Experimental verification of a non-invasive method to monitor the lateral pencil beam position in an anthropomorphic phantom for carbon-ion radiotherapy.

The dose conformation and the sparing of neighboring critical healthy structures are improved in carbon-ion beam radiotherapy in comparison to conventional photon radiotherapy. Inter and intrafractional plan adaptation strategies may preclude the quality assurance (QA) of the actually applied treatment plan before the treatment starts. Therefore, independent measurements of the positions of scanned pencil 12C ion beams are of interest in order to monitor the beam application during the treatment and the beam in the isocenter. In this work, secondary ions outgoing from a patient-like phantom are exploited for the assessment of the lateral pencil beam position in a clinic-like 12C treatment fraction. The experiment was performed at the Heidelberg Ion-Beam Therapy Center (HIT) in Germany. A carbon-ion treatment plan was used to treat a 100 cm3 tumor volume in the center of an Alderson head phantom. Two silicon pixel detectors based on the Timepix3 technology developed at CERN were operated in synchronization to detect and to track outgoing secondary ions. We established an analysis of the measured secondary ion track distribution which enabled us to follow the beam scanning movement of the carbon-ion pencil beam by assessing the lateral position of the single beam spots. The precision of the developed method was found to range from 0.84 mm to 2.59 mm. For beam energies greater than 197.58 MeV/n, the mean of absolute distances of the measured lateral pencil beam positions with respect to the pencil beam positions measured by the beam application system (averaged over each energy layer) were smaller than 2 mm. We conclude that the presented method has shown capabilities of monitoring the lateral pencil beam positions by means of secondary ions with precision and sensitivity of clinical interest.

BrachyView: initial preclinical results for a real-time in-body HDR PBT source tracking system with simultaneous TRUS image fusion.

A prototype in-body gamma camera system with integrated trans-rectal ultrasound (TRUS) and associated real-time image acquisition and analysis software was developed for intraoperative source tracking in high dose rate (HDR) brachytherapy. The accuracy and temporal resolution of the system was validated experimentally using a deformable tissue-equivalent prostate gel phantom and a full clinical HDR treatment plan. The BrachyView system was able to measure 78% of the 200 source positions with an accuracy of better than 1 mm. A minimum acquisition time of 0.28 s/frame was required to achieve this accuracy, restricting dwell times to a minimum of 0.3 s. Additionally, the performance of the BrachyView-TRUS fusion probe for mapping the spatial location of the tracked source within the prostate volume was evaluated. A global coordinate system was defined by scanning the phantom with the probe in situ using a CT scanner, and was subsequently used for co-registration of the BrachyView and TRUS fields of view (FoVs). TRUS imaging was used to segment the prostate volume and reconstruct it into a three-dimensional (3D) image. Fusion of the estimated source locations with the 3D prostate image was performed using integrated 3D visualisation software. HDR BrachyView is demonstrated to be a valuable tool for intraoperative source tracking in HDR brachytherapy, capable of resolving source dwell locations relative to the prostate anatomy when combined with TRUS.

Investigation of mixed ion fields in the forward direction for 220.5 MeV/u helium ion beams: comparison between water and PMMA targets.

Currently there is a rising interest in helium ion beams for radiotherapy. For benchmarking of the physical beam models used in treatment planning, there is a need for experimental data on the composition and spatial distribution of mixed ion fields. Of particular interest are the attenuation of the primary helium ion fluence and the build-up of secondary hydrogen ions due to nuclear interactions. The aim of this work was to provide such data with an enhanced precision. Moreover, the validity and limits of the mixed ion field equivalence between water and PMMA targets were investigated. Experiments with a 220.5 MeV/u helium ion pencil beam were performed at the Heidelberg Ion-Beam Therapy Center in Germany. The compact detection system used for ion tracking and identification was solely based on Timepix position-sensitive semiconductor detectors. In comparison to standard techniques, this system is two orders of magnitude smaller, and provides higher precision and flexibility. The numbers of outgoing helium and hydrogen ions per primary helium ion as well as the lateral particle distributions were quantitatively investigated in the forward direction behind water and PMMA targets with 5.2-18 cm water equivalent thickness (WET). Comparing water and PMMA targets with the same WET, we found that significant differences in the amount of outgoing helium and hydrogen ions and in the lateral particle distributions arise for target thicknesses above 10 cm WET. The experimental results concerning hydrogen ions emerging from the targets were reproduced reasonably well by Monte Carlo simulations using the FLUKA code. Concerning the amount of outgoing helium ions, significant differences of 3-15% were found between experiments and simulations. We conclude that if PMMA is used in place of water in dosimetry, differences in the dose distributions could arise close to the edges of the field, in particular for deep seated targets.

Visualization of air and metal inhomogeneities in phantoms irradiated by carbon ion beams using prompt secondary ions.

PURPOSE: Non-invasive methods for monitoring of the therapeutic ion beam extension in the patient are desired in order to handle deteriorations of the dose distribution related to changes of the patient geometry. In carbon ion radiotherapy, secondary light ions represent one of potential sources of information about the dose distribution in the irradiated target. The capability to detect range-changing inhomogeneities inside of an otherwise homogeneous phantom, based on single track measurements, is addressed in this paper. METHODS: Air and stainless steel inhomogeneities, with PMMA equivalent thickness of 10mm and 4.8mm respectively, were inserted into a PMMA-phantom at different positions in depth. Irradiations of the phantom with therapeutic carbon ion pencil beams were performed at the Heidelberg Ion Beam Therapy Center. Tracks of single secondary ions escaping the phantom under irradiation were detected with a pixelized semiconductor detector Timepix. The statistical relevance of the found differences between the track distributions with and without inhomogeneities was evaluated. RESULTS: Measured shifts of the distal edge and changes in the fragmentation probability make the presence of inhomogeneities inserted into the traversed medium detectable for both, 10mm air cavities and 1mm thick stainless steel. Moreover, the method was shown to be sensitive also on their position in the observed body, even when localized behind the Bragg-peak. CONCLUSIONS: The presented results demonstrate experimentally, that the method using distributions of single secondary ion tracks is sensitive to the changes of homogeneity of the traversed material for the studied geometries of the target.

BrachyView: Combining LDR seed positions with transrectal ultrasound imaging in a prostate gel phantom.

PURPOSE: BrachyView is a novel in-body imaging system which aims to provide LDR brachytherapy seeds position reconstruction within the prostate in real-time. The first prototype is presented in this study: the probe consists of a gamma camera featuring three single cone pinhole collimators embedded in a tungsten tube, above three, high resolution pixelated detectors (Timepix). METHODS: The prostate was imaged with a TRUS system using a sagittal crystal with a 2.5mm slice thickness. Eleven needles containing a total of thirty 0.508U125I seeds were implanted under ultrasound guidance. A CT scan was used to localise the seed positions, as well as provide a reference when performing the image co-registration between the BrachyView coordinate system and the TRUS coordinate system. An in-house visualisation software interface was developed to provide a quantitative 3D reconstructed prostate based on the TRUS images and co-registered with the LDR seeds in situ. A rigid body image registration was performed between the BrachyView and TRUS systems, with the BrachyView and CT-derived source locations compared. RESULTS: The reconstructed seed positions determined by the BrachyView probe showed a maximum discrepancy of 1.78mm, with 75% of the seeds reconstructed within 1mm of their nominal location. An accurate co-registration between the BrachyView and TRUS coordinate system was established. CONCLUSIONS: The BrachyView system has shown its ability to reconstruct all implanted LDR seeds within a tissue equivalent prostate gel phantom, providing both anatomical and seed position information in a single interface.

Position sensitive detection of neutrons in high radiation background field.

We present the development of a high-resolution position sensitive device for detection of slow neutrons in the environment of extremely high γ and e(-) radiation background. We make use of a planar silicon pixelated (pixel size: 55 × 55 µm(2)) spectroscopic Timepix detector adapted for neutron detection utilizing very thin (10)B converter placed onto detector surface. We demonstrate that electromagnetic radiation background can be discriminated from the neutron signal utilizing the fact that each particle type produces characteristic ionization tracks in the pixelated detector. Particular tracks can be distinguished by their 2D shape (in the detector plane) and spectroscopic response using single event analysis. A Cd sheet served as thermal neutron stopper as well as intensive source of gamma rays and energetic electrons. Highly efficient discrimination was successful even at very low neutron to electromagnetic background ratio about 10(-4).

BrachyView, a novel inbody imaging system for HDR prostate brachytherapy: design and Monte Carlo feasibility study.

PURPOSE: High dose rate (HDR) brachytherapy is a form of radiation therapy for treating prostate cancer whereby a high activity radiation source is moved between predefined positions inside applicators inserted within the treatment volume. Accurate positioning of the source is essential in delivering the desired dose to the target area while avoiding radiation injury to the surrounding tissue. In this paper, HDR BrachyView, a novel inbody dosimetric imaging system for real time monitoring and verification of the radioactive seed position in HDR prostate brachytherapy treatment is introduced. The current prototype consists of a 15 × 60 mm(2) silicon pixel detector with a multipinhole tungsten collimator placed 6.5 mm above the detector. Seven identical pinholes allow full imaging coverage of the entire treatment volume. The combined pinhole and pixel sensor arrangement is geometrically designed to be able to resolve the three-dimensional location of the source. The probe may be rotated to keep the whole prostate within the transverse plane. The purpose of this paper is to demonstrate the efficacy of the design through computer simulation, and to estimate the accuracy in resolving the source position (in detector plane and in 3D space) as part of the feasibility study for the BrachyView project. METHODS: Monte Carlo simulations were performed using the GEANT4 radiation transport model, with a (192)Ir source placed in different locations within a prostate phantom. A geometrically accurate model of the detector and collimator were constructed. Simulations were conducted with a single pinhole to evaluate the pinhole design and the signal to background ratio obtained. Second, a pair of adjacent pinholes were simulated to evaluate the error in calculated source location. RESULTS: Simulation results show that accurate determination of the true source position is easily obtainable within the typical one second source dwell time. The maximum error in the estimated projection position was found to be 0.95 mm in the imaging (detector) plane, resulting in a maximum source positioning estimation error of 1.48 mm. CONCLUSIONS: HDR BrachyView is a feasible design for real-time source tracking in HDR prostate brachytherapy. It is capable of resolving the source position within a subsecond dwell time. In combination with anatomical information obtained from transrectal ultrasound imaging, HDR BrachyView adds a significant quality assurance capability to HDR brachytherapy treatment systems.

Non-invasive monitoring of therapeutic carbon ion beams in a homogeneous phantom by tracking of secondary ions.

Radiotherapy with narrow scanned carbon ion beams enables a highly accurate treatment of tumours while sparing the surrounding healthy tissue. Changes in the patient's geometry can alter the actual ion range in tissue and result in unfavourable changes in the dose distribution. Consequently, it is desired to verify the actual beam delivery within the patient. Real-time and non-invasive measurement methods are preferable. Currently, the only technically feasible method to monitor the delivered dose distribution within the patient is based on tissue activation measurements by means of positron emission tomography (PET). An alternative monitoring method based on tracking of prompt secondary ions leaving a patient irradiated with carbon ion beams has been previously suggested. It is expected to help in overcoming the limitations of the PET-based technique like physiological washout of the beam induced activity, low signal and to allow for real-time measurements. In this paper, measurements of secondary charged particle tracks around a head-sized homogeneous PMMA phantom irradiated with pencil-like carbon ion beams are presented. The investigated energies and beam widths are within the therapeutically used range. The aim of the study is to deduce properties of the primary beam from the distribution of the secondary charged particles. Experiments were performed at the Heidelberg Ion Beam Therapy Center, Germany. The directions of secondary charged particles emerging from the PMMA phantom were measured using an arrangement of two parallel pixelated silicon detectors (Timepix). The distribution of the registered particle tracks was analysed to deduce its dependence on clinically important beam parameters: beam range, width and position. Distinct dependencies of the secondary particle tracks on the properties of the primary carbon ion beam were observed. In the particular experimental set-up used, beam range differences of 1.3 mm were detectable. In addition, variations in the beam width could be measured with a precision of 0.9 mm. Furthermore, shifts of the lateral beam position could be monitored with a sub-millimetre precision. The presented investigations demonstrate experimentally that the non-invasive measurement and analysis of secondary ion distributions around head-sized homogeneous objects provide information on the actual beam delivery. Beam range, width and position could be monitored with a precision attractive for therapeutic situations.

BrachyView: proof-of-principle of a novel in-body gamma camera for low dose-rate prostate brachytherapy.

PURPOSE: The conformity of the achieved dose distribution to the treatment plan strongly correlates with the accuracy of seed implantation in a prostate brachytherapy treatment procedure. Incorrect seed placement leads to both short and long term complications, including urethral and rectal toxicity. The authors present BrachyView, a novel concept of a fast intraoperative treatment planning system, to provide real-time seed placement information based on in-body gamma camera data. BrachyView combines the high spatial resolution of a pixellated silicon detector (Medipix2) with the volumetric information acquired by a transrectal ultrasound (TRUS). The two systems will be embedded in the same probe so as to provide anatomically correct seed positions for intraoperative planning and postimplant dosimetry. Dosimetric calculations are based on the TG-43 method using the real position of the seeds. The purpose of this paper is to demonstrate the feasibility of BrachyView using the Medipix2 pixel detector and a pinhole collimator to reconstruct the real-time 3D position of low dose-rate brachytherapy seeds in a phantom. METHODS: BrachyView incorporates three Medipix2 detectors coupled to a multipinhole collimator. Three-dimensionally triangulated seed positions from multiple planar images are used to determine the seed placement in a PMMA prostate phantom in real time. MATLAB codes were used to test the reconstruction method and to optimize the device geometry. RESULTS: The results presented in this paper show a 3D position reconstruction accuracy of the seed in the range of 0.5-3 mm for a 10-60 mm seed-to-detector distance interval (Z direction), respectively. The BrachyView system also demonstrates a spatial resolution of 0.25 mm in the XY plane for sources at 10 mm distance from Medipix2 detector plane, comparable to the theoretical value calculated for an equivalent gamma camera arrangement. The authors successfully demonstrated the capability of BrachyView for real-time imaging (using a 3 s data acquisition time) of different brachytherapy seed configurations (with an activity of 0.05 U) throughout a 60 × 60 × 60 mm(3) Perspex prostate phantom. CONCLUSIONS: The newly developed miniature gamma camera component of BrachyView, with its high spatial resolution and real time capability, allows accurate 3D localization of seeds in a prostate phantom. Combination of the gamma camera with TRUS in a single probe will complete the BrachyView system.

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.