Learning-Based Stopping Power Mapping on Dual Energy CT for Proton Radiation Therapy
Tonghe Wang, Yang Lei, Joseph Harms, Beth Ghavidel, Liyong Lin, Jonathan J. Beitler, Mark McDonald, Walter J. Curran, Tian Liu, Jun Zhou, Xiaofeng Yang
Purpose: Dual-energy CT (DECT) has been used to derive relative stopping power (RSP) map by obtaining the energy dependence of photon interactions. The DECT-derived RSP maps could potentially be compromised by image noise levels and the severity of artifacts when using physics-based mapping techniques, which would affect subsequent clinical applications. This work presents a noise-robust learning-based method to predict RSP maps from DECT for proton radiation therapy. Methods: The proposed method uses a residual attention cycle-consistent generative adversarial (CycleGAN) network. CycleGAN were used to let the DECT-to-RSP mapping be close to a one-to-one mapping by introducing an inverse RSP-to-DECT mapping. We retrospectively investigated 20 head-and-neck cancer patients with DECT scans in proton radiation therapy simulation. Ground truth RSP values were assigned by calculation based on chemical compositions, and acted as learning targets in the training process for DECT datasets, and were evaluated against results from the proposed method using a leave-one-out cross-validation strategy. Results: The predicted RSP maps showed an average normalized mean square error (NMSE) of 2.83% across the whole body volume, and average mean error (ME) less than 3% in all volumes of interest (VOIs). With additional simulated noise added in DECT datasets, the proposed method still maintained a comparable performance, while the physics-based stoichiometric method suffered degraded inaccuracy from increased noise level. The average differences in DVH metrics for clinical target volumes (CTVs) were less than 0.2 Gy for D95% and Dmax with no statistical significance. Conclusion: These results strongly indicate the high accuracy of RSP maps predicted by our machine-learning-based method and show its potential feasibility for proton treatment planning and dose calculation.
Stopping power monitoring during proton therapy by means of prompt gamma timing: first experimental results with a homogeneous phantom
Universität zu Lübeck（吕贝克大学）；INFN sezione di Torino（都灵意大利国家核物理研究所）；State University of Santa Cruz（圣克鲁斯州立大学）；Fondazione CNAO（CNAO基金会）；Università degli Studi di Torino（都灵大学）
In proton therapy both the energy, which determines the range, and the distal slope, which reflects the rate at which the protons decelerate, are of import if we are to ensure accurate dose deposition and maximum tissue sparing. This publication describes a Geant4 model and presents a two-dimensional polynomial relationship between energy, the energy spread and the distal slope for beams with Gaussian energy spectra for proton therapy. This simple polynomial relationship will be useful for non-invasive or minimally invasive near real-time monitoring of the energy and energy spread of a proton …
We present calculations and simulations on the role of the p+$^{11}$B$\to$3$α$ reaction in proton therapy. This reaction has been recently suggested to be responsible for a decrease in the survival probability of tumor cells, when they are irradiated with low-energy protons. However, at the concentration levels typical of the proposed boron carrier (sodium borocaptate, Na$_{2}$B$_{12}$H$_{11}$SH, in short BSH), i.e. less than 100 ppm, both calculations and Monte Carlo simulations suggest that the dose related to this reaction is orders of magnitude lower than the dose delivered by the primary …
Background and Objective: Recent experimental studies using ultra-high dose rate radiation therapy (FLASH-RT) have shown improved normal tissue sparing and comparable tumor control compared to conventional dose rate RT. Pencil beam scanning (PBS) proton therapy with superior dosimetry characteristics has begun to draw attention to the delivery of conformal FLASH-RT for preclinical studies. This review aims to provide recent updates on the development of PBS FLASH-RT. Methods: The information summarized in this review article is based on search results in databases such as PubMed and search eng…
Secondary radiation in a radiation therapy environment is considered a cause for post-treatment side effects including secondary carcinogenesis. In a proton-therapy setup, neutrons deliver a considerable extra dose to the patient. Various measurements and calculations of neutron dose suggest a wide range of values for this quantity. This paper provides a comparison between the previously published values and analyzes the Monte Carlo calculated neutron dose from the present work using the neutron cross-section data. The purpose is to provide a range for the convergence of several neutron-absorb…
In particle therapy, knowledge of the stopping-power ratios (STPRs) of the ion beam for air and water is necessary for accurate ionization chamber dosimetry. Earlier work has investigated the STPRs for pristine carbon ion beams, but here we expand the calculations to a range of ions (1 <= z <= 18) as well as spread out Bragg peaks (SOBPs) and provide a theoretical in-depth study with a special focus on the parameter regime relevant for particle therapy. The Monte Carlo transport code SHIELD-HIT is used to calculate complete particle-fluence spectra which are required for determining STPRs acco…
The advanced imaging and delivery techniques in proton therapy allow conformal high-dose irradiation of the target volume with high accuracy using pencil beam scanning or beam shaping apertures. These irradiation methods increasingly include small radiation fields with large dose gradients, which require detector systems with high spatial resolution for quality assurance. In addition the measurement of all success parameters for daily quality assurance with only one proton field and one simple detector system would save a lot of time in clinical usage. Based on their good spatial resolution an…
Previous measurements have shown large cross sections for the 11B(p,$α$)8Be reaction and K-shell ionization of boron from H+ ions. Past publications have shown that this reaction will likely increase the efficacy of proton therapy. This study investigates the size of boron particles for optimum treatment enhancement in proton therapy. Simulations of protons passing through varying sized boron particles were developed to compare energy outputs for alpha particles and low energy electrons. The results for the boron particle radius that produced the largest radiation output are presented in graph…
This contribution describes general concepts for control and safety systems in proton therapy. These concepts are illustrated by concrete examples implemented in the Proscan facility at PSI.
Proton Pencil-Beam Scanning Stereotactic Body Radiation Therapy and Hypofractionated Radiation Therapy for Thoracic Malignancies: Patterns of Practice Survey and Recommendations for Future Development from NRG Oncology and PTCOG
The proton boron fusion reaction, 11B(p, 3α), is investigated using MCNP6 to assess the viability for potential use in radiation therapy. The 11B(p, 3α) is theoretically desirable because it could combine the localized dose delivery protons exhibit (Bragg peak) with the creation of three high LET α particles that locally deposit energy in tumor regions. Simple simulations of a proton pencil beam incident upon a water phantom and a water phantom with an axial region also containing boron were modeled using MCNP6 in order to determine the extent of the impact boron had upon the calculated energy…
PET imaging is a non-invasive technique for particle range verification in proton therapy. It is based on measuring the beta+ annihilations caused by nuclear interactions of the protons in the patient. In this work we present measurements for proton range verification in phantoms, performed at the CNAO particle therapy treatment center in Pavia, Italy, with our 10 x 10 cm^2 planar PET prototype DoPET. PMMA phantoms were irradiated with mono-energetic proton beams and clinical treatment plans, and PET data were acquired during and shortly after proton irradiation. We created 1-D profiles of the…
Cao et al (2018) published an article on inverse planning based on dose-averaged linear energy transfer (LET). Their claim that the problem can be cast as a linear optimization model relies on an incorrect application of the Charnes-Cooper transformation. In this comment we show that their linear model is simlar to one where dose-averaged LET is multiplied with dose, explaining why their model was nonetheless able to improve the LET distribution.
Physical and biological range uncertainties limit the clinical potential of Proton Beam Therapy (PBT). In this proceedings, we report on two research projects, which we are conducting in parallel and which both tackle the problem of range uncertainties. One aims at developing software tools and the other at developing detector instrumentation. Regarding the first, we report on our development and pre-clinical application of a GPU-accelerated Monte Carlo (MC) simulation toolkit Fred. Concerning the letter, we report on our investigations of plastic scintillator based PET detectors for particle …
To expedite the commissioning process of the proton therapy system at Samsung Medical Center (SMC), we have developed a Monte Carlo simulation model of the proton therapy nozzles using TOPAS. At SMC proton therapy center, we have two gantry rooms with different types of nozzles; a multi-purpose nozzle and a dedicated scanning nozzle. Each nozzle has been modeled in detail following the geometry information provided by the manufacturer, Sumitomo Heavy Industries, Ltd. For this purpose, novel features of TOPAS, such as the time feature or the ridge filter class, have been used. And the appropria…
Background: A relative biological effectiveness (RBE) of 1.1 is used for proton therapy though clinical evidence of varying RBE was raised. Clinical studies on RBE variability have been conducted for decades for carbon radiation, which could advance the understanding of the clinical proton RBE given an ion-independent RBE model. In this work, such a model, linear and simple, using the beam quantity Q = Z^2/E (Z = ion charge, E = kinetic energy per nucleon) was tested and compared to the commonly used, proton-specific and linear energy transfer (LET) based Wedenberg RBE model. Material and meth…
For the in vivo range verification in proton therapy, it has been tried to measure the spatial distribution of the prompt gammas generated by the proton-induced interactions with the close relationship with the proton dose distribution. However, the high energy of the prompt gammas and background gammas are still problematic in measuring the distribution. In this study, we suggested a new method determining the in vivo range by utilizing the time structure of the prompt gammas formed with the rotation of a range modulation wheel (RMW) in the passive scattering proton therapy. To validate the M…
The radiotherapy of malignant diseases has reached much progress during the past decade. Thus, intensity modulated radiation therapy (IMRT) and VMAT (Rapidarc) now belong to the standard modalities of tumor treatment with high energy radiation in clinical practice. In recent time, the particle therapy (protons and partially with heavy carbon ions) has reached an important completion of these modalities with regard to some suitable applications. In spite of this enrichment essential features need further research activities and publications in this field: Nuclear reactions and the role of the r…
Therapeutic protons acting on O18-substituted thymidine increase cytotoxicity in radio-resistant human cancer cells. We consider here the physics behind the irradiation during proton beam therapy and diagnosis using O18-enriched thymine in DNA, with attention to the effect of the presence of thymine-18 on cancer cell death.
The total nuclear cross-section Qtot(E) resulting from the interaction of protons with nuclei is decomposed in 3 different contributions: 1. elastic scatter at the complete nucleus, which adopts a part of the proton kinetic energy; 2. inelastic scatter at a nucleus, which changes its quantum numbers by vibrations, rotations, transition to highly excited states; 3. proper nuclear reactions with change of the mass and/or charge number. Then different particles leave the hit nucleus (neutrons, protons, etc.), which is now referred to as 'heavy recoil' nucleus. The scatter parts of Qtot(E) accordi…
Depth distributions of positron-emitting nuclei in PMMA phantoms are calculated within a Monte Carlo model for Heavy-Ion Therapy (MCHIT) based on the GEANT4 toolkit (version 8.0). The calculated total production rates of $^{11}$C, $^{10}$C and $^{15}$O nuclei are compared with experimental data and with corresponding results of the FLUKA and POSGEN codes. The distributions of e$^+$ annihilation points are obtained by simulating radioactive decay of unstable nuclei and transporting positrons in surrounding medium. A finite spatial resolution of the Positron Emission Tomography (PET) is taken in…
Purpose: Currently, calculations of proton range in proton therapy patients are based on a conversion of CT Hounsfield Units of patient tissues into proton relative stopping power. Uncertainties in this conversion necessitate larger proximal and distal planned target volume margins. Proton CT can potentially reduce these uncertainties by directly measuring proton stopping power. We aim to demonstrate proton CT imaging with complex porcine samples, to analyze in detail three-dimensional regions of interest, and to compare proton stopping powers directly measured by proton CT to those determined…
This manuscript provides a response to a recent report by Mazzone et al. available online on arXiv that, in turn, tentatively aims at demonstrating the inefficacy of proton boron capture in hadrotherapy. We clarify that Mazzone et al. do not add any scientific or technical insights to the points extensively discussed in the original manuscript by Cirrone et al., and/or in the series of iterations had with the Referee, which ultimately lead to the publication of our original and pioneering experimental work. Here we summarize some of the key points of the long scientific debate we had during th…
The linear optimization algorithm ART3+O introduced by Chen et al. (2010) can efficiently solve large scale inverse planning problems encountered in radiation therapy by iterative projection. Its major weakness is that it cannot guarantee $ε$-optimality of the final solution due to an arbitrary stopping criterion. We propose an improvement to ART3+O where the stopping criterion is based on Farkas' lemma. The same theory can be used to detect inconsistency in other projection methods as well. The proposed algorithm guarantees to find an $ε$-optimal solution in finite time. The algorithm is demo…
Introduction. Treatment planning systems (TPS) are an essential component for simulating and optimizing a radiation therapy treatment before administering it to the patient. It ensures that the tumor is well covered and the dose to the healthy tissues is minimized. However, the TPS provided by commercial companies often come with a large panel of tools, each implemented in the form of a black-box making it difficult for researchers to use them for implementing and testing new ideas. To address this issue, we have developed an open-source TPS. Approach. We have developed an open-source software…
Purpose: Dual-energy CT (DECT) has been shown to derive stopping power ratio (SPR) map with higher accuracy than conventional single energy CT (SECT) by obtaining the energy dependence of photon interactions. However, DECT is not as widely implemented as SECT in proton radiation therapy simulation. This work presents a learning-based method to synthetize DECT images from SECT for proton radiation therapy. Methods: The proposed method uses a residual attention generative adversarial network. Residual blocks with attention gates were used to force the model focus on the difference between DECT m…
In this study, two proton beam delivery designs, passive scattering proton therapy (PSPT) and pencil beam scanning (PBS), were quantitatively compared in terms of dosimetric indices. The GATE Monte Carlo code was used to simulate the proton beam system; and the developed simulation engines were benchmarked with respect to the experimental measurements. A water phantom was used to simulate system energy parameters using a set of depth-dose data in the energy range of 120-235 MeV. To compare the performance of PSPT against PBS, multiple dosimetric parameters including FWHM, peak position, range,…
Background and purpose: The relative biological effectiveness (RBE) varies along the treatment field. However, in clinical practice, a constant RBE of 1.1 is assumed, which can result in undesirable side effects. This study provides an accurate overview of current clinical practice for considering proton RBE in Europe. Materials and Methods: A survey was devised and sent to all proton therapy centres in Europe that treat patients. The online questionnaire consisted of 39 questions addressing various aspects of RBE consideration in clinical practice, including treatment planning, patient follow…
Uncertainties in the proton range in tissue during proton therapy limit the precision in treatment delivery. These uncertainties result in expanded treatment margins, thereby increasing radiation dose to healthy tissue. Real-time range verification techniques aim to reduce these uncertainties in order to take full advantage of the finite range of the primary protons. In this paper, we propose a novel concept for real-time range verification based on detection of secondary neutrons produced in nuclear interactions during proton therapy. The proposed detector concept is simple; consisting of a h…
Beam modelling of Hitachi PROBEAT proton therapy system for a GPU-based Fast Monte Carlo dose engine
University of Nebraska Omaha（内布拉斯加大学奥马哈分校）；Rice University（莱斯大学）；The University of Texas MD Anderson Cancer（德克萨斯大学安德森癌症中心）；Mevion Medical System（美维医疗系统）；Emory University（埃默里大学）
The First Nozzle-Mounted Compton Camera Prompt Gamma Imaging System for In Vivo Proton Therapy Dose Verification
University of Maryland School of Medicine（马里兰大学医学院）；University of Cape Town（开普敦大学）；University of Wisconsin School of Medicine and Public Health（威斯康星大学医学院与公共卫生学院）；University of Maryland, Baltimore County（马里兰大学巴尔的摩县分校）；H3D, Inc.（H3D公司）
When using superconducting (SC) magnets in a gantry for proton therapy, the gantry will benefit from some reduction in size and a large reduction in weight. In this contribution we show an important additional advantage of SC magnets in proton therapy treatments. We present the design of a gantry with a SC bending section and achromatic beam optics with a very large beam momentum acceptance of $\pm15\%$. Due to the related very large energy acceptance, approximately 70% of the treatments can be performed without changing the magnetic field for synchronization with energy modulation. In our des…
Proton therapy range uncertainty reduction using vendor-agnostic tissue characterization on a virtual photon-counting CT head scan
Vinaver Medical（维纳弗医学）；Faculty of Medicine, University of Novi Sad（诺维萨德大学医学院）；Carl E. Ravin Advanced Imaging Laboratories and Center for Virtual Imaging Trials, Duke University（杜克大学卡尔·E·拉文先进成像实验室与虚拟成像试验中心）；Centro Nazionale di Adroterapia Oncologica (CNAO)（国家肿瘤质子治疗中心）；Department of Radiology, Duke University（杜克大学放射系）
Background and purpose: In-beam Positron Emission Tomography (PET) is one of the modalities that can be used for in-vivo non-invasive treatment monitoring in proton therapy. PET distributions obtained during various treatment sessions can be compared in order to identify regions that have anatomical changes. The purpose of this work is to test and compare different analysis methods in the context of inter-fractional PET image comparison for proton treatment verification. Methods: For our study we used the FLUKA Monte Carlo code and artificially generated CT scans to simulate in-beam PET distri…
Radiotherapy is one of the main methods in the successful treatment of cancer. The tumor is irradiated with photons or charged particles (e.g. protons), and in the case of massive charged particles, the treatment results in less unnecessary dose outside the tumor and therefore less side effects for the patient and a faster recovery. However, the dose planning of hadron therapy is calculated from photon CT measurements, which results in large uncertainties in the planning and therefore in a necessary enlargement of the treatment area. This uncertainty can be reduced by performing the CT scan us…
The purpose of this study was to use various dosimetrical indices to determine the best IMRT modality technique for treating patients with prostate cancer. Ten patients with prostate cancer were included in this study. Intensity modulated radiation therapy plans were designed to include different modalities, including the linac step and shoot, Tomotherapy, RapidArc, and Proton systems. Various dosimetrical indices, like the prescription isodose to target volume (PITV) ratio, conformity index (CI), homogeneity index (HI), target coverage index (TCI), modified dose homogeneity index (MHI), confo…
A work recently published experimentally demonstrates an increase in the radiobiological efficacy of clinical proton beams when a tumour is treated in the presence of a concentration of 11B. The paper, for the first time, demonstrates the potential role of the p+11B to 3α (for brevity, p-B) reaction in the biological enhancement of proton therapy effectiveness. The work reports robust experimental data in terms of clonogenic cell survival and chromosomal aberrations and unambiguously shows the presence of an enhancement when cells were exposed to a clinical proton beam subject to treatment wit…
