Multi-planner validation of RapidPlan knowledge-based model for volumetric modulated arc therapy in prostate cancer.

PURPOSE: To investigate the performance of a model-based optimization process for volumetric modulated arc therapy (VMAT) applied to prostate cancer patients with the multi-planner. METHODS AND MATERIALS: The 120 prostate plans for VMAT treatment were entered into the database system of the RapidPlan (RP) knowledge-based treatment planning. The treatment planning data for each plan was used to create and train the RP model. Twelve prostate cancer cases were selected and were used for planning by a manual of 12 planners based on the clinical protocol for dose constraints. Then, the treatment plans for each patient were compared with the RP model plans and analyzed with Wilcoxon tests. RESULTS: On average, the RP models can estimate comparable doses among all planner plans and clinical plans for the PTV, which Dmax , D95% , D98% , HI, and CI were used to evaluate. For the normal organ doses of the bladder, rectum, penile bulb, and femoral head, all RP model plans showed comparable or better dose sparing than all planner plans and clinical plans. Moreover, the average planning time of the RP model was faster than manual plans by about two times. The RP model can significantly reduce the variation dose of the normal organs compared with the manual plans among the planners. CONCLUSION: The automated plans of the RP model might benefit from further fine-tuning of the dose constraints of the normal organs, although both procedure plans are acceptable and fulfill the clinical protocol goals so that the RP model can enhance the efficacy and quality of plans.

Dosimetric Comparison between Single-energy Computed Tomography and Dual-energy Computed Tomography Relative to Stopping Power Estimation in Proton Therapy.

Purpose: The focus of this work was given on the relative stopping power (RSP) using the water equivalent thickness (WET) validation on tissue substitutes and real pig organs, as well as a dosimetric comparison of proton treatment plans between single-energy computed tomography (SECT) and dual-energy computed tomography (DECT)-based dose calculations. Materials and Methods: The CT calibration curve of SECT and DECT data was generated using the stoichiometric calibration method. WET measurement was performed for RSP validation using a Giraffe dosimeter (IBA dosimetry) in various substitute tissues (Gammex) and real pig tissues. The thorax (008A, CIRS) and head (731-HN, CIRS) phantoms were used to generate proton plans. The dosimetric evaluations of SECT and DECT-based plans were performed using the gamma analysis with 1%/1 mm and the dose-volume histograms (DVHs) comparison. Results: For RSP validation of substitute tissues, the largest percent WET difference between measurement and calculation was observed up to 17.9% (4 mm) in lung tissue, using SECT based. In real pig tissues, the average WET difference was 2.3% ± 2.1% and 2.5% ± 2.3% for SECT and DECT, respectively. The average gamma passed of about 92.1% for the lung and 96.8% for the head regions was reported. For the lung region, the DVH of the target dose was observed with a higher predicted dose in SECT than in DECT, while results in the head region were in good agreement for both SECT and DECT. Conclusion: The performed dosimetric comparison indicates the dose differences between SECT and DECT. The impact of the CT calibration curve is more pronounced for the thorax region.

Measurement of Ambient Dose Equivalent in Compact Proton Therapy using In-house Neutron Moderator-based Poly Allyl Diglycol Carbonate.

Purpose: The high-energy proton produces the unwanted dose contribution from the secondary neutron. The main purpose of this study is to report the validation results of in-house neutron moderator based on poly allyl diglycol carbonate (CR-39) detector, Chulalongkorn University Neutron Moderator (CUMOD) through the ambient dose equivalent, H*(10) measurement. Materials and Methods: The Particle and Heavy Ion Transport code System (PHITS) Monte Carlo code was used to simulate the neutron response function. The CUMOD was calibrated with 241AmBe source calibrator in the range of 100-1000 µSv. The variation of neutron fields was generated employing different proton treatment plans covering most of the clinical scenarios. The ambient dose equivalents, H*(10), evaluated employing CUMOD were compared to those obtained with WENDI-II dosimeter. Results: The linear relationship between CUMOD and WENDI-II responses showed an R2 value close to 1. The H*(10) per Gy delivered dose was in the range of 22-105 µSv for a 10 cm × 10 cm field. Conclusion: The in-house CUMOD neutron moderator can expand the neutron detection dose range of CR-39 detector for ambient dose equivalent. The advantage of CUMODs is its capability to evaluate H*(10) in various positions simultaneously.

Small field proton irradiation for in vivo studies: Potential and limitations when adapting clinical infrastructure.

PURPOSE: To evaluate the dosimetric accuracy for small field proton irradiation relevant for pre-clinical in vivo studies using clinical infrastructure and technology. In this context additional beam collimation and range reduction was implemented. METHODS AND MATERIALS: The clinical proton beam line employing pencil beam scanning (PBS) was adapted for the irradiation of small fields at shallow depths. Cylindrical collimators with apertures of 15, 12, 7 and 5mm as well as two different range shifter types, placed at different distances relative to the target, were tested: a bolus range shifter (BRS) attached to the collimator and a clinical nozzle mounted range shifter (CRS) placed at a distance of 72cm from the collimator. The Monte Carlo (MC) based dose calculation engine implemented in the clinical treatment planning system (TPS) was commissioned for these two additional hardware components. The study was conducted with a phantom and cylindrical target sizes between 2 and 25mm in diameter following a dosimetric end-to-end test concept. RESULTS: The setup with the CRS provided a uniform dose distribution across the target. An agreement of better than5% between the planned dose and the measurements was obtained for a target with 3mm diameter (collimator 5mm). A 2mm difference between the collimator and the target diameter (target being 2 mm smaller than the collimator) sufficed to cover the whole target with the planned dose in the setup with CRS. Using the BRS setup (target 8mm, collimator 12mm) resulted in non-homogeneous dose distributions, with a dose discrepancy of up to 10% between the planned and measured doses. CONCLUSION: The clinical proton infrastructure with adequate beam line adaptations and a state-of-the-art TPS based on MC dose calculations enables small animal irradiations with a high dosimetric precision and accuracy for target sizes down to 3mm.

Determination of Integral Depth Dose in Proton Pencil Beam Using Plane-parallel Ionization Chambers.

Purpose: This study aimed to determine the integral depth-dose curves and assess the geometric collection efficiency of different detector diameters in proton pencil beam scanning. Materials and Methods: The Varian ProBeam Compact spot scanning system was used for this study. The integral depth-dose curves with a proton energy range of 130 to 220 MeV were acquired with 2 types of Bragg peak chambers: 34070 with 8-cm diameter and 34089 with 15-cm diameter (PTW), multi-layer ionization chamber with 12-cm diameter (Giraffe, IBA Dosimetry), and PeakFinder with 8-cm diameter (PTW). To assess geometric collection efficiency, the integral depth-dose curves of 8- and 12-cm chamber diameters were compared to a 15-cm chamber diameter as the largest detector. Results: At intermediate depths of 130, 150, 190, and 220 MeV, PTW Bragg peak chamber type 34089 provided the highest integral depth-dose curves followed by IBA Giraffe, PTW Bragg peak chamber type 34070, and PTW PeakFinder. Moreover, PTW Bragg peak chamber type 34089 had increased geometric collection efficiency up to 3.8%, 6.1%, and 3.1% when compared to PTW Bragg peak chamber type 34070, PTW PeakFinder, and IBA Giraffe, respectively. Conclusion: A larger plane-parallel ionization chamber could increase the geometric collection efficiency of the detector, especially at intermediate depths and high-energy proton beams.

Dose calculation accuracy in particle therapy: Comparing carbon ions with protons.

PURPOSE: This work presents the validation of an analytical pencil beam dose calculation algorithm in a commercial treatment planning system (TPS) for carbon ions by measurements of dose distributions in heterogeneous phantom geometries. Additionally, a comparison study of carbon ions versus protons is performed considering current best solutions in commercial TPS. METHODS: All treatment plans were optimized and calculated using the RayStation TPS (RaySearch, Sweden). The dose distributions calculated with the TPS were compared with measurements using a 24-pinpoint ionization chamber array (T31015, PTW, Germany). Tissue-like inhomogeneities (bone, lung, and soft tissue) were embedded in water, while a target volume of 4 x 4 x 4 cm3 was defined at two different depths behind the heterogeneities. In total, 10 different test cases, with and without range shifter as well as different air gaps, were investigated. Dose distributions inside as well as behind the target volume were evaluated. RESULTS: Inside the target volume, the mean dose difference between calculations and measurements, averaged over all test cases, was 1.6% for carbon ions. This compares well to the final agreement of 1.5% obtained in water at the commissioning stage of the TPS for carbon ions and is also within the clinically acceptable interval of 3%. The mean dose difference and maximal dose difference obtained outside the target area were 1.8% and 13.4%, respectively. The agreement of dose distributions for carbon ions in the target volumes was comparable or better to that between Monte Carlo (MC) dose calculations and measurements for protons. Percentage dose differences of more than 10% were present outside the target area behind bone-lung structures, where the carbon ion calculations systematically over predicted the dose. MC dose calculations for protons were superior to carbon ion beams outside the target volumes. CONCLUSION: The pencil beam dose calculations for carbon ions in RayStation were found to be in good agreement with dosimetric measurements in heterogeneous geometries for points of interest located within the target. Large local discrepancies behind the target may contribute to incorrect dose predictions for organs at risk.

Experimental benchmarking of RayStation proton dose calculation algorithms inside and outside the target region in heterogeneous phantom geometries.

PURPOSE: The aim of the presented study was to complement existing literature on benchmarking proton dose by comparing dose calculations with experimental measurements in heterogeneous phantom. Points of interest inside and outside the target were considered to quantify the magnitude of calculation uncertainties in current and previous proton therapy practice that might especially have an impact on the dose in organs at risk (OARs). METHODS: The RayStation treatment planning system (RaySearch Laboratories), offering two dose calculation algorithms for pencil beam scanning in proton therapy, i.e., Pencil Beam (PB) and Monte Carlo (MC), was utilized. Treatment plans for a target located behind the interface of the heterogeneous tissues were generated. Dose measurements within and behind the target were performed in a water phantom with embedded slabs of various tissue equivalent materials and 24 PinPoint ionization chambers (PTW). In total 12 test configurations encompassing two different target depths, oblique beam incidence of 30 degrees and range shifter, were considered. RESULTS: PB and MC calculated doses agreed equally well with the measurements for all test geometries within the target, including the range shifter (mean dose differences ± 3%). Outside the target, the maximum dose difference of 9% (19%) was observed for MC (PB) for the oblique beam incidence and inserted range shifter. CONCLUSION: The accuracy of MC dose algorithm was superior compared to the PB algorithm, especially outside the target volumes. MC based dose calculation should therefore be preferred in treatment scenarios with heterogeneities, especially to reduce clinically relevant uncertainties for OARs.