FRoG: a fast robust analytical dose engine on GPU for p, 4He, 12C and 16O particle therapy

Radiotherapy with protons and heavier ions landmarks a novel era in the field of highprecision cancer therapy. To identify patients most benefiting from this technologically demanding therapy, fast assessment of comparative treatment plans utilizing different ion species is urgently needed. Moreover, to overcome uncertainties of actual in-vivo physical dose distribution and biological effects elicited by different radiation qualities, development of a reliable high-throughput algorithm is required. To this end, we engineered a unique graphics processing unit (GPU) based software architecture allowing rapid and robust dose calculation. Fast dose Recalculation on GPU (FRoG) currently operates with four particle beams, i.e., raster-scanning proton, helium, carbon and oxygen ions. Designed to perform fast and accurate calculations for both physical and biophysical quantities, FRoG operates an advanced analytical pencil beam algorithm using parallelized procedures on a GPU. Clinicians and medical physicists can assess both dose and dose-averaged linear energy transfer (LET) distributions for proton therapy (and in turn effective dose by applying variable RBE schemes) to further scrutinize plans for acceptance or potential re-planning purposes within minutes. In addition, various biological model predictions are readily accessible for heavy ion therapy, such as the local effect model (LEM) and microdosimetric kinetic model (MKM). FRoG has been extensively benchmarked against gold standard Monte Carlo simulations and experimental data. Evaluating against commercial treatment planning systems demonstrates the strength of FRoG in better predicting dose distributions in complex clinical settings. In preparation for the upcoming translation of novel ions, case-/disease-specific ion-beam selection and advanced multi-particle treatment modalities at the Heidelberg Ion-beam Therapy Center (HIT), we quantified the accuracy limits in particle therapy treatment planning under complex heterogeneous conditions for the four ions (p, 4He, 12C, 16O) for various dose engines, both analytical algorithms and Monte Carlo code. Devised in-house, FRoG landmarks the first GPU-based treatment planning system (non commercial) for raster-scanning 4He ion beams, with an official treatment program set for early 2020. Since its inception, FRoG has been installed and is currently in operation clinically at four centers across Europe: HIT (Heidelberg, Germany), CNAO (Pavia, Italy) , Aarhus (Denmark) and the Normandy Proton Therapy Center (Caen, France). Here, the development and validation of FRoG as well as clinical investigations and advanced topics in particle therapy dose calculation are covered. The thesis is presented in cumulative format and comprises four peer reviewed publications

Clinical commissioning of intensity-modulated proton therapy systems: Report of AAPM Task Group 185

Proton therapy is an expanding radiotherapy modality in the United States and worldwide. With the number of proton therapy centers treating patients increasing, so does the need for consistent, high-quality clinical commissioning practices. Clinical commissioning encompasses the entire proton therapy system\u27s multiple components, including the treatment delivery system, the patient positioning system, and the image-guided radiotherapy components. Also included in the commissioning process are the x-ray computed tomography scanner calibration for proton stopping power, the radiotherapy treatment planning system, and corresponding portions of the treatment management system. This commissioning report focuses exclusively on intensity-modulated scanning systems, presenting details of how to perform the commissioning of the proton therapy and ancillary systems, including the required proton beam measurements, treatment planning system dose modeling, and the equipment needed

Line focus x-ray tubes-a new concept to produce high brilliance x-rays.

Currently hard coherent x-ray radiation at high photon fluxes can only be produced with large and expensive radiation sources, such as 3[Formula: see text] generation synchrotrons. Especially in medicine, this limitation prevents various promising developments in imaging and therapy from being translated into clinical practice. Here we present a new concept of highly brilliant x-ray sources, line focus x-ray tubes (LFXTs), which may serve as a powerful and cheap alternative to synchrotrons and a range of other existing technologies. LFXTs employ an extremely thin focal spot and a rapidly rotating target for the electron beam which causes a change in the physical mechanism of target heating, allowing higher electron beam intensities at the focal spot. Monte Carlo simulations and numeric solutions of the heat equation are used to predict the characteristics of the LFXT. In terms of photon flux and coherence length, the performance of the line focus x-ray tube compares with inverse Compton scattering sources. Dose rates of up to 180 Gy [Formula: see text] can be reached in 50 cm distance from the focal spot. The results demonstrate that the line focus tube can serve as a powerful compact source for phase contrast imaging and microbeam radiation therapy. The production of a prototype seems technically feasible

Monte Carlo simulation studies for spatially fractionated radiation therapy techniques

The purpose of this work was to evaluate the possible gain in tissue sparing in hadrontherapy when a spatial fractionation of the dose is used. Monte Carlo simulations (GATE v.6) have been used as a method to assess the dose distributions in a cylindrical water phantom (16 cm height and 16 cm of diameter). The phantom was irradiated with carbon and oxygen minibeams of 0.7 mm of beam width, and with protons in a grid geometry configuration. Several centre-to-centre distances, covering a 2 x 2 cm2 area, have been taken into account. The ratio of the peak-to-valley doses (PVDR) and the penumbrae was used as evaluation parameter, since PVDR is considered to be a very relevant dosimetric parameter for tissue sparing. Extremely high PVDRs values and very narrow penumbrae were obtained in all depths. This means that this new way of dose delivery might allow the use of higher and potentially curative doses in clinical cases where tissue tolerances are a limit to achieve a curative treatment. The high PVDR obtained and the small penumbrae in comparison with existing radiosurgery techniques, suggest a potential gain in healthy tissue sparing in those new techniques