A Geant4 shielding design for the first US carbon multi-ion hybrid synchrotron facility.

The Mayo Clinic Florida Integrated Oncology Building will be the home of the first spot-scanning only carbon/proton hybrid therapy system by Hitachi, Ltd. It will provide proton beams up to kinetic energies of 230 MeV and carbon beams up to 430 MeV n-1for clinical deployment. To provide adequate radiation protection, the Geant4 (v10.6) Monte Carlo toolkit was utilized to quantify the ambient dose equivalent at a 10 mm depth (H*(10)) for photons and neutrons. To perform accurate calculations of the ambient dose equivalent, three-dimensional computer-aided design files of the entire planned facility were imported into Geant4, as well as certain particle system components such as the bending magnets, fast Faraday cup, and gantry. Particle fluence was scored using 60 cm diameter spheres, which were strategically placed throughout areas of interests. Analytical calculations were performed as first-pass design checks. Major shielding slabs were optimized using Geant4 simulations iteratively, with more than 20 alternative designs evaluated within Geant4. The 430 MeV n-1carbon beams played the most significant role in concrete thickness Requirements. The primary wall thickness for the carbon fixed beam room is 4 meters. The presence of the proton gantry structure in the simulation caused the ambient dose equivalent to increase by around 67% at the maze entrance, but a decrease in the high energy beam transport corridor. All shielding primary and secondary goals for clinical operations were met per state regulation and national guidelines.

Investigation of beam delivery time for synchrotron-based proton pencil beam scanning system with novel scanning mode.

Objective.To investigate synchrotron-based proton pencil beam scanning (PBS) beam delivery time (BDT) using novel continuous scanning mode.Approach.A BDT calculation model was developed for the Hitachi particle therapy system. The model was validated against the measured BDT of 36 representative clinical proton PBS plans with discrete spot scanning (DSS) in the current Hitachi proton therapy system. BDTs were calculated with the next generation using Mayo Clinic Florida system operating parameters for conventional DSS, and novel dose driven continuous scanning (DDCS). BDTs of DDCS with and without Break Spots were investigated.Main results.For DDCS without Break Spots, the use of Stop Ratio to control the transit dose largely reduced the beam intensity and consequently, severely prolonged the BDT. DDCS with Break Spots was able to maintain a sufficiently high beam intensity while controlling transit dose. In DDCS with Break Spots, tradeoffs were made between beam intensity and number of Break Spots. Therefore, BDT decreased with increased beam intensity but reached a plateau for beam intensity larger than 10 MU s-1. Averaging over all clinical plans, BDT was reduced by 10% for DDCS with Break Spots compared to DSS.Significance.DDCS with Break Spots reduced BDT. DDCS has the potential to further reduce BDT under the ideal scenario which requests both stable beam intensity extraction and accurately modelling the transit dose. Further investigation is warranted.

Results of a Multi-Institutional Phase 2 Clinical Trial for 4DCT-Ventilation Functional Avoidance Thoracic Radiation Therapy.

PURPOSE: Radiation pneumonitis remains a major limitation in the radiation therapy treatment of patients with lung cancer. Functional avoidance radiation therapy uses functional imaging to reduce pulmonary toxic effects by designing radiation therapy plans that reduce doses to functional regions of the lung. Lung functional imaging has been developed that uses 4-dimensional computed tomography (4DCT) imaging to calculate 4DCT-based lung ventilation (4DCT-ventilation). A phase 2 multicenter study was initiated to evaluate 4DCT-ventilation functional avoidance radiation therapy. The study hypothesis was that functional avoidance radiation therapy could reduce the rate of grade ≥2 radiation pneumonitis to 12% compared with a 25% historical rate, with the trial being positive if ≤16.4% of patients experienced grade ≥2 pneumonitis. METHODS AND MATERIALS: Lung cancer patients receiving curative-intent radiation therapy (prescription doses of 45-75 Gy) and chemotherapy were accrued. Patient 4DCT scans were used to generate 4DCT-ventilation images. The 4DCT-ventilation images were used to generate functional avoidance plans that reduced doses to functional portions of the lung while delivering the prescribed tumor dose. Pneumonitis was evaluated by a clinician at 3, 6, and 12 months after radiation therapy. RESULTS: Sixty-seven evaluable patients were accrued between April 2015 and December 2019. The median prescription dose was 60 Gy (range, 45-66 Gy) delivered in 30 fractions (range, 15-33 fractions). The average reduction in the functional volume of lung receiving ≥20 Gy with functional avoidance was 3.5% (range, 0%-12.8%). The median follow-up was 312 days. The rate of grade ≥2 radiation pneumonitis was 10 of 67 patients (14.9%; 95% upper CI, 24.0%), meeting the phase 2 criteria. CONCLUSIONS: 4DCT-ventilation offers an imaging modality that is convenient and provides functional imaging without an extra procedure necessary. This first report of a multicenter study of 4DCT-ventilation functional avoidance radiation therapy provided data showing that the trial met phase 2 criteria and that evaluation in a phase 3 study is warranted.

Design of a 3D patient-specific collision avoidance virtual framework for half-gantry proton therapy system.

INTRODUCTION: This study presents a comprehensive collision avoidance framework based on three-dimension (3D) computer-aided design (CAD) modeling, a graphical user interface (GUI) as peripheral to the radiation treatment planning (RTP) environment, and patient-specific plan parameters for intensity-modulated proton therapy (IMPT). METHODS: A stand-alone software application was developed leveraging the Varian scripting application programming interface (API) for RTP database object accessibility. The Collision Avoider software models the Hitachi ProBeat-V half gantry design and the Kuka robotic couch with triangle mesh structures. Patient-specific plan parameters are displayed in the collision avoidance software for potential proximity evaluation. The external surfaces of the patients and the immobilization devices are contoured based on computed tomography (CT) images. A "table junction-to-CT-origin" (JCT) measurement is made for every patient at the time of CT simulation to accurately provide reference location of the patient contours to the treatment couch. Collision evaluations were performed virtually with the program during treatment planning to prevent four major types of collisional events: collisions between the gantry head and the treatment couch, gantry head and the patient's body, gantry head and the robotic arm, and collisions between the gantry head and the immobilization devices. RESULTS: The Collision Avoider software was able to accurately model the proton treatment delivery system and the robotic couch position. Commonly employed clinical beam configuration and JCT values were investigated. Brain and head and neck patients require more complex gantry and patient positioning system configurations. Physical measurements were performed to validate 3D CAD model geometry. Twelve clinical proton treatment plans were used to validate the accuracy of the software. The software can predict all four types of collisional events in our clinic since its full implementation in 2020. CONCLUSION: A highly efficient patient-specific collision prevention program for scanning proton therapy has been successfully implemented. The graphical program has provided accurate collision detection since its inception at our institution.

Functional avoidance-based intensity modulated proton therapy with 4DCT derived ventilation imaging for lung cancer.

The primary objective is to evaluate the potential dosimetric gains of performing functional avoidance-based proton treatment planning using 4DCT derived ventilation imaging. 4DCT data of 31 patients from a prospective functional avoidance clinical trial were evaluated with intensity modulated proton therapy (IMPT) plans and compared with clinical volumetric modulated arc therapy (VMAT) plans. Dosimetric parameters were compared between standard and functional plans with IMPT and VMAT with one-way analysis of variance and post hoc paired student t-test. Normal Tissue Complication Probability (NTCP) models were employed to estimate the risk of two toxicity endpoints for healthy lung tissues. Dose degradation due to proton motion interplay effect was evaluated. Functional IMPT plans led to significant dose reduction to functional lung structures when compared with functional VMAT without significant dose increase to Organ at Risk (OAR) structures. When interplay effect is considered, no significant dose degradation was observed for the OARs or the clinical target volume (CTV) volumes for functional IMPT. Using fV20 as the dose metric and Grade 2+ pneumonitis as toxicity endpoint, there is a mean 5.7% reduction in Grade 2+ RP with the functional IMPT and as high as 26% in reduction for individual patient when compared to the standard IMPT planning. Functional IMPT was able to spare healthy lung tissue to avoid excess dose to normal structures while maintaining satisfying target coverage. NTCP calculation also shows that the risk of pulmonary complications can be further reduced with functional based IMPT.