Monte Carlo calculated beam quality correction factors for high energy electron beams.

PURPOSE: As the dosimetry protocol TRS 398 is being revised and the ICRU report 90 provides new recommendations for density correction as well as the mean ionization energies of water and graphite, updated beam quality correction factors kQ are calculated for reference dosimetry in electron beams and for independent validation of previously determined values. METHODS: Monte Carlo simulations have been performed using EGSnrc to calculate the absorbed dose to water and the dose to the active volumes of ionization chambers SNC600c, SNC125c and SNC350p (all Sun Nuclear, A Mirion Medical Company, Melbourne, FL). Realistic clinical electron beam spectra were used to cover the entire energy range of therapeutic electron accelerators. The Monte Carlo simulations were validated by measurements on a clinical linear accelerator. With regards to the cylindrical chambers, the simulations were performed according to the setup recommendations of TRS 398 and AAPM TG 51, i.e. with and without consideration of a reference point shift by rcav/2. RESULTS: kQ values as a function of the respective beam quality specifier R50 were fitted by recommended equations for electron beam dosimetry in the range of 5 MeV to 18 MeV. The fitting curves to the calculated values showed a root mean square deviation between 0.0016 and 0.0024. CONCLUSION: Electron beam quality correction factors kQ were calculated by Monte Carlo simulations for the cylindrical ionization chambers SNC600c and SNC125c as well as the plane parallel ionization chamber SNC350p to provide updated data for the TRS 398 and TG 51 dosimetry protocols.

Induced luminescence in water and PMMA - spectral analysis for irradiations with proton beams within the clinical energy range.

It was recently discovered that water and PMMA emit a weak luminescence signal when irradiated with protons within the clinically used energy range. This could offer a fast approach for range measurements in water. However, a complete explanation or investigation on the origin of the signal has not been published. In this work, a setup for the high-resolution spectral measurement of the weak luminescence signal in water and PMMA was designed. The measurement environment in the vicinity of a proton accelerator represented a major challenge for the sensitive optical measurements due to the presence of ionizing scattered radiation. A high-sensitive spectrometer in combination with a custom-made fiber was used to build a foundation for further analysis of the luminescence signal by providing accurate spectral information. For water, a broad distribution in the range from 240 to 900 nm with a maximum at 480 nm was obtained. A comparison of the spectra with previously published work indicates that the signal originates from excited states produced during the radiolysis of water. In comparison, differences between the water and the PMMA spectrum were observed. When examining the signal in PMMA, spectral differences were found compared to the measurements in water. The signal in PMMA was approximately 10 times stronger, had a narrower distribution and was shifted to lower wavelengths. Nevertheless, for the investigated proton energies, no spectral energy dependence was detected. In addition to the results for water and PMMA, a further luminescence signal was measured when the silica fiber used was directly irradiated with primary protons. All spectra, obtained in this work, describe the signal of proton-induced luminescence in water and PMMA with a high resolution of 3.4 nm and thus form a basis for further research, which could be a powerful tool in proton range verification.

A method to implement inter-track interactions in Monte Carlo simulations with TOPAS-nBio and their influence on simulated radical yields following water radiolysis.

Objective.In FLASH radiotherapy (dose rates ≥40 Gy s-1), a reduced normal tissue toxicity has been observed, while maintaining the same tumor control compared to conventional radiotherapy (dose rates ≤0.03 Gy s-1). This protecting effect could not be fully explained yet. One assumption is that interactions between the chemicals of different primary ionizing particles, so-called inter-track interactions, trigger this outcome. In this work, we included inter-track interactions in Monte Carlo track structure simulations and investigated the yield of chemicals (G-value) produced by ionizing particles.Approach.For the simulations, we used the Monte Carlo toolkit TOPAS, in which inter-track interactions cannot be implemented without further effort. Thus, we developed a method enabling the simultaneous simulation ofNoriginal histories in one event allowing chemical species to interact with each other. To investigate the effect of inter-track interactions we analyzed theG-value of different chemicals using various radiation sources. We used electrons with an energy of 60 eV in different spatial arrangements as well as a 10 MeV and 100 MeV proton source. For electrons we setNbetween 1 and 60, for protons between 1 and 100.Main results.In all simulations, the totalG-value decreases with increasingN. In detail, theG-value for•OH , H3O and eaqdecreases with increasingN, whereas theG-value of OH-, H2O2and H2increases slightly. The reason is that with increasingN, the concentration of chemical radicals increases allowing for more chemical reactions between the radicals resulting in a change of the dynamics of the chemical stage.Significance.Inter-track interactions resulting in a variation of the yield of chemical species, may be a factor explaining the FLASH effect. To verify this hypothesis, further simulations are necessary in order to evaluate the impact of varyingG-values on the yield of DNA damages.

Validation of an EGSnrc-based Monte Carlo model for a complex 2D-array for technical QA measurements of a linear accelerator.

PURPOSE: Multi-axis ionization chamber arrays can be used for quality assurance (QA) and measurement of linear accelerator (linac) specific data. In this work, the ability of the IC Profiler (Sun Nuclear Corp., Melbourne, Florida) detector array to measure the photon beam quality specifier %dd(10) x $_\textrm {{\it x}}$ and TPR20, 10 was investigated. To investigate the method for beam energy QA using a two-dimensional detector array, a Monte Carlo-based model of the detector array was developed and validated. METHODS: A Monte Carlo-based model of the IC Profiler detector array with Quad Wedge accessories was developed in detail from drawings provided by the manufacturer using the egs++ class library from the EGSnrc code system. Monte Carlo simulations were used to calculate the absorbed dose in the 251 ionization chambers of the IC profiler in the 6 MV Elekta Precise radiation field. To validate the results from the Monte Caro simulations, measurements were performed on clinical 6 MV linacs. To vary the photon beam quality of the Elekta 6 MV linac, the current of the bending magnet was varied. Furthermore, the area ratio A R $AR$ was calculated from IC Profiler measurements with the Quad Wedge accessories. RESULTS: Measurements as well as Monte Carlo simulations confirmed the linear relationship between the area ratio A R $AR$ and the investigated photon beam quality specifier %dd(10) x $_\textrm {{\it x}}$ and TPR20, 10 for the investigated radiation source. Furthermore, the Monte Carlo-simulated data were within the 95% confidence interval of the linear fit to the measured data. This enabled the Monte Carlo-based IC Profiler model to be used for further investigations. The A R $AR$ values were calculated for various electron beam sizes and the angle of incidence on the target of the linac. CONCLUSIONS: A Monte-Carlo-based model of the detector array was developed, which could successfully reproduce measurements, demonstrating that even very complex geometries can be modeled in EGSnrc. Moreover, the study showed that the validated Monte Carlo model has the potential to investigate variations in beam parameters and their effects on AR ratios and %dd(10) x $_\textrm {{\it x}}$ that may not be investigated experimentally. While these findings may help users gain a deeper understanding of the QA method, the Monte Carlo model enables other complex investigations, such as the simulation of measurements in the presence of magnetic fields, or the simulation of measurements on novel treatment delivery techniques and devices.

Development, Monte Carlo simulations and experimental evaluation of a 3D range-modulator for a complex target in scanned proton therapy.

The purpose of this work was to develop and manufacture a 3D range-modulator (3D RM) for a complex target contour for scanned proton therapy. The 3D RM is considered to be a viable technique for the very fast dose application in patient-specific tumors with only one fixed energy. The RM was developed based on a tumor from a patient CT and manufactured with high-quality 3D printing techniques with both polymer resin and aluminum. Monte Carlo simulations were utilized to investigate its modulating properties and the resulting dose distribution. Additionally, the simulation results were validated with measurements at the Marburg Ion-Beam Therapy Centre. For this purpose, a previously developed water phantom was used to conduct fast, automated high-resolution dose measurements. The results show a very good agreement between simulations and measurements and indicate that highly homogeneous dose distributions are possible. The delivered dose is conformed to the distal as well as to the proximal edge of the target. The 3D range-modulator concept combines a high degree of dose homogeneity and conformity, comparable to standard IMPT with very short irradiation times, promising clinically applicable dose distributions for lung and/or FLASH treatment, comparable and competitive to those from conventional irradiation techniques.

Experimental determination of modulation power of lung tissue for particle therapy.

In particle therapy of lung tumors, modulating effects on the particle beam may occur due to the microscopic structure of the lung tissue. These effects are caused by the heterogeneous nature of the lung tissue and cannot be completely taken into account during treatment planning, because these micro structures are too small to be fully resolved in the planning CT. In several publications, a new material parameter called modulation power (Pmod) was introduced to characterize the effect. For various artificial lung surrogates, this parameter was measured and published by other groups and ranges up to approximately 1000µm. Studies investigating the influence of the modulation power on the dose distribution during irradiation are using this parameter in the rang of 100-800µm. More precise measurements forPmodon real lung tissue have not yet been published. In this work, the modulation power of real lung tissue was measured using porcine lungs in order to produce more reliable data ofPmodfor real lung tissue. For this purpose,ex-vivoporcine lungs were frozen in a ventilated state and measurements in a carbon ion-beam were performed. Due to the way the lungs were prepared and transferred to a solid state, the lung structures that modulate the beam could also be examined in detail using micro CT imaging. An optimization of the established methods of measuring the modulation power, which takes better account of the typical structures within lung tissue, was developed as well.

Estimating the modulating effect of lung tissue in particle therapy using a clinical CT voxel histogram analysis.

To treat lung tumours with particle therapy, different additional tasks and challenges in treatment planning and application have to be addressed thoroughly. One of these tasks is the quantification and consideration of the Bragg peak (BP) degradation due to lung tissue: as lung is an heterogeneous tissue, the BP is broadened when particles traverse the microscopic alveoli. These are not fully resolved in clinical CT images and thus, the effect is not considered in the dose calculation. In this work, a correlation between the CT histograms of heterogeneous material and the impact on the BP curve is presented. Different inorganic materials were scanned with a conventional CT scanner and additionally, the BP degradation was measured in a proton beam and was then quantified. A model is proposed that allows an estimation of the modulation power by performing a histogram analysis on the CT scan. To validate the model for organic samples, a second measurement series was performed with frozen porcine lunge samples. This allows to investigate the possible limits of the proposed model in a set-up closer to clinical conditions. For lung substitutes, the agreement between model and measurement is within ±0.05 mm and for the organic lung samples, within ±0.15 mm. This work presents a novel, simple and efficient method to estimate if and how much a material or a distinct region (within the lung) is degrading the BP on the basis of a common clinical CT image. Up until now, only a direct in-beam measurement of the region or material of interest could answer this question.

A phantom based evaluation of the dose prediction and effects in treatment plans, when calculating on a direct density CT reconstruction.

In radiation therapy, a Computed Tomography (CT) image is needed for an accurate dose calculation. To allow such a calculation, the CT image values have to be converted into relative electron densities. Thus, standard procedure is to calibrate the CT numbers to relative electron density (RED) by using a phantom with known composition inserts. This calibration curve is energy and CT dependent, therefore most radiotherapy CT acquisitions are obtained with 120 kVp, as each tube voltage needs an additional calibration curve. The commercially available DirectDensityTM (DD) reconstruction algorithm presents a reconstruction implementation without any dependence on the tube voltage. In comparison, it allows a calibration curve that is directly proportional to the RED, reducing the need of more than one calibration curve. This could potentially optimize CT acquisitions and reducing the dose given to the patient. Three different phantoms were used to evaluate the DirectDensityTM algorithm in simple and anthropomorphic geometries, as well as setups with metal implants. Scans with the DD algorithm were performed for 80, 100, 120, and 140 kVp. As reference a scan with the standard 120 kVp scan was used. Radiotherapy photon plans were optimized and calculated on the reference image and then transferred to the DD images, where they were recalculated. The dose distributions obtained this way were compared to the reference dose. Differences were found mainly in pure air and high density materials such as bones. The difference of the mean dose was below 0.7%, in most cases below 0.4%. No indication was found that the algorithm is corrupted by metal inserts, enabling the application for all clinical cases. This algorithm offers more variability in CT parameters for radiation therapy and thus a more personalized image acquisition with a high image quality and a lower dose exposure at a robust clinical workflow.

Correction to: Effects of the Bragg peak degradation due to lung tissue in proton therapy of lung cancer patients.

Following publication of the original article [1], we have been notified that the below text parts of the Discussion chapter should be changed.

Effects of the Bragg peak degradation due to lung tissue in proton therapy of lung cancer patients.

PURPOSE: To quantify the effects of the Bragg peak degradation due to lung tissue on treatment plans of lung cancer patients with spot scanning proton therapy and to give a conservative approximation of these effects. METHODS AND MATERIALS: Treatment plans of five lung cancer patients (tumors of sizes 2.7-46.4 cm3 at different depths in the lung) were optimized without consideration of the Bragg peak degradation. These treatment plans were recalculated with the Monte Carlo code TOPAS in two scenarios: in a first scenario, the treatment plans were calculated without including the Bragg peak degradation to reproduce the dose distribution predicted by the treatment-planning system (TPS). In a second scenario, the treatment plans were calculated while including the Bragg peak degradation. Subsequently, the plans were compared by means of Dmean, D98% and D2% in the clinical target volume (CTV) and organs at risk (OAR). Furthermore, isodose lines were investigated and a gamma index analysis was performed. RESULTS: The Bragg peak degradation leads to a lower dose in the CTV and higher doses in OARs distal to the CTV compared to the prediction from the TPS. The reduction of the mean dose in the CTV was - 5% at maximum and - 2% on average. The deeper a tumor was located in the lung and the smaller its volume the bigger was the effect on the CTV. The enhancement of the mean dose in OARs distal to the CTV was negligible for the cases investigated. CONCLUSIONS: Effects of the Bragg peak degradation due to lung tissue were investigated for lung cancer treatment plans in proton therapy. This study confirms that these effects are clinically tolerable to a certain degree in the current clinical context considering the various more critical dose uncertainties due to motion and range uncertainties in proton therapy.

Quantification of the dependencies of the Bragg peak degradation due to lung tissue in proton therapy on a CT-based lung tumor phantom.

The fine, sub-millimeter sized structure of lung tissue causes a degradation of the Bragg peak curve in particle therapy. The Bragg peak is degraded because particles of the same energy traverse lung tissue of different compositions of high and low density materials. Hence, they experience different energy losses resulting in variable ranges and a broadened Bragg peak. Since this fine structure of lung tissue is not resolved in standard treatment-planning CTs, current state-of-the-art dose calculation procedures used in the clinical routine are unable to account for this degradation. Neglecting this Bragg peak degradation in treatment planning can lead to an underdose in the target volume and an overdose distal to the target. Aim of this work is to systematically investigate the potential effects of the Bragg peak degradation on the dose distribution in dependence of different parameters like the tumor volume and its depth in lung. Proton plans were optimized on CT based phantoms without considering the Bragg peak degradation and afterwards recalculated with the Monte Carlo toolkit TOPAS: first, without consideration of the degradation and second, with the Bragg peak degradation accounted for. The direct comparison of these two dose distributions enables a quantification of the degradation effect. To carve out the dependencies of various parameters that could influence the Bragg peak degradation and thus the target dose, the simulations were performed for a variety of tumor sizes and shapes, as well as different positions within the lung. The results show that due to the Bragg peak degradation the mean dose in the target volume can be reduced by a few percent up to 14% (for extreme cases) depending on the geometry. It was shown that this effect increases with a decreasing tumor volume and increasing depth of the tumor. For the first time, a tumor specific estimation of the effect on the dose distribution due to the Bragg peak degradation in lung tissue is presented.