Depth Dose Curves Research Articles

Mathematic modeling of the dose in water for calculating collimator scatter factor of flattening filter and flattening filter free megavoltage photon beams

This study presents an empirical method to model the percent depth dose (PDD) curves of flattening filter (FF) and FF-free (FFF) high-energy photon beams using a home-generated buildup function and tail function (buildup-tail function) in radiation therapy. The modeling parameters n and μ of the buildup-tail function were used to characterize the collimator scatter factor (Sc). The buildup function was a quadratic function in the form of d/ √(d2 + n) with main parameters of d (depth in water) and n, while the tail function was in the form of e−μd and was composed of an exponential function with d and μ. PDD was the product of buildup-tail function and characterized by the buildup-tail function by adjusting the parameters n and μ. The Sc of 6 and 10 MV in FF and FFF beams can be expressed simply by the modeling parameters n and μ. The main parameter n increases when photon energy increases. Its physical meaning expresses the beam hardening of photon energy in PDD. The parameter μ can be treated as an attenuation coefficient in the tail function, decreasing when photon energy increases. The values of n and μ obtained from the fitted buildup-tail function were applied into an analytical formula of Sc,FF = nE(S)0.63 μ E, Sc,FFF = nE(S)4.45 μ E to get the Sc of 6 and 10 MV in FF and FFF photon beams, with nE, μ E, S denoting n and μ at photon energy E of field size S. The calculated Sc was compared with the measured data and showed agreement, finding that the field difference was size within ±1%. This model can be used to parameterize the Sc for some clinical requirements. The modeling parameters n and μ can be used to predict the Sc in either FF or FFF beams for the treatment monitor unit in double-check dose calculation. The technique developed in this study can also be used for systematic or random errors in the quality assurance program, thus improving the clinical dose computation accuracy for patient treatment.

Evaluation of Dosimetry Formalisms in Intraoperative Radiation Therapy of Glioblastoma

The intraoperative radiotherapy in newly diagnosed glioblastoma multiforme (INTRAGO) clinical trial assesses survival in patients with glioblastoma treated with intraoperative radiation therapy (IORT) using the INTRABEAM. Treatment planning for INTRABEAM relies on vendor-provided in-water depth dose curves obtained according to the TARGeted Intraoperative radioTherapy (TARGIT) dosimetry protocol. However, recent studies have shown discrepancies between the estimated TARGIT and delivered doses. This work evaluates the effect of the choice of dosimetry formalism on organs at risk (OAR) doses. A treatment planning framework for INTRABEAM was developed to retrospectively calculate the IORT dose in 8 INTRAGO patients. These patients received an IORT prescription dose of 20 to 30 Gy in addition to external beam radiation therapy. The IORT dose was obtained using (1) the TARGIT method; (2) the manufacturer's V4.0 method; (3) the CQ method, which uses an ionization chamber Monte Carlo (MC) calculated factor; (4) MC dose-to-water; and (5) MC dose-to-tissue. The IORT dose was converted to 2 Gy fractions equivalent dose. According to the TARGIT method, the OAR dose constraints were respected in all cases. However, the other formalisms estimated a higher mean dose to OARs and revealed 1 case where the constraint for the brain stem was exceeded. The addition of the external beam radiation therapy and TARGIT IORT doses resulted in 10 cases of OARs exceeding the dose constraints. The more accurate MC calculation of dose-to-tissue led to the highest dosimetric differences, with 3, 3, 2, and 2 cases (out of 8) exceeding the dose constraint to the brain stem, optic chiasm, optic nerves, and lenses, respectively. Moreover, the mean cumulative dose to brain stem exceeded its constraint of 66 Gy with the MC dose-to-tissue method, which was not evident with the current INTRAGO clinical practice. The current clinical approach of calculating the IORT dose with the TARGIT method may considerably underestimate doses to nearby OARs. In practice, OAR dose constraints may have been exceeded, as revealed by more accurate methods.

The effects of different photon beam energies in stereotactic radiosurgery with cones.

Stereotactic radiosurgery (SRS) relies on small fields to ablate lesions. Currently, linac based treatment is delivered via circular cones using a 6 MV beam. There is interest in both lower energy photon beams, which can offer steeper dose fall off as well as higher energy photon beams, which have higher dose rates, thus reducing radiation delivery times. Of interest in this study is the 2.5 MV beam developed for imaging applications and both the 6 and 10 MV flattening-filter-free (FFF) beams, which can achieve dose rates up to 2400 cGy/min. This study aims to assess the benefit and feasibility among different energy beams ranging from 2.5 to 10 MV beams by evaluating the dosimetric effects of each beam and comparing the dose to organs-at-risk (OARs) for two separate patient plans. One based on a typical real patient tremor utilizing a 4mm cone and the other a typical brain metastasis delivered with a 10mm cone. The Monte Carlo codes BEAMnrc/DOSXYZnrc were used to generate beams of 2.5 MV, 6 MV-FFF, 6 MV-SRS, 6 MV, 10 MV-FFF, and 10 MV from a Varian TrueBeam except 6 MV-SRS, which is taken from a Varian TX model linear accelerator. Each beam's energy spectrum, mean energy, %dd curve, and dose profile were obtained by analyzing the simulated beams. Calculated patient dose distributions were compared among six different energy beam configurations based on a realistic treatment plan for thalamotomy and a conventional brain metastasis plan. Dose to OARs were evaluated using dose-volume histograms for the same target dose coverage. The mean energies of photons within the primary beam projected area were insensitive to cone sizes and the values of percentage depth-dose curves (%dd) at d=5cm and SSD=95cm for a 4mm (10mm) cone ranges from 62.6 (64.4) to 82.2 (85.7) for beam energy ranging from 2.5 to 10 MV beams, respectively. Doses to OARs were evaluated among these beams based on real treatment plans delivering 15000 and 2200cGy to the target with a 4 and 10mm cone, respectively. The maximum doses to the brainstem, which is 10mm away from the isocenter, was found to be 434 (300), 632 (352), 691 (362), 733 (375), 822 (403), and 975 (441)cGy for 2.5 MV, 6 MV-FFF, 6 MV-SRS, 6 MV, 10 MV-FFF, and 10 MV beams delivering 15000 (2200) cGy target dose, respectively. Using the 6 MV-SRS as reference, changes of the maximum dose (691 cGy) to the brain stem are -37%, -9%, +6%, +19%, and 41% for 2.5 MV, 6 MV-FFF, 6 MV, 10 MV-FFF, and 10 MV beams, respectively, based on the thalamotomy plan, where the "-" or "+" signs indicate the percentage decrease or increase. Changes of the maximum dose (362 cGy) to brain stem, based on the brain metastasis plan are much less for respective beam energies. The sum of 21 arcs beam-on time was 39 min on our 6 MV-SRS beam with 1000 cGy/min for thalamotomy. The beam-on time can be reduced to 16 min with 10 MV-FFF.

Characterization of a Gd-based color CMOS detector for proton dosimetry

A color scintillation detector for relative dose distribution measurement was developed at PSI. The system consists of a gadolinium-based scintillating screen mounted perpendicularly to the beam axis and coupled with a color CMOS camera in a light-tight box. The camera is equipped with an iris (aperture) controller to remotely adjust the number of photons reaching the image sensor. To improve the measurement accuracy and decrease the image artifacts, we investigated different methods for spatial calibration and optimized the internal light reflection by adjusting the detector structure. The response dependence on camera working distance, iris setting, and color channels was assessed. The depth-dose curves of the gadolinium-based scintillator in three RGB channels were compared with reference curves measured by an Advanced Markus plane-parallel ion chamber. The quenching effect of the ▪ screen measured with this system amounts to about 10% in the Bragg peak region of a 150 MeV proton beams. The shape of the emission spectrum was observed to be independent of the ionization density. Preliminary investigations showed that it is possible to correlate the ratio of the detector response in different color channels with the proton ionization density.

Low-energy protons shallow spread-out Bragg peak imaging with a lithium fluoride crystal

The 35 MeV proton beam produced by a modular linear accelerator was used to irradiate at grazing incidence a LiF crystal through a spinning Mylar multi-sector range modulation wheel and a Pyrex range shifter. Starting from a measured pristine depth dose curve, these energy-modulation devices were designed to plan a test shallow spread-out Bragg peak in water. The irradiation of the LiF crystal produced in its lattice a volume distribution of color centers, which could be visualized in a fluorescence microscope as a fluorescent image under blue-light illumination. Since the intensity of this fluorescent image was proportional point-by-point to the absorbed energy, it was elaborated to obtain an experimental depth dose curve in the LiF crystal, from which the proton beam energy distribution was estimated. This latter was finally used to evaluate the corresponding spread-out Bragg peak that would be obtained in water and compare it to the designed one.

A GPU-accelerated Monte Carlo dose computation engine for small animal radiotherapy.

Accurate dose computation is critical in precision small animal radiotherapy. The Monte Carlo simulation method is the gold standard for radiation dose computation but has not been widely implemented in practice due to its low computation efficiency. This study aims to develop a GPU-accelerated radiation dose engine (GARDEN) based on the Monte Carlo simulation method for fast and accurate dose computation. In the GARDEN simulation, Compton scattering, Rayleigh scattering, and photoelectric effect were considered. The Woodcock tracking algorithm and GPU-specific acceleration techniques were used to obtain a high computational efficiency. Benchmark studies against both Geant4 simulations and experimental measurements were performed for various phantoms and beams. Finally, a conformal arc treatment plan was designed for a lung tumor to further evaluate the accuracy and efficiency in small animal radiotherapy. The engine attained a speed-up of 1232 times in a homogeneous water phantom and 935 times in a water-bone-lung heterogeneous phantom when compared with Geant4. Both the depth-dose curves and cross-sectional dose profiles for various radiation field sizes showed a great match between measurements and the GARDEN calculations. For in vivo dose validation, the differences between calculations and measurements in the mouse thorax and abdomen were 2.50%±1.50% and 1.56%±1.40%, respectively. The computation time for an arc treatment plan delivered from 36 angles was 2 s at a<1% uncertainty level using an NVIDIA GeForce RTX 2060 SUPER GPU. When compared with Geant4, the 3D gamma comparison passing rate was 98.7% at 2%/0.3mm criteria. GARDEN can perform fast and accurate dose computations in heterogeneous tissue environments and is expected to play a vital role in image-guided precision small animal radiotherapy.

Characterization of 250 MeV Protons from the Varian ProBeam PBS System for FLASH Radiation Therapy.

Shoot-through proton FLASH radiation therapy has been proposed where the highest energy is extracted from a cyclotron to maximize the dose rate (DR). Although our proton pencil beam scanning system can deliver 250 MeV (the highest energy), this energy is not used clinically, and as such, 250 MeV has yet to be characterized during clinical commissioning. We aim to characterize the 250-MeV proton beam from the Varian ProBeam system for FLASH and assess the usability of the clinical monitoring ionization chamber (MIC) for FLASH use. We measured the following data for beam commissioning: integral depth dose curve, spot sigma, and absolute dose. To evaluate the MIC, we measured output as a function of beam current. To characterize a 250 MeV FLASH beam, we measured (1) the central axis DR as a function of current and spot spacing and arrangement, (2) for a fixed spot spacing, the maximum field size that achieves FLASH DR (ie, > 40 Gy/s), and (3) DR reproducibility. All FLASH DR measurements were performed using an ion chamber for the absolute dose, and irradiation times were obtained from log files. We verified dose measurements using EBT-XD films and irradiation times using a fast, pixelated spectral detector. R90 and R80 from integral depth dose were 37.58 and 37.69 cm, and spot sigma at the isocenter were σx = 3.336 and σy = 3.332 mm, respectively. The absolute dose output was measured as 0.343 Gy*mm2/MU for the commissioning conditions. Output was stable for beam currents up to 15 nA and gradually increased to 12-fold for 115 nA. Dose and DR depended on beam current, spot spacing, and arrangement and could be reproduced with 6.4% and 4.2% variations, respectively. Although FLASH was achieved and the largest field size that delivers FLASH DR was determined as 35 × 35 mm2, the current MIC has DR dependence, and users should measure dose and DR independently each time for their FLASH applications.

3D printed 2D range modulators preserve radiation quality on a microdosimetric scale in proton and carbon ion beams

IntroductionParticle therapy using pencil beam scanning (PBS) faces large uncertain- ties related to ranges and target motion. One possibility to improve existing mitigation strategies is a 2D range modulator (2DRM). A 2DRM offers faster irradiation times by reducing the number of layers and spots needed to create a spread-out Bragg peak. We have investigated the impact of 2DRM on microdosimetric spectra measured in proton and carbon ion beams. Materials and MethodsTwo 2DRMs were designed and 3D printed, one for.124.7 MeV protons and one for 238.6 MeV/u carbon ions. Their dosimetric validation was performed using Roos and PinPoint ionization chamber and EBT3 films. Monte Carlo simulations were done using GATE. A silicon-based solid-state microdosimeter was used to collect pulse-height spectra along three depths for two irradiation modalities, PBS and a single central beam. ResultsFor both particle types, the original pin design had to be optimized via GATE simulations. The difference between the R80 of the simulated and measured depth dose curve was 0.1 mm. The microdosimetric spectra collected with the two irradiation modalities overlap well. Their mean lineal energy values differ over all positions by 5.2 % for the proton 2DRM and 2.1 % for the carbon ion 2DRM. ConclusionRadiation quality in terms of lineal energy was independent of the irradiation method. This supports the current approach in reference dosimetry, where the residual range is chosen as a beam quality index to select stopping power ratios.

Spectral analysis of Monte Carlo calculated fluence correction and cema conversion factors for high-energy photon beams at different depths

Purpose: The aim of this study is to investigate the depth-dependent detector response of detailed thimble air-filled ionization chambers by calculating spectral charged particle fluence correction factors at different depths in water. Those spectral correction factors will help to understand, how the detector response varies at different depths and what kind of influences disparate effects have on the spectral detector response.Methods: The cema-approach can be used to obtain spectral charged particle fluence-based correction factors for various measurement conditions by substituting the commonly well-known dose conversion factor with a conversion factor based on the dosimetric quantity cema (“converted-energy per unit mass”). The resulting spectral fluence correction factors were calculated with the EGSnrc software toolkit and analyzed for two air-filled cylindrical ionization chambers (PTW type 31021 Semiflex 3D, SNC125c™) at different depths in a water phantom irradiated with a 6 MV linear accelerator x-ray spectrum. The ionization chamber models have been stepwise decomposed to investigate the perturbation caused by internal and external effects on the fluence distribution within the detector.Results: Monte Carlo calculated fluence-based perturbation correction factors revealed that for all investigated detectors, considerable fluence disturbances occur, especially in the build-up region of depth-dose curves. Our results have shown that even slight variations in depth can have major consequences on the differential charged particle fluence within the ionization chamber, mainly due to internal cavity-specific effects. Furthermore, the results showed that in the case of relative dose measurements, the depth-depending detector response can significantly differ from unity in a range of 1.4%–2.8% depending on the ionization chamber design.Conclusion: The complexity of different effects on the fluence disturbance could be broken down with regard to their influence on the spectral fluence distribution in the sensitive volume of the investigated detectors. It could be demonstrated, that the displacement of water is a depth-depending effect, which can not be compensated or corrected ideally for each investigated water depth by the shift of the effective point of measurement. Generally, the spectral analysis of those energy-dependent correction factors serves to a deeper understanding of the detector response under various conditions.

Ion-bunch energy acoustic tracing by modulation of the depth-dose curve

Abstract Characterizing exact energy density distributions for laser-accelerated ion bunches in a medium is challenging due to very high beam intensities and the electro-magnetic pulse emitted in the laser–plasma interaction. Ion-bunch energy acoustic tracing allows for reconstructing the spatial energy density from the ionoacoustic wave generated upon impact in water. We have extended this approach to tracing ionoacoustic modulations of broad energy distributions by introducing thin foils in the water reservoir to shape the acoustic waves at distinct points along the depth–dose curve. Here, we present first simulation studies of this new detector and reconstruction approach, which provides an online read-out of the deposited energy with depth within the centimeter range behind the ion source of state-of-the-art laser–plasma-based accelerators.

Commissioning a beam line for MR-guided particle therapy assisted by in-silico methods.

Radiation therapy is continuously moving towards more precise dose delivery. The combination of on-line MR imaging and particle therapy, e.g. radiation therapy using protons or carbon ions, could enable the next level of precision in radiotherapy. In particle therapy, research towards a combination of MR and particle therapy, is well underway, but still far from clinical systems. The combination of high magnetic fields with particle therapy delivery poses several challenges for treatment planning, treatment workflow, dose delivery anddosimetry. To present a workflow for commissioning of a light ion beam line with an integrated dipole magnet to perform MR-guided particle therapy research, producing not only basic beam data but also magnetic field maps for accurate dose calculation. Accurate dose calculation in magnetic field environments requires high-quality magnetic field maps to compensate for magnetic field dependent trajectory changes and doseperturbations. The research beam line at MedAustron was coupled with a resistive dipole magnet positioned at the isocenter. Beam data was measured for proton and carbon ions with and without an applied magnetic field of 1 T. Laterally integrated depth dose curves as well as beam profiles were measured in water while beam trajectories were measured in air. Based on manufacturer data, an in-silico model of the magnet was created, allowing to extract high-quality 3D magnetic field data. An existing GATE/Geant4 Monte Carlo (MC) model of the beam line was extended with the generated magnetic field data and benchmarked against experimentaldata. A 3D magnetic field volume covering fringe fields until 50 mT was found to be sufficient for accurate beam trajectory modeling. The effect on particle range retraction were found to be 2.3 and 0.3 mm for protons and carbon ions, respectively. Measured lateral beam offsets in water agreed within 0.4 and -0.5 mm with MC simulations for protons and carbon ions, respectively. Experimentally determined in-air beam trajectories agreed within 0.4 mm in the homogeneous magnetic fieldarea. The presented approach based on in-silico modelling and measurements allows to commission a beam line for MR-guided particle therapy while providing benchmarking data for the magnetic field modeling, required for state-of-the art dose calculationmethods. This article is protected by copyright. All rights reserved.

Evaluation of scanning resolution, detector choice and detector orientation to be used for accurate and time-efficient commissioning of a 6MV clinical linear accelerator

The present study is aimed at exploring different scanning parameters, detectors and their orientations for time-efficient and accurate commissioning of a 6 MV clinical linear accelerator (LINAC). Beam profiles and percentage depth dose (PDD) curves were measured with a PTW dosimetry diode, a PTW Semiflex and a PinPoint ion chamber in different orientations. To acquire beam data, equidistant (step size of 0.5mm, 1mm, 2mm and 3mm) and fanline (step size of 2-0.5mm, 2-1mm, 3-0.5mm and 3-1mm) scanning modes were employed and data measurement time was recorded. Scan time per measurement point was also varied (0.2s, 0.5s and 1.0s) to investigate its effect on the accuracy and acquisition time of beam data. Accuracy of the measured data was analyzed on the basis of the variation between measured data and data modeled by a treatment planning system. Beam profiles (particularly in penumbra region) were found to be sensitive to variation in scanning resolution and showed an improved accuracy with decrease in step size, while PDD curves were affected negligibly. The accuracy of beam data obtained with the PTW dosimetry diode and the PinPoint ion chamber was higher than those obtained with the PTW Semiflex ion chamber for small fields (2 × 2cm2 and 3 × 3cm2). However, the response of the PTW diode and the PinPoint ion chamber was significantly indifferent in these fields. Furthermore, axial orientation of the PTW Semiflex ion chamber improved accuracy of profiles and PDDs as compared to radial orientation, while such a difference was not significant for the PinPoint ion chamber. It is concluded that a scan time of 0.2s/point with a fanline scanning resolution of 2-1mm for beam profiles and 3mm for PDDs are most favorable in terms of accuracy and time efficiency. For small fields (2 × 2cm2 and 3 × 3cm2), a PinPoint ion chamber in radial orientation or a dosimetry diode in axial orientation are recommended for both beam profiles and PDDs. If a PinPoint ion chamber and a PTW dosimetry diode are not available, a Semiflex ion chamber in axial orientation may be used for small fields.

Machine characterization and central axis depth dose data of a superficial x-ray radiotherapy unit

Objectives. The purpose of this study is to present data from the clinical commissioning of an Xstrahl 150 x-ray unit used for superficial radiotherapy, Methods. Commissioning tasks included vendor acceptance tests, timer reproducibility, linearity and end-effect measurements, half-value layer (HVL) measurements, inverse square law verification, head-leakage measurements, and beam output calibration. In addition, percent depth dose (PDD) curves were determined for different combinations of filter/kV settings and applicators. Automated PDD water phantom scans were performed utilizing four contemporary detectors: a microDiamond detector, a microSilicon detector, an EDGE detector, and a PinPoint ionization chamber. The measured PDD data were compared to the published values in BJR Supplement 25, Results. The x-ray unit’s mechanical, safety, and radiation characteristics were within vendor-stated specifications. Across sixty commissioned x-ray beams, the PDDs determined in water using solid state detectors were in excellent agreement with the BJR 25 data. For the lower (<100 kVp) and medium-energy (≥100 kVp) superficial beams the average agreement was within [−3.6,+0.4]% and [−3.7,+1.4]% range, respectively. For the high-energy superficial (low-energy orthovoltage) x-rays at 150 kVp, the average difference for the largest 20 × 20 cm2 collimator was (−0.7 ± 1.0)%, Conclusions. This study presents machine characterization data collected for clinical use of a superficial x-ray unit. Special focus was placed on utilizing contemporary detectors and techniques for the relative PDD measurements using a motorized water phantom. The results in this study confirm that the aggregate values published in the BJR 25 report still serve as a valid benchmark when comparing data from site-specific measurements, or the reference data for clinical utilization without such measurements, Advances in knowledge. This paper presents comprehensive data from the acceptance and commissioning of a modern kilovoltage superficial x-ray radiotherapy machine. Comparisons between the PDD data measured in this study using different detectors and BJR 25 data are highlighted.

Commissioning of a synchrotron-based proton beam therapy system for use with a Monte Carlo treatment planning system

This work tackles the commissioning and validation of a novel combination of a synchrotron-based proton beam therapy system (Hitachi, Ltd.) for use with a Monte Carlo treatment planning system (TPS). Four crucial aspects in this configuration have been investigated: (1) Monte Carlo-based correction performed by the TPS to the measured integrated depth-dose curves (IDD), (2) circular spot modelling with a single Gaussian function to characterize the synchrotron physical spot, which is elliptical, (3) the modelling of the range shifter that enables using only one set of measurements in open beams, and (4) the Monte Carlo dose calculation model in small fields.Integrated depth-dose curves were measured with a PTW Bragg peak chamber and corrected, with a Monte Carlo model, to account for energy absorbed outside the detector. The elliptical spot was measured by IBA Lynx scintillator, EBT3 films and PTW microDiamond. The accuracy of the TPS (RayStation, RaySearch Laboratories) at spot modelling with a circular Gaussian function was assessed.The beam model was validated using spread-out Bragg peak (SOBP) fields. We took single-point doses at several depths through the central axis using a PTW Farmer chamber, for fields between 2 × 2cm and 30 × 30cm. We checked the range-shifter modelling from open-beam data. We tested clinical cases with film and an ionization chamber array (IBA Matrix).Sigma differences for spots fitted using 2D images and 1D profiles to elliptical and circular Gaussian models were below 0.22 mm. Differences between SOBP measurements at single points and TPS calculations for all fields between 5 × 5 and 30 × 30cm were below 2.3%. Smaller fields had larger differences: up to 3.8% in the 2 × 2cm field. Mean differences at several depths along the central axis were generally below 1%. Differences in range-shifter doses were below 2.4%. Gamma test (3%, 3 mm) results for clinical cases were generally above 95% for Matrix and film.Approaches for modelling synchrotron proton beams have been validated. Dose values for open and range-shifter fields demonstrate accurate Monte Carlo correction for IDDs. Elliptical spots can be successfully modelled using a circular Gaussian, which is accurate for patient calculations and can be used for small fields. A double-Gaussian spot can improve small-field calculations. The range-shifter modelling approach, which reduces clinical commissioning time, is adequate.

Clinical treatment planning for kilovoltage radiotherapy using EGSnrc and Python.

Kilovoltage radiotherapy dose calculations are generally performed with manual point dose calculations based on water dosimetry. Tissue heterogeneities, irregular surfaces, and introduction of lead cutouts for treatment are either not taken into account or crudely approximated in manual calculations. Full Monte Carlo (MC) simulations can account for these limitations but require a validated treatment unit model, accurately segmented patient tissues and a treatment planning interface (TPI) to facilitate the simulation setup and result analysis. EGSnrc was used in this work to create a model of Xstrahl kilovoltage unit extending the range of energies, applicators, and validation parameters previously published. The novel functionality of the Python-based framework developed in this work allowed beam modification using custom lead cutouts and shields, commonly present in kilovoltage treatments, as well as absolute dose normalization using the output of the unit. 3D user-friendly planning interface of the developed framework facilitated non-co-planar beam setups for CT phantom MC simulations in DOSXYZnrc. The MC models of 49 clinical beams showed good agreement with measured and reference data, to within 2% for percentage depth dose curves, 4% for beam profiles at various depths, 2% for backscatter factors, 0.5 mm of absorber material for half-value layers, and 3% for outputfactors. End-to-end testing of the framework using custom lead cutouts resulted in good agreement to within 3% of absolute dose distribution between simulations and EBT3 GafChromic film measurements. Gamma analysis demonstrated poor agreement at the field edges which was attributed to the limitations of simulating smooth cutout shapes. Dose simulated in a heterogeneous phantom agreed to within 7% with measured values converted using the ratio of mass energy absorption coefficients of appropriate tissues andair.

Neural Representation of Linear Accelerator Beam Data from a Single Reference Dataset for Fast Commissioning and Quality Assurance

<h3>Purpose/Objective(s)</h3> We hypothesize that linear accelerator (Linac) beam properties including lateral profiles and percentage depth dose (PDD) can be modeled through a neural representation network using a single vendor-provided reference beam dataset. Such beam model can be used to predict clinical Linac beam data distributions from sparse beam measurements, which has the potential of supporting fast commissioning and routine quality assurance (QA) in the clinic. <h3>Materials/Methods</h3> A sinusoidal neural representation network that consists of multilayer perceptron and periodic activation function was used to learn a mapping between 2D coordinates (1D spatial locations x field sizes) during beam scanning and the corresponding percentage dose. The network was trained using a vendor-provided 6 MV reference beam dataset only and evaluated using clinical beam datasets that consist of ten 6MV beam profiles at 10 cm depth and seven 6MV percentage depth dose (PDD) curves collected from multiple clinics. Only beam data with 30 × 30 cm² field size were assumed available and used to update the network weights. Beam data with 10 × 10 cm² were then predicted by the network and compared to the ground truth of clinically acquired data by calculating both the relative mean absolute error and the 1D gamma passing rate with a passing criteria of 1%/1 mm. <h3>Results</h3> Compared to vendor-provided reference beam data, the network-predicted beam data showed improved consistency with the clinically acquired data. The averaged mean relative absolute error and averaged gamma passing rate between network-predicted dose profile/reference beam dose profile and the clinical measurements were 1.9%/2.5% and 95%/90% respectively. The averaged mean relative absolute error and averaged gamma passing rate between network-predicted PDD/reference beam PDD and the clinical measurements were 0.6%/0.5% and 100%/97% respectively. <h3>Conclusion</h3> Neural representation network is capable of modeling inherent Linac beam properties and predicting clinical beam data accurately from sparse beam measurements. The proposed beam model has the potential of simplifying the clinical beam scanning process with much reduced beam data collection.

Longitudinally Heterogeneous Tumor Dose Optimizes Proton Broadbeam, Interlaced Minibeam, and FLASH Therapy.

Simple SummaryThe aim of any kind of external radiation therapy is to control a tumor with the highest possible probability of the lowest possible side effects. Here, we study further opportunities of reducing the side effects of proton therapy by applying longitudinally heterogeneous dose distributions in the tumor respecting the delivery of a minimum prescribed dose. In our simulations, the longitudinally heterogeneous dose distributions show a reduced dose in the healthy tissue already in the case of proton broadbeam irradiations, but a much higher (calculated) mean cell survival in the case of proton minibeam irradiation. This demonstrates its potential to substantially reduce side effects at a simultaneously higher tumor control probability, opening new opportunities of easier application when striving for high dose-rate applications of proton beams (>~10 Gy/s), in order to additionally profit from the so-called FLASH effects.The prerequisite of any radiation therapy modality (X-ray, electron, proton, and heavy ion) is meant to meet at least a minimum prescribed dose at any location in the tumor for the best tumor control. In addition, there is also an upper dose limit within the tumor according to the International Commission on Radiation Units (ICRU) recommendations in order to spare healthy tissue as well as possible. However, healthy tissue may profit from the lower side effects when waving this upper dose limit and allowing a larger heterogeneous dose deposition in the tumor, but maintaining the prescribed minimum dose level, particularly in proton minibeam therapy. Methods: Three different longitudinally heterogeneous proton irradiation modes and a standard spread-out Bragg peak (SOBP) irradiation mode are simulated for their depth-dose curves under the constraint of maintaining a minimum prescribed dose anywhere in the tumor region. Symmetric dose distributions of two opposing directions are overlaid in a 25 cm-thick water phantom containing a 5 cm-thick tumor region. Interlaced planar minibeam dose distributions are compared to those of a broadbeam using the same longitudinal dose profiles. Results and Conclusion: All longitudinally heterogeneous proton irradiation modes show a dose reduction in the healthy tissue compared to the common SOBP mode in the case of broad proton beams. The proton minibeam cases show eventually a much larger mean cell survival and thus a further reduced equivalent uniform dose (EUD) in the healthy tissue than any broadbeam case. In fact, the irradiation mode using only one proton energy from each side shows better sparing capabilities in the healthy tissue than the common spread-out Bragg peak irradiation mode with the option of a better dose fall-off at the tumor edges and an easier technical realization, particularly in view of proton minibeam irradiation at ultra-high dose rates larger than ~10 Gy/s (so-called FLASH irradiation modes).

Feasibility of using dental putty-based custom molds for high-dose-rate brachytherapy of oral mucosal melanoma

PurposeTo investigate the feasibility of using dental putty to fabricate custom molds for high-dose-rate (HDR) brachytherapy of oral mucosal melanoma. Practical guidelines of using dental putty for the custom mold fabrication are presented. MethodsDose measurements were performed using radiochromic films to understand the dosimetric characteristics of dental putty. The percentage depth dose (PDD) and profile curves were obtained using a single Co-60 source located on top of a cubic volume of the dental putty. Two custom molds were fabricated for a patient with mucosal melanoma lesions, which were spread throughout the right mandibular gingiva and soft palate regions. Furthermore, pretreatment dosimetry for both lesions was performed to evaluate the delivery quality of the resulting HDR brachytherapy plans and adjust the overall dose level. ResultsPrescribed doses for the two oral cavity regions were successfully delivered with a reasonable dose uniformity. Based on the measured single-source PDD curve, the maximum dose was observed at a depth of approximately 1 mm, which indicated steep dose gradients at depths ranging from 0 to 2 mm. Furthermore, a simulation with the measured single-source two-dimensional profile revealed that a source-to-source distance of 10 mm was appropriate to generate a uniform dose distribution at a source-to-surface distance of 5 mm. ConclusionsThe use of a custom mold was found to be feasible for HDR brachytherapy while carefully considering the source-to-surface and source-to-source distances. Pretreatment delivery verification would be necessary when a uniform dose distribution is required.

Evaluation and Comparison of Dosimetric Characteristics of Semiflex®3D and Microdiamond in Relative Dosimetry under 6 and 15 MV Photon Beams in Small Fields

Background: In modern radiotherapy techniques, the frequently small and non-uniformed fields can increase treatment efficiency due to their highly conformal dose distribution. Particular features including lack of Lateral Charge Particle Equilibrium (LCPE) lead to detectors with high resolution since any error in obtained dosimetric data could cause patient mistreatments.Objective: This study aims to evaluate and compare two small detectors (Semiflex®3D and microdiamond) dosimetric characteristics in small field relative dosimetry.Material and Methods: In this experimental study, the dosimetric properties of Semiflex®3D and microdiamond were assessed under 6 and 15 MV photon beams. The linearity and stability of the detector’s response and dose rate were measured. Square-field sizes ranging from 0.6×0.6 - 5×5 cm2 were used for obtaining percentage depth dose curves (PDDs) and in-plane profiles. The angular and temperature dependence of both detectors’ responses were also studied.Results: The detector response shows good stability, no deviation from linearity, and low dose rate dependence (≤1.6%). PDDs and in-plan profiles of both detectors are in good agreement and no significant difference was observed except for the high dose gradient regions (P-value≤0.017). Both detectors demonstrated low angular dependence (<0.3%) with temperature dependence lower than 1% for both detectors.Conclusion: The results indicate both investigated detectors were well performed in small field relative dosimetry and for measuring penumbra, it is better to use microdiamond detector.

A Novel Treatment Planning Design for Intraoperative Electron Radiation Therapy (IOERT) using an Electronic Board.

Intraoperative Irradiation Therapy (IORT) refers to the delivery of radiation during surgery and needs the computed- thickness of the target as one of the most significant factors. This paper aimed to compute target thickness and design a radiation pattern distributing the irradiation uniformly throughout the target. The Monte Carlo code was used to simulate the experimental setup in this simulation study. The electron flux variations on an electronic board's metallic layer were studied for different thicknesses of the target tissue and validated with experimental data of the electronic board. Based on the electron number for different Poly Methyl Methacrylate (PMMA) phantom thicknesses at various energies, 6 MeV electrons are suitable to determine the target thickness. Uniformity in radiation and corresponding time for each target were investigated. The iso-dose and percentage depth dose curves show that higher energies are suitable for treatment and distribute uniform radiation throughout the target. Increasing the phantom thickness leads to rising radiation time based on the radiation time corresponding to these energies. The tissue thickness of each section is determined, and the radiation time is managed by scanning the target. Calculation of the thickness of the remaining tissue and irradiation time are needed after incomplete tumor removal in IORT for various remaining tissues. The patients should be protected from overexposure to uniform irradiation of tissues since the radiation dose is prescribed and checked by an oncologist.