An in-vivo treatment monitoring system for ion-beam radiotherapy based on 28 Timepix3 detectors.

Ion-beam radiotherapy is an advanced cancer treatment modality offering steep dose gradients and a high biological effectiveness. These gradients make the therapy vulnerable to patient-setup and anatomical changes between treatment fractions, which may go unnoticed. Charged fragments from nuclear interactions of the ion beam with the patient tissue may carry information about the treatment quality. Currently, the fragments escape the patient undetected. Inter-fractional in-vivo treatment monitoring based on these charged nuclear fragments could make ion-beam therapy safer and more efficient. We developed an ion-beam monitoring system based on 28 hybrid silicon pixel detectors (Timepix3) to measure the distribution of fragment origins in three dimensions. The system design choices as well as the ion-beam monitoring performance measurements are presented in this manuscript. A spatial resolution of 4 mm along the beam axis was achieved for the measurement of individual fragment origins. Beam-range shifts of 1.5 mm were identified in a clinically realistic treatment scenario with an anthropomorphic head phantom. The monitoring system is currently being used in a prospective clinical trial at the Heidelberg Ion Beam Therapy Centre for head-and-neck as well as central nervous system cancer patients.

Towards precise LET measurements based on energy deposition of therapeutic ions in Timepix3 detectors.

Objective.There is an increasing interest in calculating and measuring linear energy transfer (LET) spectra in particle therapy in order to assess their impact in biological terms. As such, the accuracy of the particle fluence energy spectra becomes paramount. This study focuses on quantifying energy depositions of distinct proton, helium, carbon, and oxygen ion beams using a silicon pixel detector developed at CERN to determine LET spectra in silicon.Approach.While detection systems have been investigated in this pursuit, the scarcity of detectors capable of providing per-ion data with high spatial and temporal resolution remains an issue. This gap is where silicon pixel detector technology steps in, enabling online tracking of single-ion energy deposition. The used detector consisted of a 300µm thick silicon sensor operated in partial depletion.Main results.During post-processing, artifacts in the acquired signals were identified and methods for their corrections were developed. Subsequently, a correlation between measured and Monte Carlo-based simulated energy deposition distributions was performed, relying on a two-step recalibration approach based on linear and saturating exponential models. Despite the observed saturation effects, deviations were confined below 7% across the entire investigated range of track-averaged LET values in silicon from 0.77 keVµm-1to 93.16 keVµm-1.Significance.Simulated and measured mean energy depositions were found to be aligned within 7%, after applying artifact corrections. This extends the range of accessible LET spectra in silicon to clinically relevant values and validates the accuracy and reliability of the measurements. These findings pave the way towards LET-based dosimetry through an approach to translate these measurements to LET spectra in water. This will be addressed in a future study, extending functionality of treatment planning systems into clinical routine, with the potential of providing ion-beam therapy of utmost precision to cancer patients.

Energy painting: helium-beam radiography with thin detectors and multiple beam energies.

Objective.Compact ion imaging systems based on thin detectors are a promising prospect for the clinical environment since they are easily integrated into the clinical workflow. Their measurement principle is based on energy deposition instead of the conventionally measured residual energy or range. Therefore, thin detectors are limited in the water-equivalent thickness range they can image with high precision. This article presents ourenergy paintingmethod, which has been developed to render high precision imaging with thin detectors feasible even for objects with larger, clinically relevant water-equivalent thickness (WET) ranges.Approach.A detection system exclusively based on pixelated silicon Timepix detectors was used at the Heidelberg ion-beam therapy center to track single helium ions and measure their energy deposition behind the imaged object. Calibration curves were established for five initial beam energies to relate the measured energy deposition to WET. They were evaluated regarding their accuracy, precision and temporal stability. Furthermore, a 60 mm × 12 mm region of a wedge phantom was imaged quantitatively exploiting the calibrated energies and five different mono-energetic images. These mono-energetic images were combined in a pixel-by-pixel manner by averaging the WET-data weighted according to their single-ion WET precision (SIWP) and the number of contributing ions.Main result.A quantitative helium-beam radiograph of the wedge phantom with an average SIWP of 1.82(5) % over the entire WET interval from 150 mm to 220 mm was obtained. Compared to the previously used methodology, the SIWP improved by a factor of 2.49 ± 0.16. The relative stopping power value of the wedge derived from the energy-painted image matches the result from range pullback measurements with a relative deviation of only 0.4 %.Significance.The proposed method overcomes the insufficient precision for wide WET ranges when employing detection systems with thin detectors. Applying this method is an important prerequisite for imaging of patients. Hence, it advances detection systems based on energy deposition measurements towards clinical implementation.

Detecting perturbations of a radiation field inside a head-sized phantom exposed to therapeutic carbon-ion beams through charged-fragment tracking.

PURPOSE: Noninvasive methods to monitor carbon-ion beams in patients are desired to fully exploit the advantages of carbon-ion radiotherapy. Prompt secondary ions produced in nuclear fragmentations of carbon ions are of particular interest for monitoring purposes as they can escape the patient and thus be detected and tracked to measure the radiation field in the irradiated object. This study aims to evaluate the performance of secondary-ion tracking to detect, visualize, and localize an internal air cavity used to mimic inter-fractional changes in the patient anatomy at different depths along the beam axis. METHODS: In this work, a homogeneous head phantom was irradiated with a realistic carbon-ion treatment plan with a typical prescribed fraction dose of 3 Gy(RBE). Secondary ions were detected by a mini-tracker with an active area of 2 cm2 , based on the Timepix3 semiconductor pixel detector technology. The mini-tracker was placed 120 mm behind the center of the target at an angle of 30 degrees with respect to the beam axis. To assess the performance of the developed method, a 2-mm thick air cavity was inserted in the head phantom at several depths: in front of as well as at the entrance, in the middle, and at the distal end of the target volume. Different reconstruction methods of secondary-ion emission profile were studied using the FLUKA Monte Carlo simulation package. The perturbations in the emission profiles caused by the air cavity were analyzed to detect the presence of the air cavity and localize its position. RESULTS: The perturbations in the radiation field mimicked by the 2-mm thick cavity were found to be significant. A detection significance of at least three standard deviations in terms of spatial distribution of the measured tracks was found for all investigated cavity depths, while the highest significance (six standard deviations) was obtained when the cavity was located upstream of the tumor. For a tracker with an eight-fold sensitive area, the detection significance rose to at least nine standard deviations and up to 17 standard deviations, respectively. The cavity could be detected at all depths and its position measured within 6.5 ± 1.4 mm, which is sufficient for the targeted clinical performance of 10 mm. CONCLUSION: The presented systematic study concerning the detection and localization of small inter-fractional structure changes in a realistic clinical setting demonstrates that secondary ions carry a large amount of information on the internal structure of the irradiated object and are thus attractive to be further studied for noninvasive monitoring of carbon-ion treatments.

Investigation of Suitable Detection Angles for Carbon-Ion Radiotherapy Monitoring in Depth by Means of Secondary-Ion Tracking.

The dose conformity of carbon-ion beam radiotherapy, which allows the reduction of the dose deposition in healthy tissue and the escalation of the dose to the tumor, is associated with a high sensitivity to anatomical changes during and between treatment irradiations. Thus, the monitoring of inter-fractional anatomical changes is crucial to ensure the dose conformity, to potentially reduce the size of the safety margins around the tumor and ultimately to reduce the irradiation of healthy tissue. To do so, monitoring methods of carbon-ion radiotherapy in depth using secondary-ion tracking are being investigated. In this work, the detection and localization of a small air cavity of 2 mm thickness were investigated at different detection angles of the mini-tracker relative to the beam axis. The experiments were conducted with a PMMA head phantom at the Heidelberg Ion-Beam Therapy Center (HIT) in Germany. In a clinic-like irradiation of a single field of 3 Gy (RBE), secondary-ion emission profiles were measured by a 2 cm2 mini-tracker composed of two silicon pixel detectors. Two positions of the cavity in the head phantom were studied: in front and in the middle of the tumor volume. The significance of the cavity detection was found to be increased at smaller detection angles, while the accuracy of the cavity localization was improved at larger detection angles. Detection angles of 20° - 30° were found to be a good compromise for accessing both, the detectability and the position of the air cavity along the depth in the head of a patient.

Quality assurance method for monitoring of lateral pencil beam positions in scanned carbon-ion radiotherapy using tracking of secondary ions.

PURPOSE: Ion beam radiotherapy offers enhances dose conformity to the tumor volume while better sparing healthy tissue compared to conventional photon radiotherapy. However, the increased dose gradient also makes it more sensitive to uncertainties. While the most important uncertainty source is the patient itself, the beam delivery is also subject to uncertainties. Most of the proton therapy centers used cyclotrons, which deliver typically a stable beam over time, allowing a continuous extraction of the beam. Carbon-ion beam radiotherapy (CIRT) in contrast uses synchrotrons and requires a larger and energy-dependent extrapolation of the nozzle-measured positions to obtain the lateral beam positions in the isocenter, since the nozzle-to-isocenter distance is larger than for cyclotrons. Hence, the control of lateral pencil beam positions at isocenter in CIRT is more sensitive to uncertainties than in proton radiotherapy. Therefore, an independent monitoring of the actual lateral positions close to the isocenter would be very valuable and provide additional information. However, techniques capable to do so are scarce, and they are limited in precision, accuracy and effectivity. METHODS: The detection of secondary ions (charged nuclear fragments) has previously been exploited for the Bragg peak position of C-ion beams. In our previous work, we investigated for the first time the feasibility of lateral position monitoring of pencil beams in CIRT. However, the reported precision and accuracy were not sufficient for a potential implementation into clinical practice. In this work, it is shown how the performance of the method is improved to the point of clinical relevance. To minimize the observed uncertainties, a mini-tracker based on hybrid silicon pixel detectors was repositioned downstream of an anthropomorphic head phantom. However, the secondary-ion fluence rate in the mini-tracker rises up to 1.5 × 105 ions/s/cm2 , causing strong pile-up of secondary-ion signals. To solve this problem, we performed hardware changes, optimized the detector settings, adjusted the setup geometry and developed new algorithms to resolve ambiguities in the track reconstruction. The performance of the method was studied on two treatment plans delivered with a realistic dose of 3 Gy (RBE) and averaged dose rate of 0.27 Gy/s at the Heidelberg Ion-Beam Therapy Center (HIT) in Germany. The measured lateral positions were compared to reference beam positions obtained either from the beam nozzle or from a multi-wire proportional chamber positioned at the room isocenter. RESULTS: The presented method is capable to simultaneously monitor both lateral pencil beam coordinates over the entire tumor volume during the treatment delivery, using only a 2-cm2 mini-tracker. The effectivity (defined as the fraction of analyzed pencil beams) was 100%. The reached precision of (0.6 to 1.5) mm and accuracy of (0.5 to 1.2) mm are in line with the clinically accepted uncertainty for QA measurements of the lateral pencil beam positions. CONCLUSIONS: It was demonstrated that the performance of the method for a non-invasive lateral position monitoring of pencil beams is sufficient for a potential clinical implementation. The next step is to evaluate the method clinically in a group of patients in a future observational clinical study.

Proof of principle of helium-beam radiography using silicon pixel detectors for energy deposition measurement, identification, and tracking of single ions.

PURPOSE: Hadron therapy has the capability to provide a high dose conformation to tumor regions. However, it requires an accurate target positioning. Thus, the precise monitoring of the patient's anatomical positioning during treatment is desirable. For this purpose, hadron-beam radiography with protons (pRad) and ions (iRad) could be an attractive tool complementing the conventional imaging technologies. On the pathway to an envisaged clinical application, several challenges have to be addressed. Among them are achieving the desired spatial resolution in the presence of multiple Coulomb scattering (MCS), performing radiographs with a sufficient thickness resolution at clinically applicable dose levels, and the search for combinations of particularly suitable hadrons and detectors. These topics are investigated in this work for a detection system based on silicon pixel detectors. METHODS: A method of iRad based on energy deposition measurements in thin layers is introduced. It exploits a detection system consisting of three parallel silicon pixel detectors, which also enables particle tracking and identification. Helium ions, which exhibit less pronounced MCS than protons, were chosen as imaging radiation. A PMMA phantom with a mean water-equivalent thickness (WET) of 192 mm, containing maximal WET-variations of ±6 mm, was imaged with a 173 MeV/u helium ion beam at the Heidelberg Ion-Beam Therapy Center. WET-differences in form of 2.3 mm × 2.3 mm steps were aimed to be visualized and resolved in images of the energy deposition measured behind the phantom. The detection system was placed downstream of the imaged object in order to detect single ions leaving it. The combination of the measured information on energy deposition, ion type, and the track behind the phantom was used for the image formation, employing a self-developed data-processing procedure. RESULTS: It was shown that helium-beam radiography is feasible with the reported detection system. The introduced data preprocessing purified the detector signal from detector artifacts and improved the image quality. Additionally, the rejection of hydrogen ions originating from nuclear interactions was shown to increase the contrast-to-noise ratio (CNR) by at least a factor of 2.5. This enabled the resolution of relative thickness differences of 1.2% at a dose level typical for diagnostic x-ray images. The spatial resolution was improved by taking into account the direction of single helium ions leaving the phantom. A spatial resolution (MTF10% ) of at least 1.15p mm-1 for the presented experimental set-up was achieved. CONCLUSION: A successful feasibility study of helium-beam radiography with the introduced detection system was conducted. The methodology of iRad was based on energy deposition measurements in thin silicon layers. The tracking of single ions and the method of the ion identification was shown to be important for helium-beam radiography in terms of spatial resolution and CNR.

A novel method for assessment of fragmentation and beam-material interactions in helium ion radiotherapy with a miniaturized setup.

Radiotherapy with protons and carbon ions enables to deliver dose distributions of high conformation to the target. Treatment with helium ions has been suggested due to their physical and biological advantages. A reliable benchmarking of the employed physics models with experimental data is required for treatment planning. However, experimental data for helium interactions is limited, in part due to the complexity and large size of conventional experimental setups. We present a novel method for the investigation of helium interactions with matter using miniaturized instrumentation based on highly integrated pixel detectors. The versatile setup consisted of a monitoring detector in front of the PMMA phantom of varying thickness and a detector stack for investigation of outgoing particles. The ion type downstream from the phantom was determined by high-resolution pattern recognition analysis of the single particle signals in the pixelated detectors. The fractions of helium and hydrogen ions behind the used targets were determined. As expected for the stable helium nucleus, only a minor decrease of the primary ion fluence along the target depth was found. E.g. the detected fraction of hydrogen ions on axis of a 220MeV/u 4He beam was below 6% behind 24.5cm of PMMA. Monte-Carlo simulations using Geant4 reproduce the experimental data on helium attenuation and yield of helium fragments qualitatively, but significant deviations were found for some combinations of target thickness and beam energy. The presented method is promising to contribute to the reduction of the uncertainty of treatment planning for helium ion radiotherapy.

Three dimensional reconstruction of therapeutic carbon ion beams in phantoms using single secondary ion tracks.

Carbon ion beam radiotherapy enables a very localised dose deposition. However, even small changes in the patient geometry or positioning errors can significantly distort the dose distribution. A live, non-invasive monitoring system of the beam delivery within the patient is therefore highly desirable, and could improve patient treatment. We present a novel three-dimensional method for imaging the beam in the irradiated object, exploiting the measured tracks of single secondary ions emerging under irradiation. The secondary particle tracks are detected with a TimePix stack-a set of parallel pixelated semiconductor detectors. We developed a three-dimensional reconstruction algorithm based on maximum likelihood expectation maximization. We demonstrate the applicability of the new method in the irradiation of a cylindrical PMMA phantom of human head size with a carbon ion pencil beam of [Formula: see text] MeV u-1. The beam image in the phantom is reconstructed from a set of nine discrete detector positions between [Formula: see text] and [Formula: see text] from the beam axis. Furthermore, we demonstrate the potential to visualize inhomogeneities by irradiating a PMMA phantom with an air gap as well as bone and adipose tissue surrogate inserts. We successfully reconstructed a three-dimensional image of the treatment beam in the phantom from single secondary ion tracks. The beam image corresponds well to the beam direction and energy. In addition, cylindrical inhomogeneities with a diameter of [Formula: see text] cm and density differences down to [Formula: see text] g cm-3 to the surrounding material are clearly visualized. This novel three-dimensional method to image a therapeutic carbon ion beam in the irradiated object does not interfere with the treatment and requires knowledge only of single secondary ion tracks. Even with detectors with only a small angular coverage, the three-dimensional reconstruction of the fragmentation points presented in this work was found to be feasible.

A Novel Method for Fragmentation Studies in Particle Therapy: Principles of Ion Identification.

PURPOSE: In carbon ion beam radiation therapy, fragmentation processes within the patient lead to changes in the composition of the particle field with increasing depth. Consequences are alterations of the resulting dose distribution and its biological effectiveness. To enable accurate treatment planning, the characteristics of the ion spectra resulting from fragmentation processes need to be known for various ion energies and target materials. In this work, we present a novel method for ion type identification using a small and highly flexible setup based on a single detector and designed to simplify measurements and overcome current shortages in available fragmentation data. MATERIALS AND METHODS: The presented approach is based on the pixelated, semiconductor detector Timepix. The large number of pixels with small pitch, all individually calibrated for energy deposition, enables detection and visualization of single particle tracks. For discrimination among different ion species, the pattern recognition analysis of the detector signal is used. Fragmentation spectra resulting from a primary carbon ion beam at various depths of tissue-equivalent material were studied to identify different ion species in mixed particle fields. The performance of the method was evaluated quantitatively using reference data from an established technique. RESULTS: All ion species resulting from carbon ion fragmentation in tissue-equivalent material could be separated. For measurements behind a 158-mm-thick water tank, the relative fractions of H, He, Be, and B ions detected agreed with corresponding reference data within the limits of uncertainty. For the relatively rare lithium ions, the agreement was within 2.3 Δref (uncertainty of reference). CONCLUSION: For designated configurations, the presented ion type identification method enables studies of therapeutic carbon ion beams with a simple, small, and configurable detection setup. The technique is promising to enable online fragmentation studies over a wide range of beam and target parameters in the future.

Dose-response of EBT3 radiochromic films to proton and carbon ion clinical beams.

We investigated the dose-response of the external beam therapy 3 (EBT3) films for proton and carbon ion clinical beams, in comparison with conventional radiotherapy beams; we also measured the film response along the energy deposition-curve in water. We performed measurements at three hadrontherapy centres by delivering monoenergetic pencil beams (protons: 63-230 MeV; carbon ions: 115-400 MeV/u), at 0.4-20 Gy dose to water, in the plateau of the depth-dose curve. We also irradiated the films to clinical MV-photon and electron beams. We placed the EBT3 films in water along the whole depth-dose curve for 148.8 MeV protons and 398.9 MeV/u carbon ions, in comparison with measurements provided by a plane-parallel ionization chamber. For protons, the response of EBT3 in the plateau of the depth-dose curve is not different from that of photons, within experimental uncertainties. For carbon ions, we observed an energy dependent under-response of EBT3 film, from 16% to 29% with respect to photon beams. Moreover, we observed an under-response in the Bragg peak region of about 10% for 148.8 MeV protons and of about 42% for 398.9 MeV/u carbon ions. For proton and carbon ion clinical beams, an under-response occurs at the Bragg peak. For carbon ions, we also observed an under-response of the EBT3 in the plateau of the depth-dose curve. This effect is the highest at the lowest initial energy of the clinical beams, a phenomenon related to the corresponding higher LET in the film sensitive layer. This behavior should be properly modeled when using EBT3 films for accurate 3D dosimetry.

Experimental verification of ion range calculation in a treatment planning system using a flat-panel detector.

Heavy ion-beam therapy is a highly precise radiation therapy exploiting the characteristic interaction of ions with matter. The steep dose gradient of the Bragg curve allows the irradiation of targets with high-dose and a narrow dose penumbra around the target, in contrast to photon irradiation. This, however, makes heavy ion-beam therapy very sensitive to minor changes in the range calculation of the treatment planning system, as it has a direct influence on the outcome of the treatment. Our previous study has shown that ion radiography with an amorphous silicon flat-panel detector allows the measurement of the water equivalent thickness (WET) of an imaging object with good accuracy and high spatial resolution. In this study, the developed imaging technique is used to measure the WET distribution of a patient-like phantom, and these results are compared to the WET calculation of the treatment planning system. To do so, a measured two-dimensional map of the WET of an anthropomorphic phantom was compared to WET distributions based on x-ray computed tomography images as used in the treatment planning system. It was found that the WET maps agree well in the overall shape and two-dimensional distribution of WET values. Quantitatively, the ratio of the two-dimensional WET maps shows a mean of 1.004 with a standard deviation of 0.022. Differences were found to be concentrated at high WET gradients. This could be explained by the Bragg-peak degradation, which is measured in detail by ion radiography with the flat-panel detector, but is not taken into account in the treatment planning system. Excluding pixels exhibiting significant Bragg-peak degradation, the mean value of the ratio was found to be 1.000 with a standard deviation of 0.012. Employment of the amorphous silicon flat-panel detector for WET measurements allows us to detect uncertainties of the WET determination in the treatment planning process. This makes the investigated technique a very helpful tool to study the WET determination of critical and complex phantom cases.

High-resolution fluence verification for treatment plan specific QA in ion beam radiotherapy.

Ion beam radiotherapy exploits the finite range of ion beams and the increased dose deposition of ions toward the end of their range in material. This results in high dose conformation to the target region, which can be further increased using scanning ion beams. The standard method for patient-plan verification in ion beam therapy is ionization chamber dosimetry. The spatial resolution of this method is given by the distance between the chambers (typically 1 cm). However, steep dose gradients created by scanning ion beams call for more information and improved spatial resolution. Here we propose a clinically applicable method, supplementary to standard patient-plan verification. It is based on ion fluence measurements in the entrance region with high spatial resolution in the plane perpendicular to the beam, separately for each energy slice. In this paper the usability of the RID256 L amorphous silicon flat-panel detector for the measurements proposed is demonstrated for carbon ion beams. The detector provides sufficient spatial resolution for this kind of measurement (pixel pitch 0.8 mm). The experiments were performed at the Heidelberg Ion-Beam Therapy Center in Germany. This facility is equipped with a synchrotron capable of accelerating ions from protons up to oxygen to energies between 48 and 430 MeV u(-1). Beam application is based on beam scanning technology. The measured signal corresponding to single energy slices was translated to ion fluence on a pixel-by-pixel basis, using calibration, which is dependent on energy and ion type. To quantify the agreement of the fluence distributions measured with those planned, a gamma-index criterion was used. In the patient field investigated excellent agreement was found between the two distributions. At least 95% of the slices contained more than 96% of points agreeing with our criteria. Due to the high spatial resolution, this method is especially valuable for measurements of strongly inhomogeneous fluence distributions like those in intensity-modulated treatment plans or plans including dose painting. Since no water phantom is needed to perform measurements, the flat-panel detector investigated has high potential for use with gantries. Before the method can be used in the clinical routine, it has to be sufficiently tested for each detector-facility combination.

Quantitative carbon ion beam radiography and tomography with a flat-panel detector.

High dose gradients are inherent to ion beam therapy. This results in high sensitivity to discrepancies between planned and delivered dose distributions. Therefore an accurate knowledge of the ion stopping power of the traversed tissue is critical. One proposed method to ensure high quality dose deposition is to measure the stopping power by ion radiography. Although the idea of imaging with highly energetic ions is more than forty years old, there is a lack of simple detectors suitable for this purpose. In this study the performance of an amorphous silicon flat-panel detector, originally designed for photon imaging, was investigated for quantitative carbon ion radiography and tomography. The flat-panel detector was exploited to measure the water equivalent thickness (WET) and water equivalent path length (WEPL) of a phantom at the Heidelberg Ion-Beam Therapy Center (HIT). To do so, the ambiguous correlation of detector signal to particle energy was overcome by active or passive variation of carbon ion beam energy and measurement of the signal-to-beam energy correlation. The active method enables one to determine the WET of the imaged object with an uncertainty of 0.5 mm WET. For tomographic WEPL measurements the passive method was exploited resulting in an accuracy of 0.01 WEPL. The developed imaging technique presents a method to measure the two-dimensional maps of WET and WEPL of phantoms with a simple and commercially available detector. High spatial resolution of 0.8 × 0.8 mm(2) is given by the detector design. In the future this powerful tool will be used to evaluate the performance of the treatment planning algorithm by studying WET uncertainties.

Characterization of a flat-panel detector for ion beam spot measurements.

Dynamic beam delivery techniques are being increasingly used for cancer therapy. Scanning ion beams require extensive and time-demanding quality assurance procedures and beam tuning. Accordingly, fast measurement techniques improving the efficiency of the procedures and accommodating the safety requirements are highly desirable. Major requirements for a detector used for beam-shape measurements are high spatial resolution in two dimensions, reusability, online readout and easy handling. At the Heidelberg Ion Beam Therapy Facility (Germany), we examined the performance of the RID 256 L flat-panel detector for beam spot measurements. The two-dimensional beam profiles of proton and carbon ion beams measured were compared to measurements with radiographic films at intermediate energies using the index. The difference to the beam width measured with radiographic films of less than 3% demonstrates sufficient accuracy of ion beam width measurements possible with this detector for both proton and carbon ion beams. The beam shapes were also measured at different beam intensities. At both the highest and lowest energies available at the HIT, no beam spot-shape deformation was found with increasing beam intensities, as long as the boundary of the dynamic range was not exceeded. The signal leak along the readout direction was identified as an undesirable effect. However, due to small amplitudes and static beams, this effect is of minor importance for beam spot measurements. Distortion of results due to detector radiation damage was monitored. No detector radiation damage was observed over the experiments. Moreover, the observed short-time detector response stability (within ±0.1%) as well as medium term stability (within 0.5% in 15 months) was excellent. This flat-panel detector is compact and easy to use. Together with its low weight, this helps to speed up measurement procedures substantially. All these properties make this an ideal detector for the fast, high-resolution imaging of static ion beam spots needed for constancy measurements in daily beam quality assurance and for accelerator tuning. For daily use, radiation damage has to be monitored continuously and corrected for if necessary.

Investigations of a flat-panel detector for quality assurance measurements in ion beam therapy.

Increased accuracy in radiation delivery to a patient provided by scanning particle beams leads to high demands on quality assurance (QA). To meet the requirements, an extensive quality assurance programme has been implemented at the Heidelberg Ion Beam Therapy Center. Currently, high-resolution radiographic films are used for beam spot position measurements and homogeneity measurements for scanned fields. However, given that using this film type is time and equipment demanding, considerations have been made to replace the radiographic films in QA by another appropriate device. In this study, the suitability of the flat-panel detector RID 256 L based on amorphous silicon was investigated as an alternative method. The currently used radiographic films were taken as a reference. Investigations were carried out for proton and carbon ion beams. The detectors were irradiated simultaneously to allow for a direct comparison. The beam parameters (e.g. energy, focus, position) currently used in the daily QA procedures were applied. Evaluation of the measurements was performed using newly implemented automatic routines. The results for the flat-panel detector were compared to the standard radiographic films. Additionally, a field with intentionally decreased homogeneity was applied to test the detector's sensitivities toward possible incorrect scan parameters. For the beam position analyses, the flat-panel detector results showed good agreement with radiographic films. For both detector types, deviations between measured and planned spot distances were found to be below 1% (1 mm). In homogeneously irradiated fields, the flat-panel detector showed a better dose response homogeneity than the currently used radiographic film. Furthermore, the flat-panel detector is sensitive to field irregularities. The flat-panel detector was found to be an adequate replacement for the radiographic film in QA measurements. In addition, it saves time and equipment because no post-exposure treatment and no developer and darkroom facilities are needed.

Dosimetric properties of Gafchromic(R) EBT films in medical carbon ion beams.

High spatial resolution is desired for dosimetrical verification of patient plans for radiotherapy treatments employing scanned ion beams. This is provided by Gafchromic EBT film, the ancestor of currently available EBT2 films. In this contribution, dosimetric properties of EBT films were investigated. Measurements of depth response were performed for monoenergetic fields (250 MeV/u) for different ion fluences as well as for an energy-modulated spread-out Bragg peak of 5 x 5 x 5 cm(3) in 10 cm depth. The films were positioned perpendicular to the incoming carbon ion beams. The observed quenching of the response relative to the same dose of photons was quantified by the relative efficiency. In monenenergetic beams, a relative efficiency of about 0.73 was found in the plateau, 0.4 in the peak and 0.55 in the tail region. No dependence of the relative efficiency on the ion fluence was observed well beyond the clinically used levels. This gives a constant peak to plateau ratio, which is about 1.8 times lower than that for the delivered dose. In the spread-out Bragg peak, the relative efficiency was found to decrease from 0.64 to 0.54 toward the distal end. Thus when aiming for a prediction of the film response in mixed ion beams, the efficiency of the film has to be parametrized as a function of the ion type and energy over the whole ion spectrum. In addition, the relative water-equivalent range of EBT films was measured here to be 1.291 +/- 0.015.

Dosimetric properties of Gafchromic EBT films in monoenergetic medical ion beams.

For quality assurance measurements in radiotherapy with scanned ion beams, such as beam profile measurements and dosimetrical verification of patient plans, high spatial accuracy is required. We investigated the Gafchromic EBT film, which is the ancestor of the currently available EBT2 film, for this purpose. The excellent spatial resolution and improvements in sensitivity as compared to older types of radiochromic films make it a suitable candidate. In this contribution a study of the dose-response relation for monoenergetic beams (plateau), based on the absolute dose, is presented. We found the film response to be comparable for protons and photons. For carbon ions we observed a decrease in the darkening efficiency of about 30% with respect to photons. This effect is likely to be caused by the ion track structure. We did not find any dependence of the relative efficiency on the applied dose and energy over typical ranges used in ion beam therapy. Furthermore, it is shown that overlaps of ion tracks are not an issue for EBT film dosimetry in medical ion beams. The above findings enable the use of EBT films calibrated in a beam of a particular ion type for dose measurements at any other dose and energy. The uncertainty of the film darkening determination in ion beams is also discussed.

Homogeneity of Gafchromic EBT2 film.

PURPOSE: The self-developing Gafchromic EBT film is a radiochromic film, widely used for relative photon dosimetry. Recently, the manufacturer has replaced the well-investigated EBT film by the new Gafchromic EBT2 film. It has the same sensitive component and, in addition, it contains a yellow marker dye in order to protect the film against ambient light exposure and to serve as a base for corrections of small differences in film response. Furthermore, the configuration of the film layers as well as the binder material have been changed in comparison to the EBT film. When investigating the properties of EBT2 film, all characteristics were found to be similar to those of EBT film, except for the film response homogeneity. Thus, in this article special focus was put on examining the homogeneity of EBT2 film. METHODS: A scan protocol established for EBT film and published previously was used. The uniformity of the film coloration was investigated for unirradiated and irradiated EBT2 film sheets. The dose response of EBT2 film was measured and the influence of film inhomogeneities on dose determination was evaluated. RESULTS: Inhomogeneities in pixel values of up to +/- 3.7% within one film were detected. The relative inhomogeneities were found to be approximately independent of the dose. Nonuniformities of the film response lead to uncertainties in dose determination of +/- 8.7% at 1 Gy. When using net optical densities for dose calibration, uncertainties in dose determination amount to more than +/- 6%. CONCLUSIONS: EBT2 films from the lot investigated in this study show response inhomogeneities, which lead to uncertainties in dose determination exceeding the commonly accepted tolerance levels. It is important to test further EBT2 lots regarding homogeneity before using the film in clinical routine.

Study of Gafchromic EBT film response over a large dose range.

Presently Gafchromic EBT films are widely used for relative dose verification in standard radiation therapy using high-energy photons, inclusive IMRT. The use of films for dosimetry in medical ion beams is more complicated due to the strongly inhomogeneous dose deposition by ions on microscopic level. Track structure models, presently used to describe dosimeter response as a function of the ion field properties, are based on input information which can be obtained from the film response in photon beams. We therefore studied the performance of Gafchromic EBT films, ancestors of currently available EBT2 films, in (60)Co photon beams. The dose-response curve was measured from 7.5 x 10(-2) Gy to 3 x 10(4) Gy. The dynamic range, linearity and dose rate dependence of this calibration curve were studied. A high saturation dose of 3 x 10(3) Gy, and thus a large dynamic range, was observed. No signs of supralinearity and bleaching due to radiation were found. No dependence of the response on the dose rate at high dose rates and high doses was found. All those properties justify the use of simplified models of the film response to ions. Furthermore, fits of the calibration data by predictions of different models for signal creation mechanism of dosimetric materials were performed. The best description was found for the recently published gamma-distributed single-hit model which takes into account different sizes of the active centres.