Intrafractional dose variation and beam configuration in carbon ion radiotherapy for esophageal cancer.

BACKGROUND: In carbon ion radiotherapy (CIR) for esophageal cancer, organ and target motion is a major challenge for treatment planning due to potential range deviations. This study intends to analyze the impact of intrafractional variations on dosimetric parameters and to identify favourable settings for robust treatment plans. METHODS: We contoured esophageal boost volumes in different organ localizations for four patients and calculated CIR-plans with 13 different beam geometries on a free-breathing CT. Forward calculation of these plans was performed on 4D-CT datasets representing seven different phases of the breathing cycle. Plan quality was assessed for each patient and beam configuration. RESULTS: Target volume coverage was adequate for all settings in the baseline CIR-plans (V95 > 98% for two-beam geometries, > 94% for one-beam geometries), but reduced on 4D-CT plans (V95 range 50-95%). Sparing of the organs at risk (OAR) was adequate, but range deviations during the breathing cycle partly caused critical, maximum doses to spinal cord up to 3.5x higher than expected. There was at least one beam configuration for each patient with appropriate plan quality. CONCLUSIONS: Despite intrafractional motion, CIR for esophageal cancer is possible with robust treatment plans when an individually optimized beam setup is selected depending on tumor size and localization.

SU-E-T-610: Impact of Variable Beam Spot Size on Treatment Time in Particle Therapy.

PURPOSE: The dosimetric advantage of particle therapy comes with a much higher infrastructure investment and operation costs. Increasing patient throughput is a key factor to manage operation costs. We investigate the impact of variable beam spot sizes on treatment time and discuss the tradeoffs involved. METHODS: The following realistic assumptions were used. (1) The beam traveling speed is independent of the beam spot size. (2) The beam spot is a 2D Gaussian. Changing the beam spot size implies varying the standard deviation. (3) The maximum beam intensity is a constant independent of the beam spot size. Increasing the beam spot reduces the fluence. (4) Varying the beam spot size incurs in a reset time penalty.A 2D tumor was used in the study. Dose calculations were based on pencil beam kernels from GEANT4.The total treatment time is divided into the beam travel time, the beam-on time, andthe time for changing the spot size. RESULTS: We found that: (1) Changing the beam spot size has no impact on the beam-on time, because the maximum beam intensity is independentof the beam spot and increasing the beam spot only reduces the fluence. (2) Larger beam spot size shortens the total travel time inversely proportional to the radius of the beam spot. (3) Plans with different beam spot sizes have similar dosimetric qualities. (4) If higher beam intensity could be used for larger beam spot size, savings in beam-on time would be inversely proportional to the intensity available. CONCLUSIONS: We have studied the interplay among beam intensity, travel time, and beam size reset time for a scanning beam with variable beam spot size. Our initial studies show necessary conditions for and limitations on savings in total treatment times. Further studies are being carried out to find additional time saving sources. Supported in part by NSF CBET-0853157.

SU-E-T-105: The LET Dependence of Liquid Ionization Chambers (LICs) in High-LET Beams.

PURPOSE: LICs are novel detectors for radiotherapy: the higher density of the medium allows to build them with a smaller sensitive volume, making them appealing in particle therapy. With RBE varying along the depth dose curve (DDC) and with the rising interest in dose/LET-painting, verifying the LET is becoming more important. Nevertheless, while the LET distributions for different ionizing particles have been calculated, they have never been directly measured in realistic therapeutic beams. Our interest in LICs is based on the characterization of the beam quality in terms of LET. It has been shown in earlier works that the extrapolation of the linear portion of the voltage curve yields an intercept with the x-axis that depends on LET. The quantitative establishment of this method, however, depends on how accurately recombination effects are taken into account. METHODS: Due to the higher density of charge carriers produced in the liquid, LICs have high recombination effects: general recombination effects, involving pairs belonging to different tracks (dose rate dependent), and initial recombination between ion-electron pairs belonging to the same incident particle event (LET dependent). To perform this study we propose a two-dimensional array of LICs, composed by a 16×8 matrix of 2×2 mm2 pixels, which gives a fine spatial resolution on the plane. RESULTS: Voltage curves have been measured for proton, carbon and oxygen beams available at the HIT facility in Heidelberg for different energies and dose rates. After correcting the curves for general recombination losses using the Three Voltage Method, we have indications of dose rate independence, indicating successful correction. CONCLUSIONS: Further investigations are foreseen to quantify the LET dependence along the DDC, where different LET values are expected. A comparison with simulated dose averaged LET values will give quantitative information about 2D LET distributions for different beam species.

SU-D-BRB-02: Investigations of Secondary Ion Distributions in Carbon Ion Therapy Using the Timepix Detector.

PURPOSE: Due to the high conformity of carbon ion therapy, unpredictable changes in the patient's geometry or deviations from the planned beam properties can result in changes of the dose distribution. PET has been used successfully to monitor the actual dose distribution in the patient. However, it suffers from biological washout processes and low detection efficiency. The purpose of this contribution is to investigate the potential of beam monitoring by detection of prompt secondary ions emerging from a homogeneous phantom, simulating a patient's head. METHODS: Measurements were performed at the Heidelberg Ion-Beam Therapy Center (Germany) using a carbon ion pencil beam irradiated on a cylindrical PMMA phantom (16cm diameter). For registration of the secondary ions, the Timepix detector was used. This pixelated silicon detector allows position-resolved measurements of individual ions (256×256 pixels, 55µm pitch). To track the secondary ions we used several parallel detectors (3D voxel detector). RESULTS: For monitoring of the beam in the phantom, we analyzed the directional distribution of the registered ions. This distribution shows a clear dependence on the initial beam energy, width and position. Detectable were range differences of 1.7mm, as well as vertical and horizontal shifts of the beam position by 1mm. To estimate the clinical potential of this method, we measured the yield of secondary ions emerging from the phantom for a beam energy of 226MeV/u. The differential distribution of secondary ions as a function of the angle from the beam axis for angles between 0 and 90° will be presented. In this setup the total yield in the forward hemisphere was found to be in the order of 10-1 secondary ions per primary carbon ion. CONCLUSIONS: The presented measurements show that tracking of secondary ions provides a promising method for non-invasive monitoring of ion beam parameters for clinical relevant carbon ion fluences. Research with the pixel detectors was carried out in frame of the Medipix Collaboration.

MO-A-213AB-11: First Experimental Test of Secondary Ion Tracking for the Assessment of Beam Range in a Patient-Like Phantom.

PURPOSE: Radiation therapy with ion beams provides highly conformal dose distributions. Therefore, monitoring the dose delivery within the patient in a non- invasive way is desired. The clinically available method based on tissue activation measurements with a PET-camera shows limitations due to the low induced activities and biological washout of the activated nuclei. The prompt production of secondary ions is supposed to be less influenced by biological processes. This contribution investigates the feasibility of beam range monitoring in a patient-like geometry containing realistic tissue inhomogeneities. METHODS: The experiments were performed at the Heidelberg Ion-Beam Therapy Center in Germany using carbon ion beams of 213 and 250MeV/u. Static pencil beams (FWHM of 6mm) were applied to the skull base and brain regions of a head phantom containing real bones. The emerging secondary ions were registered by the silicon detector Timepix. It was developed by the Medipix Collaboration and provides 256×256 pixels with 55um pitch. To determine the direction of the particles, a multi-layered detector (3D voxel detector, J.Jakubek etal. JINST6 C12010) was employed. The contribution of K. Gwosch etal. addresses the performance of this method in a homogeneous phantom. RESULTS: In the 3D distributions of the measured secondary ions clear differences between the application of lower and higher energies were observed. This Result was achieved in both brain (homogeneous) and skull base regions (containing inhomogeneities). Differences between the energies could be observed with the detector positioned on the occipital side as well as on the facial side of the head. CONCLUSIONS: We performed the first experiments towards beam range monitoring in a patient-like geometry exploiting tracking of prompt secondary ions with a small detector prototype. Despite the inherent tissue inhomogeneities, we found sensitivity on the beam range in both brain and skull base. Research carried out in frame of the Medipix Collaboration. Research carried out in frame of the Medipix Collaboration.

Proton dosimetry intercomparison based on the ICRU report 59 protocol.

BACKGROUND AND PURPOSE: A new protocol for calibration of proton beams was established by the ICRU in report 59 on proton dosimetry. In this paper we report the results of an international proton dosimetry intercomparison, which was held at Loma Linda University Medical Center. The goals of the intercomparison were, first, to estimate the level of consistency in absorbed dose delivered to patients if proton beams at various clinics were calibrated with the new ICRU protocol, and second, to evaluate the differences in absorbed dose determination due to differences in 60Co-based ionization chamber calibration factors. MATERIALS AND METHODS: Eleven institutions participated in the intercomparison. Measurements were performed in a polystyrene phantom at a depth of 10.27 cm water equivalent thickness in a 6-cm modulated proton beam with an accelerator energy of 155 MeV and an incident energy of approximately 135 MeV. Most participants used ionization chambers calibrated in terms of exposure or air kerma. Four ionization chambers had 60Co-based calibration in terms of absorbed dose-to-water. Two chambers were calibrated in a 60Co beam at the NIST both in terms of air kerma and absorbed dose-to-water to provide a comparison of ionization chambers with different calibrations. RESULTS: The intercomparison showed that use of the ICRU report 59 protocol would result in absorbed doses being delivered to patients at their participating institutions to within +/-0.9% (one standard deviation). The maximum difference between doses determined by the participants was found to be 2.9%. Differences between proton doses derived from the measurements with ionization chambers with N(K)-, or N(W) - calibration type depended on chamber type. CONCLUSIONS: Using ionization chambers with 60Co calibration factors traceable to standard laboratories and the ICRU report 59 protocol, a distribution of stated proton absorbed dose is achieved with a difference less than 3%. The ICRU protocol should be adopted for clinical proton beam calibration. A comparison of proton doses derived from measurements with different chambers indicates that the difference in results cannot be explained only by differences in 60Co calibration factors.