positron annihilation and parent isotope production yields predicted by each simulation were compared between simulations and experiments using normalised mean squared error and Pearson cross-correlation coefficient. Finally, we compared the depth of maximum positron annihilation yield and the distal point at which positron yield decreases to 50% of peak between each model and the experimental results. Results: Performance varied considerably across versions and models, with no one version/model combination providing the best prediction of all positron-emitting fragments in all evaluated target materials and irradiation conidiations. BIC in Geant4 10.2 provided the best overall agreement with experimental results in the largest number of test cases. QMD consistently provided the best estimates of both the depth of peak positron yield (10.4 and 10.6) and the distal 50%-of-peak point (10.2), while BIC also performed well and INCL generally performed the worst across most Geant4 versions. Conclusions: Best spatial prediction of annihilation yield and positron-emitting fragment production during carbon and oxygen ion therapy was found to be 10.2.p03 with BIC or QMD. These version/model combinations are recommended for future heavy ion therapy research.

Neutron Capture Enhances Dose and Reduces Cancer Cell Viability in and out of Beam During Helium and Carbon Ion Therapy

PURPOSE

Neutron capture enhanced particle therapy (NCEPT) is a proposed augmentation of charged particle therapy that exploits thermal neutrons generated internally, within the treatment volume via nuclear fragmentation, to deliver a biochemically targeted radiation dose to cancer cells. This work is the first experimental demonstration of NCEPT, performed using both carbon and helium ion beams with 2 different targeted neutron capture agents (NCAs).

METHODS AND MATERIALS

Human glioblastoma cells (T98G) were irradiated by carbon and helium ion beams in the presence of NCAs [10B]-BPA and [157Gd]-DOTA-TPP. Cells were positioned within a polymethyl methacrylate phantom either laterally adjacent to or within a 100 × 100 × 60 mm spread out Bragg peak (SOBP). The effect of NCAs and location relative to the SOBP on the cells was measured by cell growth and survival assays in 6 independent experiments. Neutron fluence within the phantom was characterized by quantifying the neutron activation of gold foil.

RESULTS

Cells placed inside the treatment volume reached 10% survival by 2 Gy of carbon or 2 to 3 Gy of helium in the presence of NCAs compared with 5 Gy of carbon and 7 Gy of helium with no NCA. Cells placed adjacent to the treatment volume showed a dose-dependent decrease in cell growth when treated with NCAs, reaching 10% survival by 6 Gy of carbon or helium (to the treatment volume), compared with no detectable effect on cells without NCA. The mean thermal neutron fluence at the center of the SOBP was approximately 2.2 × 109 n/cm2/Gy (relative biological effectiveness) for the carbon beam and 5.8 × 109 n/cm2/Gy (relative biological effectiveness) for the helium beam and gradually decreased in all directions.

CONCLUSIONS

The addition of NCAs to cancer cells during carbon and helium beam irradiation has a measurable effect on cell survival and growth in vitro. Through the capture of internally generated neutrons, NCEPT introduces the concept of a biochemically targeted radiation dose to charged particle therapy. NCEPT enables the established pharmaceuticals and concepts of neutron capture therapy to be applied to a wider range of deeply situated and diffuse tumors, by targeting this dose to microinfiltrates and cells outside of defined treatment regions. These results also demonstrate the potential for NCEPT to provide an increased dose to tumor tissue within the treatment volume, with a reduction in radiation doses to off-target tissue.

LETd Optimization Verification With an SOI Microdosimeter

PURPOSE

A first of its kind experimental verification of dose-averaged linear energy transfer (LETd) optimized treatment plans for proton therapy has been carried out using a silicon-on-insulator microdosimeter at the Massachusetts General Hospital (MGH), Boston, USA.

METHODS AND MATERIALS

Three clinical treatment plans of a typical ependymoma structure set were designed using the standard clinical approach, the proposed protocol approach, and a one-field approach. The plans were then reoptimized to reduce the LETd-weighted dose in the brain stem. All six plans were delivered in a solid water phantom and the experimental yD‾ measured.

RESULTS

After LETd optimization, a reduction in yD‾ was found within the brain stem by an average of 12%, 19%, and 4% for the clinical, protocol, and one-field plans, respectively, while maintaining adequate coverage of the tumor structure. The experimental LETd-weighted doses were in agreement with the treatment planning system calculations and Monte Carlo simulations and reinforced the improvement of the optimization.

CONCLUSIONS

This work demonstrates the first experimental verification of the clinical implementation of LETd optimization for patient treatment with proton therapy.

Microdosimetry of a 62-MeV clinical proton beam with five detectors

In proton therapy, most treatment planning systems (TPS) use a fixed relative biological effectiveness (RBE) of 1.1 all along the depth-dose profile. Innovative TPS are now investigated considering the variability of RBE with radiation quality. New TPS need an experimental verification in the quality assurance (QA) routine in clinics, but RBE data are usually obtained with radiobiological measurements that are time consuming and not suitable for daily QA. Microdosimetry is a useful tool based on physical measurements which can monitor the radiation quality. Several microdosimeters are available in different research institutions, which could potentially be used for the QA in TPS. In this study, the response functions of five detectors in the same 62-MeV proton Spread Out Bragg Peak is compared in terms of spectral distributions and their average values and microdosimetric RBE. Their different response function has been commented and must be considered in the clinical practice.

Assessment of cross-dose contributions from tumors within computational phantoms using a Geant4 radiation dosimetry tool exploiting hybrid analytical/voxelised geometries

BACKGROUND

Dosimetry software tools developed for Radiopharmaceutical Therapy, such as OLINDA/EXM or IDAC-Dose, account only for radiation dose to organs from radiopharmaceutical taken up in other organs.

PURPOSE

The aim of this study is to present a methodology, that can be applied to any voxelised computational model, able to account for cross-dose to organs from tumors of any shape and number enclosed within an organ.

METHODS

A Geant4 application using hybrid analytical/voxelised geometries has been developed as an extension to the ICRP110_HumanPhantom Geant4 advanced example and validated against ICRP publication 133. In this new Geant4 application, tumors are defined using the Geant4 Parallel Geometry functionality, which allows the co-existence of two independent geometries in the same Monte Carlo simulation. The methodology was validated by estimating total dose to healthy tissue from 90 Y and from 177 Lu distributed within tumors of various sizes localized within the liver of the ICRP110 adult male phantom.

RESULTS

Agreement of the Geant4 application with ICRP133 was within 5% when masses were adjusted for blood content. Total dose to healthy liver and to tumors was found to agree within 1% when compared to the ground truth.

CONCLUSIONS

The methodology presented in this work can be extended to investigate total dose to healthy tissue from systemic uptake of radiopharmaceuticals in tumors of different sizes using any voxelised computational dosimetric model.

An inception network for positron emission tomography based dose estimation in carbon ion therapy

Objective. We aim to evaluate a method for estimating 1D physical dose deposition profiles in carbon ion therapy via analysis of dynamic PET images using a deep residual learning convolutional neural network (CNN). The method is validated using Monte Carlo simulations of 12C ion spread-out Bragg peak (SOBP) profiles, and demonstrated with an experimental PET image. Approach. A set of dose deposition and positron annihilation profiles for monoenergetic 12C ion pencil beams in PMMA are first generated using Monte Carlo simulations. From these, a set of random polyenergetic dose and positron annihilation profiles are synthesised and used to train the CNN. Performance is evaluated by generating a second set of simulated 12C ion SOBP profiles (one 116 mm SOBP profile and ten 60 mm SOBP profiles), and using the trained neural network to estimate the dose profile deposited by each beam and the position of the distal edge of the SOBP. Next, the same methods are used to evaluate the network using an experimental PET image, obtained after irradiating a PMMA phantom with a 12C ion beam at QST’s Heavy Ion Medical Accelerator in Chiba facility in Chiba, Japan. The performance of the CNN is compared to that of a recently published iterative technique using the same simulated and experimental 12C SOBP profiles. Main results. The CNN estimated the simulated dose profiles with a mean relative error (MRE) of 0.7% ± 1.0% and the distal edge position with an accuracy of 0.1 mm ± 0.2 mm, and estimate the dose delivered by the experimental 12C ion beam with a MRE of 3.7%, and the distal edge with an accuracy of 1.7 mm. Significance. The CNN was able to produce estimates of the dose distribution with comparable or improved accuracy and computational efficiency compared to the iterative method and other similar PET-based direct dose quantification techniques.

Microdosimetric investigation for multi-ion therapy by means of silicon on insulator (SOI) microdosimeter

[Objective] Ion radiotherapy with protons or carbon ions is one of the most advanced clinical methods for cancer treatment. To further improve the local tumor control, ion radiotherapy using multiple ion species has been investigated. Due to complexity of dose distributions delivered by multi-ion therapy in a tumor, a validation strategy for the planned treatment efficacy must be established that can be potentially used in the quality assurance (QA) protocol for the multi-ion treatment plans. In previous work, we demonstrated that the microdosimetric approach using the silicon on insulator (SOI) microdosimeter is practical for validating cell surviving fraction of MIA PaCa-2 cells in the independent fields of helium, carbon, oxygen, and neon ion beams. [Approach] This paper extends the previous study, and we demonstrate a microdosimetry based approach as a pilot study to build the QA protocol in the multi-ion therapy predicting the cell surviving fraction along the SOBP obtained by combined irradiations of He+O and C+Ne ions. Across the study, the SOI microdosimeter system MicroPlus was used for measurement of the lineal energy in individual ion fields followed by deriving the lineal energy of combined ion fields delivered by a pencil beam scanning system at HIMAC. [Main results] The predicted cell surviving fraction based on derived lineal energy and dose in the combined fields was in good agreement with the planned cell surviving fraction byour in-house treatment planning system (TPS) [Significance] The presented results indicated the potential benefit of the SOI microdosimeter system MicroPlus as the QA system in the multi-ion radiotherapy.

Characterizing magnetically focused contamination electrons by off-axis irradiation on an inline MRI-Linac

Purpose

The aim of this study is to investigate off‐axis irradiation on the Australian MRI‐Linac using experiments and Monte Carlo simulations. Simulations are used to verify experimental measurements and to determine the minimum offset distance required to separate electron contamination from the photon field.

Methods

Dosimetric measurements were performed using a microDiamond detector, Gafchromic^® EBT3 film, and MOSkin^TM. Three field sizes were investigated including 1.9 × 1.9, 5.8 × 5.8, and 9.7 × 9.6 cm². Each field was offset a maximum distance, approximately 10 cm, from the central magnetic axis (isocenter). Percentage depth doses (PDDs) were collected at a source‐to‐surface distance (SSD) of 1.8 m for fields collimated centrally and off‐axis. PDD measurements were also acquired at isocenter for each off‐axis field to measure electron contamination. Monte Carlo simulations were used to verify experimental measurements, determine the minimum field offset distance, and demonstrate the use of a spoiler to absorb electron contamination.

Results

Off‐axis irradiation separates the majority of electron contamination from an x‐ray beam and was found to significantly reduce in‐field surface dose. For the 1.9 × 1.9, 5.8 × 5.8, and 9.7 × 9.6 cm² field, surface dose was reduced from 120.9% to 24.9%, 229.7% to 39.2%, and 355.3% to 47.3%, respectively. Monte Carlo simulations generally were within experimental error to MOSkin^TM and microDiamond, and used to determine the minimum offset distance, 2.1 cm, from the field edge to isocenter. A water spoiler 2 cm thick was shown to reduce electron contamination dose to near zero.

Conclusions

Experimental and simulation data were acquired for a range of field sizes to investigate off‐axis irradiation on an inline MRI‐Linac. The skin sparing effect was observed with off‐axis irradiation, a feature that cannot be achieved to the same extent with other methods, such as bolusing, for beams at isocenter.

Quantitative analysis of dose-averaged linear energy transfer (LETd ) robustness in pencil beam scanning proton lung plans

PURPOSE

The primary objective of our study was to perform a quantitative robustness analysis of the dose-averaged linear energy transfer (LET_d ) and related RBE-weighted dose in robustly optimized (in terms of the range and set up uncertainties) pencil beam scanning (PBS) proton lung cancer plans.

METHODS

In this study, we utilized the 4DCT data set of six anonymized lung patients. PBS lung plans were generated using a robust optimization technique (range uncertainty: ±3.5% and setup errors: ±5 mm) on the CTV for a total dose of 5000 cGy(RBE) in 5 fractions using RBE of 1.1. For each patient, the LET_d distributions were calculated for the nominal plan and three groups. Group 1: two plan robustness scenarios for range uncertainties of ±3.5%; Group 2: twelve plan robustness scenarios (range uncertainty (±3.5%) in conjunction with setup errors (±5 mm)); and Group 3: ten different breathing phases of the 4DCT data set. RBE-weighted dose to the OARs was evaluated for all robustness scenarios and breathing phases. The variation (∆) in the mean LET_d and mean RBE-weighted dose from each group was recorded.

RESULTS

The mean LET_d in the CTV of nominal PBS lung plans among six patients ranged from 2.2 to 2.6 keV/μm. On average, for the combined range and setup uncertainties, the ∆ in the mean LET_d among 12 scenarios of all six patients was 0.6 keV/μm, which is slightly higher than when only the range uncertainties were considered (0.4 keV/μm). The ∆ in the mean LET_d in a patient was ≤1.7 keV/μm in the heart and ≤1.2 keV/μm in the esophagus and total lung. The ∆ in the mean RBE-weighted dose in a patient was up to 79 cGy for the total lung, 165 cGy for the heart, and 258 cGy for the esophagus. For ten breathing phases, the ∆ in the mean LET_d in a patient was ≤0.3 keV/μm in the CTV, ≤0.5 keV/μm in the heart, ≤0.4 keV/μm in the esophagus, and ≤0.7 keV/μm in the total lung.

CONCLUSION

The addition of setup errors to the range uncertainties resulted in slightly less homogeneous LET_d distributions. The variations in the mean LET_d among ten breathing phases were slightly larger in the total lung than in the heart and esophagus. The combination of setup and range uncertainties had a greater impact than the effect of breathing phases on the variations in the mean RBE-weighted dose to the OARs. Overall, the LET_d distributions in the CTV were less sensitive than those in the OARs to setup errors, range uncertainties, and breathing phases for robustly optimized PBS proton lung cancer plans. This article is protected by copyright. All rights reserved.

A portable magnet for radiation biology and dosimetry studies in magnetic fields

BACKGROUND AND PURPOSE

In the current and rapidly evolving era of real-time MRI-guided radiotherapy, our radiation biology and dosimetry knowledge is being tested in a novel way. This paper presents the successful design and implementation of a portable device used to generate strong localized magnetic fields. These are ideally suited for small scale experiments that mimic the magnetic field environment inside an MRI-linac system, or more broadly MRI-guided particle therapy as well.

MATERIALS AND METHODS

A portable permanent magnet based device employing an adjustable steel yoke and magnetic field focusing cones has been designed, constructed and tested. The apparatus utilises two banks of Nd₂ Fe₁₄ B permanent magnets totalling around 50 kg in mass to generate a strong magnetic field throughout a small volume between two pole tips. The yoke design allows adjustment of the pole tip gap and exchanging of the focusing cones. Further to this, beam portal holes are present in the yoke and focusing cones, allowing for radiation beams of up to 5 x 5 cm² to pass through the region of high magnetic field between the focusing cone tips. Finite element magnetic modelling was performed to design and characterise the performance of the device. Automated physical measurements of the magnetic field components at various locations were measured to confirm the performance. The adjustable pole gap and interchangeable cones allows rapid changing of the experimental set-up to allow different styles of measurements to be performed.

RESULTS

A mostly uniform magnetic field of 1.2 T can be achieved over a volume of at least 3 x 3 x 3 cm³ . This can be reduced in strength to 0.3 T but increased in volume to 10 x 10 x 10 cm³ via removal of the cone tips and/or adjustment of the steel yoke. Although small, these volumes are sufficient to house radiation detectors, cell culture dishes and various phantom arrangements targeted at examining small radiation field dosimetry inside magnetic field strengths that can be changed with ease. Most important is the ability to align the magnetic field both perpendicular to, or inline with the radiation beam. To date, the system has been successfully used to conduct published research in the areas of radiation detector performance, lung phantom dosimetry, and how small clinical electron beams behave in these strong magnetic fields.

CONCLUSIONS

A portable, relatively inexpensive, and simple to operate device has successfully been constructed and used for performing radiation oncology studies around the theme of MRI-guided radiotherapy. This can be in either inline and perpendicular magnetic fields of up to 1.2 T with x-ray and particle beams.

Small spot size versus large spot size: Effect on plan quality for lung cancer in pencil beam scanning proton therapy

Purpose

The purpose of the current study was to evaluate the impact of spot size on the interplay effect, plan robustness, and dose to the organs at risk for lung cancer plans in pencil beam scanning (PBS) proton therapy

Methods

The current retrospective study included 13 lung cancer patients. For each patient, small spot (∼3 mm) plans and large spot (∼8 mm) plans were generated. The Monte Carlo algorithm was used for both robust plan optimization and final dose calculations. Each plan was normalized, such that 99% of the clinical target volume (CTV) received 99% of the prescription dose. Interplay effect was evaluated for treatment delivery starting in two different breathing phases (T0 and T50). Plan robustness was investigated for 12 perturbed scenarios, which combined the isocenter shift and range uncertainty. The nominal and worst‐case scenario (WCS) results were recorded for each treatment plan. Equivalent uniform dose (EUD) and normal tissue complication probability (NTCP) were evaluated for the total lung, heart, and esophagus.

Results

In comparison to large spot plans, the WCS values of small spot plans at CTV D_95%, D_96%, D_97%, D_98%, and D_99% were higher with the average differences of 2.2% (range, 0.3%–3.7%), 2.3% (range, 0.5%–4.0%), 2.6% (range, 0.6%–4.4%), 2.7% (range, 0.9%–5.2%), and 2.7% (range, 0.3%–6.0%), respectively. The nominal and WCS mean dose and EUD for the esophagus, heart, and total lung were higher in large spot plans. The difference in NTCP between large spot and small spot plans was up to 1.9% for the total lung, up to 0.3% for the heart, and up to 32.8% for the esophagus. For robustness acceptance criteria of CTV D_95% ≥ 98% of the prescription dose, seven small spot plans had all 12 perturbed scenarios meeting the criteria, whereas, for 13 large spot plans, there were ≥2 scenarios failing to meet the criteria. Interplay results showed that, on average, the target coverage in large spot plans was higher by 1.5% and 0.4% in non‐volumetric and volumetric repainting plans, respectively.

Conclusion

For robustly optimized PBS lung cancer plans in our study, a small spot machine resulted in a more robust CTV against the setup and range errors when compared to a large spot machine. In the absence of volumetric repainting, large spot PBS lung plans were more robust against the interplay effect. The use of a volumetric repainting technique in both small and large spot PBS lung plans led to comparable interplay target coverage.

Response of SOI microdosimeter in fast neutron beams: experiment and Monte Carlo simulations

In this study, Monte Carlo codes, Geant4 and MCNP6, were used to characterize the fast neutron therapeutic beam produced at iThemba LABS in South Africa. Experimental and simulation results were compared using the latest generation of Silicon on Insulator (SOI) microdosimeters from the Centre for Medical Radiation Physics (CMRP). Geant4 and MCNP6 were able to successfully model the neutron gantry and simulate the expected neutron energy spectrum produced from the reaction by protons bombarding a ⁹Be target. The neutron beam was simulated in a water phantom and its characteristics recorded by the silicon microdosimeters; bare and covered by a ¹⁰B enriched boron carbide converter, at different positions. The microdosimetric quantities calculated using Geant4 and MCNP6 are in agreement with experimental measurements. The thermal neutron sensitivity and production of ¹⁰B capture products in the p+ boron-implanted dopant regions of the Bridge microdosimeter is investigated. The obtained results are useful for the future development of dedicated SOI microdosimeters for Boron Neutron Capture Therapy (BNCT). This paper provides a benchmark comparison of Geant4 and MCNP6 capabilities in the context of further applications of these codes for neutron microdosimetry.

On the evaluation of edgeless diode detectors for patient-specific QA in high-dose stereotactic radiosurgery

PURPOSE

In this work, the potential of an innovative "edgeless" silicon diode was evaluated as a response to the still unmet need of a reliable tool for plan dosimetry verification of very high dose, non-coplanar, patient-specific radiosurgery treatments. In order to prove the effectiveness of the proposed technology, we focused on radiosurgical treatments for functional disease like tremor or pain.

METHODS

The edgeless diodes response has been validated with respect to clinical practice standard detectors by reproducing the reference dosimetry data adopted for the Treatment Planning System. In order to evaluate the potential for radiosurgery patient-specific treatment plan verification, the anthropomorphic phantom Alderson RANDO has been adopted along with three edgeless sensors, one placed in the centre of the Planning Target Volume, one superiorly and one inferiorly.

RESULTS

The reference dosimetry data obtained from the edgeless detectors are within 2.6% for output factor, off-axis ratio and well within 2% for tissue phantom ratio when compared to PTW 60,018 diode. The edgeless detectors measure a dose discrepancy of approximately 3.6% from the mean value calculated by the TPS. Larger discrepancies are obtained in very steep gradient dose regions when the sensors are placed outside the PTV.

CONCLUSIONS

The angular independent edgeless diode is proposed as an innovative dosimeter for patient quality assurance of brain functional disorders and other radiosurgery treatments. The comparison of the diode measurements with TPS calculations confirms that edgeless diodes are suitable candidates for patient-specific dosimetric verification in very high dose ranges delivered by non-isocentric stereotactic radiosurgery modalities.

In-field and out-of-field microdosimetric characterisation of a 62 MeV proton beam at CATANA

PURPOSE

A 5 and 10 μm thin silicon on insulator (SOI) 3D mushroom microdosimeter was used to characterize both the in-field and out-of-field of a 62 MeV proton beam.

METHODS

The SOI mushroom microdosimeter consisted of an array of cylindrical sensitive volumes (SVs), developed by the Centre for Medical Radiation Physics, University of Wollongong, was irradiated with 62 MeV protons at the CATANA (Centro di AdroTerapia Applicazioni Nucleari Avanzate) facility in Catania, Italy, a facility dedicated to the radiation treatment of ocular melanomas. Dose mean lineal energy, ( y D ¯ ), values were obtained at various depths in PMMA along a pristine and spread out Bragg peak (SOBP). The measured microdosimetric spectra at each position were then used as inputs into the modified Microdosimetric Kinetic Model (MKM) to derive the RBE for absorbed dose in a middle of the SOBP 2Gy (RBE_D ). Microdosimetric spectra were obtained with both the 5 and 10 μm 3D SOI microdosimeters, with a focus on the distal part of the BP. The in-field and out-of-field measurement configurations along the Bragg curve were modeled in Geant4 for comparison with experimental results. Lateral out-of-field measurements were performed to study secondary particles' contribution to normal tissue's dose, up to 12 mm from the edge of the beam field, and quality factor and dose equivalent results were obtained.

RESULTS

Comparison between experimental and simulation results showed good agreement between one another for both the pristine and SOBP beams in terms of y D ¯ and RBED. Though a small discrepancy between experiment and simulation was seen at the entrance of the Bragg curve, where experimental results were slightly lower than Geant4. The dose equivalent value measured 12 mm from the edge of the target volume was 1.27 ± 0.15 mSv/Gy with a Q ¯ value of 2.52 ± 0.30, both of which agree within uncertainty with Geant4 simulation.

CONCLUSIONS

These results demonstrate that SOI microdosimeters are an effective tool to predict RBED in-field as well as dose equivalent monitoring out-of-field to provide insight to probability of second cancer generation.

Impact of errors in spot size and spot position in robustly optimized pencil beam scanning proton-based stereotactic body radiation therapy (SBRT) lung plans

Purpose

The purpose of the current study was threefold: (a) investigate the impact of the variations (errors) in spot sizes in robustly optimized pencil beam scanning (PBS) proton‐based stereotactic body radiation therapy (SBRT) lung plans, (b) evaluate the impact of spot sizes and position errors simultaneously, and (c) assess the overall effect of spot size and position errors occurring simultaneously in conjunction with either setup or range errors.

Methods

In this retrospective study, computed tomography (CT) data set of five lung patients was selected. Treatment plans were regenerated for a total dose of 5000 cGy(RBE) in 5 fractions using a single‐field optimization (SFO) technique. Monte Carlo was used for the plan optimization and final dose calculations. Nominal plans were normalized such that 99% of the clinical target volume (CTV) received the prescription dose. The analysis was divided into three groups. Group 1: The increasing and decreasing spot sizes were evaluated for ±10%, ±15%, and ±20% errors. Group 2: Errors in spot size and spot positions were evaluated simultaneously (spot size: ±10%; spot position: ±1 and ±2 mm). Group 3: Simulated plans from Group 2 were evaluated for the setup (±5 mm) and range (±3.5%) errors.

Results

Group 1: For the spot size errors of ±10%, the average reduction in D_99% for −10% and +10% errors was 0.7% and 1.1%, respectively. For −15% and +15% spot size errors, the average reduction in D_99% was 1.4% and 1.9%, respectively. The average reduction in D_99% was 2.1% for −20% error and 2.8% for +20% error. The hot spot evaluation showed that, for the same magnitude of error, the decreasing spot sizes resulted in a positive difference (hotter plan) when compared with the increasing spot sizes. Group 2: For a 10% increase in spot size in conjunction with a −1 mm (+1 mm) shift in spot position, the average reduction in D_99% was 1.5% (1.8%). For a 10% decrease in spot size in conjunction with a −1 mm (+1 mm) shift in spot position, the reduction in D_99% was 0.8% (0.9%). For the spot size errors of ±10% and spot position errors of ±2 mm, the average reduction in D_99% was 2.4%. Group 3: Based on the results from 160 plans (4 plans for spot size [±10%] and position [±1 mm] errors × 8 scenarios × 5 patients), the average D_99% was 4748 cGy(RBE) with the average reduction of 5.0%. The isocentric shift in the superior–inferior direction yielded the least homogenous dose distributions inside the target volume.

Conclusion

The increasing spot sizes resulted in decreased target coverage and dose homogeneity. Similarly, the decreasing spot sizes led to a loss of target coverage, overdosage, and degradation of dose homogeneity. The addition of spot size and position errors to plan robustness parameters (setup and range uncertainties) increased the target coverage loss and decreased the dose homogeneity.

Impact of proton dose calculation algorithms on the interplay effect in PBS proton based SBRT lung plans

Purpose. The purpose of the current study was to investigate the impact of RayStation analytical pencil beam (APB) and Monte Carlo (MC) algorithms on the interplay effect in pencil beam scanning (PBS) proton-based stereotactic body radiation therapy (SBRT) lung plans.Methods. The currentin-silicoplanning study was designed for a total dose of 5000 cGy(RBE) with a fractional dose of 1000 cGy(RBE). First, three sets of nominal plans were generated for each patient: (a) APB optimization followed by APB dose calculation (PB-PB), (b) APB optimization followed by MC dose calculation (PB-MC), and (c) MC optimization followed by MC dose calculation (MC-MC). Second, for each patient, two sets of volumetric repainting plans (five repaintings) - PB-MC_VR5and MC-MC_VR5were generated based on PB-MC and MC-MC, respectively. Dosimetric differences between APB and MC algorithms were calculated on the nominal and interplay dose-volume-histograms (DVHs).Results. Interplay evaluation in non-volumetric repainting plans showed that APB algorithm overestimated the target coverage by up to 8.4% for D_95%and 10.5% for D_99%, whereas in volumetric repainting plans, APB algorithm overestimated by up to 5.3% for D_95%and 7.0% for D_99%. Interplay results for MC calculations showed a decrease in D_95%and D_99%by average differences of 3.5% and 4.7%, respectively, in MC-MC plans and by 1.8% and 3.0% in MC-MC_VR5plans.Conclusion. In PBS proton-based SBRT lung plans, the combination of APB algorithm and interplay effect reduced the target coverage. This may result in inferior local control. The use of MC algorithm for both optimization and final dose calculations in conjunction with the volumetric repainting technique yielded superior target coverage.

The dose magnifying glass quality assurance system for daily proton therapy range verification

Proton therapy has a distinct dosimetric advantage over conventional photon therapy due to its Bragg peak profile. This allows greater accuracy in dose delivery and dose conformation to the target, however it requires greater precision in setup, delivery and for quality assurance (QA) procedures. The AAPM TG 224 report recommends daily range and spot position checks with tolerance on the order of a millimetre. Daily QA systems must therefore be efficient for daily use and be capable of sub-millimetre precision however few suitable commercial systems are available. In this work, a compact, real-time daily QA system is optimised and characterised for proton range verification using an ad-hoc Geant4 simulation. The system is comprised of a monolithic silicon diode array detector embedded in a perspex phantom. The detector is orientated at an angular offset to the incident proton beam to allow range in perspex to be determined for flat proton fields. The accuracy of the system for proton range in perspex measurements was experimentally evaluated over the full range of clinical proton energies. The meanR₁₀₀,R₉₀andR₈₀ranges measured with the system were accurate within ±0.6 mm of simulated ranges in a perspex phantom for all energies assessed. This system allows real-time read-out of individual detector channels also making it appropriate for temporal beam delivery diagnostics and for spot position monitoring along one axis. The system presented provides a suitable, economical and efficient alternative for daily QA in proton therapy.

Investigating volumetric repainting to mitigate interplay effect on 4D robustly optimized lung cancer plans in pencil beam scanning proton therapy

Purpose

The interplay effect between dynamic pencil proton beams and motion of the lung tumor presents a challenge in treating lung cancer patients in pencil beam scanning (PBS) proton therapy. The main purpose of the current study was to investigate the interplay effect on the volumetric repainting lung plans with beam delivery in alternating order (“down” and “up” directions), and explore the number of volumetric repaintings needed to achieve acceptable lung cancer PBS proton plan.

Method

The current retrospective study included ten lung cancer patients. The total dose prescription to the clinical target volume (CTV) was 70 Gy(RBE) with a fractional dose of 2 Gy(RBE). All treatment plans were robustly optimized on all ten phases in the 4DCT data set. The Monte Carlo algorithm was used for the 4D robust optimization, as well as for the final dose calculation. The interplay effect was evaluated for both the nominal (i.e., without repainting) as well as volumetric repainting plans. The interplay evaluation was carried out for each of the ten different phases as the starting phases. Several dosimetric metrics were included to evaluate the worst‐case scenario (WCS) and bandwidth based on the results obtained from treatment delivery starting in ten different breathing phases.

Results

The number of repaintings needed to meet the criteria 1 (CR1) of target coverage (D_95% ≥ 98% and D_99% ≥ 97%) ranged from 2 to 10. The number of repaintings needed to meet the CR1 of maximum dose (ΔD_1% < 1.5%) ranged from 2 to 7. Similarly, the number of repaintings needed to meet CR1 of homogeneity index (ΔHI < 0.03) ranged from 3 to 10. For the target coverage region, the number of repaintings needed to meet CR1 of bandwidth (<100 cGy) ranged from 3 to 10, whereas for the high‐dose region, the number of repaintings needed to meet CR1 of bandwidth (<100 cGy) ranged from 1 to 7. Based on the overall plan evaluation criteria proposed in the current study, acceptable plans were achieved for nine patients, whereas one patient had acceptable plan with a minor deviation.

Conclusion

The number of repaintings required to mitigate the interplay effect in PBS lung cancer (tumor motion < 15 mm) was found to be highly patient dependent. For the volumetric repainting with an alternating order, a patient‐specific interplay evaluation strategy must be adopted. Determining the optimal number of repaintings based on the bandwidth and WCS approach could mitigate the interplay effect in PBS lung cancer treatment.

Estimating the biological effects of helium, carbon, oxygen, and neon ion beams using 3D silicon microdosimeters

In this study, the survival fraction (SF) and relative biological effectiveness (RBE) of pancreatic cancer cells exposed to spread-out Bragg peak helium, carbon, oxygen, and neon ion beams are estimated from the measured microdosimetric spectra using a microdosimeter and the application of the microdosimetric kinetic (MK) model. To measure the microdosimetric spectra, a 3D mushroom silicon-on-insulator microdosimeter connected to low noise readout electronics (MicroPlus probe) was used. The parameters of the MK model were determined for pancreatic cancer cells such that the calculated SFs reproduced previously reported in vitro SF data. For a cuboid target of 10 × 10 × 6 cm³, treatment plans of helium, carbon, oxygen, and neon ion beams were designed using in-house treatment planning software (TPS) to achieve a 10% SF of pancreatic cancer cells throughout the target. The physical doses and microdosimetric spectra of the planned fields were measured at different depths in polymethyl methacrylate phantoms. The biological effects, such as SF, RBE, and RBE-weighted dose at different depths along the fields were predicted from the measurements. The predicted SFs at the target region were generally in good agreement with the planned SF from the TPS in most cases.

Consistency of small-field dosimetry, on and off axis, in beam-matched linacs used for stereotactic radiosurgery

PURPOSE

Stereotactic radiosurgery (SRS) can be delivered with a standard linear accelerator (linac). At institutions having more than one linac, beam matching is common practice. In the literature, there are indications that machine central axis (CAX) matching for broad fields does not guarantee matching of small fields with side ≤2 cm. There is no indication on how matching for broad fields on axis translates to matching small fields off axis. These are of interest to multitarget single-isocenter (MTSI) SRS planning and the present work addresses that gap in the literature.

METHODS

We used 6 MV flattening filter free (FFF) beams from four Elekta VersaHD® linacs equipped with an Agility™ multileaf collimator (MLC). The linacs were strictly matched for broad fields on CAX. We compared output factors (OPFs) and effective field size, measured concurrently using a novel 2D solid-state dosimeter "Duo" with a spatial resolution of 0.2 mm, in square and rectangular static fields with sides from 0.5 to 2 cm, either on axis or away from it by 5 to 15 cm.

RESULTS

Among the four linacs, OPF for fields ≥1 × 1 cm2 ranged 1.3% on CAX, whereas off axis a maximum range of 1.9% was observed at 15 cm. A larger variability in OPF was noted for the 0.5 × 0.5 cm2 field, with a range of 5.9% on CAX, which improved to a maximum of 2.3% moving off axis. Two linacs showed greater consistency with a range of 1.4% on CAX and 2.2% at 15 cm off axis. Between linacs, the effective field size varied by <0.04 cm in most cases, both on and off axis. Tighter matching was observed for linacs with a similar focal spot position.

CONCLUSIONS

Verification of small-field consistency for matched linacs used for SRS is an important task for dosimetric validation. A significant benefit of concurrent measurement of field size and OPF allowed for a comprehensive assessment using a novel diode array. Our study showed the four linacs, strictly matched for broad fields on CAX, were still matched down to a field size of 1 x 1 cm2 on and off axis.

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.

Microdosimetry of a therapeutic proton beam with a mini-TEPC and a MicroPlus-Bridge detector for RBE assessment

Proton beams are widely used worldwide to treat localized tumours, the lower entrance dose and no exit dose, thus sparing surrounding normal tissues, being the main advantage of this treatment modality compared to conventional photon techniques. Clinical proton beam therapy treatment planning is based on the use of a general relative biological effectiveness (RBE) of 1.1 along the whole beam penetration depth, without taking into account the documented increase in RBE at the end of the depth dose profile, in the Bragg peak and beyond. However, an inaccurate estimation of the RBE can cause both underdose or overdose, in particular it can cause the unfavourable situation of underdosing the tumour and overdosing the normal tissue just beyond the tumour, which limits the treatment success and increases the risk of complications. In view of a more precise dose delivery that takes into account the variation of RBE, experimental microdosimetry offers valuable tools for the quality assurance of LET or RBE-based treatment planning systems. The purpose of this work is to compare the response of two different microdosimetry systems: the mini-TEPC and the MicroPlus-Bridge detector. Microdosimetric spectra were measured across the 62 MeV spread out Bragg peak of CATANA with the mini-TEPC and with the Bridge microdosimeter. The frequency and dose distributions of lineal energy were compared and the different contributions to the spectra were analysed, discussing the effects of different site sizes and chord length distributions. The shape of the lineal energy distributions measured with the two detectors are markedly different, due to the different water-equivalent sizes of the sensitive volumes: 0.85 μm for the TEPC and 17.3 μm for the silicon detector. When the Loncol's biological weighting function is applied to calculate the microdosimetric assessment of the RBE, both detectors lead to results that are consistent with biological survival data for glioma U87 cells. Both the mini-TEPC and the MicroPlus-Bridge detector can be used to assess the RBE variation of a 62 MeV modulated proton beam along its penetration depth. The microdosimetric assessment of the RBE based on the Loncol's weighting function is in good agreement with radiobiological results when the 10% biological uncertainty is taken into account.

Advances in modelling gold nanoparticle radiosensitization using new Geant4-DNA physics models

Gold nanoparticles have demonstrated significant radiosensitization of cancer treatment with x-ray radiotherapy. To understand the mechanisms at the basis of nanoparticle radiosensitization, Monte Carlo simulations are used to investigate the dose enhancement, given a certain nanoparticle concentration and distribution in the biological medium. Earlier studies have ordinarily used condensed history physics models to predict nanoscale dose enhancement with nanoparticles. This study uses Geant4-DNA complemented with novel track structure physics models to accurately describe electron interactions in gold and to calculate the dose surrounding gold nanoparticle structures at nanoscale level. The computed dose in silico due to a clinical kilovoltage beam and the presence of gold nanoparticles was related to in vitro brain cancer cell survival using the local effect model. The comparison of the simulation results with radiobiological experimental measurements shows that Geant4-DNA and local effect model can be used to predict cell survival in silico in the case of x-ray kilovoltage beams.

BrachyView: development of an algorithm for real-time automatic LDR brachytherapy seed detection

BrachyView is a novel in-body imaging system developed to provide real-time intraoperative dosimetry for low dose rate prostate brachytherapy treatments. Seed positions can be reconstructed after in-vivo implantation using a high-resolution pinhole gamma camera inserted into the patient rectum. The obtained data is a set of 2D projections of the seeds on the image plane. The 3D reconstruction algorithm requires the identification of the seed's centre of mass. This work presents the development and techniques adopted to build an algorithm that provides the means for fully automatic seed centre of mass identification and 3D position reconstruction for real-time applications. The algorithm presented uses a local feature detector, speeded up robust features, to perform detection of brachytherapy seed 2D projections from images, allowing for robust seed identification. Initial results have been obtained with datasets of 30, 96 and 98 I-125 brachytherapy seeds implanted into a prostate gel phantom. It can detect 97% of seeds and correctly match 97% of seeds. The average overall computation time of 2.75 s per image and improved reconstruction accuracy of 22.87% for the 98 seed dataset was noted. Elimination processes for initial false positive detection removal have shown to be extremely effective, resulting in a 99.9% reduction of false positives, and when paired with automatic frame alignment and subtraction procedures allows for the effective removal of excess counts generated by previously implanted needles. The proposed algorithm will allow the BrachyView system to be used as a real-time intraoperative dosimetry tool for low dose rate prostate brachytherapy treatments.

Impact of magnetic field regulation in conjunction with the volumetric repainting technique on the spot positions and beam range in pencil beam scanning proton therapy

Purpose

The objective of this study was to evaluate the impact of the magnetic field regulation in conjunction with the volumetric repainting technique on the spot positions and range in pencil beam scanning proton therapy.

Methods

“Field regulation” — a feature to reduce the switching time between layers by applying a magnetic field setpoint (instead of a current setpoint) has been implemented on the proton beam delivery system at the Miami Cancer Institute. To investigate the impact of field regulation for the volumetric repainting technique, several spot maps were generated with beam delivery sequence in both directions, that is, irradiating from the deepest layer to the most proximal layer (“down” direction) as well as irradiating from the most proximal layer to the deepest layer (“up” direction). Range measurements were performed using a multi‐layer ionization chamber array. Spot positions were measured using two‐dimensional and three‐dimensional scintillation detectors. For range and central‐axis spot position, spot maps were delivered for energies ranging from 70–225 MeV. For off‐axis spot positions, the maps were delivered for high‐, medium, and low‐energies at eight different gantry angles. The results were then compared between the “up” and “down” directions.

Results

The average difference in range for given energy between “up” and “down” directions was 0.0 ± 0.1 mm. The off‐axis spot position results showed that 846/864 of the spots were within ±1 mm, and all off‐axis spot positions were within ±1.2 mm. For spots (n = 126) at the isocenter, the evaluation between “up” and “down” directions for given energy showed the spot position difference within ±0.25 mm. At the nozzle entrance, the average differences in X and Y positions for given energy were 0.0 ± 0.2 mm and −0.0 ± 0.4 mm, respectively. At the nozzle exit, the average differences in X and Y positions for given energy were 0.0 ± 0.1 mm and −0.1 ± 0.1 mm, respectively.

Conclusion

The volumetric repainting technique in magnetic field regulation mode resulted in acceptable spot position and range differences for our beam delivery system. The range differences were found to be within ±1 mm (TG224). For the spot positions (TG224: ±1 mm), the central axis measurements were within ±1 mm, whereas for the off‐axis measurements, 97.9% of the spots were within ±1 mm, and all spots were within ±1.2 mm.

Parametrization of in-air spot size as a function of energy and air gap for the ProteusPLUS pencil beam scanning proton therapy system

The purpose of this study was to parametrize the in-air one sigma spot size for various energies and air gaps in pencil beam scanning (PBS) proton therapy. The current study included range shifters with a water equivalent thickness (WET) of 40 mm (RS40) and 75 mm (RS75). For RS40, the spot sizes were measured for energies ranging from 80 to 225 MeV in increments of 2.5 MeV, whereas the air gap was varied from 5 to 25 cm in increments of 2.5 cm. For RS75, the spot sizes were measured for energies ranging from 120 to 225 MeV in increments of 2.5 MeV, whereas the air gap was varied from 5 to 35 cm in increments of 2.5 cm. For both RS40 and RS75, all measurements (n = 1090) were acquired at the isocenter using a Lynx 2D scintillation detector. For RS40, the spot sizes increased from 3.1 mm to 10.4 mm, whereas the variation in spot sizes for RS75 ranged from 3.3 mm to 13.1 mm. For each range shifter, an analytical equation demonstrating the relationship of the spot size with the proton energy and air gap was obtained. The best parametrization results were obtained with the 3^rd degree polynomial fits of the energy and air gap parameters. The average difference between the modeled and measured spot sizes was 0.0 ± 0.1 mm (range, - 0.24-0.21 mm) for RS40, and 0.0 ± 0.1 mm (range, - 0.23-0.15 mm) for RS75. In conclusion, the analytical model agrees within ± 0.25 mm of the measured spot sizes on a ProteusPLUS PBS proton system with a PBS dedicated nozzle.

Evaluation of the PTW microDiamond in edge-on orientation for dosimetry in small fields

Purpose

The PTW microDiamond has an enhanced spatial resolution when operated in an edge‐on orientation but is not typically utilized in this orientation due to the specifications of the IAEA TRS‐483 code of practice for small field dosimetry. In this work the suitability of an edge‐on orientation and advantages over the recommended face‐on orientation will be presented.

Methods

The PTW microDiamond in both orientations was compared on a Varian TrueBeam linac for: machine output factor (OF), percentage depth dose (PDD), and beam profile measurements from 10 × 10 cm² to a 0.5 × 0.5 cm² field size for 6X and 6FFF beam energies in a water tank. A quantification of the stem effect was performed in edge‐on orientation along with tissue to phantom ratio (TPR) measurements. An extensive angular dependence study for the two orientations was also undertaken within two custom PMMA plastic cylindrical phantoms.

Results

The OF of the PTW microDiamond in both orientations agrees within 1% down to the 2 × 2 cm² field size. The edge‐on orientation overresponds in the build‐up region but provides improved penumbra and has a maximum observed stem effect of 1%. In the edge‐on orientation there is an angular independent response with a maximum of 2% variation down to a 2 × 2 cm² field. The PTW microDiamond in edge‐on orientation for TPR measurements agreed to the CC01 ionization chamber within 1% for all field sizes.

Conclusions

The microDiamond was shown to be suitable for small field dosimetry when operated in edge‐on orientation. When edge‐on, a significantly reduced angular dependence is observed with no significant stem effect, making it a more versatile QA instrument for rotational delivery techniques.

The impact of sensitive volume thickness for silicon on insulator microdosimeters in hadron therapy

Compact silicon on insulator (SOI) microdosimeters have been used to characterise the radiation field of many different hadron therapy beams. SOI devices are particularly attractive in hadron therapy fields due to their spatial resolution being well suited to the sharp dose gradients at the end of the primary beam's range. Due to the small size of SOI's sensitive volumes (SVs), which are usually  ∼1-10 [Formula: see text]m thick, the fabrication of these devices can present challenges which are not as common for more conventional thickness silicon devices such as silicon spectroscopy detectors. Microdosimetry is the study of the energy deposition in micrometre sized volumes representing biological sites and is a powerful approach to estimate the biological effect of radiation on the micron-scale level, in a cell. However, cell sizes vary extensively translating in different energy deposition spectra. This work studies SV thicknesses between 1 and 100 [Formula: see text]m using Geant4 and examines the impact of SV dimensions on microdosimetric quantities. The quantities studied were the frequency mean lineal energy, [Formula: see text], and the dose mean lineal energy, [Formula: see text]. Additionally the relative biological effectiveness (RBE), estimated by the microdosimetric kinetic model (MKM), is also investigated. To study the impact of the SV thickness, SOI microdosimeters were irradiated with proton, [Formula: see text] and [Formula: see text] ion beams with ranges of  ∼160 mm, with the microdosimeter being set at various positions along the Bragg curve. It was found that [Formula: see text] was influenced the least in proton beams and increased for heavier ion beams. Conversely, [Formula: see text] was impacted by the SV thickness the most in proton beams and [Formula: see text] was the least. Similar to [Formula: see text], protons were impacted the most by the SV thickness when estimating the RBE using the MKM. The cause of these differences was largely due to the different densities of the delta electron track structure for the case of [Formula: see text] and the energy transferred to the medium from the primary beam for [Formula: see text].

Validation of linear energy transfer computed in a Monte Carlo dose engine of a commercial treatment planning system

The relative biological effectiveness (RBE) of protons is highly variable and difficult to quantify. However, RBE is related to the local ionization density, which can be related to the physical measurable dose weighted linear energy transfer (LET_D). The aim of this study was to validate the LET_D calculations for proton therapy beams implemented in a commercially available treatment planning system (TPS) using microdosimetry measurements and independent LET_D calculations (Open-MCsquare (MCS)). The TPS (RayStation v6R) was used to generate treatment plans on the CIRS-731-HN anthropomorphic phantom for three anatomical sites (brain, nasopharynx, neck) for a spherical target (Ø  =  5 cm) with uniform target dose to calculate the LET_D distribution. Measurements were performed at the University Medical Center Groningen proton therapy center (Proteus Plus, IBA) using a µ ⁺-probe utilizing silicon on insulator microdosimeters capable of detecting lineal energies as low as 0.15 keV µm^-1 in tissue. Dose averaged mean lineal energy [Formula: see text] depth-profiles were measured for 70 and 130 MeV spots in water and for the three treatment plans in water and an anthropomorphic phantom. The [Formula: see text] measurements were compared to the LET_D calculated in the TPS and MCS independent dose calculation engine. D · [Formula: see text] was compared to D · LET_D in terms of a gamma-index with a distance-to-agreement criteria of 2 mm and increasing dose difference criteria to determine the criteria for which a 90% pass rate was accomplished. Measurements of D · [Formula: see text] were in good agreement with the D · LET_D calculated in the TPS and MCS. The 90% passing rate threshold was reached at different D · LET_D difference criteria for single spots (TPS: 1% MCS: 1%), treatment plans in water (TPS: 3% MCS: 6%) and treatment plans in an anthropomorphic phantom (TPS: 6% MCS: 1%). We conclude that D · LET_D calculations accuracy in the RayStation TPS and open MCSquare are within 6%, and sufficient for clinical D · LET_D evaluation and optimization. These findings remove an important obstacle in the road towards clinical implementation of D · LET_D evaluation and optimization of proton therapy treatment plans. Novelty and significance The dose weighed linear energy transfer (LET_D) distribution can be calculated for proton therapy treatment plans by Monte Carlo dose engines. The relative biological effectiveness (RBE) of protons is known to vary with the LET_D distribution. Therefore, there exists a need for accurate calculation of clinical LET_D distributions. Previous LET_D validations have focused on general purpose Monte Carlo dose engines which are typically not used clinically. We present the first validation of mean lineal energy [Formula: see text] measurements of the LET_D against calculations by the Monte Carlo dose engines of the Raystation treatment planning system and open MCSquare.

High resolution silicon array detector implementation in an inline MRI-linac

PURPOSE

Dynamic dosimaging is a concept whereby a detector in motion is tracked with magnetic resonance imaging (MRI) to validate the amount and position of dose in a radiation therapy treatment on an MRI-linac. This work takes steps toward the realization of dynamic dosimaging with the novel high resolution silicon array detector: MagicPlate-512 (M512). The performance of the M512 was assessed in a 1.0 T inline MRI-linac, without simultaneous imaging and then during an imaging sequence, both during dosimetry. MR images were acquired to determine the effect of the detector and its components on image quality.

METHODS

Beam profiles were measured using the M512 on the Australian MRI-Linac and a comparison made with Gafchromic EBT3 film to investigate any intrinsic magnetic field effects in the silicon. The M512 has 512 sensitive volumes, each 0.5 × 0.5 × 0.037 mm³ in dimension, organized in a two-dimensional array. Small field sizes up to 4.2 × 3.8 cm² were investigated in both solid water and then solid lung phantoms. Beam profiles taken at 1.0 T were compared to 0 T conditions, and also to profiles taken during a gradient echo (GRE) imaging sequence. Differences in 80%-20% penumbral width and full width at half maximum (FWHM) were investigated. Localizer MR images were acquired of the detector adjacent to a water phantom.

RESULTS

Good agreement was observed between the M512 and film, with average differences in penumbral width and FWHM of <1 mm in the absence of the imaging sequence. Concurrent imaging widened the penumbra by up to 1.2 mm due to RF noise affecting the detector; film profiles were unchanged. Magnetic resonance images were affected by noise, in particular, due to the large amount of aluminum present, as well as from the USB cable, which acted as an antenna. Unfortunately, due to these issues, suitable dynamic dose imaging was not achieved with the current M512/phantom configuration and the MRI-linac. However, progress was made toward achieving this goal for future work.

CONCLUSIONS

The M512 silicon array detector successfully measured high-resolution beam profiles in agreement with Gafchromic film to within an average of <1 mm on the first MRI-linac in Australia. More effective noise reduction will be required for the achievement of dynamic dosimaging in the future.

In vivo dosimetry using MOSkin detector during Cobalt-60 high-dose-rate (HDR) brachytherapy of skin cancer

The MOSkin, a metal-oxide semiconductor field-effect transistor based detector, is suitable for evaluating skin dose due to its water equivalent depth (WED) of 0.07 mm. This study evaluates doses received by target area and unavoidable normal skin during a the case of skin brachytherapy. The MOSkin was evaluated for its feasibility as detector of choice for in vivo dosimetry during skin brachytherapy. A high-dose rate Cobalt-60 brachytherapy source was administered to the tumour located at the medial aspect of the right arm, complicated with huge lymphedema thus limiting the arm motion. The source was positioned in the middle of patients' right arm with supine, hands down position. A 5 mm lead and 5 mm bolus were sandwiched between the medial aspect of the arm and lateral chest to reduce skin dose to the chest. Two calibrated MOSkin detectors were placed on the target and normal skin area for five treatment sessions for in vivo dose monitoring. The mean dose to the target area ranged between 19.9 and 21.1 Gy and was higher in comparison with the calculated dose due to contribution of backscattered dose from lead. The mean measured dose at normal skin chest area was 1.6 Gy (1.3-1.9 Gy), less than 2 Gy per fraction. Total dose in EQD₂ received by chest skin was much lower than the recommended skin tolerance. The MOSkin detector presents a reliable real-time dose measurement. This study has confirmed the applicability of the MOSkin detector in monitoring skin dose during brachytherapy treatment due to its small sensitive volume and WED 0.07 mm.

Validation of a Monte Carlo simulation for Microbeam Radiation Therapy on the Imaging and Medical Beamline at the Australian Synchrotron

Microbeam Radiation Therapy (MRT) is an emerging cancer treatment modality characterised by the use of high-intensity synchrotron-generated x-rays, spatially fractionated by a multi-slit collimator (MSC), to ablate target tumours. The implementation of an accurate treatment planning system, coupled with simulation tools that allow for independent verification of calculated dose distributions are required to ensure optimal treatment outcomes via reliable dose delivery. In this article we present data from the first Geant4 Monte Carlo radiation transport model of the Imaging and Medical Beamline at the Australian Synchrotron. We have developed the model for use as an independent verification tool for experiments in one of three MRT delivery rooms and therefore compare simulation results with equivalent experimental data. The normalised x-ray spectra produced by the Geant4 model and a previously validated analytical model, SPEC, showed very good agreement using wiggler magnetic field strengths of 2 and 3 T. However, the validity of absolute photon flux at the plane of the Phase Space File (PSF) for a fixed number of simulated electrons was unable to be established. This work shows a possible limitation of the G4SynchrotronRadiation process to model synchrotron radiation when using a variable magnetic field. To account for this limitation, experimentally derived normalisation factors for each wiggler field strength determined under reference conditions were implemented. Experimentally measured broadbeam and microbeam dose distributions within a Gammex RMI457 Solid Water® phantom were compared to simulated distributions generated by the Geant4 model. Simulated and measured broadbeam dose distributions agreed within 3% for all investigated configurations and measured depths. Agreement between the simulated and measured microbeam dose distributions agreed within 5% for all investigated configurations and measured depths.

Study on the RBE estimation for carbon beam scanning irradiation using a solid-state microdosimeter

PURPOSE

The purpose of this study was to study the field size effect on the estimated Relative Biological Effectiveness (RBE) for carbon scanning beam irradiation.

METHODS

A silicon-on-insulator (SOI) microdosimeter system developed by the Centre for Medical Radiation Physics, University of Wollongong, Australia, was used for lineal-energy measurements (microdosimetric quantity). The RBE values were derived based on the modified microdosimetric kinetic model (MKM) at different depths in a water phantom in the scanning carbon beam for various scanned areas.

RESULTS

Our study shows that the difference in RBE values derived from the SOI microdosimeter measurements with the MKM model and from the Treatment Planning System (TPS). The difference of the RBE values is within 6.5 % at the peak point of the spread-out Bragg Peak (SOBP) region. Compared to the spot-beam, RBE values obtained in the scanned-beam with a larger scanned area of 1.0 × 1.0 cm² have better agreement with which estimated by the TPS.

CONCLUSIONS

This study shows the possibility of using the SOI microdosimeter system as a quality assurance (QA) tool for RBE evaluation in carbon-pencil beam scanning radiotherapy.

In vivo dosimetry using MOSkin detector during Cobalt-60 high-dose-rate (HDR) brachytherapy of skin cancer

The MOSkin, a metal-oxide semiconductor field-effect transistor based detector, is suitable for evaluating skin dose due to its water equivalent depth (WED) of 0.07 mm. This study evaluates doses received by target area and unavoidable normal skin during a the case of skin brachytherapy. The MOSkin was evaluated for its feasibility as detector of choice for in vivo dosimetry during skin brachytherapy. A high-dose rate Cobalt-60 brachytherapy source was administered to the tumour located at the medial aspect of the right arm, complicated with huge lymphedema thus limiting the arm motion. The source was positioned in the middle of patients' right arm with supine, hands down position. A 5 mm lead and 5 mm bolus were sandwiched between the medial aspect of the arm and lateral chest to reduce skin dose to the chest. Two calibrated MOSkin detectors were placed on the target and normal skin area for five treatment sessions for in vivo dose monitoring. The mean dose to the target area ranged between 19.9 and 21.1 Gy and was higher in comparison with the calculated dose due to contribution of backscattered dose from lead. The mean measured dose at normal skin chest area was 1.6 Gy (1.3-1.9 Gy), less than 2 Gy per fraction. Total dose in EQD₂ received by chest skin was much lower than the recommended skin tolerance. The MOSkin detector presents a reliable real-time dose measurement. This study has confirmed the applicability of the MOSkin detector in monitoring skin dose during brachytherapy treatment due to its small sensitive volume and WED 0.07 mm.

Experimental characterization of magnetically focused electron contamination at the surface of a high-field inline MRI-linac

PURPOSE

The fringe field of the Australian MRI-linac causes contaminant electrons to be focused along the central axis resulting in a high surface dose. This work aims to characterize this effect using Gafchromic film and high-resolution detectors, MOSkin^TM and microDiamond. The secondary aim is to investigate the influence of the inline magnetic field on the relative dose response of these detectors.

METHODS

The Australian MRI-linac has the unique feature that the linac is mounted on rails allowing for measurements to be performed at different magnetic field strengths while maintaining a constant source-to-surface distance (SSD). Percentage depth doses (PDD) were collected at SSD 1.82 m in a solid water phantom positioned in a low magnetic field region and then at isocenter of the MRI where the magnetic field is 1 T. Measurements for a range of field sizes were taken with the MOSkin^TM , microDiamond, and Gafchromic^® EBT3 film. The detectors' relative responses at 1 T were compared to the near 0 T PDD beyond the region of electron contamination, that is, 20 mm depth. The near surface measurements inside the MRI bore were compared among the different detectors.

RESULTS

Skin dose in the MRI, as measured with the MOSkin^TM , was 104.5% for 2.1 × 1.9 cm² , 185.6% for 6.1 × 5.8 cm² , 369.1% for 11.8 × 11.5 cm² , and 711.1% for 23.5 × 23 cm² . The detector measurements beyond the electron contamination region showed agreement between the relative response at 1 T and near 0 T. Film was in agreement with both detectors in this region further demonstrating their relative response is unaffected by the magnetic field.

CONCLUSIONS

Experimental characterization of the high electron contamination at the surface was performed for a range of field sizes. The relative response of MOSkin^TM and microDiamond detectors, beyond the electron contamination region, were confirmed to be unaffected by the 1-T inline magnetic field.

First application of a high-resolution silicon detector for proton beam Bragg peak detection in a 0.95 T magnetic field

PURPOSE

To report on experimental results of a high spatial resolution silicon-based detector exposed to therapeutic quality proton beams in a 0.95 T transverse magnetic field. These experimental results are important for the development of accurate and novel dosimetry methods in future potential real-time MRI-guided proton therapy systems.

METHODS

A permanent magnet device was utilized to generate a 0.95 T magnetic field over a 4 × 20 × 15 cm³ volume. Within this volume, a high-resolution silicon diode array detector was positioned inside a PMMA phantom of 4 × 15 × 12 cm³ . This detector contains two orthogonal strips containing 505 sensitive volumes spaced at 0.2 mm apart. Proton beams collimated to a circle of 10 mm diameter with nominal energies of 90 MeV, 110 MeV, and 125 MeV were incident on the detector from an edge-on orientation. This allows for a measurement of the Bragg peak at 0.2 mm spatial resolution in both the depth and lateral profile directions. The impact of the magnetic field on the proton beams, that is, a small deflection was also investigated. A Geant4 Monte Carlo simulation was performed of the experimental setup to aid in interpretation of the results.

RESULTS

The nominal Bragg peak for each proton energy was successfully observed with a 0.2 mm spatial resolution in the 0.95 T transverse magnetic field in both a depth and lateral profiles. The proton beam deflection (at 0.95 T) was a consistent 2 ±0.5 mm at the center of the magnetic volume for each beam energy. However, a pristine Bragg peak was not observed for each energy. This was caused by the detector packaging having small air gaps between layers of the phantom material surrounding the diode array. These air gaps act to degrade the shape of the Bragg peak, and further to this, the nonwater equivalent silicon chip acts to separate the Bragg peak into multiple peaks depending on the proton path taken. Overall, a promising performance of the silicon detector array was observed, however, with a qualitative assessment rather than a robust quantitative dosimetric evaluation at this stage of development.

CONCLUSIONS

For the first time, a high-resolution silicon-based radiation detector has been used to measure proton beam Bragg peak deflections in a phantom due to a strong magnetic field. Future efforts are required to optimize the detector packaging to strengthen the robustness of the dosimetric quantities obtained from the detector. Such high-resolution silicon diode arrays may be useful in future efforts in MRI-guided proton therapy research.

Two-dimensional solid-state array detectors: A technique for in vivo dose verification in a variable effective area

Purpose

We introduce a technique that employs a 2D detector in transmission mode (TM) to verify dose maps at a depth of d_max in Solid Water. TM measurements, when taken at a different surface‐to‐detector distance (SDD), allow for the area at d_max (in which the dose map is calculated) to be adjusted.

Methods

We considered the detector prototype “MP512” (an array of 512 diode‐sensitive volumes, 2 mm spatial resolution). Measurements in transmission mode were taken at SDDs in the range from 0.3 to 24 cm. Dose mode (DM) measurements were made at d_max in Solid Water. We considered radiation fields in the range from 2 × 2 cm² to 10 × 10 cm², produced by 6 MV flattened photon beams; we derived a relationship between DM and TM measurements as a function of SDD and field size. The relationship was used to calculate, from TM measurements at 4 and 24 cm SDD, dose maps at d_max in fields of 1 × 1 cm² and 4 × 4 cm², and in IMRT fields. Calculations were cross‐checked (gamma analysis) with the treatment planning system and with measurements (MP512, films, ionization chamber).

Results

In the square fields, calculations agreed with measurements to within ±2.36%. In the IMRT fields, using acceptance criteria of 3%/3 mm, 2%/2 mm, 1%/1 mm, calculations had respective gamma passing rates greater than 96.89%, 90.50%, 62.20% (for a 4 cm SSD); and greater than 97.22%, 93.80%, 59.00% (for a 24 cm SSD). Lower rates (1%/1 mm criterion) can be explained by submillimeter misalignments, dose averaging in calculations, noise artifacts in film dosimetry.

Conclusions

It is possible to perform TM measurements at the SSD which produces the best fit between the area at d_max in which the dose map is calculated and the size of the monitored target.

Evaluation of silicon based microdosimetry for Boron Neutron Capture Therapy Quality Assurance

The shift from reactor to accelerator based neutron production has created a renewed interested in Boron Neutron Capture Therapy (BNCT). BNCT is reliant upon the favourable uptake of ¹⁰B by tumour cells along with the interaction with neutrons to produce high LET fragments (He and Li nuclei) that deposit energy locally within the tumour cells. As with any radiation based treatment, Quality Assurance (QA) is crucial. In particular, Geant4 was used to model and optimise the geometry and packaging of Silicon on Insulator (SOI) microdosimeters for BNCT Quality Assurance purposes in view of experimental measurements at the KUR research reactor, in Japan. In this context, design optimisation pertains to the sensitive volume size and probability of neutron activation. This study has shown conclusively that whilst the materials currently used in the fabrication of silicon based microdosimeters are appropriate, there are changes with respect to the sensitive volume thickness that should be addressed to reduce the number of 'stoppers' in the microdosimeter.

The microdosimetric extension in TOPAS: development and comparison with published data

Microdosimetric energy depositions have been suggested as a key variable for the modeling of the relative biological effectiveness (RBE) in proton and ion radiation therapy. However, microdosimetry has been underutilized in radiation therapy. Recent advances in detector technology allow the design of new mico- and nano-dosimeters. At the same time Monte Carlo (MC) simulations have become more widely used in radiation therapy. In order to address the growing interest in the field, a microdosimetric extension was developed in TOPAS. The extension provides users with the functionality to simulate microdosimetric spectra as well as the contribution of secondary particles to the spectra, calculate microdosimetric parameters, and determine RBE with a biological weighting function approach or with the microdosimetric kinetic (MK) model. Simulations were conducted with the extension and the results were compared with published experimental data and other simulation results for three types of microdosimeters, a spherical tissue equivalent proportional counter (TEPC), a cylindrical TEPC and a solid state microdosimeter. The corresponding microdosimetric spectra obtained with TOPAS from the plateau region to the distal tail of the Bragg curve generally show good agreement with the published data.

A feasibility study for high-resolution silicon array detector performance in the magnetic field of a permanent magnet system

PURPOSE

Magnetic field effects on dose distribution and detector functionality must be well understood. The detector utilized to investigate these magnetic field effects was the DUO silicon array detector; the performance of this high spatial resolution detector was assessed under these conditions. The results were compared to Gafchromic EBT3 film to highlight any intrinsic magnetic field effects in the silicon. The results were also compared to previously published MagicPlate-512 (M512) data. The DUO has an improved spatial resolution (200 µm) over the M512 (2 mm).

METHODS

A permanent magnet named Magnetic Apparatus for RaDiation Oncology Studies (MARDOS) paired with a standard linear accelerator (linac) enables either transverse (1.2 T) or inline (0.95 T) orientations of the magnetic field with respect to the radiation beam. A 6 MV Varian 2100C Linac provided the radiation component for the measurements. The DUO detector has 505 sensitive volumes (each volume measuring 800 × 40 × 100 µm³ ) organized in two orthogonal, linear arrays. The DUO was embedded in a solid water phantom in the first set-up and then a solid lung phantom in the second set-up and placed between the magnet cones. Beam profiles were compared under the magnetic field conditions and 0 T. Small field sizes from 0.8 × 0.8 cm² up to 2.3 × 2.3 cm² were investigated. The size of the air gap above the sensitive volumes of the DUO was investigated in the transverse orientation to assess the anticipated magnetic field effects. Full width at half maximum (FWHM), 80-20% penumbral widths and maximum dose differences between detectors and between the presence/absence of a magnetic field were investigated. Symmetry was also assessed for investigation of profile skewness under the transverse field.

RESULTS

The penumbral widths measured by the DUO detector demonstrated good agreement with film and the M512 to within an average of 0.5 mm (within uncertainty: ±1 mm). The static inline magnetic field had minimal effect on the profiles in solid water. As expected, the lower density of solid lung meant that this material was more susceptible to demonstrating magnetic field effects in the dose deposited. The greatest penumbral narrowing due to the inline field (0.7 mm) occurred in lung. Central axis dose increase was greatest in lung (maximum: 9%). The transverse field widened penumbra, most notably in the solid lung phantom, by a maximum of 2.3 mm. The largest asymmetry due to the transverse field (4.6%) was also in solid lung. When the air gap above the DUO was filled with bolus, the dose maximum measured by the DUO was within 1.4% of film.

CONCLUSIONS

The DUO detector has been shown to be successful in accurately describing the dose changes for small field sizes to within a 200-µm resolution in an environment resembling that of an MRI-linac. The DUO measurements were in agreement with both film and the M512 measurements, and therefore the DUO was found to be an appropriate alternative to the M512, with improvement in terms of its higher spatial resolution. MARDOS provided a suitable environment for these preliminary tests before progressing to the MRI-linac.

2D monolithic silicon-diode array detectors in megavoltage photon beams: does the fabrication technology matter? A medical physicist's perspective

A family of prototype 2D monolithic silicon-diode array detectors (MP512, Duo, Octa) has been proposed by the Centre for Medical Radiation Physics, University of Wollongong (Australia) for relative dosimetry in small megavoltage photon beams. These detectors, which differ in the topology of their 512 sensitive volumes, were originally fabricated on bulk p-type substrates. More recently, they have also been fabricated on epitaxial p-type substrates. In the literature, their performance has been individually characterized for quality assurance (QA) applications. The present study directly assessed and compared that of a MP512-bulk and that of a MP512-epitaxial in terms of radiation hardness, long-term stability, response linearity with dose, dose per pulse and angular dependence. Their measurements of output factors, off-axis ratios and percentage depth doses in square radiation fields collimated by the jaws and produced by 6 MV and 10 MV flattened photon beams were then benchmarked against those by commercially available detectors. The present investigation was aimed at establishing, from a medical physicist's perspective, how the bulk and epitaxial fabrication technologies would affect the implementation of the MP512s into a QA protocol. Based on results, the MP512-epitaxial would offer superior radiation hardness, long-term stability and achievable uniformity and reproducibility of the response across the 2D active area.

INVESTIGATING VARIABLE RBE IN A 12C MINIBEAM FIELD WITH MICRODOSIMETRY AND GEANT4

An experimental and simulation-based study was performed on a 12C ion minibeam radiation therapy (MBRT) field produced with a clinical broad beam and a brass multi-slit collimator (MSC). Silicon-on-insulator (SOI) microdosimeters developed at the Centre for Medical Radiation Physics (CMRP) with micron sized sensitive volumes were used to measure the microdosimetric spectra at varying positions throughout the MBRT field and the corresponding dose-mean lineal energies and RBE for 10% cell survival (RBE10) were calculated using the modified Microdosimetric Kinetic Model (MKM). An increase in the average RBE10 of ∼30% and 10% was observed in the plateau region compared to broad beam for experimental and simulation values, respectively. The experimental collimator misalignment was determined to be 0.7° by comparison between measured and simulated microdosimetric spectra at varying collimator angles. The simulated dose-mean lineal energies in the valley region between minibeams were found to be higher on average than in the minibeams due to higher LET particles being produced in these regions from the MSC. This work presents the first experimental microdosimetry measurements and characterisation of the local biological effectiveness in a MBRT field.