Monte Carlo fast dose calculator for proton radiotherapy: Application to a voxelized geometry representing a patient with prostate cancer

The Monte Carlo method is used to provide accurate dose estimates in proton radiation therapy research. While it is more accurate than commonly used analytical dose calculations, it is computationally intense. The aim of this work was to characterize for a clinical setup the fast dose calculator (FDC), a Monte Carlo track-repeating algorithm based on GEANT4. FDC was developed to increase computation speed without diminishing dosimetric accuracy. The algorithm used a database of proton trajectories in water to calculate the dose of protons in heterogeneous media. The extrapolation from water to 41 materials was achieved by scaling the proton range and the scattering angles. The scaling parameters were obtained by comparing GEANT4 dose distributions with those calculated with FDC for homogeneous phantoms. The FDC algorithm was tested by comparing dose distributions in a voxelized prostate cancer patient as calculated with well-known Monte Carlo codes (GEANT4 and MCNPX). The track-repeating approach reduced the CPU time required for a complete dose calculation in a voxelized patient anatomy by more than two orders of magnitude, while on average reproducing the results from the Monte Carlo predictions within 2% in terms of dose and within 1 mm in terms of distance. © 2009 Institute of Physics and Engineering in Medicine

A track-repeating algorithm for fast Monte Carlo dose calculations of proton radiotherapy

Monte Carlo codes are utilized for accurate dose calculations in proton radiation therapy research. While they are superior in accuracy to commonly used analytical dose calculations, they require significantly longer computation times. The aim of this work is to characterize a Monte Carlo track-repeating algorithm to increase computation speed without compromising dosimetric accuracy. The track-repeating approach reduced the CPU time required for a complete dose calculation in voxel- ized patient anatomy by more than two orders of magnitude, while on average reproducing the results from the traditional Monte Carlo approach within 4% dose difference and within 1-mm distance to agreement

Water equivalent thickness values of materials used in beams of protons, helium, carbon and iron ions

Heavy charged particle beam radiotherapy for cancer is of increasing interest because it delivers a highly conformal radiation dose to the target volume. Accurate knowledge of the range of a heavy charged particle beam after it penetrates a patient\u27s body or other materials in the beam line is very important and is usually stated in terms of the water equivalent thickness (WET). However, methods of calculating WET for heavy charged particle beams are lacking. Our objective was to test several simple analytical formulas previously developed for proton beams for their ability to calculate WET values for materials exposed to beams of protons, helium, carbon and iron ions. Experimentally measured heavy charged particle beam ranges and WET values from an iterative numerical method were compared with the WET values calculated by the analytical formulas. In most cases, the deviations were within 1 mm. We conclude that the analytical formulas originally developed for proton beams can also be used to calculate WET values for helium, carbon and iron ion beams with good accuracy. © 2010 Institute of Physics and Engineering in Medicine

Effective dose from stray radiation for a patient receiving proton therapy for liver cancer

Because of its advantageous depth-dose relationship, proton radiotherapy is an emerging treatment modality for patients with liver cancer. Although the proton dose distribution conforms to the target, healthy tissues throughout the body receive low doses of stray radiation, particularly neutrons that originate in the treatment unit or in the patient. The aim of this study was to calculate the effective dose from stray radiation and estimate the corresponding risk of second cancer fatality for a patient receiving proton beam therapy for liver cancer. Effective dose from stray radiation was calculated using detailed Monte Carlo simulations of a double-scattering proton therapy treatment unit and a voxelized human phantom. The treatment plan and phantom were based on CT images of an actual adult patient diagnosed with primary hepatocellular carcinoma. For a prescribed dose of 60 Gy to the clinical target volume, the effective dose from stray radiation was 370 mSv; 61% of this dose was from neutrons originating outside of the patient while the remaining 39% was from neutrons originating within the patient. The excess lifetime risk of fatal second cancer corresponding to the total effective dose from stray radiation was 1.2%. The results of this study establish a baseline estimate of the stray radiation dose and corresponding risk for an adult patient undergoing proton radiotherapy for liver cancer and provide new evidence to corroborate the suitability of proton beam therapy for the treatment of liver tumors. © 2009 American Institute of Physics

Assessment of targeting accuracy of a low-energy stereotactic radiosurgery treatment for age-related macular degeneration

Age-related macular degeneration (AMD), a leading cause of blindness in the United States, is a neovascular disease that may be controlled with radiation therapy. Early patient outcomes of external beam radiotherapy, however, have been mixed. Recently, a novel multimodality treatment was developed, comprising external beam radiotherapy and concomitant treatment with a vascular endothelial growth factor inhibitor. The radiotherapy arm is performed by stereotactic radiosurgery, delivering a 16 Gy dose in the macula (clinical target volume, CTV) using three external low-energy x-ray fields while adequately sparing normal tissues. The purpose of our study was to test the sensitivity of the delivery of the prescribed dose in the CTV using this technique and of the adequate sparing of normal tissues to all plausible variations in the position and gaze angle of the eye. Using Monte Carlo simulations of a 16 Gy treatment, we varied the gaze angle by ±5° in the polar and azimuthal directions, the linear displacement of the eye ±1mm in all orthogonal directions, and observed the union of the three fields on the posterior wall of spheres concentric with the eye that had diameters between 20 and 28 mm. In all cases, the dose in the CTV fluctuated \u3c6%, the maximum dose in the sclera was \u3c20 Gy, the dose in the optic disc, optic nerve, lens and cornea were \u3c0.7 Gy and the three-field junction was adequately preserved. The results of this study provide strong evidence that for plausible variations in the position of the eye during treatment, either by the setup error or intrafractionmotion, the prescribed dose will be delivered to the CTV and the dose in structures at risk will be kept far below tolerance doses. © 2010 Institute of Physics and Engineering in Medicine

Ambient dose equivalent versus effective dose for quantifying stray radiation exposures to a patient receiving proton therapy for prostate cancer

The purpose of this study was to evaluate the suitability of the quantity ambient dose equivalent H*(10) as a conservative estimate of effective dose E for estimating stray radiation exposures to patients receiving passively scattered proton radiotherapy for cancer of the prostate. H*(10), which is determined from fluence free-in-air, is potentially useful because it is simpler to measure or calculate because it avoids the complexities associated with phantoms or patient anatomy. However, the suitability of H*(10) as a surrogate for E has not been demonstrated for exposures to high-energy neutrons emanating from radiation treatments with proton beams. The suitability was tested by calculating H*(10) and E for a proton treatment using a Monte Carlo model of a double-scattering treatment machine and a computerized anthropomorphic phantom. The calculated E for the simulated treatment was 5.5 mSv/Gy, while the calculated H*(10) at the isocenter was 10 mSv/Gy. A sensitivity analysis revealed that H*(10) conservatively estimated E for the interval of treatment parameters common in proton therapy for prostate cancer. However, sensitivity analysis of a broader interval of parameters suggested that H*(10) may underestimate E for treatments of other sites, particularly those that require large field sizes. Simulations revealed that while E was predominated by neutrons generated in the nozzle, neutrons produced in the patient contributed up to 40% to dose equivalent in near-field organs

An analytic model of neutron ambient dose equivalent and equivalent dose for proton radiotherapy

Stray neutrons generated in passively scattered proton therapy are of concern because they increase the risk that a patient will develop a second cancer. Several investigations characterized stray neutrons in proton therapy using experimental measurements and Monte Carlo simulations, but capabilities of analytical methods to predict neutron exposures are less well developed. The goal of this study was to develop a new analytical model to calculate neutron ambient dose equivalent in air and equivalent dose in phantom based on Monte Carlo modeling of a passively scattered proton therapy unit. The accuracy of the new analytical model is superior to a previous analytical model and comparable to the accuracy of typical Monte Carlo simulations and measurements. Predictions from the new analytical model agreed reasonably well with corresponding values predicted by a Monte Carlo code using an anthropomorphic phantom. © 2010 Institute of Physics and Engineering in Medicine

A comparative study on the risks of radiogenic second cancers and cardiac mortality in a set of pediatric medulloblastoma patients treated with photon or proton craniospinal irradiation

Purpose: To compare the risks of radiogenic second cancers and cardiac mortality in 17 pediatric medulloblastoma patients treated with passively scattered proton or field-in-field photon craniospinal irradiation (CSI). Material/methods: Standard of care photon or proton CSI treatment plans were created for all 17 patients in a commercial treatment planning system (TPS) (Eclipse version 8.9; Varian Medical Systems, Palo Alto, CA) and prescription dose was 23.4 or 23.4 Gy (RBE) to the age specific target volume at 1.8 Gy/fraction. The therapeutic doses from proton and photon CSI plans were estimated from TPS. Stray radiation doses were determined from Monte Carlo simulations for proton CSI and from measurements and TPS for photon CSI. The Biological Effects of Ionization Radiation VII report and a linear model based on childhood cancer survivor data were used for risk predictions of second cancer and cardiac mortality, respectively. Results: The ratios of lifetime attributable risk (RLARs) (proton/photon) ranged from 0.10 to 0.22 for second cancer incidence and ranged from 0.20 to 0.53 for second cancer mortality, respectively. The ratio of relative risk (RRR) (proton/photon) of cardiac mortality ranged from 0.12 to 0.24. The RLARs of both cancer incidence and mortality decreased with patient\u27s age at exposure (e), while the RRRs of cardiac mortality increased with e. Girls had a significantly higher RLAR of cancer mortality than boys. Conclusion: Passively scattered proton CSI provides superior predicted outcomes by conferring lower predicted risks of second cancer and cardiac mortality than field-in-field photon CSI for all medulloblastoma patients in a large clinically representative sample in the United States, but the magnitude of superiority depends strongly on the patients\u27 anatomical development status

Comparison of risk of radiogenic second cancer following photon and proton craniospinal irradiation for a pediatric medulloblastoma patient

Pediatric patients who received radiation therapy are at risk of developing side effects such as radiogenic second cancer. We compared proton and photon therapies in terms of the predicted risk of second cancers for a 4 year old medulloblastoma patient receiving craniospinal irradiation (CSI). Two CSI treatment plans with 23.4 Gy or Gy (RBE) prescribed dose were computed: a three-field 6 MV photon therapy plan and a four-field proton therapy plan. The primary doses for both plans were determined using a commercial treatment planning system. Stray radiation doses for proton therapy were determined from Monte Carlo simulations, and stray radiation doses for photon therapy were determined from measured data. Dose-risk models based on the Biological Effects of Ionization Radiation VII report were used to estimate the risk of second cancer in eight tissues/organs. Baseline predictions of the relative risk for each organ were always less for proton CSI than for photon CSI at all attained ages. The total lifetime attributable risk of the incidence of second cancer considered after proton CSI was much lower than that after photon CSI, and the ratio of lifetime risk was 0.18. Uncertainty analysis revealed that the qualitative findings of this study were insensitive to any plausible changes of dose-risk models and mean radiation weighting factor for neutrons. Proton therapy confers lower predicted risk of second cancer than photon therapy for the pediatric medulloblastoma patient. © 2013 Institute of Physics and Engineering in Medicine

Risk of second malignant neoplasm following proton versus intensity-modulated photon radiotherapies for hepatocellular carcinoma

Hepatocellular carcinoma (HCC), the sixthmost common cancer in theworld, is a global health concern. Radiotherapy for HCC is uncommon, largely because of the likelihood of radiation-induced liver disease, an acute side effect that is often fatal. Proton beam therapy (PBT) and intensity-modulated radiation therapy (IMRT)may offer HCC patients a better option for treating the diseased liver tissue while largely sparing the surrounding tissues, especially the nontumor liver. However, even advanced radiotherapies carry a risk of late effects, including second malignant neoplasms (SMNs). It is unclear whether PBT or IMRT confers less risk of an SMN than the other. The purpose of this study was to compare the predicted risk of developing an SMN for a patient with HCC between PBT and IMRT. For both treatments, radiation doses in organs and tissues from primary radiation were determined using a treatment planning system; doses in organs and tissues from stray radiation from PBT were determined usingMonte Carlo simulations and from IMRT using thermoluminescent dosimeter measurements. Risk models of SMN incidence were taken from the literature. The predicted absolute lifetime attributable risks of SMN incidence were 11.4% after PBT and 19.2% after IMRT. The results of this study suggest that using proton beams instead of photon beams for radiotherapy may reduce the risk of SMN incidence for some HCC patients. © 2010 Institute of Physics and Engineering in Medicine