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Gamma electron vertex imaging and application to beam range verification in proton therapy

Purpose: This paper describes a new gamma-ray imaging method, ''gamma electron vertex imaging (GEVI)'', which can be used for precise beam range verification in proton therapy. Methods: In GEVI imaging, the high-energy gammas from a source or nuclear interactions are first converted, by Compton scattering, to electrons, which subsequently are traced by hodoscopes to determine the location of the gamma source or the vertices of the nuclear interactions. The performance of GEVI imaging for use in-beam range verification was evaluated by Monte Carlo simulations employing geant4 equipped with the QGSP{sub B}IC{sub H}P physics package. Results: Our simulation results show that GEVI imaging can determine the proton beam range very accurately, within 2-3 mm of error, even without any sophisticated analysis. The results were obtained under simplified conditions of monoenergetic pencil beams stopped in a homogeneous phantom and on the basis of the obtained results it is expected to achieve submillimeter accuracy in proton beam range measurement. Conclusions: If future experimental work confirms the simulated results presented in this paper, the use of GEVI imaging is expected to have a great potential in increasing the accuracy of proton beam range verification in a patient, resulting in significant improvement of treatment effectiveness by enabling tight conformation of radiation dose to the tumor volume and patient safety.

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗

Electron contamination modeling and skin dose in 6 MV longitudinal field MRIgRT: Impact of the MRI and MRI fringe field

Purpose: In recent times, longitudinal field MRI-linac systems have been proposed for 6 MV MRI-guided radiotherapy (MRIgRT). The magnetic field is parallel with the beam axis and so will alter the transport properties of any electron contamination particles. The purpose of this work is to provide a first investigation into the potential effects of the MR and fringe magnetic fields on the electron contamination as it is transported toward a phantom, in turn, providing an estimate of the expected patient skin dose changes in such a modality. Methods: Geant4 Monte Carlo simulations of a water phantom exposed to a 6 MV x-ray beam were performed. Longitudinal magnetic fields of strengths between 0 and 3 T were applied to a 30 x 30 x 20 cm{sup 3} phantom. Surrounding the phantom there is a region where the magnetic field is at full MRI strength, consistent with clinical MRI systems. Beyond this the fringe magnetic field entering the collimation system is also modeled. The MRI-coil thickness, fringe field properties, and isocentric distance are varied and investigated. Beam field sizes of 5 x 5, 10 x 10, 15 x 15 and 20 x 20 cm{sup 2} were simulated. Central axis dose, 2D virtual entry skin dose films, and 70 {mu}m skin depth doses were calculated using high resolution scoring voxels. Results: In the presence of a longitudinal magnetic field, electron contamination from the linear accelerator is encouraged to travel almost directly toward the patient surface with minimal lateral spread. This results in a concentration of electron contamination within the x-ray beam outline. This concentration is particularly encouraged if the fringe field encompasses the collimation system. Skin dose increases of up to 1000% were observed for certain configurations and increases above Dmax were common. In nonmagnetically shielded cases, electron contamination generated from the jaw faces and air column is trapped and propagated almost directly to the phantom entry region, giving rise to intense dose hot spots inside the x-ray treatment field. These range up to 1000% or more of Dmax at the CAX, depending on field size, isocenter, and coil thickness. In the case of a fully magnetically shielded collimation system and the lowest MRI field of 0.25 T, the entry skin dose is expected to increase to at least 40%, 50%, 65%, and 80% of Dmax for 5 x 5, 10 x 10, 15 x 15, and 20 x 20 cm{sup 2}, respectively. Conclusions: Electron contamination from the linac head and air column may cause considerable skin dose increases or hot spots at the beam central axis on the entry side of a phantom or patient in longitudinal field 6 MV MRIgRT. This depends heavily on the properties of the magnetic fringe field entering the linac beam collimation system. The skin dose increase is also related to the MRI-coil thickness, the fringe field, and the isocenter distance of the linac. The results of this work indicate that the properties of the MRI fringe field, electron contamination production, and transport must be considered carefully during the design stage of a longitudinal MRI-linac system.

43 PARTICLE ACCELERATORS↗

Monte Carlo calculation of the maximum therapeutic gain of tumor antivascular alpha therapy

Purpose: Metastatic melanoma lesions experienced marked regression after systemic targeted alpha therapy in a phase 1 clinical trial. This unexpected response was ascribed to tumor antivascular alpha therapy (TAVAT), in which effective tumor regression is achieved by killing endothelial cells (ECs) in tumor capillaries and, thus, depriving cancer cells of nutrition and oxygen. The purpose of this paper is to quantitatively analyze the therapeutic efficacy and safety of TAVAT by building up the testing Monte Carlo microdosimetric models. Methods: Geant4 was adapted to simulate the spatial nonuniform distribution of the alpha emitter {sup 213}Bi. The intraluminal model was designed to simulate the background dose to normal tissue capillary ECs from the nontargeted activity in the blood. The perivascular model calculates the EC dose from the activity bound to the perivascular cancer cells. The key parameters are the probability of an alpha particle traversing an EC nucleus, the energy deposition, the lineal energy transfer, and the specific energy. These results were then applied to interpret the clinical trial. Cell survival rate and therapeutic gain were determined. Results: The specific energy for an alpha particle hitting an EC nucleus in the intraluminal and perivascular models is 0.35 and 0.37 Gy, respectively. As the average probability of traversal in these models is 2.7% and 1.1%, the mean specific energy per decay drops to 1.0 cGy and 0.4 cGy, which demonstrates that the source distribution has a significant impact on the dose. Using the melanoma clinical trial activity of 25 mCi, the dose to tumor EC nucleus is found to be 3.2 Gy and to a normal capillary EC nucleus to be 1.8 cGy. These data give a maximum therapeutic gain of about 180 and validate the TAVAT concept. Conclusions: TAVAT can deliver a cytotoxic dose to tumor capillaries without being toxic to normal tissue capillaries.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Scatter factors assessment in microbeam radiation therapy

Purpose: The success of the preclinical studies in Microbeam Radiation Therapy (MRT) paved the way to the clinical trials under preparation at the Biomedical Beamline of the European Synchrotron Radiation Facility. Within this framework, an accurate determination of the deposited dose is crucial. With that aim, the scatter factors, which translate the absolute dose measured in reference conditions (2 x 2 cm{sup 2} field size at 2 cm-depth in water) to peak doses, were assessed. Methods: Monte Carlo (MC) simulations were performed with two different widely used codes, PENELOPE and GEANT4, for the sake of safety. The scatter factors were obtained as the ratio of the doses that are deposited by a microbeam and by a field of reference size, at the reference depth. The calculated values were compared with the experimental data obtained by radiochromic (ISP HD-810) films and a PTW 34070 large area chamber. Results: The scatter factors for different microbeam field sizes assessed by the two MC codes were in agreement and reproduced the experimental data within uncertainty bars. Those correction factors were shown to be non-negligible for the future MRT clinical settings: an average 30% lower dose was deposited by a 50 {mu}m microbeam with respect to the reference conditions. Conclusions: For the first time, the scatter factors in MRT were systematically studied. They constitute an essential key to deposit accurate doses in the forthcoming clinical trials in MRT. The good agreement between the different calculations and the experimental data confirms the reliability of this challenging micrometric dose estimation.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Dedicated breast CT: radiation dose for circle-plus-line trajectory

Purpose: Dedicated breast CT prototypes used in clinical investigations utilize single circular source trajectory and cone-beam geometry with flat-panel detectors that do not satisfy data-sufficiency conditions and could lead to cone beam artifacts. Hence, this work investigated the glandular dose characteristics of a circle-plus-line trajectory that fulfills data-sufficiency conditions for image reconstruction in dedicated breast CT. Methods: Monte Carlo-based computer simulations were performed using the GEANT4 toolkit and was validated with previously reported normalized glandular dose coefficients for one prototype breast CT system. Upon validation, Monte Carlo simulations were performed to determine the normalized glandular dose coefficients as a function of x-ray source position along the line scan. The source-to-axis of rotation distance and the source-to-detector distance were maintained constant at 65 and 100 cm, respectively, in all simulations. The ratio of the normalized glandular dose coefficient at each source position along the line scan to that for the circular scan, defined as relative normalized glandular dose coefficient (RD{sub g}N), was studied by varying the diameter of the breast at the chest wall, chest-wall to nipple distance, skin thickness, x-ray beam energy, and glandular fraction of the breast. Results: The RD{sub g}N metric when stated as a function of source position along the line scan, relative to the maximum length of line scan needed for data sufficiency, was found to be minimally dependent on breast diameter, chest-wall to nipple distance, skin thickness, glandular fraction, and x-ray photon energy. This observation facilitates easy estimation of the average glandular dose of the line scan. Polynomial fit equations for computing the RD{sub g}N and hence the average glandular dose are provided. Conclusions: For a breast CT system that acquires 300-500 projections over 2{pi} for the circular scan, the addition of a line trajectory with equal source spacing and constant x-ray beam quality (kVp and HVL) and mAs matched to the circular scan, will result in less than 0.18% increase in average glandular dose to the breast per projection along the line scan.

61 RADIATION PROTECTION AND DOSIMETRY↗

Exploring {sup 57}Co as a new isotope for brachytherapy applications

Purpose: The characteristics of the radionuclide {sup 57}Co make it interesting for use as a brachytherapy source. {sup 57}Co combines a possible high specific activity with the emission of relatively low-energy photons and a half-life (272 days) suitable for regular source exchanges in an afterloader. {sup 57}Co decays by electron capture to the stable {sup 57}Fe with emission of 136 and 122 keV photons. Methods: A hypothetical {sup 57}Co source based on the Flexisource brachytherapy encapsulation with the active core set as a pure cobalt cylinder (length 3.5 mm and diameter 0.6 mm) covered with a cylindrical stainless-steel capsule (length 5 mm and thickness 0.125 mm) was simulated using Geant4 Monte Carlo (MC) code version 9.4. The radial dose function, g(r), and anisotropy function F(r,{theta}), for the line source approximation were calculated following the TG-43U1 formalism. The results were compared to well-known {sup 192}Ir and {sup 125}I radionuclides, representing the higher and the lower energy end of brachytherapy, respectively. Results: The mean energy of photons in water, after passing through the core and the encapsulation material was 123 keV. This hypothetical {sup 57}Co source has an increasing g(r) due to multiple scatter of low-energy photons, which results in a more uniform dose distribution than {sup 192}Ir. Conclusions: {sup 57}Co has many advantages compared to {sup 192}Ir due to its low-energy gamma emissions without any electron contamination. {sup 57}Co has an increasing g(r) that results in a more uniform dose distribution than {sup 192}Ir due to its multiple scattered photons. The anisotropy of the {sup 57}Co source is comparable to that of {sup 192}Ir. Furthermore, {sup 57}Co has lower shielding requirements than {sup 192}Ir.

07 ISOTOPE AND RADIATION SOURCES↗

Evaluation of hybrid depth scanning for carbon-ion radiotherapy

Purpose: In radiotherapy with a scanned carbon-ion beam, its Bragg peak is shifted along the depth direction either by inserting the range shifter plates or by changing the beam-extraction energy of a synchrotron. In the former technique (range shifter scanning: RS), the range shifter plates broaden the beam size and produce secondary fragments through nuclear reactions. In the latter technique (active-energy scanning: ES), it may take several seconds to change the beam energy depending on the synchrotron operation cycle, leading to a long treatment time. The authors propose a hybrid depth scan technique (hybrid scanning: HS), where several beam energies are used in conjunction with the range shifter plates for finer range shift. In this study, HS is evaluated from the viewpoints of dose distribution and treatment time. Methods: Assuming realistic accelerator and beam-delivery systems, the authors performed computer simulations using GEANT4 Monte Carlo code for beam modeling and a treatment planning system to evaluate HS. Three target volumes with the same dimensions of 60 x 60 x 60 mm{sup 3} were generated at depths of 45, 85, and 125 mm in water phantom, and uniform clinical dose was planned for these targets. The sizes of lateral dose falloff and the peak to plateau ratio defined as the ratio of the clinical dose averaged over the target to the clinical dose at the entrance as well as the treatment time were compared among the three depth scan techniques. Results: The sizes of lateral dose falloffs at the center of SOBP are 11.4, 8.5, and 5.9 mm for the three targets in RS, while they are 5.7, 4.8, and 4.6 mm in ES and 6.6, 5.7, and 5.0 mm in HS, respectively. The peak to plateau ratios are 1.39, 1.96, and 2.15 in RS, while they are 1.48, 2.04, and 2.19 in ES and 1.47, 2.03, and 2.18 in HS, respectively. The treatment times are 128.7, 128.6, and 128.6 s in ES, while they are 61.2, 54.6, and 47.8 s in RS and 43.2, 44.1, and 44.7 s in HS, respectively. The multiple scattering and the nuclear reaction by range shifter degraded the beam qualities such as lateral dose falloff and peak to plateau ratio, which was especially pronounced for the shallow target in RS. The depth scan timing was limited by accelerator cycle in ES. That increased the treatment time by a few times. Conclusions: This study revealed that HS can provide dose distributions with steeper lateral dose falloffs and higher peak to plateau ratio comparing to RS and comparable to ES. In addition, the treatment time can be considerably reduced in HS compared to ES.

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗

Estimation of organ and effective dose due to Compton backscatter security scans

Purpose: To estimate organ and effective radiation doses due to backscatter security scanners using Monte Carlo simulations and a voxelized phantom set. Methods: Voxelized phantoms of male and female adults and children were used with the GEANT4 toolkit to simulate a backscatter security scan. The backscatter system was modeled based on specifications available in the literature. The simulations modeled a 50 kVp spectrum with 1.0 mm-aluminum-equivalent filtration and a previously measured exposure of approximately 4.6 {mu}R at 30 cm from the source. Photons and secondary interactions were tracked from the source until they reached zero kinetic energy or exited from the simulation's boundaries. The energy deposited in the phantoms' respective organs was tallied and used to calculate total organ dose and total effective dose for frontal, rear, and full scans with subjects located 30 and 75 cm from the source. Results: For a full screen, all phantoms' total effective doses were below the established 0.25 {mu}Sv standard, with an estimated maximum total effective dose of 0.07 {mu}Sv for full screen of a male child. The estimated maximum organ dose due to a full screen was 1.03 {mu}Gy, deposited in the adipose tissue of the male child phantom when located 30 cm from the source. All organ dose estimates had a coefficient of variation of less than 3% for a frontal scan and less than 11% for a rear scan. Conclusions: Backscatter security scanners deposit dose in organs beyond the skin. The effective dose is below recommended standards set by the Health Physics Society (HPS) and the American National Standards Institute (ANSI) assuming the system provides a maximum exposure of approximately 4.6 {mu}R at 30 cm.

60 APPLIED LIFE SCIENCES↗

Comparison of measured with calculated dose distribution from a 120-MeV electron beam from a laser-plasma accelerator

Purpose: To evaluate the dose distribution of a 120-MeV laser-plasma accelerated electron beam which may be of potential interest for high-energy electron radiation therapy. Methods: In the interaction between an intense laser pulse and a helium gas jet, a well collimated electron beam with very high energy is produced. A secondary laser beam is used to optically control and to tune the electron beam energy and charge. The potential use of this beam for radiation treatment is evaluated experimentally by measurements of dose deposition in a polystyrene phantom. The results are compared to Monte Carlo simulations using the geant4 code. Results: It has been shown that the laser-plasma accelerated electron beam can deliver a peak dose of more than 1 Gy at the entrance of the phantom in a single laser shot by direct irradiation, without the use of intermediate magnetic transport or focusing. The dose distribution is peaked on axis, with narrow lateral penumbra. Monte Carlo simulations of electron beam propagation and dose deposition indicate that the propagation of the intense electron beam (with large self-fields) can be described by standard models that exclude collective effects in the response of the material. Conclusions: The measurements show that the high-energy electron beams produced by an optically injected laser-plasma accelerator can deliver high enough dose at penetration depths of interest for electron beam radiotherapy of deep-seated tumors. Many engineering issues must be resolved before laser-accelerated electrons can be used for cancer therapy, but they also represent exciting challenges for future research.

61 RADIATION PROTECTION AND DOSIMETRY↗

Transmission of broad W/Rh and W/Al (target/filter) x-ray beams operated at 25-49 kVp through common shielding materials

Purpose: To provide transmission data for broad 25-39 kVp (kilovolt peak) W/Rh and 25-49 kVp W/Al (target/filter, W-tungsten, Rh-rhodium, and Al-aluminum) x-ray beams through common shielding materials, such as lead, concrete, gypsum wallboard, wood, steel, and plate glass. Methods: The unfiltered W-target x-ray spectra measured on a Selenia Dimensions system (Hologic Inc., Bedford, MA) set at 20-49 kVp were, respectively, filtered using 50-{mu}m Rh and 700-{mu}m Al, and were subsequently used for Monte Carlo calculations. The transmission of broad x-ray beams through shielding materials was simulated using Geant4 low energy electromagnetic physics package with photon- and electron-processes above 250 eV, including photoelectric effect, Compton scattering, and Rayleigh scattering. The calculated transmission data were fitted using Archer equation with a robust fitting algorithm. Results: The transmission of broad x-ray beams through the above-mentioned shielding materials was calculated down to about 10{sup -5} for 25-39 kVp W/Rh and 25-49 kVp W/Al. The fitted results of {alpha}, {beta}, and {gamma} in Archer equation were provided. The {alpha} values of kVp Greater-Than-Or-Slanted-Equal-To 40 were approximately consistent with those of NCRP Report No. 147. Conclusions: These data provide inputs for the shielding designs of x-ray imaging facilities with W-anode x-ray beams, such as from Selenia Dimensions.

36 MATERIALS SCIENCE↗

A dose point kernel database using GATE Monte Carlo simulation toolkit for nuclear medicine applications: Comparison with other Monte Carlo codes

Purpose: GATE is a Monte Carlo simulation toolkit based on the Geant4 package, widely used for many medical physics applications, including SPECT and PET image simulation and more recently CT image simulation and patient dosimetry. The purpose of the current study was to calculate dose point kernels (DPKs) using GATE, compare them against reference data, and finally produce a complete dataset of the total DPKs for the most commonly used radionuclides in nuclear medicine. Methods: Patient-specific absorbed dose calculations can be carried out using Monte Carlo simulations. The latest version of GATE extends its applications to Radiotherapy and Dosimetry. Comparison of the proposed method for the generation of DPKs was performed for (a) monoenergetic electron sources, with energies ranging from 10 keV to 10 MeV, (b) beta emitting isotopes, e.g., {sup 177}Lu, {sup 90}Y, and {sup 32}P, and (c) gamma emitting isotopes, e.g., {sup 111}In, {sup 131}I, {sup 125}I, and {sup 99m}Tc. Point isotropic sources were simulated at the center of a sphere phantom, and the absorbed dose was stored in concentric spherical shells around the source. Evaluation was performed with already published studies for different Monte Carlo codes namely MCNP, EGS, FLUKA, ETRAN, GEPTS, and PENELOPE. A complete dataset of total DPKs was generated for water (equivalent to soft tissue), bone, and lung. This dataset takes into account all the major components of radiation interactions for the selected isotopes, including the absorbed dose from emitted electrons, photons, and all secondary particles generated from the electromagnetic interactions. Results: GATE comparison provided reliable results in all cases (monoenergetic electrons, beta emitting isotopes, and photon emitting isotopes). The observed differences between GATE and other codes are less than 10% and comparable to the discrepancies observed among other packages. The produced DPKs are in very good agreement with the already published data, which allowed us to produce a unique DPKs dataset using GATE. The dataset contains the total DPKs for {sup 67}Ga, {sup 68}Ga, {sup 90}Y, {sup 99m}Tc, {sup 111}In, {sup 123}I, {sup 124}I, {sup 125}I, {sup 131}I, {sup 153}Sm, {sup 177}Lu {sup 186}Re, and {sup 188}Re generated in water, bone, and lung. Conclusions: In this study, the authors have checked GATE's reliability for absorbed dose calculation when transporting different kind of particles, which indicates its robustness for dosimetry applications. A novel dataset of DPKs is provided, which can be applied in patient-specific dosimetry using analytical point kernel convolution algorithms.

61 RADIATION PROTECTION AND DOSIMETRY↗

Water and tissue equivalence of a new PRESAGE{sup Registered-Sign} formulation for 3D proton beam dosimetry: A Monte Carlo study

Purpose: To evaluate the water and tissue equivalence of a new PRESAGE{sup Registered-Sign} 3D dosimeter for proton therapy. Methods: The GEANT4 software toolkit was used to calculate and compare total dose delivered by a proton beam with mean energy 62 MeV in a PRESAGE{sup Registered-Sign} dosimeter, water, and soft tissue. The dose delivered by primary protons and secondary particles was calculated. Depth-dose profiles and isodose contours of deposited energy were compared for the materials of interest. Results: The proton beam range was found to be Almost-Equal-To 27 mm for PRESAGE{sup Registered-Sign }, 29.9 mm for soft tissue, and 30.5 mm for water. This can be attributed to the lower collisional stopping power of water compared to soft tissue and PRESAGE{sup Registered-Sign }. The difference between total dose delivered in PRESAGE{sup Registered-Sign} and total dose delivered in water or tissue is less than 2% across the entire water/tissue equivalent range of the proton beam. The largest difference between total dose in PRESAGE{sup Registered-Sign} and total dose in water is 1.4%, while for soft tissue it is 1.8%. In both cases, this occurs at the distal end of the beam. Nevertheless, the authors find that PRESAGE{sup Registered-Sign} dosimeter is overall more tissue-equivalent than water-equivalent before the Bragg peak. After the Bragg peak, the differences in the depth doses are found to be due to differences in primary proton energy deposition; PRESAGE{sup Registered-Sign} and soft tissue stop protons more rapidly than water. The dose delivered by secondary electrons in the PRESAGE{sup Registered-Sign} differs by less than 1% from that in soft tissue and water. The contribution of secondary particles to the total dose is less than 4% for electrons and Almost-Equal-To 1% for protons in all the materials of interest. Conclusions: These results demonstrate that the new PRESAGE{sup Registered-Sign} formula may be considered both a tissue- and water-equivalent 3D dosimeter for a 62 MeV proton beam. The results further suggest that tissue-equivalent thickness may provide better dosimetric and geometric accuracy than water-equivalent thickness for 3D dosimetry of this proton beam.

60 APPLIED LIFE SCIENCES↗

Evaluation of clinical IMRT treatment planning using the GATE Monte Carlo simulation platform for absolute and relative dose calculations

Purpose: The objective of this study was to evaluate and validate the use of the Geant4 application for emission tomography (GATE) Monte Carlo simulation platform for clinical intensity modulated radiotherapy (IMRT) dosimetry studies. Methods: The first step consisted of modeling a 6 MV photon beam linear accelerator (LINAC), with its corresponding validation carried out using percent depth dose evaluation, transverse profiles, tissue phantom ratio, and output factor on water phantom. The IMRT evaluation was performed by comparing simulation and measurements in terms of absolute and relative doses using IMRT dedicated quality assurance phantoms considering seven different patient datasets. Results: Concerning the LINAC simulated model validation tissue phantom ratios at 20 and 10 cm in water TPR{sub 10}{sup 20} obtained from GATE and measurements were 0.672 {+-} 0.063 and 0.675, respectively. In terms of percent depth dose and transverse profiles, error ranges were, respectively: 1.472%{+-} 0.285% and 4.827%{+-} 1.323% for field size of 4 Multiplication-Sign 4, 5 Multiplication-Sign 5, 10 Multiplication-Sign 10, 15 Multiplication-Sign 15, 20 Multiplication-Sign 20, 25 Multiplication-Sign 25, 30 Multiplication-Sign 30, and 40 Multiplication-Sign 40 cm{sup 2}. Most errors were observed at the edge of radiation fields because of higher dose gradient in these areas. Output factors showed good agreement between simulation and measurements with a maximum error of 1.22%. Finally, for IMRT simulations considering seven patient datasets, GATE provided good results with a relative error of 0.43%{+-} 0.25% on absolute dose between simulated and measured beams (measurements at the isocenter, volume 0.125 cm{sup 3}). Planar dose comparisons were also performed using gamma-index analysis. For the whole set of beams considered the mean gamma-index value was 0.497 {+-} 0.152 and 90.8%{+-} 3.6% of the evaluated dose points satisfied the 5%/ 4 mm criterion. Conclusions: These results show that GATE allows reliable simulation of complex beams in radiotherapy after an accurate LINAC modeling is validated. A simple cross-calibration procedure proposed in this work allows obtaining absolute dose values even in complex fields.

60 APPLIED LIFE SCIENCES↗

Calculated organ doses using Monte Carlo simulations in a reference male phantom undergoing HDR brachytherapy applied to localized prostate carcinoma

Purpose: The aim of this study was to obtain equivalent doses in radiosensitive organs (aside from the bladder and rectum) when applying high-dose-rate (HDR) brachytherapy to a localized prostate carcinoma using {sup 60}Co or {sup 192}Ir sources. These data are compared with results in a water phantom and with expected values in an infinite water medium. A comparison with reported values from proton therapy and intensity-modulated radiation therapy (IMRT) is also provided. Methods: Monte Carlo simulations in Geant4 were performed using a voxelized phantom described in International Commission on Radiological Protection (ICRP) Publication 110, which reproduces masses and shapes from an adult reference man defined in ICRP Publication 89. Point sources of {sup 60}Co or {sup 192}Ir with photon energy spectra corresponding to those exiting their capsules were placed in the center of the prostate, and equivalent doses per clinical absorbed dose in this target organ were obtained in several radiosensitive organs. Values were corrected to account for clinical circumstances with the source located at various positions with differing dwell times throughout the prostate. This was repeated for a homogeneous water phantom. Results: For the nearest organs considered (bladder, rectum, testes, small intestine, and colon), equivalent doses given by {sup 60}Co source were smaller (8%-19%) than from {sup 192}Ir. However, as the distance increases, the more penetrating gamma rays produced by {sup 60}Co deliver higher organ equivalent doses. The overall result is that effective dose per clinical absorbed dose from a {sup 60}Co source (11.1 mSv/Gy) is lower than from a {sup 192}Ir source (13.2 mSv/Gy). On the other hand, equivalent doses were the same in the tissue and the homogeneous water phantom for those soft tissues closer to the prostate than about 30 cm. As the distance increased, the differences of photoelectric effect in water and soft tissue, and appearance of other materials such as air, bone, or lungs, produced variations between both phantoms which were at most 35% in the considered organ equivalent doses. Finally, effective doses per clinical absorbed dose from IMRT and proton therapy were comparable to those from both brachytherapy sources, with brachytherapy being advantageous over external beam radiation therapy for the furthest organs. Conclusions: A database of organ equivalent doses when applying HDR brachytherapy to the prostate with either {sup 60}Co or {sup 192}Ir is provided. According to physical considerations, {sup 192}Ir is dosimetrically advantageous over {sup 60}Co sources at large distances, but not in the closest organs. Damage to distant healthy organs per clinical absorbed dose is lower with brachytherapy than with IMRT or protons, although the overall effective dose per Gy given to the prostate seems very similar. Given that there are several possible fractionation schemes, which result in different total amounts of therapeutic absorbed dose, advantage of a radiation treatment (according to equivalent dose to healthy organs) is treatment and facility dependent.

60 APPLIED LIFE SCIENCES↗

Proton beam scattering system optimization for clinical and research applications

Purpose: To develop and test a method for optimizing and constructing a dual scattering system in passively scattered proton therapy. Methods: A beam optics optimization algorithm was developed to optimize the thickness of the first scatterer (S1) and the profile (of both the high-Z material and Lexan) of the second scatterer (S2) to deliver a proton beam matching a given set of parameters, including field diameter, fluence, flatness, and symmetry. A new manufacturing process was also tested that allows the contoured second scattering foil to be created much more economically and quickly using Cerrobend casting. Two application-specific scattering systems were developed and tested using both experimental and Monte Carlo techniques to validate the optimization process described. Results: A scattering system was optimized and constructed to deliver large uniform irradiations of radiobiology samples at low dose rates. This system was successfully built and tested using film and ionization chambers. The system delivered a uniform radiation field of 50 cm diameter (to a dose of {+-}7% of the central axis) while the depth dose profile could be tuned to match the specifications of the particular investigator using modulator wheels and range shifters. A second scattering system for intermediate field size (4 cm < diameter < 10 cm) stereotactic radiosurgery and radiation therapy (SRS and SRT) treatments was also developed and tested using GEANT4. This system improved beam efficiency by over 70% compared with existing scattering systems while maintaining field flatness and depth dose profile. In both cases the proton range uniformity across the radiation field was maintained, further indicating the accuracy of the energy loss formalism in the optimization algorithm. Conclusions: The methods described allow for rapid prototyping of scattering foils to meet the demands of both research and clinical beam delivery applications in proton therapy.

60 APPLIED LIFE SCIENCES↗

Geometrical splitting technique to improve the computational efficiency in Monte Carlo calculations for proton therapy

Purpose: To present the implementation and validation of a geometrical based variance reduction technique for the calculation of phase space data for proton therapy dose calculation. Methods: The treatment heads at the Francis H Burr Proton Therapy Center were modeled with a new Monte Carlo tool (TOPAS based on Geant4). For variance reduction purposes, two particle-splitting planes were implemented. First, the particles were split upstream of the second scatterer or at the second ionization chamber. Then, particles reaching another plane immediately upstream of the field specific aperture were split again. In each case, particles were split by a factor of 8. At the second ionization chamber and at the latter plane, the cylindrical symmetry of the proton beam was exploited to position the split particles at randomly spaced locations rotated around the beam axis. Phase space data in IAEA format were recorded at the treatment head exit and the computational efficiency was calculated. Depth-dose curves and beam profiles were analyzed. Dose distributions were compared for a voxelized water phantom for different treatment fields for both the reference and optimized simulations. In addition, dose in two patients was simulated with and without particle splitting to compare the efficiency and accuracy of the technique. Results: A normalized computational efficiency gain of a factor of 10-20.3 was reached for phase space calculations for the different treatment head options simulated. Depth-dose curves and beam profiles were in reasonable agreement with the simulation done without splitting: within 1% for depth-dose with an average difference of (0.2 {+-} 0.4)%, 1 standard deviation, and a 0.3% statistical uncertainty of the simulations in the high dose region; 1.6% for planar fluence with an average difference of (0.4 {+-} 0.5)% and a statistical uncertainty of 0.3% in the high fluence region. The percentage differences between dose distributions in water for simulations done with and without particle splitting were within the accepted clinical tolerance of 2%, with a 0.4% statistical uncertainty. For the two patient geometries considered, head and prostate, the efficiency gain was 20.9 and 14.7, respectively, with the percentages of voxels with gamma indices lower than unity 98.9% and 99.7%, respectively, using 2% and 2 mm criteria. Conclusions: The authors have implemented an efficient variance reduction technique with significant speed improvements for proton Monte Carlo simulations. The method can be transferred to other codes and other treatment heads.

60 APPLIED LIFE SCIENCES↗

BrachyView, A novel inbody imaging system for HDR prostate brachytherapy: Design and Monte Carlo feasibility study

Purpose: High dose rate (HDR) brachytherapy is a form of radiation therapy for treating prostate cancer whereby a high activity radiation source is moved between predefined positions inside applicators inserted within the treatment volume. Accurate positioning of the source is essential in delivering the desired dose to the target area while avoiding radiation injury to the surrounding tissue. In this paper, HDR BrachyView, a novel inbody dosimetric imaging system for real time monitoring and verification of the radioactive seed position in HDR prostate brachytherapy treatment is introduced. The current prototype consists of a 15 Multiplication-Sign 60 mm{sup 2} silicon pixel detector with a multipinhole tungsten collimator placed 6.5 mm above the detector. Seven identical pinholes allow full imaging coverage of the entire treatment volume. The combined pinhole and pixel sensor arrangement is geometrically designed to be able to resolve the three-dimensional location of the source. The probe may be rotated to keep the whole prostate within the transverse plane. The purpose of this paper is to demonstrate the efficacy of the design through computer simulation, and to estimate the accuracy in resolving the source position (in detector plane and in 3D space) as part of the feasibility study for the BrachyView project.Methods: Monte Carlo simulations were performed using the GEANT4 radiation transport model, with a {sup 192}Ir source placed in different locations within a prostate phantom. A geometrically accurate model of the detector and collimator were constructed. Simulations were conducted with a single pinhole to evaluate the pinhole design and the signal to background ratio obtained. Second, a pair of adjacent pinholes were simulated to evaluate the error in calculated source location.Results: Simulation results show that accurate determination of the true source position is easily obtainable within the typical one second source dwell time. The maximum error in the estimated projection position was found to be 0.95 mm in the imaging (detector) plane, resulting in a maximum source positioning estimation error of 1.48 mm.Conclusions: HDR BrachyView is a feasible design for real-time source tracking in HDR prostate brachytherapy. It is capable of resolving the source position within a subsecond dwell time. In combination with anatomical information obtained from transrectal ultrasound imaging, HDR BrachyView adds a significant quality assurance capability to HDR brachytherapy treatment systems.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Proton radiography in three dimensions: A proof of principle of a new technique

Purpose: Monte Carlo simulations were used to investigate a range of phantom configurations to establish enabling three-dimensional proton radiographic techniques.Methods: A large parameter space of stacked phantom geometries composed of tissue inhomogeneity materials such as lung, bone, and cartilage inserted within water background were simulated using a purposefully modified version of TOPAS, an application running on top of the GEANT4 Monte Carlo code. The phantoms were grouped in two classes, one with the inhomogeneity inserted only half-way in the lateral direction and another with complete inhomogeneity insertion. The former class was used to calculate the track count and the energy fluence of the protons as they exit the phantoms either having traversed the inhomogeneity or not. The latter class was used to calculate one yield value accounting for loss of protons due to physical processes only and another yield value accounting for deliberately discarded protons due to large scattering angles. A graphical fingerprinting method was developed to determine the inhomogeneity thickness and location within the phantom based on track count and energy fluence information. Two additional yield values extended this method to the general case which also determines the inhomogeneity material and the phantom thickness.Results: The graphical fingerprinting method was manually validated for two, and automatically tested for all, tissue materials using an exhaustive set of inhomogeneity geometries for 16 cm thick phantoms. Unique recognition of test phantom configurations was achieved in the large majority of cases. The method in the general case was further tested using an exhaustive set of inhomogeneity and phantom tissues and geometries where the phantom thicknesses ranged between 8 and 24 cm. Unique recognition of the test phantom configurations was achieved only for part of the phantom parameter space. The correlations between the remaining false positive recognitions were analyzed.Conclusions: The concept of 3D proton radiography for tissue inhomogeneities of simple geometries was established with the current work. In contrast to conventional 2D proton radiography, the main objective of the demonstrated 3D technique is not proton range. Rather, it is to measure the depth and thickness of an inhomogeneity located in an imaged geometry. Further work is needed to extend and apply the method to more complex geometries.

62 RADIOLOGY AND NUCLEAR MEDICINE↗