Simulation model criteria for a synchrotron radiation based MBRS/MRT clinical facility

Abstract

MicroBeam Radiosurgery (MBRS, also referred to as Microbeam Radiation Therapy, MRT) is a potential clinical technique for the treatment of solid tumors. MBRS utilizes a series of narrow 30 to 50μm beams of ultra-high, lethal dose synchrotron x-ray radiation (peaks) separated by relatively wide spaces of no radiation (valleys) with spacings of 200 to 400μm center-to-center. It has been observed that healthy small animal tissue, including neurologic tissue (brain and spinal cord), can recover quickly, but solid tumors take a prolonged time of many months to regrow. This vast difference in recovery period is the basis for the therapeutic effect of MBRS on tumors. The interactions of X rays and tissue cells in alignment with the microbeams cause some deposited dose to be delivered to the tissue between the peak region of the microbeams and spill into the valley regions. It is generally believed that the dose delivered between the microbeam peak regions must be maintained at a low level to maximize the efficacy of MBRS. To date the most widely used criterion for the efficacy of MBRS is known as the Peak-to-Valley Dose Ratio (PVDR). This ratio depends on the geometry of the system along with the X-ray spectra. As most of the experimental work to date has used polychromatic microbeams of X rays, the PVDR will change with the energy range and spectrum. We are reporting novel investigations and present data suggesting considerations additional to the PVDR are needed for the design of a human clinical facility. In this paper we studied X-ray interactions in simulated human biologic material (Water - H2O) using the MCNP6 radiation transport computer code. The new slit geometry dependent information includes: (1) rounding of peak shape; (2) decrease of the maximum peak height with decreasing peak slit width; (3) qualitative and quantitative changes to the “skirt” radiation dose delivered in the valley regions adjacent to the peak regions. All these effects were highly dependent on incident X-ray energy because of the transition of the dominant X-ray interaction from the photo-electric effect to atomic Compton scattering with increasing energy in the 50 to 300 keV range. Changes in the radiation dose distributions, as a function of X-ray energy, delivered to both the peak and valley regions after the X-ray interactions were investigated in detail. Insights from understanding how the dose is delivered in the valley regions have implications for the calculations of the clinical radiation dose planning. Accurate dose distribution calculations are necessary in human clinical treatment since it is anticipated that most patients will have received prior radiation therapy treatments that need to be considered in microbeam dose planning so that radiation side-effects and toxicity are accounted for and minimized.This work suggests an X-ray energy range of 130–250 keV is the most appropriate range for a human clinical facility. Using the results of this work, the authors suggest that the PVDR may not be the only criteria one should consider for determining the energy range needed for a human clinical facility; analysis of the data presented demonstrates the benefit of also using the full width at 10% maximum of the distribution.