Dosimetric impact of range uncertainty in passive scattering proton therapy.

PURPOSE: The objective of this study was to investigate the dosimetric impact of range uncertainty in a large cohort of patients receiving passive scatter proton therapy. METHODS: A cohort of 120 patients were reviewed in this study retrospectively, of which 61 were brain, 39 lung, and 20 prostate patients. Range uncertainties of ±3.5% (overshooting and undershooting by 3.5%, respectively) were added and recalculated on the original plans, which had been planned according to our clinical planning protocol while keeping beamlines, apertures, compensators, and dose grids intact. Changes in the coverage on CTV and DVH for critical organs were compared and analyzed. Correlation between dose change and minimal distance between CTV and critical organs were also investigated. RESULTS: Although CTV coverages and maximum dose to critical organs were largely maintained for most brain patients, large variations over 5% were still observed sporadically. Critical organs, such as brainstem and chiasm, could still be affected by range uncertainty at 4 cm away from CTV. Coverage and OARs in lung and prostate patients were less likely to be affected by range uncertainty with very few exceptions. CONCLUSION: The margin recipe in modern TPS leads to clinically acceptable OAR doses in the presence of range uncertainties. However, range uncertainties still pose a noticeable challenge for small but critical serial organs near tumors, and occasionally for large parallel organs that are located distal to incident proton beams.

Automatic x-ray image contrast enhancement based on parameter auto-optimization.

PURPOSE: Insufficient image contrast associated with radiation therapy daily setup x-ray images could negatively affect accurate patient treatment setup. We developed a method to perform automatic and user-independent contrast enhancement on 2D kilo voltage (kV) and megavoltage (MV) x-ray images. The goal was to provide tissue contrast optimized for each treatment site in order to support accurate patient daily treatment setup and the subsequent offline review. METHODS: The proposed method processes the 2D x-ray images with an optimized image processing filter chain, which consists of a noise reduction filter and a high-pass filter followed by a contrast limited adaptive histogram equalization (CLAHE) filter. The most important innovation is to optimize the image processing parameters automatically to determine the required image contrast settings per disease site and imaging modality. Three major parameters controlling the image processing chain, i.e., the Gaussian smoothing weighting factor for the high-pass filter, the block size, and the clip limiting parameter for the CLAHE filter, were determined automatically using an interior-point constrained optimization algorithm. RESULTS: Fifty-two kV and MV x-ray images were included in this study. The results were manually evaluated and ranked with scores from 1 (worst, unacceptable) to 5 (significantly better than adequate and visually praise worthy) by physicians and physicists. The average scores for the images processed by the proposed method, the CLAHE, and the best window-level adjustment were 3.92, 2.83, and 2.27, respectively. The percentage of the processed images received a score of 5 were 48, 29, and 18%, respectively. CONCLUSION: The proposed method is able to outperform the standard image contrast adjustment procedures that are currently used in the commercial clinical systems. When the proposed method is implemented in the clinical systems as an automatic image processing filter, it could be useful for allowing quicker and potentially more accurate treatment setup and facilitating the subsequent offline review and verification.

Commissioning and initial experience with the first clinical gantry-mounted proton therapy system.

The purpose of this study is to describe the comprehensive commissioning process and initial clinical experience of the Mevion S250 proton therapy system, a gantry-mounted, single-room proton therapy platform clinically implemented in the S. Lee Kling Proton Therapy Center at Barnes-Jewish Hospital in St. Louis, MO, USA. The Mevion S250 system integrates a compact synchrocyclotron with a C-inner gantry, an image guidance system and a 6D robotic couch into a beam delivery platform. We present our commissioning process and initial clinical experience, including i) CT calibration; ii) beam data acquisition and machine characteristics; iii) dosimetric commissioning of the treatment planning system; iv) validation through the Imaging and Radiation Oncology Core credentialing process, including irradiations on the spine, prostate, brain, and lung phantoms; v) evaluation of localization accuracy of the image guidance system; and vi) initial clinical experience. Clinically, the system operates well and has provided an excellent platform for the treatment of diseases with protons.

A three-field monoisocentric inverse breast treatment planning technique without half-beam blocking.

The purpose of this study was to introduce a three-field monoisocentric inverse treatment planning method without half-beam blocks for breast cancer radiation treatments. Three-field monoisocentric breast treatment planning with half-beam blocks limits the tangential field length to 20 cm. A dual-isocenter approach accommodates patients with larger breasts, but prolongs treatment time and may introduce dose uncertainty at the matching plane due to daily setup variations. We developed a novel monoisocentric, three-field treatment planning method without half-beam blocking. The new beam-matching method utilizes the full field size with a single isocenter. Furthermore, an open/IMRT hybrid inverse optimization method was employed to improve dose uniformity and coverage. Geometric beam matching was achieved by rotating the couch, collimator, and gantry together. Formulae for three-field geometric matching were derived and implemented in Pinnacle scripts. This monoisocentric technique can be used for patients with larger breast size. The new method has no constraints on the length of tangential fields. Compared with the dual-isocenter method, it can significantly reduce patient setup time anduncertainties.

Dosimetric evaluation of dose shaping by adaptive aperture and its impact on plan quality.

Mevion's single-room HYPERSCAN proton therapy system employs a proton multileaf collimator called the adaptive aperture (AA), which collimates individual spots in the proton delivery as determined by the Treatment Planning System (TPS). The purpose of this study is to assess the dosimetric benefits of the AA, specifically in the dynamic aperture (DA) mode, and evaluate its impact on proton treatment plan quality as compared to a traditional pencil beam scanning (PBS) system (Varian ProBeam). The spot dose distributions with dynamic collimation (DA), a unique AA shape for each energy layer, and with static collimation (SA), a single AA collimation shape shared by all energy layers per field, were calculated and compared with the spot dose distribution of the Varian ProBeam proton therapy system. The lateral and distal dose falloff gradients and their dependence on air gap were evaluated quantitatively. Treatment plans for ten arbitrarily selected intracranial target image sets were created, and the HYPERSCAN and ProBeam beam models were compared. The spot sizes of the HYPERSCAN system are significantly larger than ProBeam system, especially at low energy. With the help of DA, the lateral dose penumbra of the HYPERSCAN is dramatically improved at lower energy and comparable at higher to ProBeam PBS beams. While the ProBeam spot size does not change with the air gap, beam penumbra of the HYPERSCAN with DA increases with the air gap. The distal dose falloff gradient for the HYPERSCAN with or without DA remains consistently around 4.8 mm through all energies due to the beamline design, not substantially varying with energy or air gap. Treatment plans of ten randomly selected intracranial cases demonstrated favorable OAR sparing but unfavorable dose uniformity for the HYPERSCAN with DA compared to ProBeam. Dose shaping by adaptive aperture substantially improves the lateral penumbra without a significant change in the distal dose gradient. The dose gradients of the multiple beam DA plans with layer-by-layer blocking are improved compared with SA plans and are close to the ProBeam plans for the ten randomly selected brain cases. With layer-by-layer DA blocking, the HYPERSCAN plans have similar plan conformality indices as the ProBeam plans, but the overall plan quality indices are lower than ProBeam plans, largely due to the lower dose homogeneity. In some cases, DA blocking was found to be superior in sparing OAR surrounding the target.

Millimeter wave-based patient setup verification and motion tracking during radiotherapy.

BACKGROUND: Position verification and motion monitoring are critical for safe and precise radiotherapy (RT). Existing approaches to these tasks based on visible light or x-ray are suboptimal either because they cannot penetrate obstructions to the patient's skin or introduce additional radiation exposure. The low-cost mmWave radar is an ideal solution for these tasks as it can monitor patient position and motion continuously throughout the treatment delivery. PURPOSE: To develop and validate frequency-modulated continuous wave (FMCW) mmWave radars for position verification and motion tracking during RT delivery. METHODS: A 77 GHz FMCW mmWave module was used in this study. Chirp Z Transform-based (CZT) algorithm was developed to process the intermediate frequency (IF) signals. Absolute distances to flat Solid Water slabs and human shape phantoms were measured. The accuracy of absolute distance and relative displacement were evaluated. RESULTS: Without obstruction, mmWave based on the CZT algorithm was able to detect absolute distance within 1 mm for a Solid Water slab that simulated the reflectivity of the human body. Through obstructive materials, the mmWave device was able to detect absolute distance within 5 mm in the worst case and within 3.5 mm in most cases. The CZT algorithm significantly improved the accuracy of absolute distance measurement compared with Fast Fourier Transform (FFT) algorithm and was able to achieve submillimeter displacement accuracy with and without obstructions. The surface-to-skin distance (SSD) measurement accuracy was within 8 mm in the anterior of the phantom. CONCLUSIONS: With the CZT signal processing algorithm, the mmWave radar is able to measure the absolute distance to a flat surface within 1 mm. But the absolute distance measurement to a human shape phantom is as large as 8 mm at some angles. Further improvement is necessary to improve the accuracy of SSD measurement to uneven surfaces by the mmWave radar.

Proton 3D dose measurement with a multi-layer strip ionization chamber (MLSIC) device.

Objective. In current clinical practice for quality assurance (QA), intensity modulated proton therapy (IMPT) fields are verified by measuring planar dose distributions at one or a few selected depths in a phantom. A QA device that measures full 3D dose distributions at high spatiotemporal resolution would be highly beneficial for existing as well as emerging proton therapy techniques such as FLASH radiotherapy. Our objective is to demonstrate feasibility of 3D dose measurement for IMPT fields using a dedicated multi-layer strip ionization chamber (MLSIC) device.Approach.Our developed MLSIC comprises a total of 66 layers of strip ion chamber (IC) plates arranged, alternatively, in thexandydirection. The first two layers each has 128 channels in 2 mm spacing, and the following 64 layers each has 32/33 IC strips in 8 mm spacing which are interconnected every eight channels. A total of 768-channel IC signals are integrated and sampled at a speed of 6 kfps. The MLSIC has a total of 19.2 cm water equivalent thickness and is capable of measurement over a 25 × 25 cm2field size. A reconstruction algorithm is developed to reconstruct 3D dose distribution for each spot at all depths by considering a double-Gaussian-Cauchy-Lorentz model. The 3D dose distribution of each beam is obtained by summing all spots. The performance of our MLSIC is evaluated for a clinical pencil beam scanning (PBS) plan.Main results.The dose distributions for each proton spot can be successfully reconstructed from the ionization current measurement of the strip ICs at different depths, which can be further summed up to a 3D dose distribution for the beam. 3D Gamma Index analysis indicates acceptable agreement between the measured and expected dose distributions from simulation, Zebra and MatriXX.Significance.The dedicated MLSIC is the first pseudo-3D QA device that can measure 3D dose distribution in PBS proton fields spot-by-spot.

Simulation study of a novel small animal FLASH irradiator (SAFI) with integrated inverse-geometry CT based on circularly distributed kV X-ray sources.

Ultra-high dose rate (UHDR) radiotherapy (RT) or FLASH-RT can potentially reduce normal tissue toxicity. A small animal irradiator that can deliver FLASH-RT treatments similar to clinical RT treatments is needed for pre-clinical studies of FLASH-RT. We designed and simulated a novel small animal FLASH irradiator (SAFI) based on distributed x-ray source technology. The SAFI system comprises a distributed x-ray source with 51 focal spots equally distributed on a 20 cm diameter ring, which are used for both FLASH-RT and onboard micro-CT imaging. Monte Carlo simulation was performed to estimate the dosimetric characteristics of the SAFI treatment beams. The maximum dose rate, which is limited by the power density of the tungsten target, was estimated based on finite-element analysis (FEA). The maximum DC electron beam current density is 2.6 mA/mm2, limited by the tungsten target's linear focal spot power density. At 160 kVp, 51 focal spots, each with a dimension of [Formula: see text] mm2 and 10° anode angle, can produce up to 120 Gy/s maximum DC irradiation at the center of a cylindrical water phantom. We further demonstrate forward and inverse FLASH-RT planning, as well as inverse-geometry micro-CT with circular source array imaging via numerical simulations.

Design and optimization of thin-film tungsten (W)-diamond target for multi-pixel X-ray sources.

BACKGROUND: Emerging multi-pixel X-ray source technology enables new designs for X-ray imaging systems. The power of multi-pixel X-ray sources with a fixed anode is limited by focal spot power density. PURPOSE: The purpose of this study is to optimize the W-diamond target and predict its performance in multi-pixel X-ray sources. METHODS: X-ray intensity and energy deposition in the W-diamond target with different thicknesses of tungsten film and incident electron energies was calculated with the Geant4 Monte Carlo toolkit. COMSOL Multiphysics software was used to analyze the transient and stationary heat transfer in the thin-film W-diamond target. The maximum tube power and X-ray output intensity were predicted for both transmission and reflection target configurations. RESULTS: The maximum focal spot power density was limited by either the graphitization of the diamond substrate or the melting point of the W target. With optimal W-target thickness, the maximum transmission X-ray intensities are about 40%-50% higher than the maximum reflection intensities. Thin-film W-diamond targets allow four to five times more maximum power input and produce six to seven times higher transmission X-ray intensity in continuous mode compared with conventional reflection W thick targets. Depending on the focal spot size, reducing the X-ray pulse duration can further enhance the tube power. CONCLUSIONS: Multi-pixel X-ray sources using this W-diamond target design can produce significantly higher X-ray output than traditional thick tungsten targets without major modification of the tube design.

A reconstruction approach for proton computed tomography by modeling the integral depth dose of the scanning proton pencil beam.

PURPOSE: To present a proton computed tomography (pCT) reconstruction approach that models the integral depth dose (IDD) of the clinical scanning proton beam into beamlets. Using a multilayer ionization chamber (MLIC) as the imager, the proposed pCT system and the reconstruction approach can minimize extra ambient neutron dose and simplify the beamline design by eliminating an additional collimator to confine the proton beam. METHODS: Monte Carlo simulation was applied to digitally simulate the IDDs of the exiting proton beams detected by the MLIC. A forward model was developed to model each IDD into a weighted sum of percentage depth doses of the constituent beamlets separated laterally by 1 mm. The water equivalent path lengths (WEPLs) of the beamlets were determined by iteratively minimizing the squared L2-norm between the forward projected and simulated IDDs. The final WEPL values were reconstructed to pCT images, that is, proton stopping power ratio (SPR) maps, through simultaneous algebraic reconstruction technique with total variation regularization. The reconstruction process was tested with a digital cylindrical water-based phantom and an ICRP adult reference computational phantom. The mean of SPR within regions of interest (ROIs) and the WEPL along a 4 mm-wide beam ( WEP L 4 mm ${\rm{WEP}}{{\rm{L}}_{4{\rm{mm}}}}$ ) were compared with the reference values. The spatial resolution was analyzed at the edge of a cortical insert of the cylindrical phantom. RESULTS: The percentage deviations from reference SPR were within ±1% in all selected ROIs. The mean absolute error of the reconstructed SPR was 0.33%, 0.19%, and 0.27% for the cylindrical phantom, the adult phantom at the head and lung region, respectively. The corresponding percentage deviations from reference WEP L 4 mm ${\rm{WEP}}{{\rm{L}}_{4{\rm{mm}}}}$ were 0.48 ± 0.64%, 0.28 ± 0.48%, and 0.22 ± 0.49%. The full width at half maximum of the line spread function (LSF) derived from the radial edge spread function (ESF) of a cortical insert was 0.13 cm. The frequency at 10% of the modulation transfer function (MTF) was 6.38 cm-1 . The mean signal-to-noise ratio (SNR) of all the inserts was 2.45. The mean imaging dose was 0.29 and 0.25 cGy at the head and lung region of the adult phantom, respectively. CONCLUSION: A new pCT reconstruction approach was developed by modeling the IDDs of the uncollimated scanning proton beams in the pencil beam geometry. SPR accuracy within ±1%, spatial resolution of better than 2 mm at 10% MTF, and imaging dose at the magnitude of mGy were achieved. Potential side effects caused by neutron dose were eliminated by removing the extra beam collimator.

Validation of a deep learning-based material estimation model for Monte Carlo dose calculation in proton therapy.

Objective. Computed tomography (CT) to material property conversion dominates proton range uncertainty, impacting the quality of proton treatment planning. Physics-based and machine learning-based methods have been investigated to leverage dual-energy CT (DECT) to predict proton ranges. Recent development includes physics-informed deep learning (DL) for material property inference. This paper aims to develop a framework to validate Monte Carlo dose calculation (MCDC) using CT-based material characterization models.Approach.The proposed framework includes two experiments to validatein vivodose and water equivalent thickness (WET) distributions using anthropomorphic and porcine phantoms. Phantoms were irradiated using anteroposterior proton beams, and the exit doses and residual ranges were measured by MatriXX PT and a multi-layer strip ionization chamber. Two pre-trained conventional and physics-informed residual networks (RN/PRN) were used for mass density inference from DECT. Additional two heuristic material conversion models using single-energy CT (SECT) and DECT were implemented for comparisons. The gamma index was used for dose comparisons with criteria of 3%/3 mm (10% dose threshold).Main results. The phantom study showed that MCDC with PRN achieved mean gamma passing rates of 95.9% and 97.8% for the anthropomorphic and porcine phantoms. The rates were 86.0% and 79.7% for MCDC with the empirical DECT model. WET analyses indicated that the mean WET variations between measurement and simulation were -1.66 mm, -2.48 mm, and -0.06 mm for MCDC using a Hounsfield look-up table with SECT and empirical and PRN models with DECT. Validation experiments indicated that MCDC with PRN achieved consistent dose and WET distributions with measurement.Significance. The proposed framework can be used to identify the optimal CT-based material characterization model for MCDC to improve proton range uncertainty. The framework can systematically verify the accuracy of proton treatment planning, and it can potentially be implemented in the treatment room to be instrumental in online adaptive treatment planning.

A multi-layer strip ionization chamber (MLSIC) device for proton pencil beam scan quality assurance.

Objective. Proton pencil beam scanning (PBS) treatment fields needs to be verified before treatment deliveries to ensure patient safety. In current practice, treatment beam quality assurance (QA) is measured at a few selected depths using film or a 2D detector array, which is insensitive and time-consuming. A QA device that can measure all key dosimetric characteristics of treatment beams spot-by-spot within a single beam delivery is highly desired.Approach. We developed a multi-layer strip ionization chamber (MLSIC) prototype device that comprises of two layers of strip ionization chambers (IC) plates for spot position measurement and 64 layers of plate IC for beam energy measurement. The 768-channel strip ion chamber signals are integrated and sampled at a speed of 3.125 kHz. It has a 25.6 cm × 25.6 cm maximum measurement field size and 2 mm spatial resolution for spot position measurement. The depth resolution and maximum depth were 2.91 mm and 18.6 cm for 1.6 mm thick IC plate, respectively. The relative weight of each spot was determined from total charge by all IC detector channels.Main results. The MLSIC is able to measure ionization currents spot-by-spot. The depth dose measurement has a good agreement with the ground truth measured using a water tank and commercial one-dimensional (1D) multi-layer plate chamber. It can verify the spot position, energy, and relative weight of clinical PBS beams and compared with the treatment plans.Significance. The MLSIC is a highly efficient QA device that can measure the key dosimetric characteristics of proton treatment beams spot-by-spot with a single beam delivery. It may improve the quality and efficiency of clinical proton treatments.

A tetrahedron beam computed tomography benchtop system with a multiple pixel field emission x-ray tube.

PURPOSE: To demonstrate the feasibility of Tetrahedron Beam Computed Tomography (TBCT) using a carbon nanotube (CNT) multiple pixel field emission x-ray (MPFEX) tube. METHODS: A multiple pixel x-ray source facilitates the creation of novel x-ray imaging modalities. In a previous publication, the authors proposed a Tetrahedron Beam Computed Tomography (TBCT) imaging system which comprises a linear source array and a linear detector array that are orthogonal to each other. TBCT is expected to reduce scatter compared with Cone Beam Computed Tomography (CBCT) and to have better detector performance. Therefore, it may produce improved image quality for image guided radiotherapy. In this study, a TBCT benchtop system has been developed with an MPFEX tube. The tube has 75 CNT cold cathodes, which generate 75 x-ray focal spots on an elongated anode, and has 4 mm pixel spacing. An in-house-developed, 5-row CT detector array using silicon photodiodes and CdWO(4) scintillators was employed in the system. Hardware and software were developed for tube control and detector data acquisition. The raw data were preprocessed for beam hardening and detector response linearity and were reconstructed with an FDK-based image reconstruction algorithm. RESULTS: The focal spots were measured at about 1 × 2 mm(2) using a star phantom. Each cathode generates around 3 mA cathode current with 2190 V gate voltage. The benchtop system is able to perform TBCT scans with a prolonged scanning time. Images of a commercial CT phantom were successfully acquired. CONCLUSIONS: A prototype system was developed, and preliminary phantom images were successfully acquired. MPFEX is a promising x-ray source for TBCT. Further improvement of tube output is needed in order for it to be used in clinical TBCT systems.

Tetrahedron beam imaging with a multi-pixel thermionic emission X-ray source and a photon-counting detector: A benchtop experimental study.

PURPOSE: A tetrahedron beam (TB) X-ray system with a linear X-ray source array and a linear detector array positioned orthogonal to each other may overcome the X-ray scattering problem of traditional cone-beam X-ray systems. We developed a TB imaging benchtop system using a linear array X-ray source to demonstrate the principle and benefits of TB imaging. METHODS: A multi-pixel thermionic emission X-ray (MPTEX) source with 48 focal spots in 4-mm spacing was developed in-house. The X-ray beams are collimated to a stack of fan beams that are converged to a 6-mm wide multi-row photon-counting detector (PCD). The data collected with a sequential scan of the sources at a fixed view angle were synthesized to a 2D radiography image by a shift-and-add algorithm. The data collected with a full rotation of the system were reconstructed into 3D TB CT (TBCT) images using an Feldkamp, Davis, and Kress (FDK)-based computed tomography (CT) algorithm modified for the TB geometry. RESULTS: With an 18.8-cm long source array and a 35-cm long detector array, the TB benchtop system provides a 25-cm cross-sectional and 8-cm axial field of view (FOV). The scatter-to-primary ratio (SPR) was approximately 17% for TB, as compared with 120% for cone beam geometry. The TBCT system enables reconstructions in two-dimensional radiography and three-dimensional volumetric CT. The TBCT images were free of "cupping" artifacts and have similar image quality as diagnostic helical CT. CONCLUSIONS: A TB imaging benchtop imaging system was successfully developed with MPTEX source and PCD. Phantom and animal cadaver imaging demonstrated that the TB system can produce satisfactory radiographic X-ray images and 3D CT images with image quality comparable to diagnostic helical CTs.

A novel proton counting detector and method for the validation of tissue and implant material maps for Monte Carlo dose calculation.

The presence of artificial implants complicates the delivery of proton therapy due to inaccurate characterization of both the implant and the surrounding tissues. In this work, we describe a method to characterize implant and human tissue mimicking materials in terms of relative stopping power (RSP) using a novel proton counting detector. Each proton is tracked by directly measuring the deposited energy along the proton track using a fast, pixelated spectral detector AdvaPIX-TPX3 (TPX3). We considered three scenarios to characterize the RSPs. First, in-air measurements were made in the presence of metal rods (Al, Ti and CoCr) and bone. Then, measurements of energy perturbations in the presence of metal implants and bone in an anthropomorphic phantom were performed. Finally, sampling of cumulative stopping power (CSP) of the phantom were made at different locations of the anthropomorphic phantom. CSP and RSP information were extracted from energy spectra at each beam path. To quantify the RSP of metal rods we used the shift in the most probable energy (MPE) of CSP from the reference CSP without a rod. Overall, the RSPs were determined as 1.48, 2.06, 3.08, and 5.53 from in-air measurements; 1.44, 1.97, 2.98, and 5.44 from in-phantom measurements, for bone, Al, Ti and CoCr, respectively. Additionally, we sampled CSP for multiple paths of the anthropomorphic phantom ranging from 18.63 to 25.23 cm deriving RSP of soft tissues and bones in agreement within 1.6% of TOPAS simulations. Using minimum error of these multiple CSP, optimal mass densities were derived for soft tissue and bone and they are within 1% of vendor-provided nominal densities. The preliminary data obtained indicates the proposed novel method can be used for the validation of material and density maps, required by proton Monte Carlo Dose calculation, provided by competing multi-energy computed tomography and metal artifact reduction techniques.

Investigating neutron activated contrast agent imaging for tumor localization in proton therapy: a feasibility study for proton neutron gamma-x detection (PNGXD).

Proton neutron gamma-x detection (PNGXD) is a novel imaging concept being investigated for tumor localization during proton therapy that uses secondary neutron interactions with a gadolinium contrast agent (GDCA) to produce characteristic photons within the 40-200 keV energy region. The purpose of this study is to experimentally investigate the feasibility of implementing this procedure by performing experimental measurements on a passive double scattering proton treatment unit. Five experimental measurements were performed with varying concentrations and irradiation conditions. Photon spectra were measured with a 25 mm2, 1 mm thick uncollimated X-123 CdTe spectrometer. For a 10.4 Gy administration on a 100 ml volume phantom with 10 mg g-1 Gd solution placed in a water phantom, 1129 ± 184 K-shell Gd counts were detected. For an administered dose of 21 Gy and the same Gd solution measured in air, resulted in 3296 ± 256 counts. A total of 1094 ± 171, 421 ± 150 and 23 ± 141 K-shell Gd counts were measured for Gd concentrations of 10 mg g-1, 1 mg g-1 and 0 mg g-1 for 7 Gy dose in air. The signal to noise ratio for these five measurements were: 7, 15, 6, 3, and 0.2, respectively. The spectrum contained 43 keV K α and 49 keV K ß peaks, however a small amount of 79.5 and 181.9 keV prompt gamma rays were detected from gadolinium neutron capture. This discrepancy is due to a drop in the intrinsic detection efficiency of the CdTe spectrometer over this energy range. The measurements were compared with Monte-Carlo simulation to determine the contributions of Gd neutron capture from internal and external neutrons on a passive scattering proton therapy unit and to investigate the discrepancy in detected characteristic x-rays versus prompt gamma rays.

Feasibility study of surface motion tracking with millimeter wave technology during radiotherapy.

PURPOSE: Continuous monitoring of patient movement is crucial to administering safe radiation therapy (RT). Conventional optical approaches often cannot be used when the patient's surface is blocked by immobilization devices. Millimeter waves (mmWaves) are capable of penetrating nonconductive objects. In this study, we investigated using mmWave technology to monitor patient surface displacements, as well as breathing and cardiac phases, through clothing and body fixtures. METHODS: A mmWave device was mounted inside the bore of a ring-based radiotherapy linear accelerator and pointed at a reflective surface on top of the couch. Measurements were obtained at displacements of 10, 7.5, 5.0, 2.5, and 1.0 mm at heights 100, 150, and 200 mm below isocenter. Submillimeter displacements were performed at a height of 200 mm. Additionally, millimeter and submillimeter displacements were measured with and without a gown and body mold placed between the surface and the sensor. The device was programmed to transmit chirp signals at 77-81 GHz. The subject's surface was detected by fast Fourier transform (FFT) of the reflected chirp signal within a rough range bin. Fine displacements within that range bin were calculated through phase extraction and phase demodulation. The displacement data were sent through two separate bandpass filters with passbands of 0.1-0.6 and 0.8-2.0 Hz to obtain the subject's breathing and cardiac waveforms, respectively. The breathing and cardiac measurements were compared to those of a Vernier Respiration Monitor Belt and an electrocardiogram (EKG), respectively, to assess validity. RESULTS: The device was able to detect millimeter and submillimeter displacements as small as 0.1 mm, as well as monitor displacement with an accuracy within 1 mm in the presence of an obstructive object. The device's breathing and cardiac waveforms exhibited a strong phase correlation between the respiration monitor belt (ρ = 0.9156) and EKG (ρ = 0.7895), respectively. CONCLUSIONS: The mmWave device can monitor surface displacements with an accuracy better than 0.1 mm without obstructions and better than 1 mm with obstructions. It can also provide real-time monitoring of breathing and cardiac waveforms simultaneously with high correlation with traditional respiratory and cardiac monitoring devices. Overall, mmWave technology demonstrates potential for motion monitoring in the field of radiation oncology.

A novel design of proton computed tomography detected by multiple-layer ionization chamber with strip chambers: A feasibility study with Monte Carlo simulation.

PURPOSE: Uncertainty in proton range can be reduced by proton computed tomography (CT). A novel design of proton CT using a multiple-layer ionization chamber with two strip ionization chambers on the surface is proposed to simplify the imaging acquisition and reconstruction. METHODS: Two strip ionization chambers facing the proton source were coupled into a multiple-layer ionization chamber (MLIC). The strip chambers measured locations and lateral profiles of incident proton beamlets after exiting the imaging object, while the integral of depth dose measured in the MLIC was translated into the residual energy of the beamlet. The simulation was performed at five levels of imaging dose to demonstrate the feasibility and performance expectations of our design. The energy of the proton beamlet was set to 150 ± 0.6 MeV. A collimator with a round slit of 1 cm in diameter was placed in the central beam axis upstream from steering magnets. Proton stopping power ratio (SPR) was reconstructed through inverse radon transform on sinograms generated with proton beamlets scanning through an imaging phantom from a half-circle gantry rotation. The imaging phantom was 10 cm in diameter. The base was made of water-equivalent material holding 13-tissue equivalent inserts constructed according to ICRP 1975 (Task Group on Reference Man. "Report of the Task Group on Reference Man: A Report", Pergamon Press 23, 1975). All inserts were 1 cm in diameter with materials ranging from lung to cortical bone. Percentage discrepancies were reported by comparing to the ground truths. The imaging dose and quality were also evaluated. RESULTS: The maximum deviation in reconstructed proton SPR from the ground truths was reported to be 1.02% in one of the 13 inserts when the number of protons per beamlet passing through the slit dropped to 103 . Imaging dose was correlated linearly to incident protons and was determined to be 0.54 cGy if 5 × 102 protons per beamlet were used. Imaging quality was acceptable for planning purpose and held consistently through all levels of imaging dose. Spatial resolution was measured as five line pairs per cm consistently in all simulations varying in imaging dose. CONCLUSIONS: Proton CT using a multiple-layer ionization chamber with two strip ionization chambers on the surface simplifies data acquisition while achieving excellent accuracy in proton SPR and acceptable spatial resolution. The imaging dose is lower compared to kV CBCT, making it potentially a great tool for localization and plan adaption in proton therapy.

Comparison of various online IGRT strategies: The benefits of online treatment plan re-optimization.

PURPOSE: To compare the dosimetric differences of various online IGRT strategies and to predict potential benefits of online re-optimization techniques in prostate cancer radiation treatments. MATERIALS AND METHODS: Nine prostate patients were recruited in this study. Each patient has one treatment planning CT images and 10-treatment day CT images. Five different online IGRT strategies were evaluated which include 3D conformal with bone alignment, 3D conformal re-planning via aperture changes, intensity modulated radiation treatment (IMRT) with bone alignment, IMRT with target alignment and IMRT daily re-optimization. Treatment planning and virtual treatment delivery were performed. The delivered doses were obtained using in-house deformable dose mapping software. The results were analyzed using equivalent uniform dose (EUD). RESULTS: With the same margin, rectum and bladder doses in IMRT plans were about 10% and 5% less than those in CRT plans, respectively. Rectum and bladder doses were reduced as much as 20% if motion margin is reduced by 1cm. IMRT is more sensitive to organ motion. Large discrepancies of bladder and rectum doses were observed compared to the actual delivered dose with treatment plan predication. The therapeutic ratio can be improved by 14% and 25% for rectum and bladder, respectively, if IMRT online re-planning is employed compared to the IMRT bone alignment approach. The improvement of target alignment approach is similar with 11% and 21% dose reduction to rectum and bladder, respectively. However, underdosing in seminal vesicles was observed on certain patients. CONCLUSIONS: Online treatment plan re-optimization may significantly improve therapeutic ratio in prostate cancer treatments mostly due to the reduction of PTV margin. However, for low risk patient with only prostate involved, online target alignment IMRT treatment would achieve similar results as online re-planning. For all IGRT approaches, the delivered organ-at-risk doses may be significantly different from treatment planning prediction.

Tetrahedron beam computed tomography (TBCT): a new design of volumetric CT system.

Volumetric CT imaging systems usually comprise a point x-ray source and a 2D detector. Flat panel imager (FPI)-based cone beam CT (CBCT) has become an important online imaging modality for image-guided radiotherapy and intervention. However, due to excessive scatter photons and inferior detector performance, the image quality of current CBCT is significantly inferior to diagnostic fan-beam CT. We propose a novel tetrahedron beam computed tomography (TBCT) imaging system which consists of a linear scan x-ray source and a linear x-ray detector array. The linear x-ray tube and detector array are aligned perpendicular and parallel to the rotation plane, respectively. The x-ray beams are narrowly collimated into fan beams and focused on the linear detector array. The linear detector and linear x-ray source form a 'tetrahedron' volume instead of a 'cone' volume. TBCT is similar to CBCT in image reconstruction geometry; however, its image quality will be significantly superior to that of CBCT due to its scatter rejection mechanism and the use of high-performance discrete x-ray detectors. In this paper, we describe the design of the TBCT system for image-guided radiotherapy and some results of preliminary studies.