On proton CT reconstruction using MVCT-converted virtual proton projections.

PURPOSE: To describe a novel methodology of converting megavoltage x-ray projections into virtual proton projections that are otherwise missing due to the proton range limit. These converted virtual proton projections can be used in the reconstruction of proton computed tomography (pCT). METHODS: Relations exist between proton projections and multispectral megavoltage x-ray projections for human tissue. Based on these relations, these tissues can be categorized into: (a) adipose tissue; (b) nonadipose soft tissues; and (c) bone. These three tissue categories can be visibly identified on a regular megavoltage x-ray computed tomography (MVCT) image. With an MVCT image and its projection data available, the x-ray projections through heterogeneous anatomy can be converted to the corresponding proton projections using predetermined calibration curves for individual materials, aided by a coarse segmentation on the x-ray CT image. To show the feasibility of this approach, mathematical simulations were carried out. The converted proton projections, plotted on a proton sinogram, were compared to the simulated ground truth. Proton stopping power images were reconstructed using either the virtual proton projections only or a blend of physically available proton projections and virtual proton projections that make up for those missing due to the range limit. These images were compared to a reference image reconstructed from theoretically calculated proton projections. RESULTS: The converted virtual projections had an uncertainty of ±0.8% compared to the calculated ground truth. Proton stopping power images reconstructed using a blend of converted virtual projections (48%) and physically available projections (52%) had an uncertainty of ±0.86% compared with that reconstructed from theoretically calculated projections. Reconstruction solely from converted virtual proton projections had an uncertainty of ±1.1% compared with that reconstructed from theoretical projections. If these images are used for treatment planning, the average proton range uncertainty is estimated to be less than 1.5% for an imaging dose in the milligray range. CONCLUSIONS: The proposed method can be used to convert x-ray projections into virtual proton projections. The converted proton projections can be blended with existing proton projections or can be used solely for pCT reconstruction, addressing the range limit problem of pCT using current therapeutic proton machines.

Bragg peak prediction from quantitative proton computed tomography using different path estimates.

This paper characterizes the performance of the straight-line path (SLP) and cubic spline path (CSP) as path estimates used in reconstruction of proton computed tomography (pCT). The GEANT4 Monte Carlo simulation toolkit is employed to simulate the imaging phantom and proton projections. SLP, CSP and the most-probable path (MPP) are constructed based on the entrance and exit information of each proton. The physical deviations of SLP, CSP and MPP from the real path are calculated. Using a conditional proton path probability map, the relative probability of SLP, CSP and MPP are calculated and compared. The depth dose and Bragg peak are predicted on the pCT images reconstructed using SLP, CSP, and MPP and compared with the simulation result. The root-mean-square physical deviations and the cumulative distribution of the physical deviations show that the performance of CSP is comparable to MPP while SLP is slightly inferior. About 90% of the SLP pixels and 99% of the CSP pixels lie in the 99% relative probability envelope of the MPP. Even at an imaging dose of ∼0.1 mGy the proton Bragg peak for a given incoming energy can be predicted on the pCT image reconstructed using SLP, CSP, or MPP with 1 mm accuracy. This study shows that SLP and CSP, like MPP, are adequate path estimates for pCT reconstruction, and therefore can be chosen as the path estimation method for pCT reconstruction, which can aid the treatment planning and range prediction of proton radiation therapy.

On the use of a proton path probability map for proton computed tomography reconstruction.

PURPOSE: To describe a method to estimate the proton path in proton computed tomography (pCT) reconstruction, which is based on the probability of a proton passing through each point within an object to be imaged. METHODS: Based on multiple Coulomb scattering and a semianalytically derived model, the conditional probability of a proton passing through each point within the object given its incoming and exit condition is calculated in a Bayesian inference framework, employing data obtained from Monte Carlo simulation using GEANT4. The conditional probability at all of the points in the reconstruction plane forms a conditional probability map and can be used for pCT reconstruction. RESULTS: From the generated conditional probability map, a most-likely path (MLP) and a 90% probability envelope around the most-likely path can be extracted and used for pCT reconstruction. The reconstructed pCT image using the conditional probability map yields a smooth pCT image with minor artifacts. pCT reconstructions obtained using the extracted MLP and the 90% probability envelope compare well to reconstructions employing the method of cubic spline proton path estimation. CONCLUSIONS: The conditional probability of a proton passing through each point in an object given its entrance and exit condition can be obtained using the proposed method. The extracted MLP and the 90% probability envelope match the proton path recorded in the GEANT4 simulation well. The generated probability map also provides a benchmark for comparing different path estimation methods.

Proof of principle of ocular sparing in dogs with sinonasal tumors treated with intensity-modulated radiation therapy.

Intensity-modulated radiation therapy (IMRT) allows optimization of radiation dose delivery to complex tumor volumes with rapid dose drop-off to surrounding normal tissues. A prospective study was performed to evaluate the concept of conformal avoidance using IMRT in canine sinonasal cancer. The potential of IMRT to improve clinical outcome with respect to acute and late ocular toxicity was evaluated. Thirty-one dogs with sinonasal cancer were treated definitively with IMRT using helical tomotherapy and/or dynamic multileaf collimator (DMLC) delivery. Ocular toxicity was evaluated prospectively and compared with a comparable group of historical controls treated with conventional two-dimensional radiotherapy (2D-RT) techniques. Treatment plans were devised for each dog using helical tomotherapy and DMLC that achieved the target dose to the planning treatment volume and limited critical normal tissues to the prescribed dose-volume constraints. Overall acute and late toxicities were limited and minor, detectable by an experienced observer. This was in contrast to the profound ocular morbidity observed in the historical control group treated with 2D-RT. Overall median survival for IMRT-treated and 2D-treated dogs was 420 and 411 days, respectively. Compared with conventional techniques, IMRT reduced dose delivered to eyes and resulted in bilateral ocular sparing in the dogs reported herein. These data provide proof-of-principle that conformal avoidance radiotherapy can be delivered through high conformity IMRT, resulting in decreased normal tissue toxicity as compared with historical controls treated with 2D-RT.

Megavoltage computed tomography: an emerging tool for image-guided radiotherapy.

BACKGROUND: Helical tomotherapy is a unique approach to image-guided IMRT that combines features of a linear accelerator and a CT scanner. This design allows generation of megavoltage CT (MVCT) images, which among other uses, are used to verify daily setup. In this study, we assessed the image-quality, absorbed radiation doses, and clinical practicality of MVCT from our helical tomotherapy prototype unit. MATERIALS AND METHODS: Phantom studies were first performed to assess the capabilities of MVCT. Next, MVCT images from human patients prospectively enrolled on institutional review board-approved imaging and treatment protocols were analyzed. MVCT was obtained using a 4-MV beam from the University of Wisconsin helical tomotherapy prototype device. These scans were compared with conventional kilovoltage (kVCT) images from a diagnostic CT scanner. RESULTS: MVCT images in phantoms demonstrate an ability to detect contrast differences as small as 3%. Small objects, 1.2 to 1.6 mm, were seen with good resolution. In human subjects, MVCT imaging of tumor targets and normal anatomy revealed sufficient detail for patient repositioning. MVCT imaging of metallic objects showed minimal artifact in comparison with kVCT. Patient scans were obtained in about 1 to 5 minutes and resulted in absorbed radiation doses of 1.5 to 3 cGy. CONCLUSIONS: MVCT is an elegant pretreatment position and setup verification tool. MVCT images of human subjects obtained from the helical tomotherapy unit showed good resolution and contrast. The high-quality three-dimensional information permits its use in day-to-day setup verification. The unique properties of MVCT also provide the potential for primary imaging of anatomic regions near metal prostheses as well as nonmedical applications. Additional investigations are underway to improve image quality, further reduce patient dose, and aid adaptive radiotherapy and dose reconstruction.

PET/CT following intensity-modulated radiation therapy for primary lung tumor in a dog.

A primary lung tumor in a dog treated with intensity-modulated radiation therapy was imaged approximately 6 weeks and 1-year posttreatment with combined positron emission tomography (PET) and computed tomography, utilizing the radiotracers 18F-fluorodeoxyglucose and 18F-fluorothymidine. These two tracers allowed discrimination of tumor from inflammation, and demonstrated spread of tumor along airways over time after treatment. Fusion of functional imaging with anatomic imaging is a useful tool, particularly in the field of oncology, with the potential for PET markers that delineate tumor from normal or reactive tissue, and potential or actual response to therapy.

Confirmation, refinement, and extension of a study in intrafraction motion interplay with sliding jaw motion.

The interplay between a constant scan speed and intrafraction oscillatory motion produces interesting fluence intensity modulations along the axis of motion that are sensitive to the motion function, as originally shown in a classic paper by Yu et al. [Phys. Med. Biol. 43, 91-104 (1998)]. The fluence intensity profiles are explored in this note for an intuitive understanding, then compared with Yu et al., and finally further explored for the effects of low scan speed and random components of both intrafraction and interfraction motion. At slow scan speeds typical of helical tomotherapy, these fluence intensity modulations are only a few percent. With the addition of only a small amount of cycle-to-cycle randomness in frequency and amplitude, the fluence intensity profiles change dramatically. It is further shown that after a typical 30-fraction treatment, the sensitivities displayed in the single fraction fluence intensity profiles greatly diminish.

Confirmation, refinement, and extension of a study in intrafraction motion interplay with sliding jaw motion.

The interplay between a constant scan speed and intrafraction oscillatory motion produces interesting fluence intensity modulations along the axis of motion that are sensitive to the motion function, as originally shown in a classic paper by Yu et al. [Phys. Med. Biol. 43, 91-104 (1998)]. The fluence intensity profiles are explored in this note for an intuitive understanding, then compared with Yu et al., and finally further explored for the effects of low scan speed and random components of both intrafraction and interfraction motion. At slow scan speeds typical of helical tomotherapy, these fluence intensity modulations are only a few percent. With the addition of only a small amount of cycle-to-cycle randomness in frequency and amplitude, the fluence intensity profiles change dramatically. It is further shown that after a typical 30-fraction treatment, the sensitivities displayed in the single fraction fluence intensity profiles greatly diminish.

Technical note: A novel boundary condition using contact elements for finite element based deformable image registration.

Deformable image registration is an important tool for image-guided radiotherapy. Physics-model-based deformable image registration using finite element analysis is one of the methods currently being investigated. The calculation accuracy of finite element analysis is dependent on given boundary conditions, which are usually based on the surface matching of the organ in two images. Such a surface matching, however, is hard to obtain from medical images. In this study, we developed a new boundary condition to circumvent the traditional difficulties. Finite element contact-impact analysis was employed to simulate the interaction between the organ of interest and the surrounding body. The displacement loading is not necessarily specified. The algorithm automatically deforms the organ model into the minimum internal energy state. The analysis was performed on CT images of the lung at two different breathing phases (exhalation and full inhalation). The result gave the displacement vector map inside the lung. Validation of the result showed satisfactory agreement in most parts of the lung. This approach is simple, operator independent and may provide improved accuracy of the prediction of organ deformation.

Plastic scintillation dosimetry: optimization of light collection efficiency.

Practical contemporary radiotherapy dosimetry systems used for dose measurement and verification are ionization chambers (which typically have at least a 0.1 cm3 air cavity volume), thermoluminescent dosimeters (TLDs) and silicon diodes. However, during the last decade, there has been an increased interest in scintillation dosimetry using small water-equivalent plastic scintillators, due to their favourable characteristics when compared with other more commonly used detector systems. Although plastic scintillators have been shown to have many desirable dosimetric properties, as yet there is no successful commercial detector system of this type available for routine clinical use in radiation oncology. The objectives of this study are to identify the factors preventing this new technology from realizing its full potential in commercial applications. A definition of signal to noise ratio (S/N) will be proposed for this category of detectors. In doing so the S/N ratio for an early prototype design has been calculated and/or measured. Criteria to optimize the response and sensitivity of this category of detectors are presented.

Helical tomotherapy: an innovative technology and approach to radiation therapy.

Helical tomotherapy represents both a novel radiation treatment device and an innovative means of delivering radiotherapy. The helical tomotherapy unit itself is essentially a hybrid between a linear accelerator and a helical CT scanner for the purpose of delivering intensity-modulated radiation therapy (IMRT). The imaging capacity conferred by the CT component allows targeted regions to be visualized prior to, during, and immediately after each treatment. The megavoltage CT (MVCT) images supplant the port-films used in conventional radiotherapy, providing unprecedented anatomical detail. Image-guidance through MVCT will allow the development and refinement of the concept of "adaptive radiotherapy", the reconstruction of the actual daily delivered dose (as opposed to planned dose) accompanied by prescription and delivery adjustments when appropriate. In addition to this unique feature, helical tomotherapy appears capable of further improvements over 3-dimensional conformal radiation therapy and non-helical IMRT in the specific avoidance of critical normal structures, i.e "conformal avoidance", the counterpart of conformal radiation therapy. Based on radiobiological principles that exploit the physical advantages of helical tomotherapy, several dosimetric and clinical investigations are underway.