Measurement of stray neutron doses inside the treatment room from a proton pencil beam scanning system.

PURPOSE: To measure the environmental doses from stray neutrons in the vicinity of a solid slab phantom as a function of beam energy, field size and modulation width, using the proton pencil beam scanning (PBS) technique. METHOD: Measurements were carried out using two extended range WENDI-II rem-counters and three tissue equivalent proportional counters. Detectors were suitably placed at different distances around the RW3 slab phantom. Beam irradiation parameters were varied to cover the clinical ranges of proton beam energies (100-220MeV), field sizes ((2×2)-(20×20)cm2) and modulation widths (0-15cm). RESULTS: For pristine proton peak irradiations, large variations of neutron H∗(10)/D were observed with changes in beam energy and field size, while these were less dependent on modulation widths. H∗(10)/D for pristine proton pencil beams varied between 0.04µSvGy-1 at beam energy 100MeV and a (2×2)cm2 field at 2.25m distance and 90° angle with respect to the beam axis, and 72.3µSvGy-1 at beam energy 200MeV and a (20×20) cm2 field at 1m distance along the beam axis. CONCLUSIONS: The obtained results will be useful in benchmarking Monte Carlo calculations of proton radiotherapy in PBS mode and in estimating the exposure to stray radiation of the patient. Such estimates may be facilitated by the obtained best-fitted simple analytical formulae relating the stray neutron doses at points of interest with beam irradiation parameters.

A numerical method to optimise the spatial dose distribution in carbon ion radiotherapy planning.

The authors describe a numerical algorithm to optimise the entrance spectra of a composition of pristine carbon ion beams which delivers a pre-assumed dose-depth profile over a given depth range within the spread-out Bragg peak. The physical beam transport model is based on tabularised data generated using the SHIELD-HIT10A Monte-Carlo code. Depth-dose profile optimisation is achieved by minimising the deviation from the pre-assumed profile evaluated on a regular grid of points over a given depth range. This multi-dimensional minimisation problem is solved using the L-BFGS-B algorithm, with parallel processing support. Another multi-dimensional interpolation algorithm is used to calculate at given beam depths the cumulative energy-fluence spectra for primary and secondary ions in the optimised beam composition. Knowledge of such energy-fluence spectra for each ion is required by the mixed-field calculation of Katz's cellular Track Structure Theory (TST) that predicts the resulting depth-survival profile. The optimisation algorithm and the TST mixed-field calculation are essential tools in the development of a one-dimensional kernel of a carbon ion therapy planning system. All codes used in the work are generally accessible within the libamtrack open source platform.

Proton microbeam radiotherapy with scanned pencil-beams--Monte Carlo simulations.

Irradiation, delivered by a synchrotron facility, using a set of highly collimated, narrow and parallel photon beams spaced by 1 mm or less, has been termed Microbeam Radiation Therapy (MRT). The tolerance of healthy tissue after MRT was found to be better than after standard broad X-ray beams, together with a more pronounced response of malignant tissue. The microbeam spacing and transverse peak-to-valley dose ratio (PVDR) are considered to be relevant biological MRT parameters. We investigated the MRT concept for proton microbeams, where we expected different depth-dose profiles and PVDR dependences, resulting in skin sparing and homogeneous dose distributions at larger beam depths, due to differences between interactions of proton and photon beams in tissue. Using the FLUKA Monte Carlo code we simulated PVDR distributions for differently spaced 0.1 mm (sigma) pencil-beams of entrance energies 60, 80, 100 and 120 MeV irradiating a cylindrical water phantom with and without a bone layer, representing human head. We calculated PVDR distributions and evaluated uniformity of target irradiation at distal beam ranges of 60-120 MeV microbeams. We also calculated PVDR distributions for a 60 MeV spread-out Bragg peak microbeam configuration. Application of optimised proton MRT in terms of spot size, pencil-beam distribution, entrance beam energy, multiport irradiation, combined with relevant radiobiological investigations, could pave the way for hypofractionation scenarios where tissue sparing at the entrance, better malignant tissue response and better dose conformity of target volume irradiation could be achieved, compared with present proton beam radiotherapy configurations.

The principles of Katz's cellular track structure radiobiological model.

The cellular track structure theory (TST), introduced by Katz in 1968, applies the concept of action cross section as the probability of targets in the radiation detector being activated to elicit the observed endpoint (e.g. cell killing). The ion beam radiation field is specified by the charge Z, speed ß (or energy), fluence and linear energy transfer (LET) of the ion, rather than by its total absorbed dose or dose-averaged LET. The detector is represented by radiosensitive elements of size a0 and radiosensitivity D0, its gamma-ray response being represented by c-hit or multi-target expressions rather than by the linear-quadratic formula. Key to TST is the Dδ(r) formula describing the radial distribution of delta-ray dose (RDD) around the ion path. This formula, when folded with the dose response of the detector and radially integrated, yields the 'point target' action cross section value, σPT. The averaged value of the cross section, σ, is obtained by radially integrating the a0-averaged RDD. In the 'track width' regime which may occur at the distal end of the ion's path, the value of σ may considerably exceed its geometrical value, [Formula: see text]. Several scaling principles are applied in TST, resulting in its simple analytic formulation. Multi-target detectors, such as cells, are represented in TST by m, D0, σ0 (the 'saturation value' of the cross section which replaces a0) and κ (a 'detector saturation index'), as the fourth model parameter. With increasing LET of the ion, the two-component formulation of TST allows for successive transition from shouldered survival curves at low LET values to exponential ones at radiobiological effectiveness (RBE) maximum, followed by 'thindown' at the end of the ion track. For a given cell line, having best-fitted the four model parameters (m, D0, σ0 and κ) to an available data set of measured survival curves, TST is able to quantitatively predict cell survival and RBE for this cell line after any other ion irradiation.

A TPS kernel for calculating survival vs. depth: distributions in a carbon radiotherapy beam, based on Katz's cellular Track Structure Theory.

An algorithm was developed of a treatment planning system (TPS) kernel for carbon radiotherapy in which Katz's Track Structure Theory of cellular survival (TST) is applied as its radiobiology component. The physical beam model is based on available tabularised data, prepared by Monte Carlo simulations of a set of pristine carbon beams of different input energies. An optimisation tool developed for this purpose is used to find the composition of pristine carbon beams of input energies and fluences which delivers a pre-selected depth-dose distribution profile over the spread-out Bragg peak (SOBP) region. Using an extrapolation algorithm, energy-fluence spectra of the primary carbon ions and of all their secondary fragments are obtained over regular steps of beam depths. To obtain survival vs. depth distributions, the TST calculation is applied to the energy-fluence spectra of the mixed field of primary ions and of their secondary products at the given beam depths. Katz's TST offers a unique analytical and quantitative prediction of cell survival in such mixed ion fields. By optimising the pristine beam composition to a published depth-dose profile over the SOBP region of a carbon beam and using TST model parameters representing the survival of CHO (Chinese Hamster Ovary) cells in vitro, it was possible to satisfactorily reproduce a published data set of CHO cell survival vs. depth measurements after carbon ion irradiation. The authors also show by a TST calculation that 'biological dose' is neither linear nor additive.

Performance of two commercial electron beam algorithms over regions close to the lung-mediastinum interface, against Monte Carlo simulation and point dosimetry in virtual and anthropomorphic phantoms.

Electron radiotherapy is applied to treat the chest wall close to the mediastinum. The performance of the GGPB and eMC algorithms implemented in the Varian Eclipse treatment planning system (TPS) was studied in this region for 9 and 16 MeV beams, against Monte Carlo (MC) simulations, point dosimetry in a water phantom and dose distributions calculated in virtual phantoms. For the 16 MeV beam, the accuracy of these algorithms was also compared over the lung-mediastinum interface region of an anthropomorphic phantom, against MC calculations and thermoluminescence dosimetry (TLD). In the phantom with a lung-equivalent slab the results were generally congruent, the eMC results for the 9 MeV beam slightly overestimating the lung dose, and the GGPB results for the 16 MeV beam underestimating the lung dose. Over the lung-mediastinum interface, for 9 and 16 MeV beams, the GGPB code underestimated the lung dose and overestimated the dose in water close to the lung, compared to the congruent eMC and MC results. In the anthropomorphic phantom, results of TLD measurements and MC and eMC calculations agreed, while the GGPB code underestimated the lung dose. Good agreement between TLD measurements and MC calculations attests to the accuracy of "full" MC simulations as a reference for benchmarking TPS codes. Application of the GGPB code in chest wall radiotherapy may result in significant underestimation of the lung dose and overestimation of dose to the mediastinum, affecting plan optimization over volumes close to the lung-mediastinum interface, such as the lung or heart.

The application of amorphous track models to study cell survival in heavy ions beams.

In a study of amorphous track models, in the local effect model (LEM), the Kellerer algorithm was used, which folds radial dose distributions from different ion tracks. In representative set of 10 experimental cell survival curves of normal human skin fibroblast cells irradiated with carbon ions, the method that applies the Kellerer algorithm was found to be more accurate and 10(4) times faster than the usual Monte Carlo summation method based on a regular grid.

Two-dimensional dosimetry of radiotherapeutical proton beams using thermoluminescence foils.

In modern radiation therapy such as intensity modulated radiation therapy or proton therapy, one is able to cover the target volume with improved dose conformation and to spare surrounding tissue with help of modern measurement techniques. Novel thermoluminescence dosimetry (TLD) foils, developed from the hot-pressed mixture of LiF:Mg,Cu,P (MCP TL) powder and ethylene-tetrafluoroethylene (ETFE) copolymer, have been applied for 2-D dosimetry of radiotherapeutical proton beams at INFN Catania and IFJ Krakow. A TLD reader with 70 mm heating plate and CCD camera was used to read the 2-D emission pattern of irradiated foils. The absorbed dose profiles were evaluated, taking into account correction factors specific for TLD such as dose and energy response. TLD foils were applied for measuring of dose distributions within an eye phantom and compared with predictions obtained from the MCNPX code and Eclipse Ocular Proton Planning (Varian Medical Systems) clinical radiotherapy planning system. We demonstrate the possibility of measuring 2-D dose distributions with point resolution of about 0.5 x 0.5 mm(2).

Radon survey in the high natural radiation region of Niska Banja, Serbia.

A radon survey has been carried out around the town of Niska Banja (Serbia) in a region partly located over travertine formations, showing an enhanced level of natural radioactivity. Outdoor and indoor radon concentrations were measured seasonally over the whole year, using CR-39 diffusion type radon detectors. Outdoor measurements were performed at 56 points distributed over both travertine and alluvium sediment formations. Indoor radon concentrations were measured in 102 living rooms and bedrooms of 65 family houses. In about 50% of all measurement sites, radon concentration was measured over each season separately, making it possible to estimate seasonal variations, which were then used to correct values measured over different periods, and to estimate annual values. The average annual indoor radon concentration was estimated at over 1500 Bq/m3 and at about 650 Bq/m3 in parts of Niska Banja located over travertine and alluvium sediment formations, respectively, with maximum values exceeding 6000 Bq/m3. The average value of outdoor annual radon concentration was 57 Bq/m3, with a maximum value of 168 Bq/m3. The high values of indoor and outdoor radon concentrations found at Niska Banja make this region a high natural background radiation area. Statistical analysis of our data confirms that the level of indoor radon concentration depends primarily on the underlying soil and building characteristics.

Evidence of low-dose hyper-radiosensitivity in normal cells of cervix cancer patients?

The aim of the present study was to examine the low-dose radiation response of human normal cells using the micronucleus assay. Skin fibroblasts and keratinocytes derived from 40 cervix cancer patients were studied. After in vitro gamma irradiation with single doses ranging from 0.05 to 4 Gy, the fraction of binucleated cells with micronuclei was assessed. For each patient, the Linear-Quadratic (LQ) model and the Induced-Repair (IR) model were fitted over the whole data set (0.05-4 Gy). In conclusion, the present study showed some evidence of low-dose hypersensitivity in the fibroblasts of two patients and in the keratinocytes of four of the forty patients studied.

A simple track structure model of ion beam radiotherapy.

A simple radiotherapy ion beam calculation based on the cellular track structure model, using in vitro cell survival parameters fitted from recent experimental data, is presented. The calculation represents a single-fraction ion exposure (roughly corresponding to a 2 Gy fraction of megavolt X rays) and exploits concepts used in clinical radiotherapy, such as entrance, or 'skin' ion dose. The depth distribution of cells surviving their irradiation by a beam of 385 MeV amu(-1) carbon ions is calculated over the range of the stopping ions, as a sequence of track-segments, in the continuous slowing-down approximation. An interpretation of the 'clinical relative biological effectiveness' concept is suggested.

New 2-D dosimetric technique for radiotherapy based on planar thermoluminescent detectors.

At the Institute of Nuclear Physics of the Polish Academy of Sciences (IFJ) in Kraków, a two-dimensional (2-D) thermoluminescence (TL) dosimetry system was developed within the MAESTRO (Methods and Advanced Equipment for Simulation and Treatment in Radio-Oncology) 6 Framework Programme and tested by evaluating 2-D dose distributions around radioactive sources. A thermoluminescent detector (TLD) foil was developed, of thickness 0.3 mm and diameter 60 mm, containing a mixture of highly sensitive LiF:Mg,Cu,P powder and Ethylene TetraFluoroEthylene (ETFE) polymer. Foil detectors were irradiated with (226)Ra brachytherapy sources and a (90)Sr/(90)Y source. 2-D dose distributions were evaluated using a prototype planar (diameter 60 mm) reader, equipped with a 12 bit Charge Coupled Devices (CCD) PCO AG camera, with a resolution of 640 x 480 pixels. The new detectors, showing a spatial resolution better than 0.5 mm and a measurable dose range typical for radiotherapy, can find many applications in clinical dosimetry. Another technology applicable to clinical dosimetry, also developed at IFJ, is the Si microstrip detector of size 95 x 95 mm(2), which may be used to evaluate the dose distribution with a spatial resolution of 120 microm along one direction, in real-time mode. The microstrip and TLD technology will be further improved, especially to develop detectors of larger area, and to make them applicable to some advanced radiotherapy modalities, such as intensity modulated radiotherapy (IMRT) or proton radiotherapy.

Two-dimensional thermoluminescence dosimetry using planar detectors and a TL reader with CCD camera readout.

A novel method of determining two-dimensional (2-D) dose distributions is presented, using in-house developed, large-area (a few cm(2)) thermoluminescent (TL) detectors based on LiF powder plated on Al foil. An in-house developed planar large-area TL reader equipped with a coupled charge device (CCD) camera is used for readout, providing digital images of 2-D dose distributions on the surface of these large-area TL detectors. The capability of the newly developed system is demonstrated by mapping 2-D dose distributions around a brachytherapy source, at dose ranges and source geometries relevant for clinical radiotherapy. Examples of local and dynamic evaluation of TL output from conventional TL detectors are also shown.

A TL-based anthropomorphic benchmark for verifying 3-D dose distributions from external electron beams calculated by radiotherapy treatment planning systems.

Initial results are reported of a Polish-Finnish project to verify electron dose distributions calculated by treatment planning systems (TPSs), CadPlan v.6.3.2 and Theraplan v.3.5, which use different electron beam dose distribution algorithms. Treatment of gross tumour volumes representing lung and parotid cancer was simulated in an Alderson anthropomorphic phantom with thermoluminescent detectors (TLDs) (Li(2)B(4)O(7):Mn,Si) placed at selected measurement points inside its volume. The observed discrepancy between relative values of dose calculated and measured by TLDs at each of the measurement points and those calculated by the different TPSs at the same points is discussed.

On the relationship between dose-, energy- and LET-response of thermoluminescent detectors.

Measurements of the response of thermoluminescent (TL) detectors after gamma ray doses high enough to observe signal saturation provide input to microdosimetric models which relate this gamma-ray response with the energy response after low doses of photons (gamma rays and low-energy X rays) and after high-LET irradiation. To measure their gamma ray response up to saturation, LiF:Mg,Ti (MTS-7 and MTT), LiF:Mg,Cu,P (MCP-7), CaSO4:Dy (KCD) and Al2O3:C detectors were irradiated with 60Co gamma rays over the range 1-5000 Gy. The X-ray photon energy response and TL efficiency (relative to gamma rays) after doses of beta rays and alpha particles, were also measured, for CaSO4:Dy and for Al2O3:C. Microdosimetric and track structure modelling was then applied to the experimental data. In a manner similar to LiF:Mg,Cu,P, the experimentally observed under response of alpha-Al2O3:C to X rays <100 keV, compared with cross-section calculations, is explained as a microdosimetric effect caused by the saturation of response of this detector without prior supralinearity (saturation of traps along the tracks). The enhanced X-ray photon energy response of CaSO4:Dy is related to the supralinearity observed in this material after high gamma ray doses, similarly to that in LiF:Mg,Ti. The discussed model approaches support the general rule relating dose-, energy- and ionisation density-responses in TL detectors: if their gamma ray response is sublinear prior to saturation, the measured photon energy response is lower, and if it is supralinear, it may be higher than that expected from the calculation of the interaction cross sections alone. Since similar rules have been found to apply to other solid-state detector systems, microdosimetry may offer a valuable contribution to solid-state dosimetry even prior to mechanistic explanations of physical phenomena in different TL detectors.

Microdosimetric modelling of the response of thermoluminescence detectors to low- and high-LET ionising radiation.

The microdosimetric one hit detector model was applied to calculate the dose response, energy response and relative thermoluminescence (TL) efficiency, eta, of high sensitive LiF:Mg,Cu,P and Al(2)O(3):C detectors after their irradiations by X rays, gamma rays, beta electrons and heavy charged particles (HCP). Microdosimetric distributions in 60 nm targets for photons and beta rays were calculated using the TRION MC track structure code, for HCP using the analytical model of Xapsos with modified transport of secondary electrons and the model of Olko & Booz. The calculated values of eta compare favourably with a broad spectrum of experimental data, including ICHIBAN experiments with HCP. The model offers a method for calculating the thermoluminescence response of TL foils applied to 2-D dosimetry of radiotherapeutic proton beams.

Cellular parameters for track structure modeling of radiation hazard in space.

Based on irradiation with 45 MeV/u N and B ions and with Co-60 gamma rays, cellular parameters of Katz's track structure model have been fitted for the survival of V79-379A Chinese hamster lung fibroblasts. Cellular parameters representing neoplastic transformations in C3H10T/1/2 cells after their irradiation with heavy ion beams, taken from earlier work, were also used to model the radiation hazard in deep space, following the system for evaluating, summing and reporting occupational exposures proposed in 1967 by a subcommittee of NCRP. We have performed model calculations of the number of transformations in surviving cells, after a given fluence of heavy charged particles of initial energy 500 MeV/u, penetrating thick layers of cells. We take the product of cell transformation and survival probabilities, calculated along the path lengths of charged particles using cellular survival and transformation parameters, to represent a quantity proportional to the "radiation risk factor" discussed in the NCRP document. The "synergistic" effect of simultaneous charged particle transfers is accounted for by the "track overlap" mode inherent in the model of Katz.

Miniature thermoluminescent detectors for dosimetry in radiotherapy.

At the Institute of Nuclear Physics in Kraków (INP), in collaboration with the Centre of Oncology in Kraków, several types of miniature thermoluminescent LiF:Mg,Ti and LiF:Mg,Cu,P detectors specially designed for clinical dosimetry in radiotherapy have been developed. The detectors are manufactured in the form of solid pellets of diameter down to 1 mm and typical thickness 0.5 mm, in the form of rods with a diameter of 0.5 mm and a length of a few mm, and as two-layer detectors with a thin (in the range of 0.065 mm) active layer of high-sensitive LiF:Mg,Cu,P. All three types of newly developed detectors have already been applied in proton beam dosimetry, surface dosimetry of eye-plaque brachytherapy applicators, phantom dosimetry for vascular brachytherapy and in vivo dosimetry in interstitial brachytherapy. These detectors were found to be very useful for dose measurements in high dose gradients, where spatial resolution better than 1 mm is required.

Validation of a radiotherapy treatment planning system using an anthropomorphic phantom and MTS-N thermoluminescent detectors.

A treatment planning system (TPS) was validated in conditions of simulated radiotherapy (RT) of an anthropomorphic tissue-equivalent phantom. Individually calibrated solid MTS-N (LiF:Mg,Ti) detectors were placed within the treatment volume in this phantom which was then repeatedly irradiated by external 60Co or 6 MV X ray beams. On the basis of TLD-measured depth-dose curves for the two beams, the relative accuracy of determining dose (of the order of 1 Gy) at live depths in a water phantom is about 0.4-0.6%. In the volume of interest representing the target volume, the relative standard difference between the calculated and measured dose values ranged between 1.3% and 2.2% for the 60Co and 6 MV X ray beams, respectively. The TPS-calculated uniformity of irradiation of that volume is within 1%. While fraction-to-fraction repeatability was within 1-2%, systematic underexposure around the reference point, by 2-3%, was found in two consecutive exposures by sets of both beams.

CVD diamonds as thermoluminescent detectors for medical applications.

Diamond is believed to be a promising material for medical dosimetry due to its tissue equivalence, mechanical and radiation hardness, and lack of solubility in water or in disinfecting agents. A number of diamond samples, obtained under different growth conditions at Limburg University, using the chemical vapour deposition (CVD) technique, was tested as thermoluminescence dosemeters. Their TL glow curve, TL response after doses of gamma rays, fading, and so on were studied at dose levels and for radiation modalities typical for radiotherapy. The investigated CVD diamonds displayed sensitivity comparable with that of MTS-N (Li:Mg,Ti) detectors, signal stability (reproducibility after several readouts) below 10% (1 SD) and no fading was found four days after irradiation. A dedicated CVD diamond plate was grown, cut into 20 detector chips (3 x 3 x 0.5 mm) and used for measuring the dose-depth distribution at different depths in a water phantom, for 60Co and six MV X ray radiotherapy beams. Due to the sensitivity of diamond to ambient light, it was difficult to achieve reproducibility comparable with that of standard LiF detectors.