Applications of a patient-specific whole-body CT-mesh hybrid computational phantom in second cancer risk prediction

Objective. CT-mesh hybrid phantoms (or 'hybrid(s)') made from integrated patient CT data and mesh-type reference computational phantoms (MRCPs) can be beneficial for patient-specific whole-body dose evaluation, but this benefit has yet to be evaluated for second cancer risk prediction. The purpose of this study is to compare the hybrid's ability to predict risk throughout the body with a patient-scaled MRCP against ground truth whole-body CTs (WBCTs). Approach. Head and neck active scanning proton treatment plans were created for and simulated on seven hybrids and the corresponding scaled MRCPs and WBCTs. Equivalent dose throughout the body was calculated and input into five second cancer risk models for both excess absolute and excess relative risk (EAR and ERR). The hybrid phantom was evaluated by comparing equivalent dose and risk predictions against the WBCT. Main results. The hybrid most frequently provides whole-body second cancer risk predictions which are closer to the ground truth when compared to a scaled MRCP alone. The performance of the hybrid relative to the scaled MRCP was consistent across ERR, EAR, and all risk models. For all in-field organs, where the hybrid shares the WBCT anatomy, the hybrid was better than or equal to the scaled MRCP for both equivalent dose and risk prediction. For out-of-field organs across all patients, the hybrid's equivalent dose prediction was superior than the scaled MRCP in 48% of all comparisons, equivalent for 34%, and inferior for 18%. For risk assessment in the same organs, the hybrid's prediction was superior than the scaled MRCP in 51.8% of all comparisons, equivalent in 28.6%, and inferior in 19.6%. Significance. Whole-body risk predictions from the CT-mesh hybrid have shown to be more accurate than those from a reference phantom alone. These hybrids could aid in risk-optimized treatment planning and individual risk assessment to minimize second cancer incidence

Electron dosimetry in human skin: a reliability assessment of simulation scenarios

The feasibility and reliability of Geant4-based simulation of human skin irradiation by low energy electrons (up to a few MeV) are reviewed, with emphasis on physics validation and the generation of a dedicated phantom for the simulation of Total Skin Electron Therapy

Implications of using a 50-μm-thick skin target layer in skin dose coefficient calculation for photons, protons, and helium ions

In a previous study, a set of polygon-mesh (PM)-based skin models including a 50-μm-thick radiosensitive target layer were constructed and used to calculate skin dose coefficients (DCs) for idealized external beams of electrons. The results showed that the calculated skin DCs were significantly different from the International Commission on Radiological Protection (ICRP) Publication 116 skin DCs calculated using voxel-type ICRP reference phantoms that do not include the thin target layer. The difference was as large as 7,700 times for electron energies less than 1 MeV, which raises a significant issue that should be addressed subsequently. In the present study, therefore, as an extension of the initial, previous study, skin DCs for three other particles (photons, protons, and helium ions) were calculated by using the PM-based skin models and the calculated values were compared with the ICRP-116 skin DCs. The analysis of our results showed that for the photon exposures, the calculated values were generally in good agreement with the ICRP-116 values. For the charged particles, by contrast, there was a significant difference between the PM-model-calculated skin DCs and the ICRP-116 values. Specifically, the ICRP-116 skin DCs were smaller than those calculated by the PM models—which is to say that they were underestimated—by up to ∼16 times for both protons and helium ions. These differences in skin dose also significantly affected the calculation of the effective dose (E) values, which is reasonable, considering that the skin dose is the major factor determining effective dose calculation for charged particles. The results of the current study generally show that the ICRP-116 DCs for skin dose and effective dose are not reliable for charged particles

Dose coefficients of mesh-type ICRP reference computational phantoms for idealized external exposures of photons and electrons

In the present study, we established a comprehensive dataset of dose coefficients (DCs) of the new mesh-type ICRP reference computational phantoms (MRCPs) for idealized external exposures of photons and electrons with the Geant4 code. Subsequently, the DCs for the nine organs/tissues, calculated for their thin radiosensitive target regions, were compared with the values calculated by averaging the absorbed doses over the entire organ/tissue regions to observe the influence of the thin sensitive regions on dose calculations. The result showed that the influences for both photons and electrons were generally insignificant for the majority of organs/tissues, but very large for the skin and eye lens, especially for electrons. Furthermore, the large influence for the skin eventually affected the effective dose calculations for electrons. The DCs of the MRCPs also were compared with the current ICRP-116 values produced with the current ICRP-110 reference phantoms. The result showed that the DCs for the majority of organs/tissues and effective dose were generally similar to the ICRP-116 values for photons, except for very low energies; however, for electrons, significant differences from the ICRP-116 values were found in the DCs, particularly for superficial organs/tissues and skeletal tissues, and also for effective dose. Keywords: Dose coefficients, ICRP, Reference phantoms, Mesh, Monte Carlo, Geant

A patient-specific hybrid phantom for calculating radiation dose and equivalent dose to the whole body

Objective. As cancer survivorship increases, there is growing interest in minimizing the late effects of radiation therapy such as radiogenic second cancer, which may occur anywhere in the body. Assessing the risk of late effects requires knowledge of the dose distribution throughout the whole body, including regions far from the treatment field, beyond the typical anatomical extent of clinical computed tomography (CT) scans. Approach. A hybrid phantom was developed which consists of in-field patient CT images extracted from ground truth whole-body CT scans, out-of-field mesh phantoms scaled to basic patient measurements, and a blended transition region. Four of these hybrid phantoms were created, representing male and female patients receiving proton therapy treatment in pelvic and cranial sites. To assess the performance of the hybrid approach, we simulated treatments using the hybrid phantoms, the scaled and unscaled mesh phantoms, and the ground truth whole-body CTs. We calculated absorbed dose and equivalent dose in and outside of the treatment field, with a focus on neutrons induced in the patient by proton therapy. Proton and neutron dose was calculated using a general purpose Monte Carlo code. Main results. The hybrid phantom provided equal or superior accuracy in calculated organ dose and equivalent dose values relative to those obtained using the mesh phantoms in 78% in all selected organs and calculated dose quantities. Comparatively the default mesh and scaled mesh were equal or superior to the other phantoms in 21% and 28% of cases respectively. Significance. The proposed methodology for hybrid synthesis provides a tool for whole-body organ dose estimation for individual patients without requiring CT scans of their entire body. Such a capability would be useful for personalized assessment of late effects and risk-optimization of treatment plans

New thyroid models for ICRP pediatric mesh-type reference computational phantoms

As part of the ICRP Task Group 103 project, we developed ten thyroid models for the pediatric mesh-type reference computational phantoms (MRCPs). The thyroid is not only a radiosensitive target organ needed for effective dose calculation but an important source region particularly for radioactive iodines. The thyroid models for the pediatric MRCPs were constructed by converting those of the pediatric voxel-type reference computational phantoms (VRCPs) in ICRP Publication 143 to a high-quality mesh format, faithfully maintaining their original topology. At the same time, we improved several anatomical parameters of the thyroid models for the pediatric MRCPs, including the mass, overlying tissue thickness, location, and isthmus dimensions. Absorbed doses to the thyroid for the pediatric MRCPs for photon external exposures were calculated and compared with those of the pediatric VRCPs, finding that the differences between the MRCPs and VRCPs were not significant except for very low energies (<0.03 MeV). Specific absorbed fractions (target ← thyroid) for photon internal exposures were also compared, where significant differences were frequently observed especially for the target organs/tissues close to the thyroid (e.g., a factor of ∼1.2–∼327 for the thymus as a target) due mainly to anatomical improvement of the MRCP thyroid models