Water Equivalent Path Length Values Research Articles

A denoising method based on deep learning for proton radiograph using energy resolved dose function

Objective. Proton radiograph has been broadly applied in proton radiotherapy which is affected by scattered protons which result in the lower spatial resolution of proton radiographs than that of x-ray images. Traditional image denoising method may lead to the change of water equivalent path length (WEPL) resulting in the lower WEPL measurement accuracy. In this study, we proposed a new denoising method of proton radiographs based on energy resolved dose function curves. Approach. Firstly, the corresponding relationship between the distortion of WEPL characteristic curve, and energy and proportion of scattered protons was established. Then, to improve the accuracy of proton radiographs, deep learning technique was used to remove scattered protons and correct deviated WEPL values. Experiments on a calibration phantom to prove the effectiveness and feasibility of this method were performed. In addition, an anthropomorphic head phantom was selected to demonstrate the clinical relevance of this technology and the denoising effect was analyzed. Main results. The curves of WEPL profiles of proton radiographs became smoother and deviated WEPL values were corrected. For the calibration phantom proton radiograph, the average absolute error of WEPL values decreased from 2.23 to 1.72, the mean percentage difference of all materials of relative stopping power decreased from 1.24 to 0.39, and the average relative WEPL corrected due to the denoising process was 1.06%. In addition, WEPL values correcting were also observed on the proton radiograph for anthropomorphic head phantom due to this denoising process. Significance. The experiments showed that this new method was effective for proton radiograph denoising and had greater advantages than end-to-end image denoising methods, laying the foundation for the implementation of precise proton radiotherapy.

Optimizing 3DCT image registration for interfractional changes in carbon-ion prostate radiotherapy

To perform setup procedures including both positional and dosimetric information, we developed a CT–CT rigid image registration algorithm utilizing water equivalent pathlength (WEPL)-based image registration and compared the resulting dose distribution with those of two other algorithms, intensity-based image registration and target-based image registration, in prostate cancer radiotherapy using the carbon-ion pencil beam scanning technique. We used the data of the carbon ion therapy planning CT and the four-weekly treatment CTs of 19 prostate cancer cases. Three CT–CT registration algorithms were used to register the treatment CTs to the planning CT. Intensity-based image registration uses CT voxel intensity information. Target-based image registration uses target position on the treatment CTs to register it to that on the planning CT. WEPL-based image registration registers the treatment CTs to the planning CT using WEPL values. Initial dose distributions were calculated using the planning CT with the lateral beam angles. The treatment plan parameters were optimized to administer the prescribed dose to the PTV on the planning CT. Weekly dose distributions using the three different algorithms were calculated by applying the treatment plan parameters to the weekly CT data. Dosimetry, including the dose received by 95% of the clinical target volume (CTV-D95), rectal volumes receiving > 20 Gy (RBE) (V20), > 30 Gy (RBE) (V30), and > 40 Gy (RBE) (V40), were calculated. Statistical significance was assessed using the Wilcoxon signed-rank test. Interfractional CTV displacement over all patients was 6.0 ± 2.7 mm (19.3 mm maximum standard amount). WEPL differences between the planning CT and the treatment CT were 1.2 ± 0.6 mm-H2O (< 3.9 mm-H2O), 1.7 ± 0.9 mm-H2O (< 5.7 mm-H2O) and 1.5 ± 0.7 mm-H2O (< 3.6 mm-H2O maxima) with the intensity-based image registration, target-based image registration, and WEPL-based image registration, respectively. For CTV coverage, the D95 values on the planning CT were > 95% of the prescribed dose in all cases. The mean CTV-D95 values were 95.8 ± 11.5% and 98.8 ± 1.7% with the intensity-based image registration and target-based image registration, respectively. The WEPL-based image registration was CTV-D95 to 99.0 ± 0.4% and rectal Dmax to 51.9 ± 1.9 Gy (RBE) compared to 49.4 ± 9.1 Gy (RBE) with intensity-based image registration and 52.2 ± 1.8 Gy (RBE) with target-based image registration. The WEPL-based image registration algorithm improved the target coverage from the other algorithms and reduced rectal dose from the target-based image registration, even though the magnitude of the interfractional variation was increased.

Improvement of proton beam range uncertainty in breast treatment using tissue samples

Objective. Proton therapy after breast-conserving surgery (BCS) can substantially reduce the dose to lung and cardiac structures. However, these dosimetric benefits are subject to beam range uncertainty in patient. The conversion of the CT-Hounsfield unit (HU) into relative stopping power (RSP) is the primary contribution to range uncertainty. Hence, an accurate HU-RSP conversion is essential. Approach. Real tissue samples, including muscle and adipose, were prepared. The water equivalent path length (WEPL) of these samples was measured under homogeneous conditions using a 12-diode detector array of our time-resolved in vivo range verification system (IRVS). The HU-RSP conversion was improved using the measured WEPL and HU for adipose tissue. The measured WEPL values were compared with the treatment planning calculation results based on the stoichiometric CT-HU calibration technique. The effect was investigated for both with and without adipose tissue in HU-RSP conversion. Main results. The IRVS was calibrated based on the solid water phantom. The relative differences in WEPL (RSP) between measurements and calculations for muscle, adipose, and water was −1.19% (−0.75%), −4.25%(−4%), and −0.23%(−0.07%), respectively. Based on the improved HU-RSP conversion, the relative differences in WEPL was reduced to −0.97%(−0.62%), −1.50%(−1.46%), and −0.22% (0.00%), respectively. Significance. The WEPL deviation of adipose tissue is larger than the testing limit of 3.5% for beam range robustness in current clinical practice. However, the improved HU-RSP conversion reduced this deviation. The main component of breast tissue is adipose. Hence, the proton treatment of BCS can be undershooting if no proper measures are taken against this specific uncertainty.

A Fast 3D/3D Registration Method Based on Water Equivalent Path Length for Heavy-Ion Radiotherapy

<h3>Purpose/Objective(s)</h3> The accuracy of patient setup needs to be high in heavy-ion radiotherapy. Accordingly, there is an increasing demand for three-dimensional (3D) image-guided systems because of the limitations of the present two-dimensional imaging registration technology. One of the limitations is the inability to directly compare with planning computed tomography (CT) images. Due to this uncertainty in conformation, high dose per fraction radiotherapy is difficult. This study proposes a fast 3D/3D registration method comparing with water equivalent path length (WEPL) that uses planning and treatment CT images to minimize range variations by using the Lucas-Kanade (LK) algorithm. <h3>Materials/Methods</h3> A six-degrees-of-freedom (6DOF) couch correction was simulated for patient positioning at our center by performing automatic rigid image registration (RIR) and using the resultant translation/rotation. Our automatic RIR algorithm was used to align the planning CT and treatment CT images, simulating 6DOF. The alignment values (Δ<i>V</i>), which represents a six-dimensional vector of the amounts of 6DOF couch movement, were calculated by minimizing the following error function: E(<i>ΔV</i>)=Σ <i>_i</i>_∈Ω [<i>T_i</i> (<i>V+ΔV</i>)-<i>P_i</i> (<i>V</i>)]², where <i>V</i> is a six-dimensional vector that denotes a CT position and rotation in a treatment room; <i>T_i</i> (<i>V</i>) and <i>P_i</i> (<i>V</i>) are treatment and planning CT images respectively, whose position in the room is represented by <i>V; i</i> is a 3D vector which denotes a point in the room; and Ω is a set of calculation points, which was assigned a planning target volume (PTV) of Ω in this study. We minimized the error function by using the LK algorithm. To minimize the range variations, each pixel value of the CT images was changed into WEPL values and the alignment values were calculated in the same manner as the above algorithm. The method was evaluated using a dataset containing eight prostate cancer patient images, including a planning CT image with PTV and treatment CT images of four fraction with a fan-beam CT. The range variations were measured by calculating WEPL variations between the planning CT and treatment CT at (1) before registration and after registration based on (2) CT pixel values and (3) WEPL values, respectively. In addition, the calculation time was measured on a workstation with a single GPU. <h3>Results</h3> The mean WEL variation across the 32 cases (eight patients of four fractions) was (1) 1.8 ± 1.16 mm, (2) 1.08 ± 0.52 mm, and (3) 0.22 ± 0.17 mm. The worst WEPL variation were (1) 6.23 mm, (2) 3.06 mm, and (3) 1.17 mm. The mean calculation time were (2) 89 ms and (3) 1066 ms. <h3>Conclusion</h3> We developed a fast 3D/3D RIR method for reducing range variations to realize more accurate heavy-ion radiotherapy. We performed experiments involving eight prostate cancer patients, and our proposed method obtained high accuracy and short computation time.

Optimizing calibration settings for accurate water equivalent path length assessment using flat panel proton radiography

Objective: Proton range uncertainties can compromise the effectiveness of proton therapy treatments. Water equivalent path length (WEPL) assessment by flat panel detector proton radiography (FP-PR) can provide means of range uncertainty detection. Since WEPL accuracy intrinsically relies on the FP-PR calibration parameters, the purpose of this study is to establish an optimal calibration procedure that ensures high accuracy of WEPL measurements. To that end, several calibration settings were investigated. Approach: FP-PR calibration datasets were obtained simulating PR fields with different proton energies, directed towards water-equivalent material slabs of increasing thickness. The parameters investigated were the spacing between energy layers (ΔE) and the increment in thickness of the water-equivalent material slabs (ΔX) used for calibration. 30 calibrations were simulated, as a result of combining ΔE = 9, 7, 5, 3, 1 MeV and ΔX = 10, 8, 5, 3, 2, 1 mm. FP-PRs through a CIRS electron density phantom were simulated, and WEPL images corresponding to each calibration were obtained. Ground truth WEPL values were provided by range probing multi-layer ionization chamber simulations on each insert of the phantom. Relative WEPL errors between FP-PR simulations and ground truth were calculated for each insert. Mean relative WEPL errors and standard deviations across all inserts were computed for WEPL images obtained with each calibration. Main results: Large mean and standard deviations were found in WEPL images obtained with large ΔE values (ΔE = 9 or 7 MeV), for any ΔX. WEPL images obtained with ΔE ≤ 5 MeV and ΔX ≤ 5 mm resulted in a WEPL accuracy with mean values within ±0.5% and standard deviations around 1%. Significance: An optimal FP calibration in the framework of this study was established, characterized by 3 MeV ≤ ΔE ≤ 5 MeV and 2 mm ≤ ΔX ≤ 5 mm. Within these boundaries, highly accurate WEPL acquisitions using FP-PR are feasible and practical, holding the potential to assist future online range verification quality control procedures.

OpenPR - A computational tool for CT conversion assessment with proton radiography.

One of the main sources of uncertainty in proton therapy is the conversion of the Hounsfield Units of the planning CT to (relative) proton stopping powers. Proton radiography provides range error maps but these can be affected by other sources of errors as well as the CT conversion (e.g., residual misalignment). To better understand and quantify range uncertainty, it is desirable to measure the individual contributions and particularly those associated to the CT conversion. A workflow is proposed to carry out an assessment of the CT conversion solely on the basis of proton radiographs of real tissues measured with a multilayer ionization chamber (MLIC). The workflow consists of a series of four stages: (a) CT and proton radiography acquisitions, (b) CT and proton radiography registration in postprocessing, (c) sample-specific validation of the semi-empirical model both used in the registration and to estimate the water equivalent path length (WEPL), and (d) WEPL error estimation. The workflow was applied to a pig head as part of the validation of the CT calibration of the proton therapy center PARTICLE at UZ Leuven, Belgium. The CT conversion-related uncertainty computed based on the well-established safety margin rule of 1.2mm+2.4% were overestimated by 71% on the pig head. However, the range uncertainty was very much underestimated where cavities were encountered by the protons. Excluding areas with cavities, the overestimation of the uncertainty was 500%. A correlation was found between these localized errors and HUs between -1000 and -950, suggesting that the underestimation was not a consequence of an inaccurate conversion but was probably rather due to the resolution of the CT leading to material mixing at interfaces. To reduce these errors, the CT calibration curve was adapted by increasing the HU interval corresponding to the air up to -950. The application of the workflow as part of the validation of the CT conversion to RSPs showed an overall overestimation of the expected uncertainty. Moreover, the largest WEPL errors were found to be related to the presence of cavities which nevertheless are associated with low WEPL values. This suggests that the use of this workflow on patients or in a generalized study on different types of animal tissues could shed sufficient light on how the contributions to the CT conversion-related uncertainty add up to potentially reduce up to several millimeters the uncertainty estimations taken into account in treatment planning. All the algorithms required to perform the workflow were implemented in the computational tool named openPR which is part of openREGGUI, an open-source image processing platform for adaptive proton therapy.

Fast In Situ Image Reconstruction for Proton Radiography.

Proton beam therapy is an emerging modality for cancer treatment that, compared to X-ray radiation therapy, promises to provide better dose delivery to clinical targets with lower doses to normal tissues. Crucial to accurate treatment planning and dose delivery is knowledge of the water equivalent path length (WEPL) of each ray, or pencil beam, from the skin to every point in the target. For protons, this length is estimated from relative stopping power based on X-ray Hounsfield units. Unfortunately, such estimates lead to 3 to 4% uncertainties in the proton range prediction. Therefore, protons in the Bragg peak may overshoot (or undershoot) the desired stopping depth in the target causing tissue damage beyond the target volume. Recent studies indicate that tomographic imaging using protons has the potential to provide directly more accurate measurement of RSPs with significantly lower radiation dose than X-rays. We are currently working on a proton radiography system that promises to provide accurate two-dimensional (2D) images of WEPL values for protons that pass through the body. These will be suitable for positioning and range verification in daily treatments. In this study, we demonstrate that this system is capable of rapidly achieving such accurate images in clinically meaningful times. We have developed a software platform to characterize the potential performance of the prototype proton radiography system. We use Geant4 to simulate raw data detected by the device. An especially-written software - pRad - was written to process these data as they are received and uses iterative methods to generate radiographs. The software has been designed to generate a radiograph from a few million protons in under a minute after receiving the first proton from the device. We used a head phantom with known chemical compositions that could be modelled quite accurately in Geant4 simulations of proton radiographs. The radiographs are displayed as pixelated WEPL values displayed on a 2D gray scale image of WEPL values. Rapid radiograph reconstruction of 3D phantoms using simulated proton pencil beams have been achieved with our software platform. On a modest desktop computer with a single central processing unit (CPU) and a single graphics processing unit (GPU), it takes about 11 seconds to reconstruct images using iterative linear algorithms to reconstruct a radiograph from 7.6 million protons. For the radiographic reconstructions of the head phantom described here, the mean WEPL errors, in the proton radiograph using a large majority of the pixels in the complete image were less than 1 mm when compared to images obtained without proton scattering and without detector resolution included. We have demonstrated, through computer simulations of proton irradiation of a pediatric head phantom using the newly built pRad detector and image reconstruction software, that high quality proton radiographs can be generated for patient alignment and verification of water equivalent thickness of the patient before each treatment.

Improvement of single detector proton radiography by incorporating intensity of time-resolved dose rate functions

Proton radiography, which images patients with the same type of particles as those with which they are to be treated, is a promising approach to image guidance and water equivalent path length (WEPL) verification in proton radiation therapy. We have shown recently that proton radiographs could be obtained by measuring time-resolved dose rate functions (DRFs) using an x-ray amorphous silicon flat panel. The WEPL values were derived solely from the root-mean-square (RMS) of DRFs, while the intensity information in the DRFs was filtered out. In this work, we explored the use of such intensity information for potential improvement in WEPL accuracy and imaging quality. Three WEPL derivation methods based on, respectively, the RMS only, the intensity only, and the intensity-weighted RMS were tested and compared in terms of the quality of obtained radiograph images and the accuracy of WEPL values. A Gammex CT calibration phantom containing inserts made of various tissue substitute materials with independently measured relative stopping powers (RSP) was used to assess the imaging performances. Improved image quality with enhanced interfaces was achieved while preserving the accuracy by using intensity information in the calibration. Other objects, including an anthropomorphic head phantom, a proton therapy range compensator, a frozen lamb’s head and an ‘image quality phantom’ were also imaged. Both the RMS only and the intensity-weighted RMS methods derived RSPs within ± 1% for most of the Gammex phantom inserts, with a mean absolute percentage error of 0.66% for all inserts. In the case of the insert with a titanium rod, the method based on RMS completely failed, whereas that based on the intensity-weighted RMS was qualitatively valid. The use of intensity greatly enhanced the interfaces between different materials in the obtained WEPL images, suggesting the potential for image guidance in areas such as patient positioning and tumor tracking by proton radiography.

Investigation of time-resolved proton radiography using x-ray flat-panel imaging system

Proton beam therapy benefits from the Bragg peak and delivers highly conformal dose distributions. However, the location of the end-of-range is subject to uncertainties related to the accuracy of the relative proton stopping power estimates and thereby the water-equivalent path length (WEPL) along the beam. To remedy the range uncertainty, an in vivo measurement of the WEPL through the patient, i.e. a proton-range radiograph, is highly desirable. Towards that goal, we have explored a novel method of proton radiography based on the time-resolved dose measured by a flat panel imager (FPI).A 226 MeV pencil beam and a custom-designed range modulator wheel (MW) were used to create a time-varying broad beam. The proton imaging technique used exploits this time dependency by looking at the dose rate at the imager as a function of time. This dose rate function (DRF) has a unique time-varying dose pattern at each depth of penetration. A relatively slow rotation of the MW (0.2 revolutions per second) and a fast image acquisition (30 frames per second, ~33 ms sampling) provided a sufficient temporal resolution for each DRF. Along with the high output of the CsI:Tl scintillator, imaging with pixel binning (2 × 2) generated high signal-to-noise data at a very low radiation dose (~0.1 cGy).Proton radiographs of a head phantom and a Gammex CT calibration phantom were taken with various configurations. The results of the phantom measurements show that the FPI can generate low noise and high spatial resolution proton radiographs. The WEPL values of the CT tissue surrogate inserts show that the measured relative stopping powers are accurate to ~2%. The panel did not show any noticeable radiation damage after the accumulative dose of approximately 3831 cGy. In summary, we have successfully demonstrated a highly practical method of generating proton radiography using an x-ray flat panel imager.

TU-FG-BRB-02: The Impact of Using Dual-Energy CT for Determining Proton Stopping Powers: Comparison Between Theory and Experiments

Purpose: To evaluate the clinical performance of dual-energy CT (DECT) in determining proton stopping power ratios (SPR) and demonstrate advantages over conventional single-energy CT (SECT). Methods: SECT and DECT scans of tissue-equivalent plastics as well as animal meat samples are performed with a Siemens SOMATOM Definition Flash. The methods of Schneider et al. (1996) and Bourque et al. (2014) are used to determine proton SPR on SECT and DECT images, respectively. Waterequivalent path length (WEPL) measurements of plastics and tissue samples are performed with a 195 MeV proton beam. WEPL values are determined experimentally using the depth-dose shift and dose extinction methods. Results: Comparison between CT-based and experimental WEPL is performed for 12 tissue-equivalent plastic as well as 6 meat boxes containing animal liver, kidney, heart, stomach, muscle and bones. For plastic materials, results show a systematic improvement in determining SPR with DECT, with a mean absolute error of 0.4% compared to 1.7% for SECT. For the meat samples, preliminary results show the ability for DECT to determine WEPL with a mean absolute value of 1.1% over all meat boxes. Conclusion: This work demonstrates the potential in using DECT for determining proton SPR with plastic materials in a clinical context. Further work is required to show the benefits of DECT for tissue samples. While experimental uncertainties could be a limiting factor to show the benefits of DECT over SECT for the meat samples, further work is required to adapt the DECT formalism in the context of clinical use, where noise and artifacts play an important role.

SU‐C‐207A‐05: Feature Based Water Equivalent Path Length (WEPL) Determination for Proton Radiography by the Technique of Time Resolved Dose Measurement

Purpose:Studies show that WEPL can be determined from modulated dose rate functions (DRF). However, the previous calibration method based on statistics of the DRF is sensitive to energy mixing of protons due to scattering through different materials (termed as range mixing here), causing inaccuracies in the determination of WEPL. This study intends to explore time‐domain features of the DRF to reduce the effect of range mixing in proton radiography (pRG) by this technique.Methods:An amorphous silicon flat panel (PaxScan™ 4030CB, Varian Medical Systems, Inc., Palo Alto, CA) was placed behind phantoms to measure DRFs from a proton beam modulated by a specially designed modulator wheel. The performance of two methods, the previously used method based on the root mean square (RMS) and the new approach based on time‐domain features of the DRF, are compared for retrieving WEPL and RSP from pRG of a Gammex phantom.Results:Calibration by T80 (the time point for 80% of the major peak) was more robust to range mixing and produced WEPL with improved accuracy. The error of RSP was reduced from 8.2% to 1.7% for lung equivalent material, with the mean error for all other materials reduced from 1.2% to 0.7%. The mean error of the full width at half maximum (FWHM) of retrieved inserts was decreased from 25.85% to 5.89% for the RMS and T80 method respectively. Monte Carlo simulations in simplified cases also demonstrated that the T80 method is less sensitive to range mixing than the RMS method.Conclusion:WEPL images have been retrieved based on single flat panel measured DRFs, with inaccuracies reduced by exploiting time‐domain features as the calibration parameter. The T80 method is validated to be less sensitive to range mixing and can thus retrieve the WEPL values in proximity of interfaces with improved numerical and spatial accuracy for proton radiography.

SU‐F‐I‐54: Spatial Resolution Studies in Proton CT Using a Phase‐II Prototype Head Scanner

Purpose:To characterize the modulation transfer function (MTF) of the pre‐clinical (phase II) head scanner developed for proton computed tomography (pCT) by the pCT collaboration. To evaluate the spatial resolution achievable by this system.Methods:Our phase II proton CT scanner prototype consists of two silicon telescopes that track individual protons upstream and downstream from a phantom, and a 5‐stage scintillation detector that measures a combination of the residual energy and range of the proton. Residual energy is converted to water equivalent path length (WEPL) of the protons in the scanned object. The set of WEPL values and associated paths of protons passing through the object over a 360° angular scan is processed by an iterative parallelizable reconstruction algorithm that runs on GP‐GPU hardware. A custom edge phantom composed of water‐equivalent polymer and tissue‐equivalent material inserts was constructed. The phantom was first simulated in Geant4 and then built to perform experimental beam tests with 200 MeV protons at the Northwestern Medicine Chicago Proton Center. The oversampling method was used to construct radial and azimuthal edge spread functions and modulation transfer functions. The spatial resolution was defined by the 10% point of the modulation transfer function in units of lp/cm.Results:The spatial resolution of the image was found to be strongly correlated with the radial position of the insert but independent of the relative stopping power of the insert. The spatial resolution varies between roughly 4 and 6 lp/cm in both the the radial and azimuthal directions depending on the radial displacement of the edge.Conclusion:The amount of image degradation due to our detector system is small compared with the effects of multiple Coulomb scattering, pixelation of the image and the reconstruction algorithm. Improvements in reconstruction will be made in order to achieve the theoretical limits of spatial resolution.

A Fast Experimental Scanner for Proton CT: Technical Performance and First Experience with Phantom Scans.

We report on the design, fabrication, and first tests of a tomographic scanner developed for proton computed tomography (pCT) of head-sized objects. After extensive preclinical testing, pCT is intended to be employed in support of proton therapy treatment planning and pre-treatment verification in patients undergoing particle-beam therapy. The scanner consists of two silicon-strip telescopes that track individual protons before and after the phantom, and a novel multistage scintillation detector that measures a combination of the residual energy and range of the proton, from which we derive the water equivalent path length (WEPL) of the protons in the scanned object. The set of WEPL values and the associated paths of protons passing through the object over a 360° angular scan are processed by an iterative, parallelizable reconstruction algorithm that runs on modern GP-GPU hardware. In order to assess the performance of the scanner, we have performed tests with 200 MeV protons from the synchrotron of the Loma Linda University Medical Center and the IBA cyclotron of the Northwestern Medicine Chicago Proton Center. Our first objective was calibration of the instrument, including tracker channel maps and alignment as well as the WEPL calibration. Then we performed the first CT scans on a series of phantoms. The very high sustained rate of data acquisition, exceeding one million protons per second, allowed a full 360° scan to be completed in less than 10 minutes, and reconstruction of a CATPHAN 404 phantom verified accurate reconstruction of the proton relative stopping power in a variety of materials.

MO-A-213AB-08: 2D Water Equivalent Path Length Imaging Technique for Pre-Treatment Range Verification in Proton Therapy.

To assess the potentials of a novel detector for providing a transmission image of the patient in terms of the Water Equivalent Path Length (WEPL) values and to evaluate the detector potential for real-time imaging of moving targets. The method is based on the principle that for passively scattered proton beams the WEPL of any point located in the dose plateau of a spread-out Bragg-Peak can be derived from the time dependence of the dose rate function measured at this point. A flat-panel 2D detector array (Sun Nuclear Corporation, 249 diodes, pitch ∼6 mm, 2 ms time resolution) was placed distal to a range of phantoms with varying complexities. The dose rate received by all diodes were measured as functions of time and analyzed to obtain the WEPL values. To assess the potential real-time features of this imaging technique, a Lucite cube was imaged while moving with a sinusoidal pattern with the amplitude and period comparable to a typical mobile tumor. In water tanks, millimeter accuracy in the determination of the WEPL could be achieved and the geometrical shape of wedge and sphere phantoms could be reproduced. In more complex phantoms such as a Lucite step-like compensator or Medulloblastoma patient compensators, multiple Coulomb scattering and range mixing cause a slight deterioration in the reconstruction of the WEPL. We found that tracking of a moving target in the coronal plane is potentially feasible. The technique gives less than 1 cGy of dose to patients and is therefore ideal for 'range-tuning' prior to treatment. For clinical applications, the beam for 'tuning' will need a deeper range than the prescription and once the radiological path length to the dosimeter is determined and compared with that from planning, the proton range for the actual treatment can be adjusted.

TU‐A‐204B‐02: On the Potential of CBCT for Range Verification in Proton Therapy

Purpose: We have investigated the potential use of cone beam CT (CBCT) for beam range verifications in proton therapy treatment, in addition to its primary role in geometric targeting. Specifically, we studied the intrinsic imaging variability of a CBCT and its effect on the water equivalent path length (WEPL) calculations, in the context of daily beam range verification/correction required for a recently proposed method of treating prostate using anterior fields. The current approach uses only lateral fields due to the lack of precise range control in patient. Materials and Methods: An anthropomorphic pelvic phantom was scanned using CBCT, in eight sessions on eight different days. In each session, the phantom was scanned twice, first at a standard position as determined by the room lasers, and then with a random shift of one centimeter in lateral directions. The Xio treatment planning system was used to perform the analysis. The average Hounsfield unit (HU) numbers for the water column in the rectal balloon was used to perform a linear calibration of the stopping power ratio, independently for each scan, as supported by the planning system. A number of WEPL values vertically from the anterior skin surface to the anterior surface of the water balloon were calculated on slices covering the region of the prostate, in relevance to a prostate treatment using an anterior field. Results: The HU number in the water column varied significantly even within the same CBCT. The average value also varied from day to day for up to 20 units. However, when these average values are used to calibrate the stopping power ratio, the variations in WEPL values along the anterior beam path are mostly within 2 mm. Conclusions: In‐room CBCT can be used in proton therapy to make online verification of protons range in patients with 2mm accuracy.

SU-GG-T-471: Towards Range Guided Prostate Treatment Using an AP Field

Purpose:Proton treatment of prostate by anterior fields offers potential benefit in rectal sparing. However such treatment requires an accurate control of the beam range. We have recently proposed a method for in‐vivo range determination for prostate treatment by anterior fields, based on time‐resolved dose rate measurement. The method has been successfully tested against range shifting and range mixing of protons due to tissue inhomogeneity using simple geometric configurations in a water tank. In this study, we further evaluate the effectiveness of the method using a human pelvic phantom. Methods: A human pelvic phantom was used to mimic a real prostate treatment. The phantom was first CT scanned with a full bladder and a water balloon in the rectum. A treatment planningsoftware was used to compute the water equivalent path length (WEPL) between the phantom surface and the anterior inner surface of the rectum cavity, along the direction of an anterior beam. The phantom prostate was then irradiated using an anterior proton beam. A pinpoint ionization chamber was used to measure the time‐resolved dose rate function along the wall of the rectal cavity with spatial resolution of 0.25 mm. The obtained dose rate function were used to derive the corresponding WEPL values, and then compared with those calculated by the treatment planning system. Results: The time‐dependence of the measured dose rate functions showed limited deviations from those measured in a water tank, indicating a relatively low level of range mixing. This is consistent with the relatively mild tissue inhomogeneity along the beam path, despite the presence of the pubic bones. The discrepancy between the measured and calculated WEPL values is below 2mm. Conclusions: The time resolved dose rate method can be used, with reasonable accuracy, to control the beam range in prostate patient if treated by anterior fields.