Nuclear halo of a 177 MeV proton beam in water: theory, measurement and parameterization

The dose distribution of a monoenergetic pencil beam in water consists of an electromagnetic "core", a "halo" from charged nuclear secondaries, and a much larger "aura" from neutral secondaries. These regions overlap, but each has distinct spatial characteristics. We have measured the core/halo using a 177MeV test beam offset in a water tank. The beam monitor was a fluence calibrated plane parallel ionization chamber (IC) and the field chamber, a dose calibrated Exradin T1, so the dose measurements are absolute (MeV/g/p). We performed depth-dose scans at ten displacements from the beam axis ranging from 0 to 10cm. The dose spans five orders of magnitude, and the transition from halo to aura is clearly visible. We have performed model-dependent (MD) and model-independent (MI) fits to the data. The MD fit separates the dose into core, elastic/inelastic nuclear, nonelastic nuclear and aura terms, and achieves a global rms measurement/fit ratio of 15%. The MI fit uses cubic splines and the same ratio is 9%. We review the literature, in particular the use of Pedroni's parametrization of the core/halo. Several papers improve on his Gaussian transverse distribution of the halo, but all retain his T(w), the radial integral of the depth-dose multiplying both the core and halo terms and motivating measurements with large "Bragg peak chambers" (BPCs). We argue that this use of T(w), which by its definition includes energy deposition by nuclear secondaries, is incorrect. T(w) should be replaced in the core term, and in at least part of the halo, by a purely electromagnetic mass stopping power. BPC measurements are unnecessary, and irrelevant to parameterizing the pencil beam.Comment: 55 pages, 4 tables, 29 figure

Opportunities and limitations of multileaf collimator based intensity modulated proton therapy

The vast majority of proton therapy institutes employ passive scattering beamlines. Treatments are delivered by means of laterally and distally conformed homogeneous dose distributions for each beam direction by utilizing spread-out Bragg peaks and custom milled hardware. Most newly built proton facilities rely upon scanned proton beams to provide intensity modulated therapy (IMPT), improvements in treatment planning and delivery workflow. This thesis investigates the benefits of IMPT in fixed proton therapy beamlines and describes aspects of multileaf collimator (MLC) based IMPT delivery. We show that IMPT has the potential to increase the range of applications for fixed proton therapy beamlines. A method for sequencing intensity modulated treatment plans into a set of segments is presented and evaluated based on results obtained for a set of clinical situations. The resulting numbers of segments made delivery technically and logistically feasible. Neutron dose was found acceptable given a well optimized beamline. The dosimetric properties of one specific multileaf collimator were investigated experimentally and compared to custom milled apertures. Small differences were found, but those are clinically insignificant in the vast majority of clinical cases. Finally, an extensive set of measurements for accurate determination of the peak dose as a function of field size is described

A Novel Proton Pencil Beam Scanning Technique for Postmastectomy Chest Wall Irradiation

Abstract of paper presented at the American Society for Radiation Oncology 56th Annual Meeting, San Francisco, United States, 14 - 17 September 2014

Immobilization precision of a modified GTC frame

The purpose of this study was to evaluate and quantify the interfraction reproducibility and intrafraction immobilization precision of a modified GTC frame. The error of the patient alignment and imaging systems were measured using a cranial skull phantom, with simulated, predetermined shifts. The kV setup images were acquired with a room‐mounted set of kV sources and panels. Calculated translations and rotations provided by the computer alignment software relying upon three implanted fiducials were compared to the known shifts, and the accuracy of the imaging and positioning systems was calculated. Orthogonal kV setup images for 45 proton SRT patients and 1002 fractions (average 22.3 fractions/patient) were analyzed for interfraction and intrafraction immobilization precision using a modified GTC frame. The modified frame employs a radiotransparent carbon cup and molded pillow to allow for more treatment angles from posterior directions for cranial lesions. Patients and the phantom were aligned with three 1.5 mm stainless steel fiducials implanted into the skull. The accuracy and variance of the patient positioning and imaging systems were measured to be 0.10±0.06 mm, with the maximum uncertainty of rotation being ±0.07°.957 pairs of interfraction image sets and 974 intrafraction image sets were analyzed. 3D translations and rotations were recorded. The 3D vector interfraction setup reproducibility was 0.13 mm ±1.8 mm for translations and the largest uncertainty of ±1.07° for rotations. The intrafraction immobilization efficacy was 0.19 mm ±0.66 mm for translations and the largest uncertainty of ±0.50° for rotations. The modified GTC frame provides reproducible setup and effective intrafraction immobilization, while allowing for the complete range of entrance angles from the posterior direction. PACS number: 87.53.Ly, 87.55.Q

A novel approach to postmastectomy radiation therapy using scanned proton beams

Purpose: Postmastectomy radiation therapy (PMRT), currently offered at Massachusetts General Hospital, uses proton pencil beam scanning (PBS) with intensity modulation, achieving complete target coverage of the chest wall and all nodal regions and reduced dose to the cardiac structures. This work presents the current methodology for such treatment and the ongoing effort for its improvements. Methods and Materials: A single PBS field is optimized to ensure appropriate target coverage and heart/lung sparing, using an in-house-developed proton planning system with the capability of multicriteria optimization. The dose to the chest wall skin is controlled as a separate objective in the optimization. Surface imaging is used for setup because it is a suitable surrogate for superficial target volumes. In order to minimize the effect of beam range uncertainties, the relative proton stopping power ratio of the material in breast implants was determined through separate measurements. Phantom measurements were also made to validate the accuracy of skin dose calculation in the treatment planning system. Additionally, the treatment planning robustness was evaluated relative to setup perturbations and patient breathing motion. Results: PBS PMRT planning resulted in appropriate target coverage and organ sparing, comparable to treatments by passive scattering (PS) beams but much improved in nodal coverage and cardiac sparing compared to conventional treatments by photon/electron beams. The overall treatment time was much shorter than PS and also shorter than conventional photon/electron treatment. The accuracy of the skin dose calculation by the planning system was within ±2%. The treatment was shown to be adequately robust relative to both setup uncertainties and patient breathing motion, resulting in clinically satisfying dose distributions. Conclusions: More than 25 PMRT patients have been successfully treated at Massachusetts General Hospital by using single-PBS fields. The methodology and robustness of both the setup and the treatment have been discussed