Dosimetric evidence confirms computational model for magnetic field induced dose distortions of therapeutic proton beams

Given the sensitivity of proton therapy to anatomical variations, this cancer treatment modality is expected to benefit greatly from integration with magnetic resonance (MR) imaging. One of the obstacles hindering such an integration are strong magnetic field induced dose distortions. These have been predicted in simulation studies, but no experimental validation has been performed so far. Here we show the first measurement of planar distributions of dose deposited by therapeutic proton pencil beams traversing a one-Tesla transversal magnetic field while depositing energy in a tissue-like phantom using film dosimetry. The lateral beam deflection ranges from one millimeter to one centimeter for 80 to 180 MeV beams. Simulated and measured deflection agree within one millimeter for all studied energies. These results proof that the magnetic field induced proton beam deflection is both measurable and accurately predictable. This demonstrates the feasibility of accurate dose measurement and hence validates dose predictions for the framework of MR-integrated proton therapy

An MLE method for finding LKB NTCP model parameters using Monte Carlo uncertainty estimates

The aims of this work were to establish a program to fit NTCP models to clinical data with multiple toxicity endpoints, to test the method using a realistic test dataset, to compare three methods for estimating confidence intervals for the fitted parameters and to characterise the speed and performance of the program

Magnetization curves of sintered heavy tungsten alloys for applications in MRI-guided radiotherapy

Purpose: Due to the current interest in MRI-guided radiotherapy, the magnetic properties of the materials commonly used in radiotherapy are becoming increasingly important. In this paper, mea- surement results for the magnetization (BH) curves of a range of sintered heavy tungsten alloys used in radiation shielding and collimation are presented. Methods: Sintered heavy tungsten alloys typically contain \u3e 90% tungsten and \u3c 10% of a combina- tion of iron, nickel, and copper binders. Samples of eight different grades of sintered heavy tungsten alloys with varying binder content were investigated. Using a superconducting quantum interference detector magnetometer, the induced magnetic moment m was measured for each sample as a function of applied external field H0and the BH curve derived. Results: The iron content of the alloys was found to play a dominant role, directly influencing the magnetization M and thus the nonlinearity of the BH curve. Generally, the saturation magnetization increased with increasing iron content of the alloy. Furthermore, no measurable magnetization was found for all alloys without iron content, despite containing up to 6% of nickel. For two samples from different manufacturers but with identical quoted nominal elemental composition (95% W, 3.5% Ni, 1.5% Fe), a relative difference in the magnetization of 11%–16% was measured. Conclusions: The measured curves show that the magnetic properties of sintered heavy tungsten alloys strongly depend on the iron content, whereas the addition of nickel in the absence of iron led to no measurable effect. Since a difference in the BH curves for two samples with identical quoted nominal composition from different manufacturers was observed, measuring of the BH curve for each individual batch of heavy tungsten alloys is advisable whenever accurate knowledge of the magnetic properties is crucial. The obtained BH curves can be used in FEM simulations to predict the magnetic impact of sintered heavy tungsten alloys

On the use of a convolution-superposition algorithm for plan checking in lung stereotactic body radiation therapy

Stereotactic body radiation therapy (SBRT) aims to deliver a highly conformal ablative dose to a small target. Dosimetric verification of SBRT for lung tumors presents a challenge due to heterogeneities, moving targets, and small fields. Recent software (M3D) designed for dosimetric verification of lung SBRT treatment plans using an advanced convolution–superposition algorithm was evaluated. Ten lung SBRT patients covering a range of tumor volumes were selected. 3D CRT plans were created using the XiO treatment planning system (TPS) with the superposition algorithm. Dose was recalculated in the Eclipse TPS using the AAA algorithm, M3D verification software using the collapsed-cone-convolution algorithm, and in-house Monte Carlo (MC). Target point doses were calculated with RadCalc software. Near-maximum, median, and near-minimum target doses, conformity indices, and lung doses were compared with MC as the reference calculation. M3D 3D gamma passing rates were compared with the XiO and Eclipse. Wilcoxon signed-rank test was used to compare each calculation method with XiO with a threshold of significance of p \u3c 0.05. M3D and RadCalc point dose calculations were greater than MC by up to 7.7% and 13.1%, respectively, with M3D being statistically significant (s.s.). AAA and XiO calculated point doses were less than MC by 11.3% and 5.2%, respectively (AAA s.s.). Median and near-minimum and near-maximum target doses were less than MC when calculated with AAA and XiO (all s.s.). Near-maximum and median target doses were higher with M3D compared with MC (s.s.), but there was no difference in near-minimum M3D doses compared with MC. M3D-calculated ipsilateral lung V20 Gy and V5 Gy were greater than that calculated with MC (s.s.); AAA- and XiO-calculated V20 Gy was lower than that calculated with MC, but not statistically different to MC for V5 Gy. Nine of the 10 plans achieved M3D gamma passing rates greater than 95% and 80%for 5%/1 mm and 3%/1 mm criteria, respectively. M3D typically calculated a higher target and lung dose than MC for lung SBRT plans. The results show a range of calculated doses with different algorithms and suggest that M3D is in closer agreement with Monte Carlo, thus discrepancies between the TPS and M3D software will be observed for lung SBRT plans. M3D provides a useful supplement to verification of lung SBRT plans by direct measurement, which typically excludes patient specific heterogeneities

Introduction to the geant4 simulation toolkit

Geant4 is a Monte Carlo simulation Toolkit, describing the interactions of particles with matter. Geant4 is widely used in radiation physics research, from High Energy Physics, to medical physics and space science, thanks to its sophisticated physics component, coupled with advanced functionality in geometry description. Geant4 is widely used at the Centre for Medical Radiation Physics (CMRP), at the University of Wollongong, to characterise and optimise novel detector concepts, radiotherapy treatments, and imaging solutions. This lecture consists of an introduction to Monte Carlo method, and to Geant4. Particular attention will be devoted to the Geant4 physics component, and to the physics models describing electromagnetic and hadronic physics interactions. The second part of the lecture will be focused on the methodology to adopt to develop a Geant4 simulation application

IMRT treatment Monitor Unit verification using absolute calibrated BEAMnrc and Geant4 Monte Carlo simulations

Intensity Modulated Radiation Therapy (IMRT) treatments are some of the most complex being delivered by modern megavoltage radiotherapy accelerators. Therefore verification of the dose, or the presecribed Monitor Units (MU), predicted by the planning system is a key element to ensuring that patients should receive an accurate radiation dose plan during IMRT. One inherently accurate method is by comparison with absolute calibrated Monte Carlo simulations of the IMRT delivery by the linac head and corresponding delivery of the plan to a patient based phantom. In this work this approach has been taken using BEAMnrc for simulation of the treatment head, and both DOSXYZnrc and Geant4 for the phantom dose calculation. The two Monte Carlo codes agreed to within 1% of each other, and these matched very well to our planning system for IMRT plans to the brain, nasopharynx, and head and neck. Published under licence by IOP Publishing Ltd

Electron contamination modeling and skin dose in 6 MV longitudinal field MRIgRT: Impact of the MRI and MRI fringe field

PURPOSE: In recent times, longitudinal field MRI-linac systems have been proposed for 6 MV MRI-guided radiotherapy (MRIgRT). The magnetic field is parallel with the beam axis and so will alter the transport properties of any electron contamination particles. The purpose of this work is to provide a first investigation into the potential effects of the MR and fringe magnetic fields on the electron contamination as it is transported toward a phantom, in turn, providing an estimate of the expected patient skin dose changes in such a modality. METHODS: Geant4 Monte Carlo simulations of a water phantom exposed to a 6 MV x-ray beam were performed. Longitudinal magnetic fields of strengths between 0 and 3 T were applied to a 30 × 30 × 20 cm(3) phantom. Surrounding the phantom there is a region where the magnetic field is at full MRI strength, consistent with clinical MRI systems. Beyond this the fringe magnetic field entering the collimation system is also modeled. The MRI-coil thickness, fringe field properties, and isocentric distance are varied and investigated. Beam field sizes of 5 × 5, 10 × 10, 15 × 15 and 20 × 20 cm(2) were simulated. Central axis dose, 2D virtual entry skin dose films, and 70 μm skin depth doses were calculated using high resolution scoring voxels. RESULTS: In the presence of a longitudinal magnetic field, electron contamination from the linear accelerator is encouraged to travel almost directly toward the patient surface with minimal lateral spread. This results in a concentration of electron contamination within the x-ray beam outline. This concentration is particularly encouraged if the fringe field encompasses the collimation system. Skin dose increases of up to 1000% were observed for certain configurations and increases above Dmax were common. In nonmagnetically shielded cases, electron contamination generated from the jaw faces and air column is trapped and propagated almost directly to the phantom entry region, giving rise to intense dose hot spots inside the x-ray treatment field. These range up to 1000% or more of Dmax at the CAX, depending on field size, isocenter, and coil thickness. In the case of a fully magnetically shielded collimation system and the lowest MRI field of 0.25 T, the entry skin dose is expected to increase to at least 40%, 50%, 65%, and 80% of Dmax for 5 × 5, 10 × 10, 15 × 15, and 20 × 20 cm(2), respectively. CONCLUSIONS: Electron contamination from the linac head and air column may cause considerable skin dose increases or hot spots at the beam central axis on the entry side of a phantom or patient in longitudinal field 6 MV MRIgRT. This depends heavily on the properties of the magnetic fringe field entering the linac beam collimation system. The skin dose increase is also related to the MRI-coil thickness, the fringe field, and the isocenter distance of the linac. The results of this work indicate that the properties of the MRI fringe field, electron contamination production, and transport must be considered carefully during the design stage of a longitudinal MRI-linac syste

On the accuracy of dose prediction near metal fixation devices for spine SBRT

The metallic fixations used in surgical procedures to support the spine mechanically usually consist of high-density materials. Radiation therapy to palliate spinal cord compression can include prophylactic inclusion of potential tumor around the site of such fixation devices. Determination of the correct density and shape of the spine fixation device has a direct effect on the dose calculation of the radiation field. Even with the application of modern computed tomography (CT), under- or overestimation of dose, both immediately next to the device and in the surrounding tissues, can occur due to inaccuracies in the dose prediction algorithm. In this study, two commercially available dose prediction algorithms (Eclipse AAA and ACUROS), EGSnrc Monte Carlo, and GAFchromic film measurements were compared for a clinical spine SBRT case to determine their accuracy. An open six-field plan and a clinical nine-field IMRT plan were applied to a phantom containing a metal spine fixation device. Dose difference and gamma analysis were performed in and around the tumor region adjacent to the fixation device. Dose calculation inconsistency was observed in the open field plan. However, in the IMRT plan, the dose perturbation effect was not observed beyond 5 mm. Our results suggest that the dose effect of the metal fixation device to the spinal cord and the tumor volume is not observable, and all dose calculation algorithms evaluated can provide clinically acceptable accuracy in the case of spinal SBRT, with the tolerance of 95% for gamma criteria of 3%/3 mm

Effects of radiation scatter exposure on electrometer dose assessment in orthovoltage radiotherapy

During orthovoltage x-ray radiotherapy dosimetry, normal practice requires the use of a standard ionisation chamber and dedicated electrometer for dosimetry. In ideal conditions, the electrometer is positioned outside the treatment room to eliminate any effects from scatter radiation on dose measurement. However in some older designed rooms, there is no access portal for the chamber cable to run to an “outside” position for the electrometer. As such the electrometer is positioned within the treatment room. This work quantifies the effects on measured charge when this occurs. Results have shown that with the electrometer positioned next to a solid water dosimetry stack and using a large 15 × 15 cm field at 250 kVp x-ray beam energy, charge results can deviate by up to ±17.2% depending on the polarity applied to the chamber compared to readings when the electrometer is outside the treatment room. It is assumed to be due to scatter radiation producing electrons in the amplifying circuit of the electrometer. Results are also shown when the electrometer is shielded by a 4 mm thick lead casing whilst inside the room which removes the scattering effect, providing the best case scenario when the electrometer must remain in the treatment room. Whilst it is well known that an electrometer should not be irradiated (even to scattered radiation), often small kilovoltage or orthovoltage rooms do not have a portal access for an electrometer to go outside. As such it would be recommended for a lead shield to be placed around the electrometer during irradiation if this was to occur to minimize dosimetric inaccuracies which may occur due to scattered radiation effects