Proton Therapy Facility Research Articles

A hybrid numerical approach to the propagation of charged particle beams through matter for hadron therapy beamline simulations

In hadron therapy beamlines, passive elements are used to reduce the beam energy or to shape its transverse profile and frequently complement the magnetic transport channel elements. In particular, cyclotron-based facilities feature energy degraders to tailor the energy to the treatment value. As such, the numerical modeling of hadron therapy beamlines is crucially reliant on the accuracy of the available beam–matter interaction models to simulate the beam properties at levels suitable for clinical applications. While integrated Monte Carlo codes reach these accuracy levels, ultra-fast numerical codes are essential for beam commissioning controls applications or fast iterative optimization of new designs. To that end, we propose a novel effective model to compute the beam–matter interactions in a hybrid fashion, using tabulated range tables, the semi-analytical Fermi–Eyges approximation, and fits extracted from Monte Carlo data. In this work, we detail the method and benchmark each step with Geant4 simulations. Finally, we validate its accuracy with beam-based measurements from a proton therapy facility using our Python-language implementation which is shown to provide computation time of the order of milliseconds. The results are discussed in detail.

Design and development of an ACCT for the Shanghai advanced proton therapy facility

Design and development of an ACCT for the Shanghai advanced proton therapy facility

3D Proton Bragg Peak Visualization and Spot Shape Measurement with Polymer Gel Dosimeters

Proton pencil beam scanning is a dynamic beam delivery technique with excellent conformability to the tumor volume. The accuracy of spot size and scanning positions will have a significant effect on the delivered dose distribution. We employed polymer gel dosimeters to measure the spot size and the scanning positions for the Shanghai Advanced Proton Therapy facility (SAPT). Polymer gel dosimeters (MAGAT-f and PAGAT) were utilized to measure the full width at half maximum (FWHM) of the beam spot at various depths on the basis of their MRI readouts. The correlation between the spot FWHM and standard deviation (σ) was analyzed at different depths. The measured Bragg peak range was compared with the Monte Carlo (MC) simulation. Three-dimensional volume rendering of the Bragg peak was reconstructed for the 3D visualization to measure the spot size three-dimensionally. The R2 dose–response curve was investigated with polymer gel dosimeters. The deviations of the Bragg peak ranging between measurement and simulation were 0.13% and −0.53% for MAGAT-f and PAGAT, respectively. Our results ascertain the feasibility of a polymer gel dosimeter to measure the spot size and positions of a proton pencil beam.

First experimental measurements of 2D microdosimetry maps in proton therapy.

Empirical data in proton therapy indicate that relative biological effectiveness (RBE) is not constant, and it is directly related to the linear energy transfer (LET). The experimental assessment of LET with high resolution would be a powerful tool for minimizing the LET hot spots in intensity-modulated proton therapy, RBE- or LET-guided evaluation and optimization to achieve biologically optimized proton plans, verifying the theoretical predictions of variable proton RBE models, and so on. This could impact clinical outcomes by reducing toxicities in organs at risk. The present work shows the first 2D LET maps obtained at a proton therapy facility using the double scattering delivery mode in clinical conditions by means of new silicon 3D-cylindrical microdetectors. The device consists of a matrix of 121 independent silicon-based detectors that have 3D-cylindrical electrodes of 25-µm diameter and 20-µm depth, resulting each one of them in a well-defined micrometric radiation sensitive volume etched inside the silicon. They have been specifically designed for a hadron therapy, improving the performance of current silicon-based microdosimeters. Microdosimetry spectra were obtained at different positions of the Bragg curve by using a water-equivalent phantom along an 89-MeV pristine proton beam generated in the Y1 proton passive scattering beamline of the Orsay Proton Therapy Centre (Institut Curie, France). Microdosimetry 2D-maps showing the variation of the lineal energy with depth in the three dimensions were obtained in situ during irradiation at clinical fluence rates (∼108 s-1 cm-2 ) for the first time with a spatial resolution of 200µm, the highest achieved in the transverse plane so far. The experimental results were cross-checked with Monte Carlo simulations and a good agreement between the spectra shapes was found. The experimental frequency-mean lineal energy values in silicon were 1.858±0.019keVµm-1 at the entrance, 2.61±0.03keVµm-1 at the proximal distance, 4.97±0.05keVµm-1 close to the Bragg peak, and 8.6±0.1keVµm-1 at the distal edge. They are in good agreement with the expected trends in the literature in clinical proton beams. We present the first 2D microdosimetry maps obtained in situ during irradiation at clinical fluence rates in proton therapy. Our results show that the arrays of 3D-cylindrical microdetectors are a reliable microdosimeter to evaluate LET maps not only in the longitudinal axis of the beam, but also in the transverse plane allowing for LET characterization in three dimensions. This work is a proof of principle showing the capacity of our system to deliver LET 2D maps. This kind of experimental data is needed to validate variable proton RBE models and to optimize LET-guided plans.

Simulation and experimental verification of ambient neutron doses in a pencil beam scanning proton therapy room as a function of treatment plan parameters

Out-of-field patient doses in proton therapy are dominated by neutrons. Currently, they are not taken into account by treatment planning systems. There is an increasing need to include out-of-field doses in the dose calculation, especially when treating children, pregnant patients, and patients with implants. In response to this demand, this work presents the first steps towards a tool for the prediction of out-of-field neutron doses in pencil beam scanning proton therapy facilities. As a first step, a general Monte Carlo radiation transport model for simulation of out-of-field neutron doses was set up and successfully verified by comparison of simulated and measured ambient neutron dose equivalent and neutron fluence energy spectra around a solid water phantom irradiated with a variation of different treatment plan parameters. Simulations with the verified model enabled a detailed study of the variation of the neutron ambient dose equivalent with field size, range, modulation width, use of a range shifter, and position inside the treatment room. For future work, it is planned to use this verified model to simulate out-of-field neutron doses inside the phantom and to verify the simulation results by comparison with previous in-phantom measurement campaigns. Eventually, these verified simulations will be used to build a library and a corresponding tool to allow assessment of out-of-field neutron doses at pencil beam scanning proton therapy facilities.

Conceptual design of a new multi-purpose, passive and flexible neutron area monitor with two configurations

In proton therapy facilities, high-energy neutron fields are generated as a consequence of (p,Xn) nuclear interactions. UPM has designed and manufactured, for these facilities, a new flexible and passive neutron area monitor with two configurations: extended-range and conventional. The conceptual design phase of this monitor is reported in this work, presenting the main functional and technical features of the monitor, including the response functions of its two configurations. These response functions are compared with those of some widely-used monitors.

Development of a fourfold dielectric-filled reentrant cavity as a beam position monitor (BPM) in a proton therapy facility

At the Paul Scherrer Institute (PSI), the superconducting cyclotron “COMET” delivers a 250 MeV proton beam for radiation therapy in pulses of 1ns at the cyclotron-RF frequency of 72.85 MHz. Accurate measurement of the beam position at proton beam currents of 0.1–10 nA in the beam transport line downstream of the degrader is of crucial importance for the treatment safety and quality, beam alignment and feedback systems. This is essential for efficient operation and beam delivery. These measurements are usually performed with intercepting monitors such as ionization chambers (ICs). In this paper, we present a novel non-intercepting position sensitive cavity resonator. The resonant monitor, tuned to the second harmonic of the cyclotron's RF, is based on the detection of the transverse magnetic dipole mode of the EM field generated by the beam. This mode is only excited for off-center beam positions and is measured with the help of four floating cavities within a common grounded cylinder. This paper discusses the BPM fundamental characteristics, design optimization and the underlying parametric investigations involving the contribution of the different modes and crosstalk. We estimate the expected signals from the prototype BPM for position offsets from simulations and compare them with test-bench measurements and beam measurements with the prototype and the improvised BPM design. We conclude by summarizing the achieved position sensitivity, precision, and measurement bandwidth.

Application of a scattering foil to increase beam transmission for cyclotron based proton therapy facilities

In proton therapy, high dose rates can reduce treatment delivery times, allowing for efficient mitigation of tumor motion, as well as increased treatment efficiency and patient throughput. In cyclotron-based facilities, however, high dose rates are difficult to achieve at low-energies. In current facilities, the emittance after the degrader is matched in both transversal planes using circular collimators; this does not provide an optimal matching to the acceptance of the following beamline. However, transmission can be substantially improved by transporting maximum acceptable emittances in the X and Y planes, but at the cost of an elliptical beam shape at the gantry entrance, leading to gantry angle-dependent beam shapes at the isocenter. Here we demonstrate that equal emittances in both planes can be recovered at the gantry entrance using a thin scattering foil, thus ensuring gantry angle-independent beam shape at the isocenter. Using modified beam optics and thin scattering foil placed in the beamline, we demonstrate experimentally that low-energy beam transmission can be increased by a factor of three compared to the currently used beam optics, whilst preserving gantry angle-independent beam shapes, at the cost of a large beam size. We expect that this approach could also bring a similar transmission improvement in other cyclotron-based proton therapy facilities.

4He dose- and track-averaged linear energy transfer: Monte Carlo algorithms and experimental verification

Objective. In the present hadrontherapy scenario, there is a growing interest in exploring the capabilities of different ion species other than protons and carbons. The possibility of using different ions paves the way for new radiotherapy approaches, such as the multi-ions treatment, where radiation could vary according to target volume, shape, depth and histologic characteristics of the tumor. For these reasons, in this paper, the study and understanding of biological-relevant quantities was extended for the case of 4He ion. Approach. Geant4 Monte Carlo based algorithms for dose- and track-averaged LET (Linear Energy Transfer) calculations, were validated for 4He ions and for the case of a mixed field characterised by the presence of secondary ions from both target and projectile fragmentation. The simulated dose and track averaged LETs were compared with the corresponding dose and frequency mean values of the lineal energy, and , derived from experimental microdosimetric spectra. Two microdosimetric experimental campaigns were carried out at the Italian eye proton therapy facility of the Laboratori Nazionali del Sud of Istituto Nazionale di Fisica Nucleare (INFN-LNS, Catania, I) using two different microdosimeters: the MicroPlus probe and the nano-TEPC (Tissue Equivalent Proportional Counter). Main results. A good agreement of and with and experimentally measured with both microdosimetric detectors MicroPlus and nano-TEPC in two configurations: full energy and modulated 4He ion beam, was found. Significance. The results of this study certify the use of a very effective tool for the precise calculation of LET, given by a Monte Carlo approach which has the advantage of allowing detailed simulation and tracking of nuclear interactions, even in complex clinical scenarios.

Dose Profile Modulation of Proton Minibeam for Clinical Application.

Simple SummaryProton minibeam radiation therapy (pMBRT) using multislit collimator (MSC) and scatterers has been proposed to spare healthy tissues and organs on the beam path and beyond the Bragg peak. An MSC that was much thicker than the maximum range of the proton beam could provide a sufficiently high peak-to-valley dose ratio at the patient’s skin, and the scatterers could actively convert the spatially fractionated proton beam to a uniform and broad beam in tumors by changing their thickness. The combination of the MSC and the scatterers can be a good solution for implementing pMBRT in clinical proton therapy facilities.The feasibility of proton minibeam radiation therapy (pMBRT) using a multislit collimator (MSC) and a scattering device was evaluated for clinical use at a clinical proton therapy facility. We fabricated, through Monte Carlo (MC) simulations, not only an MSC with a high peak-to-valley dose ratio (PVDR) at the entrance of the proton beam, to prevent radiation toxicity, but also a scattering device to modulate the PVDR in depth. The slit width and center-to-center distance of the diverging MSC were 2.5 mm and 5.0 mm at the large end, respectively, and its thickness and available field size were 100 mm and 76 × 77.5 mm2, respectively. Spatially fractionated dose distributions were measured at various depths using radiochromic EBT3 films and also tested on bacterial cells. MC simulation showed that the thicker the MSC, the higher the PVDR at the phantom surface. Dosimetric evaluations showed that lateral dose profiles varied according to the scatterer’s thickness, and the depths satisfying PVDR = 1.1 moved toward the surface as their thickness increased. The response of the bacterial cells to the proton minibeams’ depth was also established, in a manner similar to the dosimetric pattern. Conclusively, these results strongly suggest that pMBRT can be implemented in clinical centers by using MSC and scatterers.

Radiation shielding assessment of high‐energy proton imaging at a proton therapy facility

BackgroundProton imaging makes use of high‐energy, low‐intensity proton beams that fully traverse the patient and has been suggested to reduce range uncertainty in proton therapy. Upright patient positioning with proton imaging is being considered for a fixed beam room of a new proton therapy facility currently under construction. Considering that the yield and energy spectrum of secondary radiation from high‐energy proton beams is proton beam energy dependent, an assessment of radiation shielding at the energies required for proton imaging should be performed prior to use. Furthermore, NCRP 144 recommends that pion production be considered for proton energies greater than 300 MeV, which are not typically utilized for proton therapy but may be required for proton imaging.PurposeThe purpose of this work was to determine whether proton treatment and imaging with an upright patient positioning system on a fixed beamline were acceptable from a radiation shielding perspective. This is the first report on radiation shielding assessment of proton imaging applications and includes consideration of pion production at the proton beam energy of 330 MeV.MethodsThe Geant4 Monte Carlo toolkit was used for the radiation shielding assessment. The calculations consisted of the generation of secondary particle phase‐space files by simulating the passage of high‐energy proton beams in two target materials, and subsequent simulation of the secondary particles in the proton therapy facility geometry. Particle fluence was converted to operational and protection radiation safety quantities with a custom python script for assessment of instantaneous and annual doses, respectively.ResultsThe total yields of pions from a 330‐MeV proton beam were many orders of magnitude less than that of neutrons and photons. Three‐dimensional maps of ambient dose rate for a 330‐MeV proton beam showed doses arising from secondary neutrons and photons far exceed those arising from pion production. Incorporating representative annual workloads into the calculation demonstrated that proton imaging doses outside the shielded area were negligible compared to those arising from proton therapy.ConclusionsPion production has a negligible impact on the radiation shielding of proton imaging at 330 MeV relative to neutron and photon production. Radiation shielding designed for proton therapy is adequate for high‐energy proton imaging applications.

Cardiotoxicity model-based patient selection for Hodgkin lymphoma proton therapy

Introduction Hodgkin lymphoma (HL) is a highly curable hematological malignancy. Consolidation radiation therapy techniques have made significant progresses to improve organ-at-risk sparing in order to reduce late radiation-induced toxicity. Recent technical breakthroughs notably include intensity modulated proton therapy (IMPT), which has demonstrated a major dosimetric benefit at the cardiac level for mediastinal HL patients. However, its implementation in clinical practice is still challenging, notably due to the limited access to proton therapy facilities. In this context, the purpose of this study was to estimate the benefit of IMPT for HL proton therapy for diverse cardiac adverse events and to propose a general frame for mediastinal HL patient selection strategy for IMPT based on cardiotoxicity reduction, patient clinical factors, and IMPT treatment availability. Material and methods This retrospective dosimetric study included 30 mediastinal HL patients treated with VMAT. IMPT plans were generated on the initial simulation scans. Dose to the heart, to the left ventricle and to the valves were retrieved to calculate the relative risk (RR) of ischemic heart disease (IHD), congestive heart failure (CHF) and valvular disease (VD). Composite relative risk reduction (cRRR) of late cardiotoxicity, between VMAT and IMPT, were calculated as the weighted mean of relative risk reduction for IHD, CHF and VD, calculated across a wide range of cardiovascular risk factor combinations. The proportion of mediastinal HL patients who could benefit from IMPT was estimated in European countries, based on the country population and on the number of active gantries, to propose country-specific cRRR thresholds for patient selection. Results Compared with VMAT, IMPT significantly reduced average mean doses to the heart (2.36 Gy vs 0.99 Gy, p < 0.01), to the left ventricle (0.67 Gy vs 0.03, p < 0.01) and to the valves (1.29 Gy vs. 0.06, p < 0.01). For a HL patient without cardiovascular risk factor other than anthracycline-based chemotherapy, the relative risks of late cardiovascular complications were significantly lower after IMPT compared with VMAT for ischemic heart disease (1.07 vs 1.17, p < 0.01), for congestive heart failure (2.84 vs. 3.00, p < 0.01), and for valvular disease (1.01 vs. 1.06, p < 0.01). The median cRRR of cardiovascular adverse events with IMPT was 4.8%, ranging between 0.1% and 30.5%, depending on the extent of radiation fields and on the considered cardiovascular risk factors. The estimated proportion of HL patients currently treatable with IMPT in European countries with proton therapy facilities ranged between 8.0% and 100% depending on the country, corresponding to cRRR thresholds ranging from 24.0% to 0.0%. Conclusion While a statistically significant clinical benefit is theoretically expected for ischemic heart disease, cardiac heart failure and valvular disease for mediastinal HL patients with IMPT, the overall cardiotoxicity risk reduction is notable only for a minority of patients. In the context of limited IMPT availability, this study proposed a general model-based selection approach for mediastinal HL patient based on calculated cardiotoxicity reduction, taking into consideration patient clinical characteristics and IMPT facility availability.

Peripheral Organ Equivalent Dose Estimation Procedure in Proton Therapy.

The aim of this work is to present a reproducible methodology for the evaluation of total equivalent doses in organs during proton therapy facilities. The methodology is based on measuring the dose equivalent in representative locations inside an anthropomorphic phantom where photon and neutron dosimeters were inserted. The Monte Carlo simulation was needed for obtaining neutron energy distribution inside the phantom. The methodology was implemented for a head irradiation case in the passive proton beam of iThemba Labs (South Africa). Thermoluminescent dosimeter (TLD)-600 and TLD-700 pairs were used as dosimeters inside the phantom and GEANT code for simulations. In addition, Bonner sphere spectrometry was performed inside the treatment room to obtain the neutron spectra, some relevant neutron dosimetric quantities per treatment Gy, and a percentual distribution of neutron fluence and ambient dose equivalent in four energy groups, at two locations. The neutron spectrum at one of those locations was also simulated so that a reasonable agreement between simulation and measurement allowed a validation of the simulation. Results showed that the total out-of-field dose equivalent inside the phantom ranged from 1.4 to 0.28 mSv/Gy, mainly due to the neutron contribution and with a small contribution from photons, 10% on average. The order of magnitude of the equivalent dose in organs was similar, displaying a slow reduction in values as the organ is farther from the target volume. These values were in agreement with those found by other authors in other passive beam facilities under similar irradiation and measurement conditions.

Combined proton-photon therapy for non-small cell lung cancer.

PurposeAdvanced non‐small cell lung cancer (NSCLC) is still a challenging indication for conventional photon radiotherapy. Proton therapy has the potential to improve outcomes, but proton treatment slots remain a limited resource despite an increasing number of proton therapy facilities. This work investigates the potential benefits of optimally combined proton–photon therapy delivered using a fixed horizontal proton beam line in combination with a photon Linac, which could increase accessibility to proton therapy for such a patient cohort.Materials and methodsA treatment planning study has been conducted on a patient cohort of seven advanced NSCLC patients. Each patient had a planning computed tomography scan (CT) and multiple repeated CTs from three different days and for different breath‐holds on each day. Treatment plans for combined proton–photon therapy (CPPT) were calculated for individual patients by optimizing the combined cumulative dose on the initial planning CT only (non‐adapted) as well as on each daily CT respectively (adapted). The impact of inter‐fractional changes and/or breath‐hold variability was then assessed on the repeat breath‐hold CTs. Results were compared to plans for IMRT or IMPT alone, as well as against combined treatments assuming a proton gantry. Plan quality was assessed in terms of dosimetric, robustness and NTCP metrics.ResultsCombined treatment plans improved plan quality compared to IMRT treatments, especially in regard to reductions of low and medium doses to organs at risk (OARs), which translated into lower NTCP estimates for three side effects. For most patients, combined treatments achieved results close to IMPT‐only plans. Inter‐fractional changes impact mainly the target coverage of combined and IMPT treatments, while OARs doses were less affected by these changes. With plan adaptation however, target coverage of combined treatments remained high even when taking variability between breath‐holds into account.ConclusionsOptimally combined proton‐photon plans improve treatment plan quality compared to IMRT only, potentially reducing the risk of toxicity while also allowing to potentially increase accessibility to proton therapy for NSCLC patients.

Dose-Area Product Determination and Beam Monitor Calibration for the Fixed Beam of the Shanghai Advanced Proton Therapy Facility

Research conducted to-date, makes use of the IBA-Lynx scintillating screen and radiochromic film to analyze the proton field uniformity for dose-area product (DAP) determination. In this paper, the machine log file based reconstruction is proposed to calculate the field uniformity to simplify the measurement. In order to calculate the field uniformity, the dose distribution is reconstructed based on the machine log file with matRad (an open source software for analytical dose calculation in MATLAB). After acquisition of the dose distribution, the field flatness and symmetry are calculated automatically for different proton energies. A comprehensive comparison of DAP determined with Bragg peak chamber (BPC) and Markus chamber (MC) is presented. The actual delivered dose is reconstructed with the log file to analyze the lateral dose distribution of the scanned field. DAP of different energies are calculated ranging from 70.6 MeV to 235 MeV. The percentage difference is calculated, illustrating the DAP discrepancy between the MC and BPC to the mean value. The percentage difference ranges from −0.19% to 1.26%. The variation between DAP measured with the BPC and MC peaks at −2.5%. The log file based reconstruction to calculate field uniformity can be an alternative for DAP determination. The direct method using a large-area Bragg peak chamber is investigated. The two methods to determine DAP and calibrate beam monitor illustrate consistent results.

Demonstration of the Effectiveness of Monte Carlo-Based Data Sets with the Simplified Approach for Shielding Design of a Laboratory with the Therapeutic Level Proton Beam

Background: There are several proton therapy facilities in operation or planned in Taiwan, and these facilities are anticipated to not only treat cancer but also provide beam services to the industry or academia. The simplified approach based on the Monte Carlo-based data sets (source terms and attenuation lengths) with the point-source line-of-sight approximation is friendly in the design stage of the proton therapy facilities because it is intuitive and easy to use. The purpose of this study is to expand the Monte Carlo-based data sets to allow the simplified approach to cover the application of proton beams more widely.Materials and Methods: In this work, the MCNP6 Monte Carlo code was used in three simulations to achieve the purpose, including the neutron yield calculation, Monte Carlo-based data sets generation, and dose assessment in simple cases to demonstrate the effectiveness of the generated data sets.Results and Discussion: The consistent comparison of the simplified approach and Monte Carlo simulation results show the effectiveness and advantage of applying the data set to a quick shielding design and conservative dose assessment for proton therapy facilities.Conclusion: This study has expanded the existing Monte Carlo-based data set to allow the simplified approach method to be used for dose assessment or shielding design for beam services in proton therapy facilities. It should be noted that the default model of the MCNP6 is no longer the Bertini model but the CEM (cascade-exciton model), therefore, the results of the simplified approach will be more conservative when it was used to do the double confirmation of the final shielding design.

Joint EURADOS WG9-WG11 rem-counter intercomparison in a Mevion S250i proton therapy facility with Hyperscan pulsed synchrocyclotron

Objective. Proton therapy is gaining popularity because of the improved dose delivery over conventional radiation therapy. The secondary dose to healthy tissues is dominated by secondary neutrons. Commercial rem-counters are valuable instruments for the on-line assessment of neutron ambient dose equivalent (H*(10)). In general, however, a priori knowledge of the type of facility and of the radiation field is required for the proper choice of any survey meter. The novel Mevion S250i Hyperscan synchrocyclotron mounts the accelerator directly on the gantry. It provides a scanned 227 MeV proton beam, delivered in pulses with a pulse width of 10 μs at 750 Hz frequency, which is afterwards degraded in energy by a range shifter modulator system. This environment is particularly challenging for commercial rem-counters; therefore, we tested the reliability of some of the most widespread rem-counters to understand their limits in the Mevion S250i stray neutron field. Approach. This work, promoted by the European Radiation Dosimetry Group (EURADOS), describes a rem-counter intercomparison at the Maastro Proton Therapy centre in the Netherlands, which houses the novel Mevion S250i Hyperscan system. Several rem-counters were employed in the intercomparison (LUPIN, LINUS, WENDI-II, LB6411, NM2B-458, NM2B-495Pb), which included simulation of a patient treatment protocol employing a water tank phantom. The outcomes of the experiment were compared with models and data from the literature. Main results. We found that only the LUPIN allowed for a correct assessment of H*(10) within a 20% uncertainty. All other rem-counters underestimated the reference H*(10) by factors from 2 to more than 10, depending on the detector model and on the neutron dose per pulse. In pulsed fields, the neutron dose per pulse is a fundamental parameter, while the average neutron dose rate is a secondary quantity. An average 150–200 μSv/GyRBE neutron H*(10) at various positions around the phantom and at distances between 186 cm and 300 cm from it was measured per unit therapeutic dose delivered to the target. Significance. Our results are partially in line with results obtained at similar Mevion facilities employing passive energy modulation. Comparisons with facilities employing active energy modulation confirmed that the neutron H*(10) can increase up to more than a factor of 10 when passive energy modulation is employed. The challenging environment of the Mevion stray neutron field requires the use of specific rem-counters sensitive to high-energy neutrons (up to a few hundred MeV) and specifically designed to withstand pulsed neutron fields.

DOSE DISTRIBUTION ANALYSIS OF PROTON THERAPY FOR MEDULLOBLASTOMA CANCER WITH PHITS 3.24

One of the developments in particle therapy is proton radiation therapy. Meanwhile, a limited number of available proton therapy facilities makes research related to proton therapy difficult. Therefore, there is a need for alternative proton therapy simulations using programs other than those in proton therapy facilities. This research was aimed to simulate medulloblastoma brain cancer which children often experience.The program used in this research was PHITS version 3.24. The human body was modeled with the revised ORNL-MIRD phantom for a 10-year-old child. The therapy scheme was a whole posterior fossa boost of 19.8 Gy. The proton passive scattering was simulated by passing a uniform proton beam through the aperture and compensator with energy variations. The proton pencil beam scanning was simulated with small cylindrical beams with a radius of 0.5 cm, which were adjusted to the planning target volume with layers variations.The total duration to give the prescription dose was 550 seconds with passive scattering and 605 seconds with pencil beam scanning. In passive scattering, the OAR(s) with the most significant percentage of absorbed dose were the skin, cranium, and muscle, i.e., 8.22 ± 0.15 %, 5.51 ± 0.05 % and 1.39 ± 0,04 % respectively to their maximum tolerated dose, while in the pencil beam scanning, the OAR(s) with the most significant percentage of absorbed dose were the skin, cranium, and muscle, i.e., 5.42 ± 0.08 %, 4.43 ± 0.05 % and 0.51 ± 0.05 % respectively to their maximum tolerated dose. Dose distribution in passive scattering was relatively better than in pencil beam scanning in terms of dose homogeneity using dose sampling analysis at some points within the planning target volume.

Study of magnetic fringe fields and interference effects on beam dynamics for proton facility gantry

ABSTRACT Proton therapy facilities require a beamline that effectively delivers particles to a nozzle that forms symmetric and achromatic beam spots. In the gantry lattice of the SC200 facility, the magnetic components are designed with a compact layout due to space constraints. This makes it important to properly deal with fringe fields and their interference when more accurate simulations of beam dynamics are required. In this paper, we establish field distributions based on real extracted magnetic maps and analyse the influences of linear fields on beam qualities by combining a perturbation model with Monte Carlo code in BDSIM. To verify the results, COSY INFINITY with the Enge function was used to quantify the beam variations at the isocenter; the results were in good agreement with those of BDSIM. Compared with the conventional hard edge model, beam mismatch at the isocenter is evidence of the impacts of fringe fields, which pose challenges to clinical dose planning. Hence, linear optical optimization on the gantry is also necessary to meet safety and precision requirements. These efforts will guide the commissioning of the beamline.

Flourish of Proton and Carbon Ion Radiotherapy in China.

Proton and heavy ion therapy offer superior relative biological effectiveness (RBE) in the treatment of deep-seated tumors compared with conventional photon radiotherapy due to its Bragg-peak feature of energy deposition in organs. Many proton and carbon ion therapy centers are active all over the world. At present, five particle radiotherapy institutes have been built and are receiving patient in China, mainly including Wanjie Proton Therapy Center (WPTC), Shanghai Proton Heavy Ion Center (SPHIC), Heavy Ion Cancer Treatment Center (HIMM), Chang Gung Memorial Hospital (CGMH), and Ruijin Hospital affiliated with Jiao Tong University. Many cancer patients have benefited from ion therapy, showing unique advantages over surgery and chemotherapy. By the end of 2020, nearly 8,000 patients had been treated with proton, carbon ion or carbon ion combined with proton therapy. So far, there is no systemic review for proton and carbon ion therapy facility and clinical outcome in China. We reviewed the development of proton and heavy ion therapy, as well as providing the representative clinical data and future directions for particle therapy in China. It has important guiding significance for the design and construction of new particle therapy center and patients’ choice of treatment equipment.