Monte Carlo calculated ionization chamber correction factors in clinical proton beams - deriving uncertainties from published data.

For the update of the IAEA TRS-398 Code of Practice (CoP), global ionization chamber factors (fQ) and beam quality correction factors (kQ) for air-filled ionization chambers in clinical proton beams have been calculated with different Monte Carlo codes. In this study, average Monte Carlo calculated fQ and kQ factors are provided and the uncertainty of these factors is estimated. Average fQ factors in monoenergetic proton beams with energies between 60 MeV and 250 MeV were derived from Monte Carlo calculated fQ factors published in the literature. Altogether, 195 fQ factors for six plane-parallel and three cylindrical ionization chambers calculated with penh, fluka and geant4 were incorporated. Additionally, a weighted standard deviation of fQ factors was calculated, where the same weight was assigned to each Monte Carlo code. From average fQ factors, kQ factors were derived and compared to the values from the IAEA TRS-398 CoP published in 2000 as well as to the values of the upcoming version. Average Monte Carlo calculated fQ factors are constant within 0.6% over the energy range investigated. In general, the different Monte Carlo codes agree within 1% for low energies and show larger differences up to 2% for high energies. As a result, the standard deviation of fQ factors increases with energy and is ∼0.3% for low energies and ∼0.8% for high energies. kQ factors derived from average Monte Carlo calculated fQ factors differ from the values presented in the IAEA TRS-398 CoP by up to 2.4%. The overall estimated uncertainty of Monte Carlo calculated kQ factors is ∼0.5%-1% smaller than the uncertainties estimated in IAEA TRS-398 CoP since the individual ionization chamber characteristics (e.g. fluence perturbations) are considered in detail in Monte Carlo calculations. The agreement between Monte Carlo calculated kQ factors and the values of the upcoming version of IAEA TRS-398 CoP is better with deviations smaller than 1%.

Consensus guide on CT-based prediction of stopping-power ratio using a Hounsfield look-up table for proton therapy.

BACKGROUND AND PURPOSE: Studies have shown large variations in stopping-power ratio (SPR) prediction from computed tomography (CT) across European proton centres. To standardise this process, a step-by-step guide on specifying a Hounsfield look-up table (HLUT) is presented here. MATERIALS AND METHODS: The HLUT specification process is divided into six steps: Phantom setup, CT acquisition, CT number extraction, SPR determination, HLUT specification, and HLUT validation. Appropriate CT phantoms have a head- and body-sized part, with tissue-equivalent inserts in regard to X-ray and proton interactions. CT numbers are extracted from a region-of-interest covering the inner 70% of each insert in-plane and several axial CT slices in scan direction. For optimal HLUT specification, the SPR of phantom inserts is measured in a proton beam and the SPR of tabulated human tissues is computed stoichiometrically at 100 MeV. Including both phantom inserts and tabulated human tissues increases HLUT stability. Piecewise linear regressions are performed between CT numbers and SPRs for four tissue groups (lung, adipose, soft tissue, and bone) and then connected with straight lines. Finally, a thorough but simple validation is performed. RESULTS: The best practices and individual challenges are explained comprehensively for each step. A well-defined strategy for specifying the connection points between the individual line segments of the HLUT is presented. The guide was tested exemplarily on three CT scanners from different vendors, proving its feasibility. CONCLUSION: The presented step-by-step guide for CT-based HLUT specification with recommendations and examples can contribute to reduce inter-centre variations in SPR prediction.

Biological equivalent dose is associated with radiological toxicity after lung stereotactic ablative radiation therapy.

INTRODUCTION: Stereotactic ablative radiation therapy (SABR) is the standard of care for inoperable early-stage non-small-cell lung cancer. Although the probability of grade ≥ II toxicities is low, many patients present radiological subclinical toxicities usually associated with long-term patient management challenges. We evaluated radiological changes and correlated them with the received Biological Equivalent Dose (BED). METHODS: We retrospectively analyzed chest CT scans of 102 patients treated with SABR. An experienced radiologist evaluated the radiation-related changes 6 months and 2 years after SABR. The presence of consolidation, ground-glass opacities, organizing pneumonia pattern, atelectasis and the extent of affected lung were recorded. Dose-volume histograms of the lung healthy tissue were transformed to BED. Clinical parameters such as age, smoking habits, and previous pathologies were registered and correlations between BED and radiological toxicities were drawn. RESULTS: We observed a positive and statistically significant correlation between lung BED over 300 Gy and the presence of organizing pneumonia pattern, the degree of lung affectation and the 2-year prevalence and/or increase of these radiological changes. Radiological changes in patients receiving BED > 300 Gy to a healthy lung volume ≥ 30 cc increased or remained in the 2 years follow-up scan. We found no correlation between radiological changes and the analyzed clinical parameters. CONCLUSIONS: There seems to be a clear correlation between BEDs higher than 300 Gy and radiological changes both short and long term. If confirmed in an independent patient cohort, these findings could lead to the first radiotherapy dose constraints for grade I pulmonary toxicity.

Comment on 'Lateral response heterogeneity of Bragg peak ionization chambers for narrow-beam photon and proton dosimetry'.

Kuesset al(2017Phys. Med. Biol.62206-27) irradiated several PTW 34070 ionization chambers with a narrow x-ray beam impinging at different positions of the detector entrance window and they observed that the reading of the ionization chambers decreased as the impact point of the beam approached the edge of the sensitive volume. They concluded that the radial response of the detector decreased with increasing radius and they proposed a correction factor to correct for that effect. This work shows, by means of a simple Monte Carlo simulation, that the conclusions of Kuess and co-workers do not seem to be supported by their experimental findings-quite the opposite, their experimental results seem to be compatible with a rather homogeneous radial response of the PTW 34070. It is shown that the radial decrease in the ionization chamber reading (as the impact point of the beam approaches the edge of the sensitive volume) is not due to a radial decrease of the response, but to the fact that part of the energy transferred to the secondary electrons is carried away and deposited outside the sensitive volume of the ionization chamber. As a consequence, it is believed that the method and correction factors proposed by Kuess and colleagues are not suitable to assess the response uniformity of large-area ionization chambers. Furthermore, the results of the publications that have used them thus far should be thoroughly revised.

Experimental assessment of inter-centre variation in stopping-power and range prediction in particle therapy.

PURPOSE: Experimental assessment of inter-centre variation and absolute accuracy of stopping-power-ratio (SPR) prediction within 17 particle therapy centres of the European Particle Therapy Network. MATERIAL AND METHODS: A head and body phantom with seventeen tissue-equivalent materials were scanned consecutively at the participating centres using their individual clinical CT scan protocol and translated into SPR with their in-house CT-number-to-SPR conversion. Inter-centre variation and absolute accuracy in SPR prediction were quantified for three tissue groups: lung, soft tissues and bones. The integral effect on range prediction for typical clinical beams traversing different tissues was determined for representative beam paths for the treatment of primary brain tumours as well as lung and prostate cancer. RESULTS: An inter-centre variation in SPR prediction (2σ) of 8.7%, 6.3% and 1.5% relative to water was determined for bone, lung and soft-tissue surrogates in the head setup, respectively. Slightly smaller variations were observed in the body phantom (6.2%, 3.1%, 1.3%). This translated into inter-centre variation of integral range prediction (2σ) of 2.9%, 2.6% and 1.3% for typical beam paths of prostate-, lung- and primary brain-tumour treatments, respectively. The absolute error in range exceeded 2% in every fourth participating centre. The consideration of beam hardening and the execution of an independent HLUT validation had a positive effect, on average. CONCLUSION: The large inter-centre variations in SPR and range prediction justify the currently clinically used margins accounting for range uncertainty, which are of the same magnitude as the inter-centre variation. This study underlines the necessity of higher standardisation in CT-number-to-SPR conversion.

Monte Carlo calculation of beam quality correction factors in proton beams using PENH.

This work calculates beam quality correction factors ([Formula: see text]) in both modulated and unmodulated proton beams using the Monte Carlo (MC) code [Formula: see text]. The latest ICRU 90 recommendations on key data for ionizing-radiation dosimetry were adopted to calculate the electronic stopping powers and to select the mean energy to create an ion pair in dry air ([Formula: see text]). For modulated proton beams, [Formula: see text] factors were calculated in the middle of a spread-out Bragg peak, while for monoenergetic proton beams they were calculated at the entrance region. Fifteen ionization chambers were simulated. The [Formula: see text] factors calculated in this work were found to agree within 0.8% or better with the experimental data reported in the literature. For some ionization chambers, the simulation of proton nuclear interactions were found to have an effect on the [Formula: see text] factors of up to 1%; while for some others, perturbation factors were found to differ from unity by more than 1%. In addition, the combined standard uncertainty in the MC calculated [Formula: see text] factors in proton beams was estimated to be of the order of 1%. Thus, the results of this work seem to indicate that: (i) the simulation of proton nuclear interactions should be included in the MC calculation of [Formula: see text] factors in proton beams, (ii) perturbation factors in proton beams should not be neglected, and (iii) the detailed MC simulation of ionization chambers allows for an accurate and precise calculation of [Formula: see text] factors in clinical proton beams.

Comparison of penh, fluka, and Geant4/topas for absorbed dose calculations in air cavities representing ionization chambers in high-energy photon and proton beams.

PURPOSE: The purpose of this work is to analyze whether the Monte Carlo codes penh, fluka, and geant4/topas are suitable to calculate absorbed doses and f Q / f Q 0 ratios in therapeutic high-energy photon and proton beams. METHODS: We used penh, fluka, geant4/topas, and egsnrc to calculate the absorbed dose to water in a reference water cavity and the absorbed dose to air in two air cavities representative of a plane-parallel and a cylindrical ionization chamber in a 1.25 MeV photon beam and a 150 MeV proton beam - egsnrc was only used for the photon beam calculations. The physics and transport settings in each code were adjusted to simulate the particle transport as detailed as reasonably possible. From these absorbed doses, f Q 0 factors, f Q factors, and f Q / f Q 0 ratios (which are the basis of Monte Carlo calculated beam quality correction factors k Q , Q 0 ) were calculated and compared between the codes. Additionally, we calculated the spectra of primary particles and secondary electrons in the reference water cavity, as well as the integrated depth-dose curve of 150 MeV protons in water. RESULTS: The absorbed doses agreed within 1.4% or better between the individual codes for both the photon and proton simulations. The f Q 0 and f Q factors agreed within 0.5% or better for the individual codes for both beam qualities. The resulting f Q / f Q 0 ratios for 150 MeV protons agreed within 0.7% or better. For the 1.25 MeV photon beam, the spectra of photons and secondary electrons agreed almost perfectly. For the 150 MeV proton simulation, we observed differences in the spectra of secondary protons whereas the spectra of primary protons and low-energy delta electrons also agreed almost perfectly. The first 2 mm of the entrance channel of the 150 MeV proton Bragg curve agreed almost perfectly while for greater depths, the differences in the integrated dose were up to 1.5%. CONCLUSION: penh, fluka, and geant4/topas are capable of calculating beam quality correction factors in proton beams. The differences in the f Q 0 and f Q factors between the codes are 0.5% at maximum. The differences in the f Q / f Q 0 ratios are 0.7% at maximum.

Revisiting the single-energy CT calibration for proton therapy treatment planning: a critical look at the stoichiometric method.

Despite extensive research in dual-energy computed tomography (CT), single-energy CT (SECT) is still the standard imaging modality in proton therapy treatment planning and, in this context, the stoichiometric calibration method is considered to be the most accurate to establish a relationship between CT numbers and proton stopping power. This work revisits the SECT calibration for proton therapy treatment planning, with special emphasis on the stoichiometric method. Three different sets of tissue-substitutes of known elemental composition (Gammex, CIRS and Catphan) were scanned with the same scanning protocol. A stoichiometric fit was performed for each set of tissue-substitutes. Based on that, the CT number, relative electron density and relative proton stopping power were calculated for ICRU 46 biological tissues and the different sets of tissue-substitutes. Despite common belief, it was found that the stoichiometric fit depends on the elemental composition of the tissue-substitutes used in the calibration, leading to differences in relative stopping power up to 3.5% for cortical bone. In addition, according to Rutherford et al (1976 Neuroradiology 11 15-21) parametrization of the atomic cross-section, CT numbers of Gammex tissue-substitutes and ICRU 46 biological tissues were found to be similar within the whole energy range relevant to computed tomography. Consequently, it was found that, for Gammex tissue-substitutes, the CT calibration curve resulting from the stoichiometric method agrees with that obtained by simple interpolation of experimental data. In conclusion, the stoichiometric method for SECT calibration seems to depend on the tissue-substitutes used for calibration-which could be regarded as an additional source of uncertainty in proton range for bone tissues. Furthermore, Gammex tissue-substitutes appear to be a good representative of biological tissues within the energy range relevant to computed tomography-making the stoichiometric method unnecessary.

Reference dosimetry of proton pencil beams based on dose-area product: a proof of concept.

This paper describes a novel approach to the reference dosimetry of proton pencil beams based on dose-area product ([Formula: see text]). It depicts the calibration of a large-diameter plane-parallel ionization chamber in terms of dose-area product in a 60Co beam, the Monte Carlo calculation of beam quality correction factors-in terms of dose-area product-in proton beams, the Monte Carlo calculation of nuclear halo correction factors, and the experimental determination of [Formula: see text] of a single proton pencil beam. This new approach to reference dosimetry proves to be feasible, as it yields [Formula: see text] values in agreement with the standard and well-established approach of determining the absorbed dose to water at the centre of a broad homogeneous field generated by the superposition of regularly-spaced proton pencil beams.

Reply to comment on 'Proton beam monitor chamber calibration'.

This reply shows that the discrepancy of about 3% between Faraday cup dosimetry and reference dosimetry using a cylindrical ionization chamber found in Gomà (2014 Phys. Med. Biol. 59 4961-71) seems to be due to an overestimation of the beam quality correction factors tabulated in IAEA TRS-398 for the cylindrical chamber used, rather than to 'unresolved problems with Faraday cup dosimetry', as suggested by Palmans and Vatnitsky (2016 Phys. Med. Biol. 61 6585-93). Furthermore, this work shows that a good agreement between reference dosimetry and Faraday cup dosimetry is possible, provided accurate beam quality correction factors for proton beams are used. The review on W air values presented by Palmans and Vatnitsky is believed to be inaccurate, as it is based on the imprecise assumption of ionization chamber perturbation correction factors in proton beams being equal to unity.

Monte Carlo calculation of beam quality correction factors in proton beams using detailed simulation of ionization chambers.

This work calculates beam quality correction factors (kQ) in monoenergetic proton beams using detailed Monte Carlo simulation of ionization chambers. It uses the Monte Carlo code penh and the electronic stopping powers resulting from the adoption of two different sets of mean excitation energy values for water and graphite: (i) the currently ICRU 37 and ICRU 49 recommended Iw = 75 eV and Ig = 78 eV and (ii) the recently proposed Iw = 78 eV and Ig = 81.1 eV. Twelve different ionization chambers were studied. The k Q factors calculated using the two different sets of I-values were found to agree with each other within 1.6% or better. k Q factors calculated using current ICRU I-values were found to agree within 2.3% or better with the k Q factors tabulated in IAEA TRS-398, and within 1% or better with experimental values published in the literature. k Q factors calculated using the new I-values were also found to agree within 1.1% or better with the experimental values. This work concludes that perturbation correction factors in proton beams--currently assumed to be equal to unity--are in fact significantly different from unity for some of the ionization chambers studied.

The role of a microDiamond detector in the dosimetry of proton pencil beams.

In this work, the performance of a microDiamond detector in a scanned proton beam is studied and its potential role in the dosimetric characterization of proton pencil beams is assessed. The linearity of the detector response with the absorbed dose and the dependence on the dose-rate were tested. The depth-dose curve and the lateral dose profiles of a proton pencil beam were measured and compared to reference data. The feasibility of calibrating the beam monitor chamber with a microDiamond detector was also studied. It was found the detector reading is linear with the absorbed dose to water (down to few cGy) and the detector response is independent of both the dose-rate (up to few Gy/s) and the proton beam energy (within the whole clinically-relevant energy range). The detector showed a good performance in depth-dose curve and lateral dose profile measurements; and it might even be used to calibrate the beam monitor chambers-provided it is cross-calibrated against a reference ionization chamber. In conclusion, the microDiamond detector was proved capable of performing an accurate dosimetric characterization of proton pencil beams.

Experimental validation of beam quality correction factors for proton beams.

This paper presents a method to experimentally validate the beam quality correction factors (kQ) tabulated in IAEA TRS-398 for proton beams and to determine the kQ of non-tabulated ionization chambers (based on the already tabulated values). The method is based exclusively on ionometry and it consists in comparing the reading of two ionization chambers under the same reference conditions in a proton beam quality Q and a reference beam quality (60)Co. This allows one to experimentally determine the ratio between the kQ of the two ionization chambers. In this work, 7 different ionization chamber models were irradiated under the IAEA TRS-398 reference conditions for (60)Co beams and proton beams. For the latter, the reference conditions for both modulated beams (spread-out Bragg peak field) and monoenergetic beams (pseudo-monoenergetic field) were studied. For monoenergetic beams, it was found that the experimental kQ values obtained for plane-parallel chambers are consistent with the values tabulated in IAEA TRS-398; whereas the kQ values obtained for cylindrical chambers are not consistent--being higher than the tabulated values. These results support the suggestion (of previous publications) that the IAEA TRS-398 reference conditions for monoenergetic proton beams should be revised so that the effective point of measurement of cylindrical ionization chambers is taken into account when positioning the reference point of the chamber at the reference depth. For modulated proton beams, the tabulated kQ values of all the ionization chambers studied in this work were found to be consistent with each other--except for the IBA FC65-G, whose experimental kQ value was found to be 0.6% lower than the tabulated one. The kQ of the PTW Advanced Markus chamber, which is not tabulated in IAEA TRS-398, was found to be 0.997 ± 0.042 (k = 2), based on the tabulated value of the PTW Markus chamber.

Intensity modulated proton therapy for postmastectomy radiation of bilateral implant reconstructed breasts: a treatment planning study.

BACKGROUND AND PURPOSE: Delivery of post-mastectomy radiation (PMRT) in women with bilateral implants represents a technical challenge, particularly when attempting to cover regional lymph nodes. Intensity modulated proton therapy (IMPT) holds the potential to improve dose delivery and spare non-target tissues. The purpose of this study was to compare IMPT to three-dimensional (3D) conformal radiation following bilateral mastectomy and reconstruction. MATERIALS AND METHODS: Ten IMPT, 3D conformal photon/electron (P/E), and 3D photon (wide tangent) plans were created for 5 patients with breast cancer, all of whom had bilateral breast implants. Using RTOG guidelines, a physician delineated contours for both target volumes and organs-at-risk. Plans were designed to achieve 95% coverage of all targets (chest wall, IMN, SCV, axilla) to a dose of 50.4 Gy or Gy (RBE) while maximally sparing organs-at-risk. RESULTS: IMPT plans conferred similar target volume coverage with enhanced homogeneity. Both mean heart and lung doses using IMPT were significantly decreased compared to both P/E and wide tangent planning. CONCLUSIONS: IMPT provides improved homogeneity to the chest wall and regional lymphatics in the post-mastectomy setting with improved sparing of surrounding normal structures for woman with reconstructed breasts. IMPT may enable women with mastectomy to undergo radiation therapy without the need for delay in breast reconstruction.

Golden beam data for proton pencil-beam scanning.

Proton, as well as other ion, beams applied by electro-magnetic deflection in pencil-beam scanning (PBS) are minimally perturbed and thus can be quantified a priori by their fundamental interactions in a medium. This a priori quantification permits an optimal reduction of characterizing measurements on a particular PBS delivery system. The combination of a priori quantification and measurements will then suffice to fully describe the physical interactions necessary for treatment planning purposes. We consider, for proton beams, these interactions and derive a 'Golden' beam data set. The Golden beam data set quantifies the pristine Bragg peak depth-dose distribution in terms of primary, multiple Coulomb scatter, and secondary, nuclear scatter, components. The set reduces the required measurements on a PBS delivery system to the measurement of energy spread and initial phase space as a function of energy. The depth doses are described in absolute units of Gy(RBE) mm² Gp⁻¹, where Gp equals 109 (giga) protons, thus providing a direct mapping from treatment planning parameters to integrated beam current. We used these Golden beam data on our PBS delivery systems and demonstrated that they yield absolute dosimetry well within clinical tolerance.

Radiation dose assessment in a 320-detector-row CT scanner used in cardiac imaging.

PURPOSE: In the present era of cone-beam CT scanners, the use of the standardized CTDI100 as a surrogate of the idealized CTDI is strongly discouraged and, consequently, so should be the use of the dose-length product (DLP) as an estimate of the total energy imparted to the patient. However, the DLP is still widely used as a reference quantity to normalize the effective dose for a given scan protocol mainly because the CTDI100 is an easy-to-measure quantity. The aim of this article is therefore to describe a method for radiation dose assessment in large cone-beam single axial scans, which leads to a straightforward estimation of the total energy imparted to the patient. The authors developed a method accessible to all medical physicists and easy to implement in clinical practice in an attempt to update the bridge between CT dosimetry and the estimation of the effective dose. METHODS: The authors used commercially available material and a simple mathematical model. The method described herein is based on the dosimetry paradigm introduced by the AAPM Task Group 111. It consists of measuring the dose profiles at the center and the periphery of a long body phantom with a commercial solid-state detector. A weighted dose profile is then calculated from these measurements. To calculate the CT dosimetric quantities analytically, a Gaussian function was fitted to the dose profile data. Furthermore, the Gaussian model has the power to condense the z-axis information of the dose profile in two parameters: The single-scan central dose, f(0), and the width of the profile, sigma. To check the energy dependence of the solid-state detector, the authors compared the dose profiles to measurements made with a small volume ion chamber. To validate the overall method, the authors compared the CTDI100 calculated analytically to the measurement made with a 100 mm pencil ion chamber. RESULTS: For the central and weighted dose profiles, the authors found a good agreement between the measured dose profile data and the fitted Gaussian functions. The solid-state detector had no energy dependence--within the energy range of interest--and the analytical model succeeded in reproducing the absolute dose values obtained with the pencil ion chamber. For the case of large cone-beam single axial scans, the quantity that better characterizes the total energy imparted to the patient is the weighted dose profile integral (DPI(w)). The DPI(w) can be easily determined from the two parameters that define the Gaussian functions: f(0) and sigma. The authors found that the DLP underestimated the total energy imparted to the patient by more than 20%. The authors also found that the calculated CT dosimetric quantities were higher than those displayed on the scanner console. CONCLUSIONS: The authors described and validated a method to assess radiation dose in large cone-beam single axial scans. This method offers a simple and more accurate estimation of the total energy imparted to the patient, thus offering the possibility to update the bridge between CT dosimetry and the estimation of the effective dose for cone-beam CT examinations in radiology, nuclear medicine, and radiation therapy.