Characteristics of the photoneutron contamination present in a high-energy radiotherapy treatment room

The photoneutron contamination arising from a high-energy medical lineal accelerator is calculated using Monte Carlo simulation, as a function of the radiation field size. The information is used to model the neutron propagation in a radiotherapy treatment room and the transmission across concrete mazes. The Monte Carlo code MCNP4C is used to model the main components of a medical lineal accelerator. Simulations were performed to calculate the photoneutron yields and spectra as a function of the radiation field size. The yield of contaminant photoneutrons is observed to increase with the size of the radiation beam, but the energy spectra remain the same, suggesting that the contamination arises from above the movable collimator. The transport of the photoneutrons across a treatment room corroborates the validity of empirical models, but the transmission across a concrete maze produces a dose-equivalent tenth-value layer that differs from previous data.

A Monte Carlo Comparison of Three Different Media for Contrast Enhanced Radiotherapy of the Prostate

Contrast-enhanced radiotherapy makes use of a kilovoltage X-ray beam, either from a diagnostic X-ray tube or modified megavoltage linear accelerator, in conjunction with a high-Z contrast medium deposited into the target volume to enhance the absorption of radiation. In this work, using the Monte Carlo code PENELOPE and the voxelized Zubal phantom to model a prostate radiotherapy treatment, a comparison between the physical absorbed dose distributions rendered by three different enhancing agents namely bismuth, gadolinium, and iodine is performed. It is assumed that there exists a concentration of 10 mg of enhancing agent per 1 g of tissue in the target volume while in the background a concentration of 1.5 mg per 1 g of tissue is present. The X-ray beam energy spectrum was obtained by means of Monte Carlo simulation of a tungsten target upon which a 220 keV mono-energetic electron pencil beam is made to impinge, and the resultant photon beam is heavily filtrated by 0.2 cm of copper. The treatment delivery is simulated as a 360° arc collimated to conform to the target from every direction. Cumulative dose-volume histograms and isodose curves are presented for the target as well as five organs-at-risk, namely rectal wall, bladder, femoral heads, skin, and bone marrow. It is shown that under these conditions clinically acceptable treatment plans are obtained for all three contrast agents. A 72 Gy dose to 100% of the target volume results in maximum absorbed doses to the above mentioned organs-at-risk of 65, 56, 44, 32 and 65 Gy respectively when bismuth is used as the contrast agent, but the results obtained with gadolinium follow closely.

Monte Carlo microdosimetry of188Re- and131I-labelled anti-CD20

The radiolabelled monoclonal antibody anti-CD20 has the property of binding to the CD20 antigen expressed on the cell surface of B-lymphocytes, thus making it a useful tool in the treatment of non-Hodgkin's lymphoma. In this work, the event-by-event Monte Carlo code NOREC is used to calculate the single-event distribution function f(1)(z) in the cell nucleus using the beta spectra of the (188)Re and (131)I radionuclides. The simulated geometry consists of two concentric spheres representing the nucleus and the cell surface embedded in a semi-infinite water medium. An isotropic point source was placed on the cell surface to simulate the binding of the anti-CD20 labelled with either (188)Re or (131)I. The simulations were carried out for two combinations of cell surface and nucleus radii. A method was devised that allows one to calculate the contribution of betas of energy greater than 1 MeV, which cannot be simulated by the NOREC code, to the single-event distribution function. It is shown that disregarding this contribution leads to an overestimation of the frequency-mean specific energy of the order of 9-12%. In general, the antibody radiolabelled with (131)I produces single-event distribution functions that yield higher frequency-mean specific energies.

Monte Carlo modeling of converging small-field contrast-enhanced radiotherapy of prostate

Radiation therapy using a kilovoltage X-ray source to irradiate a target previously loaded with a radiological contrast agent, contrast-enhanced radiotherapy (CERT), has been shown both theoretically and in a preliminary experimental study to represent a potential alternative to high-energy treatments. It has also been shown, however, to produce an integral dose that can be up to twice that resulting from a conventional megavoltage treatment. In this work, using a realistic patient model and Monte Carlo simulation, a CERT prostate treatment plan is designed that makes use of a plurality of small circular beams aimed at the target in such a way as to minimize the radiological trajectory to the target volume. Gold nanoparticles are assumed to be the contrast agent. Two cases are examined, one with a concentration level in the target of 10 mg-Au per gram of tissue and the second with a concentration of 3 mg-Au per gram of tissue in the target. A background concentration of 1 mg of contrast agent per gram of tissue was assumed everywhere else in both cases. The Cimmino feasibility algorithm was then used to find each beam weight in order to obtain the prescribed target dose, set at 72 Gy to 100% of the tumor volume. It is shown that the approach using the small circular fields, a radiosurgery treatment, produces treatment plans with excellent absorbed dose distributions while at the same time it reduces by up to 60% the non-tumor integral dose imparted to the irradiated subject. A brief discussion on the technology necessary to clinically implement this treatment modality is also presented.

Microdosimetry of X-ray-irradiated gold nanoparticles

The use of contrast agents, particularly those made of high atomic number elements like gold nanoparticles, to enhance the X-ray absorption properties of tissue has recently gained attention in the context of radiotherapy treatments. Because these contrast agents alter the secondary electron field in the irradiated medium by adding an Auger electron component, it is necessary to determine the change in the microdosimetric spectra brought about by the incorporation of such agents. Using Monte Carlo simulation, it is shown that the linear energy transfer and the beam quality factor in the vicinity of a gold nanoparticle irradiated with kilovoltage X-ray beams increase substantially when compared with irradiation without the gold nanoparticles present.

Monte Carlo-derived TLD cross-calibration factors for treatment verification and measurement of skin dose in accelerated partial breast irradiation

Monte Carlo simulation was employed to calculate the response of TLD-100 chips under irradiation conditions such as those found during accelerated partial breast irradiation with the MammoSite radiation therapy system. The absorbed dose versus radius in the last 0.5 cm of the treated volume was also calculated, employing a resolution of 20 microm, and a function that fits the observed data was determined. Several clinically relevant irradiation conditions were simulated for different combinations of balloon size, balloon-to-surface distance and contents of the contrast solution used to fill the balloon. The thermoluminescent dosemeter (TLD) cross-calibration factors were derived assuming that the calibration of the dosemeters was carried out using a Cobalt 60 beam, and in such a way that they provide a set of parameters that reproduce the function that describes the behavior of the absorbed dose versus radius curve. Such factors may also prove to be useful for those standardized laboratories that provide postal dosimetry services.

Stereotactic breast irradiation with kilovoltage x-ray beams

The purpose of this work is to determine, using Monte Carlo simulation and a realistic patient model, the characteristics of the resultant absorbed dose distributions when breast tumors are irradiated using small-field stereotactic body radiation therapy (SBRT) with kilovoltage x-ray beams instead of the standard megavoltage energies currently in use. The Rensselaer Polytechnic Institute (RPI) female phantom was used to model a pair of small-field SBRT breast treatments: in one treatment the tumor at depth and another one with the tumor located close to the breast surface. Each treatment consisted of 300 circular beams aimed at the tumor from a plurality of positions. The PENELOPE Monte Carlo code was used to determine the absorbed dose distribution for each beam and subsequently an optimization algorithm determined each beam weight according to a set of prescription goals. Both kilo- and megavoltage beam treatments were modeled, the latter to be used as a reference. Cumulative dose-volume histograms for eleven structures were used to compare the kilovoltage and reference treatments. Integral dose values are also reported. Absorbed dose distributions for the target volumes as well as the organs at risk were within the parameters reported in a clinical trial for both treatments. While for the ipsilateral healthy breast tissue the megavoltage treatment does offer an advantage in terms of less volume irradiated to intermediate doses, for the contralateral structures, breast and lung, the low penetration ability of the kilovoltage treatment results in a lower maximum dose. Skin dose is higher for the kilovoltage treatment but still well within the tolerance limits reported in the clinical trial.

Feasibility of kilovoltage x-ray energy modulation by gaseous media and its application in contrast-enhanced radiotherapy

PURPOSE

To present a method to modulate the energy contents of a kilovoltage x-ray beam that makes use of a gas as the modulating medium. The method is capable of producing arbitrary x-ray spectra by varying the pressure of the modulating gas and the peak kilovoltage (kVp) of the x-ray beams whose energy is being modulated.

METHODS

An aluminum chamber was machined with a 0.5 cm wall thickness, designed to withstand pressures of more than 80 atm. A pressure sensor and electrovalves were used to monitor and regulate the gas pressure. Argon was used as the modulating gas. A CdTe spectrometer was used to measure x-ray spectra for different combinations of kVp and gas pressure, thus obtaining a set of basis x-ray functions. An arbitrary x-ray spectrum can then be formed by the linear combination of such basis functions. In order to show one possible application of the modulation method, a contrast-enhanced radiotherapy prostate treatment was optimized with respect to the x-ray beam energy, without restrictions on the possible shape of the resultant x-ray spectra.

RESULTS

The x-ray spectra basis functions obtained display a smooth and gradual variation of their average energy as a function of the gas pressure for a given kVp, sometimes in the order of 1 or 2 keV. This gradual variation would be difficult to obtain with a conventional aluminum or copper filters, as the change in thickness necessary to reproduce the data presented would be in the order of micrometers, making necessary the use of a large number of such filters. Using the modulation method presented here, the authors were able to reconstruct the optimized x-ray spectra from the measured basis functions, for different optimization objectives.

CONCLUSIONS

A method has been developed that allows for the controlled modulation of the energy contents of kilovoltage x-ray spectra. The method has been shown to be able to reproduce spectra of arbitrary shape, such as those obtained from the optimization of contrast-enhanced radiotherapy. The method may have other applications as well, such as in the precise matching of diagnostic x-ray catalog spectra.

Robotic stereotactic radioablation of breast tumors: Influence of beam size on the absorbed dose distributions

Robotic stereotactic radioablation (RSR) therapy for breast tumors has been shown to be an effective treatment strategy when applied concomitantly with chemotherapy, with the purpose of reducing the tumor volume thus making it more amenable for breast conserving surgery. In this paper we used Monte Carlo simulation within a realistic patient model to determine the influence that the variation in beam collimation radius has on the resultant absorbed dose distributions for this type of treatment. Separate optimized plans were obtained for treatments using 300 circular beams with radii of 0.5 cm, 0.75 cm, 1.0 cm and 1.5 cm. Cumulative dose volume histograms were obtained for the gross, clinical and planning target volumes as well as for eight organs and structures at risk. Target coverage improves as the collimator size is increased, at the expense of increasing the volume of healthy tissue receiving mid-level absorbed doses. Interestingly, it is found that the maximum dose imparted to the skin is highly dependent on collimator size, while the dosimetry of other structures, such as both the ipsilateral and contralateral lung tissue are basically unaffected by a change in beam size.

Gold nanoparticle-enhanced radiotherapy: Dependence of the macroscopic dose enhancement on the microscopic localization of the nanoparticles within the tumor vasculature

In gold nanoparticle-enhanced radiotherapy, intravenously administered nanoparticles tend to accumulate in the tumor tissue by means of the so-called permeability and retention effect and upon irradiation with x-rays, the nanoparticles release a secondary electron field that increases the absorbed dose that would otherwise be obtained from the interaction of the x-rays with tissue alone. The concentration of the nanoparticles in the tumor, number of nanoparticles per unit of mass, which determines the total absorbed dose imparted, can be measured via magnetic resonance or computed tomography images, usually with a resolution of several millimeters. Using a tumor vasculature model with a resolution of 500 nm, we show that for a given concentration of nanoparticles, the dose enhancement that occurs upon irradiation with x-rays greatly depends on whether the nanoparticles are confined to the tumor vasculature or have already extravasated into the surrounding tumor tissue. We show that, compared to the reference irradiation with no nanoparticles present in the tumor model, irradiation with the nanoparticles confined to the tumor vasculature, either in the bloodstream or attached to the inner blood vessel walls, results in a two to three-fold increase in the absorbed dose to the whole tumor model, with respect to an irradiation when the nanoparticles have already extravasated into the tumor tissue. Therefore, it is not enough to measure the concentration of the nanoparticles in a tumor, but the location of the nanoparticles within each volume element of a tumor, be it inside the vasculature or the tumor tissue, needs to be determined as well if an accurate estimation of the resultant absorbed dose distribution, a key element in the success of a radiotherapy treatment, is to be made.

Feasibility of Tc-99 m sestamibi uptake quantification with few-projection emission tomography

BACKGROUND

Molecular breast imaging uses Tc-99 m sestamibi to obtain functional images of the breast. Determining the Tc-99 m sestamibi uptake in volumes of interest in the breast may be useful in assessing the response to neoadjuvant chemotherapy or for the purposes of breast cancer risk assessment.

PURPOSE

To determine, using Monte Carlo simulation, if emission tomography can be used to quantify the uptake of Tc-99 m sestamibi in molecular breast imaging and if so, to determine the accuracy as a function of the number of projections used in the reconstruction process.

METHODS

In this study, two voxelized breast models are implemented with different ratios of fibroglandular to fatty tissue and tumoral masses of varying dimensions. Monte Carlo simulation is used to calculate sets of projections, which assumes that each tumoral mass contains a given Tc-99 m activity. Projections are also calculated for a calibration phantom in order to correlate the known activity with the image pixel value. For each case, the total number of calculated projections is 36 and the reconstruction is carried out for 36, 18, 9, 7 and 5 projections, respectively, using an open source image reconstruction toolbox.

RESULTS

Study data show that determination of Tc-99 m sestamibi uptake with and average error of 7% can be carried out with as little as 7 projections.

CONCLUSIONS

Molecular breast emission tomography enables to accurately determine the Tc-99 m sestamibi tumoral mass uptake with the number of projections very close to the number of images currently acquired in clinical practice.

Influence of the electron energy and number of beams on the absorbed dose distributions in radiotherapy of deep seated targets

With the advent of compact laser-based electron accelerators, there has been some renewed interest on the use of such charged particles for radiotherapy purposes. Traditionally, electrons have been used for the treatment of fairly superficial lesions located at depths of no more than 4cm inside the patient, but lately it has been proposed that by using very high energy electrons, i.e. those with an energy in the order of 200-250MeV it should be possible to safely reach deeper targets. In this paper, we used a realistic patient model coupled with detailed Monte Carlo simulations of the electron transport in such a patient model to examine the characteristics of the resultant absorbed dose distributions as a function of both the electron beam energy as well as the number of beams for a particular type of treatment, namely, a prostate radiotherapy treatment. Each treatment is modeled as consisting of nine, five or three beam ports isocentrically distributed around the patient. An optimization algorithm is then applied to obtain the beam weights in each treatment plan. It is shown that for this particularly challenging case, both excellent target coverage and critical structure sparing can be obtained for energies in the order of 150MeV and for as few as three treatment ports, while significantly reducing the total energy absorbed by the patient with respect to a conventional megavoltage x-ray treatment.