Relative Stopping Power Accuracy Research Articles

A direct comparison of multi-energy x-ray and proton CT for imaging and relative stopping power estimation of plastic and ex-vivo phantoms

Objective.Proton therapy administers a highly conformal dose to the tumour region, necessitating accurate prediction of the patient's 3D map of proton relative stopping power (RSP) compared to water. This remains challenging due to inaccuracies inherent in single-energy computed tomography (SECT) calibration. Recent advancements in spectral x-ray CT (xCT) and proton CT (pCT) have shown improved RSP estimation compared to traditional SECT methods. This study aims to provide the first comparison of the imaging and RSP estimation performance among dual-energy CT (DECT) and photon-counting CT (PCCT) scanners, and a pCT system prototype.Approach.Two phantoms were scanned with the three systems for their performance characterisation: a plastic phantom, filled with water and containing four plastic inserts and a wood insert, and a heterogeneous biological phantom, containing a formalin-stabilised bovine specimen. RSP maps were generated by converting CT numbers to RSP using a calibration based on low- and high-energy xCT images, while pCT utilised a distance-driven filtered back projection algorithm for RSP reconstruction. Spatial resolution, noise, and RSP accuracy were compared across the resulting images.Main results.All three systems exhibited similar spatial resolution of around 0.54 lp/mm for the plastic phantom. The PCCT images were less noisy than the DECT images at the same dose level. The lowest mean absolute percentage error (MAPE) of RSP,(0.28±0.07)%, was obtained with the pCT system, compared to MAPE values of(0.51±0.08)%and(0.80±0.08)%for the DECT- and PCCT-based methods, respectively. For the biological phantom, the xCT-based methods resulted in higher RSP values in most of the voxels compared to pCT.Significance.The pCT system yielded the most accurate estimation of RSP values for the plastic materials, and was thus used to benchmark the xCT calibration performance on the biological phantom. This study underlined the potential benefits and constraints of utilising such a novelex-vivophantom for inter-centre surveys in future.

Novel ion imaging concept based on time-of-flight measurements with low gain avalanche detectors

Treatment planning in ion beam therapy requires accurate knowledge of the relative stopping power (RSP) distribution within the patient. Currently, RSP maps are obtained via conventional x-ray computed tomography (CT) by converting the measured attenuation coefficients of photons into RSP values for ions. Alternatively, to avoid conversion errors that are inherent to this method, ion computed tomography (iCT) can be used since it allows determining the RSP directly. In typical iCT systems, which usually consist of a tracking system and a separate residual energy detector, the RSP is obtained by measuring the particle trajectory and the corresponding water equivalent path length (WEPL) of single ions travelling through the patient. In this work, we explore a novel iCT approach which does not require a residual energy detector. Instead, the WEPL is estimated indirectly by determining the change in time of flight (TOF) due to the energy loss along the ion’s path. For this purpose, we have created a Geant4 model of a TOF-iCT system based on low gain avalanche detectors (LGADs), which are fast 4D-tracking detectors that can measure the time of arrival and position of individual particles with high spatial and time precision. To assess the performance of this TOF-iCT concept, we determined the RSP resolution and accuracy for different system settings using the Catphan® CTP404 sensitometry phantom. Within the set of investigated system parameters, the lower limit of the RSP accuracy was found at 0.91%, demonstrating the proof-of-principle of this novel TOF-iCT concept. The main advantage of using this approach is that it could potentially facilitate clinical integration due to its compact design, which, however, requires experimental verification and an improvement of the current WEPL calibration procedure.

Comparative accuracy and resolution assessment of two prototype proton computed tomography scanners.

Improving the accuracy of relative stopping power (RSP) in proton therapy may allow reducing range margins. Proton computed tomography (pCT) has been shown to provide state-of-the-art RSP accuracy estimation, and various scanner prototypes have recently been built. The different approaches used in scanner design are expected to impact spatial resolution and RSPaccuracy. The goal of this study was to perform the first direct comparison, in terms of spatial resolution and RSP accuracy, of two pCT prototype scanners installed at the same facility and by using the same image reconstructionalgorithm. A phantom containing cylindrical inserts of known RSP was scanned at the phase-II pCT prototype of the U.S. pCT collaboration and at the commercially oriented ProtonVDA scanner. Following distance-driven binning filtered backprojection reconstruction, the radial edge spread function of high-density inserts was used to estimate the spatial resolution. RSP accuracy was evaluated by the mean absolute percent error (MAPE) over the inserts. No direct imaging dose estimation was possible, which prevented a comparison of the two scanners in terms of RSPnoise. In terms of RSP accuracy, both scanners achieved the same MAPE of 0.72% when excluding the porous sinus insert from the evaluation. The ProtonVDA scanner reached a better overall MAPE when all inserts and the body of the phantom were accounted for (0.81%), compared to the phase-II scanner (1.14%). The spatial resolution with the phase-II scanner was found to be 0.61lp/mm, while for the ProtonVDA scanner somewhat lower at 0.46lp/mm. The comparison between two prototype pCT scanners operated in the same clinical facility showed that they both fulfill the requirement of an RSP accuracy of about 1%. Their spatial resolution performance reflects the different design choices of either a scanner with full tracking capabilities (phase-II) or of a more compact tracker system, which only provides the positions of protons but not their directions (ProtonVDA).

Feasibility study of a proton CT system based on 4D-tracking and residual energy determination via time-of-flight

Objective. For dose calculations in ion beam therapy, it is vital to accurately determine the relative stopping power (RSP) distribution within the treatment volume. A suitable imaging modality to achieve the required RSP accuracy is proton computed tomography (pCT), which usually uses a tracking system and a separate residual energy (or range) detector to directly measure the RSP distribution. This work investigates the potential of a novel pCT system based on a single detector technology, namely low gain avalanche detectors (LGADs). LGADs are fast 4D-tracking detectors, which can be used to simultaneously measure the particle position and time with precise timing and spatial resolution. In contrast to standard pCT systems, the residual energy is determined via a time-of-flight (TOF) measurement between different 4D-tracking stations. Approach. To show the potential of using 4D-tracking for proton imaging, we studied and optimized the design parameters for a realistic TOF-pCT system using Monte Carlo simulations. We calculated the RSP accuracy and RSP resolution inside the inserts of the CTP404 phantom and compared the results to a simulation of an ideal pCT system. Main results. After introducing a dedicated calibration procedure for the TOF calorimeter, RSP accuracies less than 0.6% could be achieved. We also identified the design parameters with the strongest impact on the RSP resolution and proposed a strategy to further improve the image quality. Significance. This comprehensive study of the most important design aspects for a novel TOF-pCT system could help guide future hardware developments and, once implemented, improve the quality of treatment planning in ion beam therapy.

Evaluation of the impact of a scanner prototype on proton CT and helium CT image quality and dose efficiency with Monte Carlo simulation

Objective. The use of ion computed tomography (CT) promises to yield improved relative stopping power (RSP) estimation as input to particle therapy treatment planning. Recently, proton CT (pCT) has been shown to yield RSP accuracy on par with state-of-the-art x-ray dual energy CT. There are however concerns that the lower spatial resolution of pCT compared to x-ray CT may limit its potential, which has spurred interest in the use of helium ion CT (HeCT). The goal of this study was to investigate image quality of pCT and HeCT in terms of noise, spatial resolution, RSP accuracy and imaging dose using a detailed Monte Carlo (MC) model of an existing ion CT prototype. Approach. Three phantoms were used in simulated pCT and HeCT scans allowing estimation of noise, spatial resolution and the scoring of dose. An additional phantom was used to evaluate RSP accuracy. The imaging dose required to achieve the same image noise in a water and a head phantom was estimated at both native spatial resolution, and in a scenario where the HeCT spatial resolution was reduced and matched to that of pCT using Hann windowing of the reconstruction filter. A variance reconstruction formalism was adapted to account for Hann windowing. Main results. We confirmed that the scanner prototype would produce higher spatial resolution for HeCT than pCT by a factor 1.8 (0.86 lp mm−1 versus 0.48 lp mm−1 at the center of a 20 cm water phantom). At native resolution, HeCT required a factor 2.9 more dose than pCT to achieve the same noise, while at matched resolution, HeCT required only 38% of the pCT dose. Finally, RSP mean absolute percent error (MAPE) was found to be 0.59% for pCT and 0.67% for HeCT. Significance. This work compared the imaging performance of pCT and HeCT when using an existing scanner prototype, with the spatial resolution advantage of HeCT coming at the cost of increased dose. When matching spatial resolution via Hann windowing, HeCT had a substantial dose advantage. Both modalities provided state-of-the-art RSP MAPE. HeCT might therefore help reduce the dose exposure of patients with comparable image noise to pCT, enhanced spatial resolution and acceptable RSP accuracy at the same time.

Stopping power measurement for proton therapy by combining proton radiography and X-ray CT

Exact information on the relative stopping power (RSP) of the high-energy proton in the human body is necessary to precisely control radiation dose and position in proton beam therapy. RSP has been estimated by converting the X-ray computed tomography (CT) information. However, it causes up to 5% uncertainty in the RSP measurements because of the fundamental difference between the X-ray and proton interaction. Therefore, this study investigates a scheme of the RSP distribution measurement in the human body with a combination of X-ray CT and proton radiography with beam injection to a single direction. We studied the accuracy of the RSP measurement using GEANT4 simulation with silicon trackers, crystal calorimeter, and proton beam. The RSP accuracy has been generally measured below 1% from the reference values for simple objects with multi cylindrical shapes. The simulation results present the requirements of a proton tracking system on the spatial resolution and the acquisition rate. We developed a tracking detector prototype consisting of double-sided silicon strip detectors and amplifier–shaper–discriminator LSI chips. We evaluated the performance with an 80 MeV proton beam in Cyclotron and Radioisotope Center, Tohoku University. It succeeded in reconstructing a proton trajectory with 160 kHz and fulfilled the requirements to realize the proposed scheme. Furthermore, this study describes the detailed study of the scheme of the RSP measurement and the beam test of the tracking system prototype.

An empirical artifact correction for proton computed tomography.

To reduce image artifacts of proton computed tomography (pCT) from a preclinical scanner, for imaging of the relative stopping power (RSP) needed for particle therapy treatment planning using a simple empirical artifact correction method. We adapted and employed a correction method previously used for beam-hardening correction in x-ray CT which makes use of a single scan of a custom-built homogeneous phantom with known RSP. Exploiting the linearity of the filtered backprojection operation, a function was found which corrects water-equivalent path lengths (RSP line integrals) in experimental scans using a prototype pCT scanner. The correction function was applied to projection values of subsequent scans of a homogeneous water phantom, a sensitometric phantom with various inserts and an anthropomorphic head phantom. Data were acquired at two different incident proton energies to test the robustness of the method. Inaccuracies in the detection process caused an offset and known ring artifacts in the water phantom which were considerably reduced using the proposed method. The mean absolute percentage error (MAPE) of mean RSP values of all inserts of the sensitometric phantom and the water phantom was reduced from 0.87% to 0.44% and from 0.86% to 0.48% for the two incident energies respectively. In the head phantom a clear reduction of artifacts was observed. Image artifacts of experimental pCT scans with a prototype scanner could substantially be reduced both in homogeneous, heterogeneous and anthropomorphic phantoms. RSP accuracy was also improved.

The impact of path estimates in iterative ion CT reconstructions for clinical-like cases

Ion computed tomography (CT) promises to mitigate range uncertainties inherent in the conversion of x-ray Hounsfield units into ion relative stopping power (RSP) for ion beam therapy treatment planning. To improve accuracy and spatial resolution of ion CT by accounting for statistical multiple Coulomb scattering deflection of the ion trajectories from a straight line path (SLP), the most likely path (MLP) and the cubic spline path (CSP) have been proposed. In this work, we use FLUKA Monte Carlo simulations to investigate the impact of these path estimates in iterative tomographic reconstruction algorithms for proton, helium and carbon ions. To this end the ordered subset simultaneous algebraic reconstruction technique was used and coupled with a total variation superiorization (TVS). We evaluate the image quality and dose calculation accuracy in proton therapy treatment planning of cranial patient anatomies. CSP and MLP generally yielded nearly equal image quality with an average RSP relative error improvement over the SLP of 0.6%, 0.3% and 0.3% for proton, helium and carbon ion CT, respectively. Bone and low density materials have been identified as regions of largest enhancement in RSP accuracy. Nevertheless, only minor differences in dose calculation results were observed between the different models and relative range errors of better than 0.5% were obtained in all cases. Largest improvements were found for proton CT in complex scenarios with strong heterogeneities along the beam path. The additional TVS provided substantially reduced image noise, resulting in improved image quality in particular for soft tissue regions. Employing the CSP and MLP for iterative ion CT reconstructions enabled improved image quality over the SLP even in realistic and heterogeneous patient anatomy. However, only limited benefit in dose calculation accuracy was obtained even though an ideal detector system was simulated.

Proof of concept image artifact reduction by energy-modulated proton computed tomography (EMpCT).

To reduce imaging artifacts and improve image quality of a specific proton computed tomography (pCT) prototype scanner by combining pCT data acquired at two different incident proton energies to avoid protons stopping in sub-optimal detector sections. Image artifacts of a prototype pCT scanner are linked to protons stopping close to internal structures of the scanner's multi-stage energy detector. We aimed at avoiding such protons by acquiring pCT data at two different incident energies and combining the data in post-processing from which artifact-reduced images of the relative stopping power (RSP) were calculated. Energy-modulated pCT (EMpCT) images were assessed visually and quantitatively and compared to the original mono-energetic images in terms of RSP accuracy and noise. Data were acquired for a homogeneous water phantom. RSP images reconstructed from the mono-energetic datasets displayed local image artifacts which were ring-shaped due to the homogeneity of the phantom. The merged EMpCT dataset achieved a superior visual image quality with reduced artifacts and only minor remaining rings. The inter-quartile range (25/75) of RSP values was reduced from 0.7% with the current standard acquisition to 0.2% with EMpCT due to the reduction of ring artifacts. In this study, dose was doubled compared to a standard scan, but we discuss strategies to reduce excess dose. EMpCT allows to effectively avoid regions of the energy detector that cause image artifacts. Thereby, image quality is improved.

A High-Granularity Digital Tracking Calorimeter Optimized for Proton CT

A typical proton CT (pCT) detector comprises a tracking system, used to measure the proton position before and after the imaged object, and an energy/range detector to measure the residual proton range after crossing the object. The Bergen pCT collaboration was established to design and build a prototype pCT scanner with a high granularity digital tracking calorimeter (DTC) used as both tracking and energy/range detector. In this work the conceptual design and the layout of the mechanical and electronics implementation, along with a Monte Carlo (MC) simulation of the new pCT system are reported. The DTC is a multilayer structure with a lateral aperture of 27 cm × 15 cm, made of 41 detector/absorber sandwich layers (calorimeter), with aluminum (3.5 mm) used both as absorber and carrier, and 2 additional layers used as tracking system (rear trackers) positioned downstream of the imaged object; no tracking upstream the object is included. The rear tracker’s structure only differs from the calorimeter layers for the carrier made of ~200 μm carbon fleece and carbon paper (carbon-Epoxy sandwich), to minimize scattering. Each sensitive layer consists of 108 ALPIDE chip sensors (developed for ALICE, CERN) bonded on a polyimide flex and subsequently bonded to a larger flexible printed circuit board. Beam tests tailored to the pCT operation have been performed using high-energetic (50–220 MeV/u) proton and ion beams at the Heidelberg Ion-Beam Therapy Center (HIT) in Germany. These tests proved the ALPIDE response independent of occupancy and proportional to the particle energy deposition, making the distinction of different ion tracks possible. The read-out electronics is able to handle enough data to acquire a single 2D image in few seconds making the system fast enough to be used in a clinical environment. For the reconstructed images in the modeled MC simulation, the water equivalent path length error is lower than 2 mm, and the relative stopping power accuracy is better than 0.4%. Thanks to its ability to detect different types of radiation and its specific design, the pCT scanner can be employed for additional online applications during the treatment, such as in-situ proton range verification.

Experimental realization of dynamic fluence field optimization for proton computed tomography

Proton computed tomography (pCT) has high accuracy and dose efficiency in producing spatial maps of the relative stopping power (RSP) required for treatment planning in proton therapy. With fluence-modulated pCT (FMpCT), prescribed noise distributions can be achieved, which allows to decrease imaging dose by employing object-specific dynamically modulated fluence during the acquisition.For FMpCT acquisitions we divide the image into region-of-interest (ROI) and non-ROI volumes. In proton therapy, the ROI volume would encompass all treatment beams. An optimization algorithm then calculates dynamically modulated fluence that achieves low prescribed noise inside the ROI and high prescribed noise elsewhere. It also produces a planned noise distribution, which is the expected noise map for that fluence, as calculated with a Monte Carlo simulation. The optimized fluence can be achieved by acquiring pCT images with grids of intensity modulated pencil beams. In this work, we interfaced the control system of a clinical proton beam line to deliver the optimized fluence. Using three phantoms we acquired images with uniform fluence, with a constant noise prescription, and with an FMpCT task. Image noise distributions as well as fluence maps were compared to the corresponding planned distributions as well as to the prescription. Furthermore, we propose a correction method that removes image artifacts stemming from the acquisition with pencil beams having a spatially varying energy distribution that is not seen in clinical operation. RSP accuracy of FMpCT scans was compared to uniform scans and was found to be comparable to standard pCT scans.While we identified technical improvements for future experimental acquisitions, in particular related to an unexpected pencil beam size reduction and a misalignment of the fluence pattern, agreement with the planned noise was satisfactory and we conclude that FMpCT optimized for specific image noise prescriptions is experimentally feasible.

Optimization and performance study of a proton CT system for pre-clinical small animal imaging

Proton computed tomography (pCT) promises to reduce or even eliminate range uncertainties inherent in the conversion of Hounsfield units into relative stopping power (RSP) for proton therapy treatment planning. This is of particular interest for proton irradiation studies in animal models due to the high precision required and uncertainties in tissue properties.We propose a dedicated single-particle tracking pCT system consisting of low material budget floating strip Micromegas detectors for tracking and a segmented time-projection-chamber with vertical Mylar absorbers, functioning as a range telescope. Based on Monte Carlo simulations of a realistic in silico beam and detector implementation, a geometrical optimization of the system components was conducted to safeguard an ideal operation close to intrinsic performance limits at 75 MeV. Moreover, the overall imaging capabilities relevant for pre-clinical proton therapy treatment planning were evaluated for a mouse model.In order to minimize extrinsic uncertainties in the estimated proton trajectories, a spacing of the two tracking planes of at least 7 cm is required in both tracking detectors. Additionally, novel in-house developed and produced aluminum-based readout electrodes promise superior performance with around 3 mm−1 spatial resolution due to the reduced material budget. Concerning the range telescope, an absorber thickness within 500 µm to 750 µm was found to yield the best compromise between water-equivalent path length resolution and complexity of the detector instrumentation, still providing sub-0.5% RSP accuracy. The optimized detector configuration enables better than 2% range accuracy for proton therapy treatment planning in pre-clinical data sets.This work outlines the potential of pCT for small animal imaging. The performance of the proposed and optimized system provides superior treatment planning accuracy compared to conventional x-ray CT. Thus, pCT can play an important role in translational and pre-clinical cancer research.

A comparison of direct reconstruction algorithms in proton computed tomography

Several direct algorithms have been proposed to take into account the non-linear path of protons in the reconstruction of a proton CT (pCT) image. This paper presents a comparison between five of them, in terms of spatial resolution and relative stopping power (RSP) accuracy. Our comparison includes (1) a distance-driven algorithm extending the filtered backprojection to non-linear trajectories (DD), (2) an algorithm reconstructing a pCT image from optimized projections (ML), (3) a backproject-then-filter approach using a 2D cone filter (BTF), (4) a differentiated backprojection algorithm based on the inversion of the Hilbert transform (DBP), and (5) an algorithm using a 2D directional ramp filter (DR). We have simulated a single tracking pCT set-up using Geant4 through GATE, with a proton source and two position, direction and energy detectors upstream and downstream from the object. Tracker uncertainties were added on the position and direction measurements. A Catphan 528 phantom and a spiral phantom were simulated to measure the spatial resolution and a Gammex 467 phantom was used for the RSP accuracy. Each proton’s trajectory was estimated using a most likely path (MLP) formalism. The spatial resolution was evaluated using the frequency corresponding to a modulation transfer function of 10% of its peak value and the RSP accuracy using the mean values in the inserts of the Gammex phantom. In terms of spatial resolution, it was shown that, for ideal trackers, the DR and BTF methods offer a slightly better resolution since each proton is directly binned in the image grid according to its MLP. However, all methods but the ML show comparable resolution when using realistic trackers. Regarding the RSP, three algorithms (DR, DD and BTF) show a mean relative error inside the inserts about 0.1%. As the DR and BTF methods are more computationally expensive, the DD—which allows the same spatial resolution in realistic conditions and the same accuracy—and the DBP—which has a fairly good accuracy (<0.2%) and allows reconstruction from truncated data—can be used for a reduced reconstruction time.

Upgrading an Integrating Carbon-Ion Transmission Imaging System With Active Scanning Beam Delivery Toward Low Dose Ion Imaging

The dosimetric advantages of ion therapy come at the cost of an increased sensitivity to range inaccuracies in the treatment planning and delivery stages. This prompts the development of imaging techniques capable of an accurate assessment of the relative stopping power (RSP). We investigate carbon-ion imaging based on a prototype integration-mode detector working as a range telescope. Experiments were conducted at the Heidelberg Ion-Beam Therapy Center with active pencil beam scanning. The aim of this article is to experimentally operate the imaging system in low-dose regimes. Therefore, an adjustment of the synchronization mechanism between beam delivery and data acquisition was required. Different from the previous studies, this article investigates unexplored dosimetric scenarios and faced the related technological challenges. Radiographic and tomographic images of two tissue-equivalent phantoms were acquired and the image quality was evaluated. Relying on dedicated signal processing to solve the range mixing problem, the tomographic images showed an RSP accuracy of better than 0.6%. This article evaluates the imaging performance with low-dose exposure, focusing on the technological requirements and pointing out the current limitations. Hence, this article supports the development of upgraded integration-mode ion imaging systems for reducing range uncertainties in particle therapy.

Improving single-event proton CT by removing nuclear interaction events within the energy/range detector

Data filtering is crucial for accurate relative stopping power (RSP) reconstruction in proton CT (pCT). In this work, we assess different filters and their performance for the US pCT collaboration prototype pCT system in Monte Carlo (MC) simulations. The potential of using the recently proposed -E filter for removing nuclear interactions that occurred in the energy/range detector of the pCT system is investigated.Full pCT scans were acquired with the TOPAS MC simulated version of the prototype scanner that comprises two tracking detectors and a five stage energy/range detector. An ideal water cylinder and a water cylinder with five tissue inserts were investigated. Before image reconstruction, a WEPL filter was applied as the only filter, or in addition to filters acting on the energy deposit in each of the energy detector stages, as done currently with the prototype. The potential of the -E filter that was recently proposed for helium imaging was assessed. The results were compared to simulations for which nuclear interactions were disabled representing ground truth.The WEPL filter alone was not sufficient to filter out all nuclear interaction events and systematic fluctuations in the form of ring artifacts were present in the pCT reconstructed images. Applying energy filters currently used with the device prior to the WEPL filter only slightly improved the image quality. A WEPL filter improved the mean RSP accuracy, but could not fully remove the systematic fluctuations. The -E filter in addition to the current reconstruction procedure efficiently removed the systematic fluctuations and the achieved RSP accuracy closely matched the simulation without nuclear interactions.This study demonstrates the dependence of the accuracy of the usual WEPL filter on uncertainties arising within the energy detector. By enabling to remove such uncertainties, the -E method proved to yield some potential for improving the accuracy of pCT.

Dosimetric accuracy and radiobiological implications of ion computed tomography for proton therapy treatment planning

Ion computed tomography (iCT) represents a potential replacement for x-ray CT (xCT) in ion therapy treatment planning to reduce range uncertainties, inherent in the semi-empirical conversion of xCT information into relative stopping power (RSP). In this work, we aim to quantify the increase in dosimetric accuracy associated with using proton-, helium- and carbon-CT compared to conventional xCT for clinical scenarios in proton therapy. Three cases imaged with active beam-delivery using an ideal single-particle-tracking detector were investigated using FLUKA Monte-Carlo (MC) simulations. The RSP accuracy of the iCTs was evaluated against the ground truth at similar physical dose. Next, the resulting dosimetric accuracy was investigated by using the RSP images as a patient model in proton therapy treatment planning, in comparison to common uncertainties associated with xCT. Finally, changes in relative biological effectiveness (RBE) with iCT particle type/spectrum were investigated by incorporating the repair-misrepair-fixation (RMF) model into FLUKA, to enable first insights on the associated biological imaging dose. Helium-CT provided the lowest overall RSP error, whereas carbon-CT offered the highest accuracy for bone and proton-CT for soft tissue. For a single field, the average relative proton beam-range variation was −1.00%, +0.09%, −0.08% and −0.35% for xCT, proton-, helium- and carbon-CT, respectively. Using a 0.5%/0.5mm gamma-evaluation, all iCTs offered comparable accuracy with a better than 99% passing rate, compared to 83% for xCT. The RMF model predictions for RBE for cell death relative to a diagnostic xCT spectrum were 0.82–0.85, 0.85–0.89 and 0.97–1.03 for proton-, helium-, and carbon-CT, respectively. The corresponding RBE for DNA double-strand break induction was generally below one. iCT offers great clinical potential for proton therapy treatment planning by providing superior dose calculation accuracy as well as lower physical and potentially biological dose exposure compared to xCT. For the investigated dose level and ideal detector, proton-CT and helium-CT yielded the best performance.

The impact of secondary fragments on the image quality of helium ion imaging

Single-event ion imaging enables the direct reconstruction of the relative stopping power (RSP) information required for ion-beam therapy. Helium ions were recently hypothesized to be the optimal species for such technique. The purpose of this work is to investigate the effect of secondary fragments on the image quality of helium CT (HeCT) and to assess the performance of a prototype proton CT (pCT) scanner when operated with helium beams in Monte Carlo simulations and experiment.Experiments were conducted installing the U.S. pCT consortium prototype scanner at the Heidelberg Ion-Beam Therapy Center (HIT). Simulations were performed with the scanner using the TOPAS toolkit. HeCT images were reconstructed for a cylindrical water phantom, the CTP404 (sensitometry), and the CTP528 (line-pair) ® modules. To identify and remove individual events caused by fragmentation, the multistage energy detector of the scanner was adapted to function as a telescope.The use of the developed filter eliminated the otherwise arising ring artifacts in the HeCT reconstructed images. For the HeCT reconstructed images of a water phantom, the maximum RSP error was improved by almost a factor 8 with respect to unfiltered images in the simulation and a factor 10 in the experiment. Similarly, for the CTP404 module, the mean RSP accuracy improved by a factor 6 in both the simulation and the experiment when the filter was applied (mean relative error 0.40% in simulation, 0.45% in experiment). In the evaluation of the spatial resolution through the CTP528 module, the main effect of the filter was noise reduction. For both simulated and experimental images the spatial resolution was ∼4 lp cm−1.In conclusion, the novel filter developed for secondary fragments proved to be effective in improving the visual quality and RSP accuracy of the reconstructed images. With the filter, the pCT scanner is capable of accurate HeCT imaging.

Experimental fluence-modulated proton computed tomography by pencil beam scanning.

This experimental study is aimed at demonstrating, using a simple cylindrical water phantom, the feasibility of fluence-modulated proton computed tomography (FMpCT) by pencil beam scanning (PBS) proton computed tomography (pCT). The phase II pCT prototype of the Loma Linda U. and U. C. Santa Cruz was operated using the PBS beam line of the Northwestern Medicine Chicago Proton Center. A 20 × 10 grid of 1.37 cm full width half maximum pencil beams (PB) equally spaced by 1 cm was used to acquire 45 projections in step and shoot mode. The PB pattern's fluence was modified to allow FMpCT scans with fluence modulation factors (FMF) of 50% and 20%. A central FMpCT region of interest (FMpCT-ROI) was used to define a high image quality region. Reconstructed images were evaluated in terms of relative stopping power (RSP) accuracy and noise using annular ROIs. The FMpCT dose savings were estimated by Monte Carlo (MC) simulation of the pCT acquisitions using beam phase space distributions. PBS pCT results with homogeneous fluence were additionally compared to broad beam results in terms of RSP accuracy and noise. PBS pCT scans with acceptable pileup were possible, and images were comparable to previously acquired broad beam pCT images in terms of both noise and accuracy. In the FMpCT-ROI, the noise and accuracy from full fluence (FF) scans were preserved. Dose savings of up to 60% were achieved at the object's edge when using FMF of 20%. In this study, we have demonstrated that PBS pCT scans can achieve equivalent accuracy as those obtained from broad beams. The feasibility of FMpCT scans was demonstrated; image accuracy and noise were successfully preserved in the central FMpCT-ROI chosen for this study, and dose reduction of up to 60% at the object's edge was realized.

Abstract ID: 180 On the use of Monte Carlo techniques to improve particle imaging noise filtering and spatial resolution

Particle imaging has shown growing interest in the recent literature as it allows direct measurement of the tissue relative stopping power (RSP) within a patient, using either the radiographic or tomographic images [1] . However, its accuracy is limited by the multiple Coulomb scattering (MCS) suffered by the particles through the phantom and by the secondary particles noise measured on the detector that creates artefact in the reconstructed images. Monte Carlo (MC) techniques help investigate the spatial resolution gain obtained by using 1) different path estimate or 2) different ions to reduce the MCS effect on the final images [2] , [3] , [4] . Furthermore, secondary particles filtering techniques are paramount to achieve high RSP accuracy but may reduce contrast and spatial resolution along the process. The effect of the applied filters can be directly studied on the noise power spectrum (NPS) of perfect images acquired through MC simulations. Initial investigation demonstrates that He ions is the optimal choice between light ions (i.e. 1H to 6C) to achieve the highest path accuracy [2] decreasing the root-mean square uncertainty between the MC reference and the path estimate from 0.5 [mm] for protons to 0.18 [mm] for He. This has been shown to leads to higher spatial resolution radiographic images. On the other hands, the NPS spectrum [mm2] increases due to secondary particles on unfiltered He image is 300 times higher than that of proton, stressing the need for smart secondary particle filters.

Comparative Monte Carlo study on the performance of integration- and list-mode detector configurations for carbon ion computed tomography

Ion beam therapy offers the possibility of a highly conformal tumor-dose distribution; however, this technique is extremely sensitive to inaccuracies in the treatment procedures. Ambiguities in the conversion of Hounsfield units of the treatment planning x-ray CT to relative stopping power (RSP) can cause uncertainties in the estimated ion range of up to several millimeters. Ion CT (iCT) represents a favorable solution allowing to directly assess the RSP. In this simulation study we investigate the performance of the integration-mode configuration for carbon iCT, in comparison with a single-particle approach under the same set-up. The experimental detector consists of a stack of 61 air-filled parallel-plate ionization chambers, interleaved with 3 mm thick PMMA absorbers. By means of Monte Carlo simulations, this design was applied to acquire iCTs of phantoms of tissue-equivalent materials. An optimization of the acquisition parameters was performed to reduce the dose exposure, and the implications of a reduced absorber thickness were assessed. In order to overcome limitations of integration-mode detection in the presence of lateral tissue heterogeneities a dedicated post-processing method using a linear decomposition of the detector signal was developed and its performance was compared to the list-mode acquisition. For the current set-up, the phantom dose could be reduced to below 30 mGy with only minor image quality degradation. By using the decomposition method a correct identification of the components and a RSP accuracy improvement of around 2.0% was obtained. The comparison of integration- and list-mode indicated a slightly better image quality of the latter, with an average median RSP error below 1.8% and 1.0%, respectively. With a decreased absorber thickness a reduced RSP error was observed. Overall, these findings support the potential of iCT for low dose RSP estimation, showing that integration-mode detectors with dedicated post-processing strategies can provide a RSP accuracy comparable to list-mode configurations.