Investigating volumetric repainting to mitigate interplay effect on 4D robustly optimized lung cancer plans in pencil beam scanning proton therapy

Purpose: The interplay effect between dynamic pencil proton beams and motion of the lung tumor presents a challenge in treating lung cancer patients in pencil beam scanning (PBS) proton therapy. The main purpose of the current study was to investigate the interplay effect on the volumetric repainting lung plans with beam delivery in alternating order (“down” and “up” directions), and explore the number of volumetric repaintings needed to achieve acceptable lung cancer PBS proton plan. Method: The current retrospective study included ten lung cancer patients. The total dose prescription to the clinical target volume (CTV) was 70 Gy(RBE) with a fractional dose of 2 Gy(RBE). All treatment plans were robustly optimized on all ten phases in the 4DCT data set. The Monte Carlo algorithm was used for the 4D robust optimization, as well as for the final dose calculation. The interplay effect was evaluated for both the nominal (i.e., without repainting) as well as volumetric repainting plans. The interplay evaluation was carried out for each of the ten different phases as the starting phases. Several dosimetric metrics were included to evaluate the worst-case scenario (WCS) and bandwidth based on the results obtained from treatment delivery starting in ten different breathing phases. Results: The number of repaintings needed to meet the criteria 1 (CR1) of target coverage (D95% ≥ 98% and D99% ≥ 97%) ranged from 2 to 10. The number of repaintings needed to meet the CR1 of maximum dose (ΔD1% \u3c 1.5%) ranged from 2 to 7. Similarly, the number of repaintings needed to meet CR1 of homogeneity index (ΔHI \u3c 0.03) ranged from 3 to 10. For the target coverage region, the number of repaintings needed to meet CR1 of bandwidth (\u3c100 cGy) ranged from 3 to 10, whereas for the high-dose region, the number of repaintings needed to meet CR1 of bandwidth (\u3c100 cGy) ranged from 1 to 7. Based on the overall plan evaluation criteria proposed in the current study, acceptable plans were achieved for nine patients, whereas one patient had acceptable plan with a minor deviation. Conclusion: The number of repaintings required to mitigate the interplay effect in PBS lung cancer (tumor motion \u3c 15 mm) was found to be highly patient dependent. For the volumetric repainting with an alternating order, a patient-specific interplay evaluation strategy must be adopted. Determining the optimal number of repaintings based on the bandwidth and WCS approach could mitigate the interplay effect in PBS lung cancer treatment

Impact of errors in spot size and spot position in robustly optimized pencil beam scanning proton-based stereotactic body radiation therapy (SBRT) lung plans

Purpose: The purpose of the current study was threefold: (a) investigate the impact of the variations (errors) in spot sizes in robustly optimized pencil beam scanning (PBS) proton-based stereotactic body radiation therapy (SBRT) lung plans, (b) evaluate the impact of spot sizes and position errors simultaneously, and (c) assess the overall effect of spot size and position errors occurring simultaneously in conjunction with either setup or range errors. Methods: In this retrospective study, computed tomography (CT) data set of five lung patients was selected. Treatment plans were regenerated for a total dose of 5000 cGy(RBE) in 5 fractions using a single-field optimization (SFO) technique. Monte Carlo was used for the plan optimization and final dose calculations. Nominal plans were normalized such that 99% of the clinical target volume (CTV) received the prescription dose. The analysis was divided into three groups. Group 1: The increasing and decreasing spot sizes were evaluated for ±10%, ±15%, and ±20% errors. Group 2: Errors in spot size and spot positions were evaluated simultaneously (spot size: ±10%; spot position: ±1 and ±2 mm). Group 3: Simulated plans from Group 2 were evaluated for the setup (±5 mm) and range (±3.5%) errors. Results: Group 1: For the spot size errors of ±10%, the average reduction in D99% for −10% and +10% errors was 0.7% and 1.1%, respectively. For −15% and +15% spot size errors, the average reduction in D99% was 1.4% and 1.9%, respectively. The average reduction in D99% was 2.1% for −20% error and 2.8% for +20% error. The hot spot evaluation showed that, for the same magnitude of error, the decreasing spot sizes resulted in a positive difference (hotter plan) when compared with the increasing spot sizes. Group 2: For a 10% increase in spot size in conjunction with a −1 mm (+1 mm) shift in spot position, the average reduction in D99% was 1.5% (1.8%). For a 10% decrease in spot size in conjunction with a −1 mm (+1 mm) shift in spot position, the reduction in D99% was 0.8% (0.9%). For the spot size errors of ±10% and spot position errors of ±2 mm, the average reduction in D99% was 2.4%. Group 3: Based on the results from 160 plans (4 plans for spot size [±10%] and position [±1 mm] errors × 8 scenarios × 5 patients), the average D99% was 4748 cGy(RBE) with the average reduction of 5.0%. The isocentric shift in the superior–inferior direction yielded the least homogenous dose distributions inside the target volume. Conclusion: The increasing spot sizes resulted in decreased target coverage and dose homogeneity. Similarly, the decreasing spot sizes led to a loss of target coverage, overdosage, and degradation of dose homogeneity. The addition of spot size and position errors to plan robustness parameters (setup and range uncertainties) increased the target coverage loss and decreased the dose homogeneity

A computational technique for simulating ionization energy deposition by energetic ions in complex targets

An ion transport code was developed for simulating ionization energy deposition by energetic ions in sensitive volumes of complex structures. The code was used to simulate recent microdosimetry measurements performed with silicon-on-insulator (SOI) microdosimeters in Fast Neutron Therapy (FNT)

Magneto-radiotherapy: making the electrons conform

Magneto-radiotherapy is the application of magnetic fields during radiotherapy procedures. It aims to improve the quality of cancer treatment by using magnetic fields to alter the dose-deposition of secondary electrons in tissue. This work compares the performance of PENELOPE and EGS4 MC codes for magnetic fields applied to conventional photon beams. It also investigates the effect of a magnetic field on the electron spectrum and explores the novel idea of applying magnetic fields to MRT (Microbeam Radiation Therapy) for the treatment infantile brain tumours

Characterisation of a cobalt-60 small-beam animal irradiator using a realtime silicon pixelated detector

The paper presents a study performed by the Centre for Medical Radiation Physics (CMRP) using a high spatial and temporal resolution silicon pixelated detector named MagicPlate- 512. The study focuses on the characterisation of three pencil beams from a low-dose rate, 6 TBq, cobalt-60 source, in terms of percentage depth dose, beam profiles, output factor and shutter timing. Where applicable, the findings were verified against radiochromic EBT3 film and ionization chambers. It was found that the results of the MagicPlate-512 and film agreed within 0.9 mm for penumbra and full-width at half-maximum measurements of the beam profiles, and within 0.75% for percentage depth dose study. The dose rate of the cobalt-60 source was determined to be (10.65±0.03) cGy/min at 1.5 cm depth in Solid Water. A significant asymmetry of the small pencil beam profile was found, which is due to the irregular machining of the small collimator. The average source shutter speed was calculated to be 26 cm/s. The study demonstrates that the MagicPlate-512 dosimetry system, developed at CMRP, is capable of beam characterisation even in cases of very low dose rate sources

A simulation study of BrachyShade, a shadow-based internal source tracking system for HDR prostate brachytherapy

This paper presents a simulation study of BrachyShade, a proposed internal source-tracking system for real time quality assurance in high dose rate prostate brachytherapy. BrachyShade consists of a set of spherical tungsten occluders located above a pixellated silicon photodetector. The source location is estimated by minimising the mean squared error between a parametric model of the shadow image and acquired images of the shadows projected on the detector plane. A novel algorithm is finally employed to correct the systemic error resulting from Compton scattering in the medium. The worst-case error obtained with BrachyShade for a 13.5 ms image acquisition is less than 1.3 mm in the most distant part of the treatment volume, while for 75% of source locations an error of less than 0.42 mm was achieved

Opportunistic dose amplification for proton and carbon ion therapy via capture of internally generated thermal neutrons

This paper presents Neutron Capture Enhanced Particle Therapy (NCEPT), a method for enhancing the radiation dose delivered to a tumour relative to surrounding healthy tissues during proton and carbon ion therapy by capturing thermal neutrons produced inside the treatment volume during irradiation. NCEPT utilises extant and in-development boron-10 and gadolinium-157-based drugs from the related field of neutron capture therapy. Using Monte Carlo simulations, we demonstrate that a typical proton or carbon ion therapy treatment plan generates an approximately uniform thermal neutron field within the target volume, centred around the beam path. The tissue concentrations of neutron capture agents required to obtain an arbitrary 10% increase in biological effective dose are estimated for realistic treatment plans, and compared to concentrations previously reported in the literature. We conclude that the proposed method is theoretically feasible, and can provide a worthwhile improvement in the dose delivered to the tumour relative to healthy tissue with readily achievable concentrations of neutron capture enhancement drugs

Correction factors to convert microdosimetry measurements in silicon to tissue in \u3csup\u3e12\u3c/sup\u3eC ion therapy

Silicon microdosimetry is a promising technology for heavy ion therapy (HIT) quality assurance, because of its sub-mm spatial resolution and capability to determine radiation effects at a cellular level in a mixed radiation field. A drawback of silicon is not being tissue-equivalent, thus the need to convert the detector response obtained in silicon to tissue. This paper presents a method for converting silicon microdosimetric spectra to tissue for a therapeutic 12C beam, based on Monte Carlo simulations. The energy deposition spectra in a 10 μm sized silicon cylindrical sensitive volume (SV) were found to be equivalent to those measured in a tissue SV, with the same shape, but with dimensions scaled by a factor κ equal to 0.57 and 0.54 for muscle and water, respectively. A low energy correction factor was determined to account for the enhanced response in silicon at low energy depositions, produced by electrons. The concept of the mean path length (lPath) to calculate the lineal energy was introduced as an alternative to the mean chord length (l) because it was found that adopting Cauchy\u27s formula for the (l) was not appropriate for the radiation field typical of HIT as it is very directional (lPath) can be determined based on the peak of the lineal energy distribution produced by the incident carbon beam. Furthermore it was demonstrated that the thickness of the SV along the direction of the incident 12C ion beam can be adopted as (lPath). The tissue equivalence conversion method and (lPath) were adopted to determine the RBE10, calculated using a modified microdosimetric kinetic model, applied to the microdosimetric spectra resulting from the simulation study. Comparison of the RBE10 along the Bragg peak to experimental TEPC measurements at HIMAC, NIRS, showed good agreement. Such agreement demonstrates the validity of the developed tissue equivalence correction factors and of the determination of (lPath)

Monte Carlo study of the potential reduction in out-of-field dose using a patient-specific aperture in pencil beam scanning proton therapy

This study is aimed at identifying the potential benefits of using a patientspecific aperture in proton beam scanning. For this purpose, an accurate Monte Carlo model of the pencil beam scanning (PBS) proton therapy (PT) treatment head at Massachusetts General Hospital (MGH) was developed based on an existing model of the passive double-scattering (DS) system. The Monte Carlo code specifies the treatment head at MGH with sub-millimeter accuracy. The code was configured based on the results of experimental measurements performed at MGH. This model was then used to compare out-of-field doses in simulated DS treatments and PBS treatments. For the conditions explored, the penumbra in PBS is wider than in DS, leading to higher absorbed doses and equivalent doses adjacent to the primary field edge. For lateral distances greater than 10 cm from the field edge, the doses in PBS appear to be lower than those observed for DS. We found that placing a patient-specific aperture at nozzle exit during PBS treatments can potentially reduce doses lateral to the primary radiation field by over an order of magnitude. In conclusion, using a patient-specific aperture has the potential to further improve the normal tissue sparing capabilities of PBS

Solid State Microdosimetry With Heavy Ions for Space Applications

This work provides information pertaining to the performance of Silicon-On-Insulator (SOI) microdosimeters in heavy ion radiation fields. SOI microdosimeters have been previously tested in light ion radiation fields for both space and therapeutic applications, however their response has not been established in high energy, heavy ion radiation fields which are experienced in space. Irradiations were completed at the NASA Space Radiation Laboratory at BNL using 0.6 GeV/u Fe and 1.0 GeV/u Ti ions. Energy deposition and lineal energy spectra were obtained with this device at various depths within a Lucite phantom along the central axis of the beam. The response of which was compared with existing proportional counter data to assess the applicability of SOI microdosimeters to future deployments in space missions