A simplified methodology to produce Monte Carlo dose distributions in proton therapy.
ABSTRACT: The purpose of this study was to develop a simplified methodology that will produce Monte Carlo (MC) dose distribution for proton therapy which can be used as a clinical aid in determining the adequacy of proton plans produced from the treatment planning system (TPS). The Geant4 Monte Carlo toolkit was used for all simulations. The geometry of the double scatter nozzle in the simulation was a simplification of the treatment nozzle. The proton source was modeled as discrete energy layers, each with a unique energy distribution and weighting factor. The simplified MC system was designed to give the same dose distribution as the measured data used to commission the TPS. After the simplified MC system was finalized, a series of verification comparisons were made between it, measurements, and the clinically used TPS. Comparisons included the lateral profile of a stair-shaped compensator that simulated a sharp lateral heterogeneity and depth-dose measurements through heterogeneous materials. The simplified MC system matched measurements to within 2% or 2 mm for all commissioning data under investigation; moreover, the distal edge and lateral penumbra was within 1 mm of the measurements. The simplified MC system was able to better reproduce the measured profiles for a stair-shaped compensator than the TPS. Both MC and TPS matched the measured depth dose through heterogeneous materials to within 2% or 2 mm. The simplified MC system was straightforward to implement, and produced accurate results when compared to measurements. Therefore, it holds promise as a clinically useful methodology to validate the relative dose distribution of patient treatment plans produced by the treatment planning systems.
Project description:To quantify the accuracy of a clinical proton treatment planning system (TPS) as well as Monte Carlo (MC)-based dose calculation through measurements and to assess the clinical impact in a cohort of patients with tumors located in the lung.A lung phantom and ion chamber array were used to measure the dose to a plane through a tumor embedded in the lung, and to determine the distal fall-off of the proton beam. Results were compared with TPS and MC calculations. Dose distributions in 19 patients (54 fields total) were simulated using MC and compared to the TPS algorithm.MC increased dose calculation accuracy in lung tissue compared with the TPS and reproduced dose measurements in the target to within ±2%. The average difference between measured and predicted dose in a plane through the center of the target was 5.6% for the TPS and 1.6% for MC. MC recalculations in patients showed a mean dose to the clinical target volume on average 3.4% lower than the TPS, exceeding 5% for small fields. For large tumors, MC also predicted consistently higher V5 and V10 to the normal lung, because of a wider lateral penumbra, which was also observed experimentally. Critical structures located distal to the target could show large deviations, although this effect was highly patient specific. Range measurements showed that MC can reduce range uncertainty by a factor of ~2: the average (maximum) difference to the measured range was 3.9 mm (7.5 mm) for MC and 7 mm (17 mm) for the TPS in lung tissue.Integration of Monte Carlo dose calculation techniques into the clinic would improve treatment quality in proton therapy for lung cancer by avoiding systematic overestimation of target dose and underestimation of dose to normal lung. In addition, the ability to confidently reduce range margins would benefit all patients by potentially lowering toxicity.
Project description:The objective of this study is to validate the capabilities of a cylindrical diode array system for volumetric-modulated arc therapy (VMAT) treatment quality assurance (QA). The VMAT plans were generated by the Eclipse treatment planning system (TPS) with the analytical anisotropic algorithm (AAA) for dose calculation. An in-house Monte Carlo (MC) code was utilized as a validation tool for the TPS calculations and the ArcCHECK measurements. The megavoltage computed tomography (MVCT) of the ArcCHECK system was adopted for the geometry reconstruction in the TPS and for MC simulations. A 10 × 10 cm2 open field validation was performed for both the 6 and 10 MV photon beams to validate the absolute dose calibration of the ArcCHECK system and also the TPS dose calculations for this system. The impact of the angular dependency on noncoplanar deliveries was investigated with a series of 10 × 10 cm2 fields delivered with couch rotation 0° to 40°. The sensitivity of detecting the translational (1 to 10 mm) and the rotational (1° to 3°) misalignments was tested with a breast VMAT case. Ten VMAT plans (six prostate, H&N, pelvis, liver, and breast) were investigated to evaluate the agreement of the target dose and the peripheral dose among ArcCHECK measurements, and TPS and MC dose calculations. A customized acrylic plug holding an ion chamber was used to measure the dose at the center of the ArcCHECK phantom. Both the entrance and the exit doses measured by the ArcCHECK system with and without the plug agreed with the MC simulation to 1.0%. The TPS dose calculation with a 2.5 mm grid overestimated the exit dose by up to 7.2% when the plug was removed. The agreement between the MC and TPS calculations for the ArcCHECK without the plug improved significantly when a 1 mm dose calculation grid was used in the TPS. The noncoplanar delivery test demonstrated that the angular dependency has limited impact on the gamma passing rate (< 1.2% drop) for the 2%-3% dose and 2mm-3 mm DTA criteria. A 1° rotational misalignment introduces 11.3% (3%/3mm) to 21.3% (1%/1 mm) and 0.2% (3%/3 mm) to 0.8% (1%/1 mm) Gamma passing rate drop for ArcCHECK system and MatriXX system, respectively. Both systems have comparable sensitivity to the AP misalignments. However, a 2 mm RL misalignment introduces gamma passing rate drop ranging from 0.9% (3%/3 mm) to 4.0% (1%/1 mm) and 5.0% (3%/3 mm) to 12.0% (1%/1 mm) for ArcCHECK and MatriXX measurements, respectively. For VMAT plan QA, the gamma analysis passing rates ranged from 96.1% (H&N case) to 99.9% (prostate case), when using the 3%/3 mm DTA criteria for the peripheral dose validation between the TPS and ArcCHCEK measurements. The peripheral dose validation between the MC simulation and ArcCHECK measurements showed at least 97.9% gamma passing rates. The central dose validation also showed an agreement within 2.2% between TPS/MC calculations and ArcCHECK measurements. The worst discrepancy was found in the H&N case, which is the most complex VMAT case. The ArcCHECK system is suitable for VMAT QA evaluation based on the sensitivity to detecting misalignments, the clinical impact of the angular dependency, and the correlation between the dose agreements in the peripheral region and the central region. This work also demonstrated the importance of carrying out a thorough validation of both the TPS and the dosimetry system prior to utilizing it for QA, and the value of having an independent dose calculation tool, such as the MC method, in clinical practice.
Project description:In this study, we evaluated the performance of a three-dimensional (3D) dose verification system, COMPASS version 3, which has a dedicated beam models and dose calculation engine. It was possible to reconstruct the 3D dose distributions in patient anatomy based on the measured fluence using the MatriXX 2D array. The COMPASS system was compared with Monte Carlo simulation (MC), glass rod dosimeter (GRD), and 3DVH, using an anthropomorphic phantom for intensity-modulated radiation therapy (IMRT) dose verification in clinical neck cases. The GRD measurements agreed with the MC within 5% at most measurement points. In addition, most points for COMPASS and 3DVH also agreed with the MC within 5%. The COMPASS system showed better results than 3DVH for dose profiles due to individual adjustments, such as beam modeling for each linac. Regarding the dose-volume histograms, there were no large differences between MC, analytical anisotropic algorithm (AAA) in Eclipse treatment planning system (TPS), 3DVH, and the COMPASS system. However, AAA underestimated the dose to the clinical target volume and Rt-Parotid slightly. This is because AAA has some problems with dose calculation accuracy. Our results indicated that the COMPASS system offers highly accurate 3D dose calculation for clinical IMRT quality assurance. Also, the COMPASS system will be useful as a commissioning tool in routine clinical practice for TPS.
Project description:In particle radiotherapy, range uncertainty is an important issue that needs to be overcome. Because high-dose conformality can be achieved using a particle beam, a small uncertainty can affect tumor control or cause normal-tissue complications. From this perspective, the treatment planning system (TPS) must be accurate. However, there is a well-known inaccuracy regarding dose computation in heterogeneous media. This means that verifying the uncertainty level is one of the prerequisites for TPS commissioning. We evaluated the range accuracy of the dose computation algorithm implemented in a commercial TPS, and Monte Carlo (MC) simulation against measurement using a CT calibration phantom. A treatment plan was produced for eight different materials plugged into a phantom, and two-dimensional doses were measured using a chamber array. The measurement setup and beam delivery were simulated by MC code. For an infinite solid water phantom, the gamma passing rate between the measurement and TPS was 97.7%, and that between the measurement and MC was 96.5%. However, gamma passing rates between the measurement and TPS were 49.4% for the lung and 67.8% for bone, and between the measurement and MC were 85.6% for the lung and 100.0% for bone tissue. For adipose, breast, brain, liver, and bone mineral, the gamma passing rates computed by TPS were 91.7%, 90.6%, 81.7%, 85.6%, and 85.6%, respectively. The gamma passing rates for MC for adipose, breast, brain, liver, and bone mineral were 100.0%, 97.2%, 95.0%, 98.9%, and 97.8%, respectively. In conclusion, the described procedure successfully evaluated the allowable range uncertainty for TPS commissioning. The TPS dose calculation is inefficient in heterogeneous media with large differences in density, such as lung or bone tissue. Therefore, the limitations of TPS in heterogeneous media should be understood and applied in clinical practice.
Project description:Detailed Monte Carlo (MC) modeling of the Leksell Gamma Knife (GK) Perfexion (PFX) collimator system is the only accurate ab initio approach appearing in the literature. As a different approach, in this work, we present a MC model based on film measurement. By adjusting the model parameters and fine-tuning the derived fluence map for each individual source to match the manufacturer's ring output factors, we created a reasonable virtual source model for MC simulations to verify treatment planning dose for the GK PFX radiosurgery system. The MC simulation model was commissioned by simple single shots. Dose profiles and both ring and collimator output factors were compared with the treatment planning system (TPS). Good agreement was achieved for dose profiles especially for the region of plateau (< 2%), while larger difference (< 5%) came from the penumbra region. The maximum difference of the calculated output factor was within 0.7%. The model was further validated by a clinical test case. Good agreement was obtained. The DVHs for brainstem and the skull were almost identical and, for the target, the volume covered by the prescription (12.5 Gy to 50% isodose line) was 95.6% from MC calculation versus 100% from the TPS.
Project description:Entrance and exit doses are commonly measured in in vivo dosimetry for comparison with expected values, usually generated by the treatment planning system (TPS), to verify accuracy of treatment delivery. This report aims to evaluate the accuracy of six TPS algorithms in computing entrance and exit doses for a 6 MV beam. The algorithms tested were: pencil beam convolution (Eclipse PBC), analytical anisotropic algorithm (Eclipse AAA), AcurosXB (Eclipse AXB), FFT convolution (XiO Convolution), multigrid superposition (XiO Superposition), and Monte Carlo photon (Monaco MC). Measurements with ionization chamber (IC) and diode detector in water phantoms were used as a reference. Comparisons were done in terms of central axis point dose, 1D relative profiles, and 2D absolute gamma analysis. Entrance doses computed by all TPS algorithms agreed to within 2% of the measured values. Exit doses computed by XiO Convolution, XiO Superposition, Eclipse AXB, and Monaco MC agreed with the IC measured doses to within 2%-3%. Meanwhile, Eclipse PBC and Eclipse AAA computed exit doses were higher than the IC measured doses by up to 5.3% and 4.8%, respectively. Both algorithms assume that full backscatter exists even at the exit level, leading to an overestimation of exit doses. Despite good agreements at the central axis for Eclipse AXB and Monaco MC, 1D relative comparisons showed profiles mismatched at depths beyond 11.5 cm. Overall, the 2D absolute gamma (3%/3 mm) pass rates were better for Monaco MC, while Eclipse AXB failed mostly at the outer 20% of the field area. The findings of this study serve as a useful baseline for the implementation of entrance and exit in vivo dosimetry in clinical departments utilizing any of these six common TPS algorithms for reference comparison.
Project description:The purpose of this work was to develop an end-to-end patient-specific quality assurance (QA) technique for spot-scanned proton therapy that is more sensitive and efficient than traditional approaches. The patient-specific methodology relies on independently verifying the accuracy of the delivered proton fluence and the dose calculation in the heterogeneous patient volume. A Monte Carlo dose calculation engine, which was developed in-house, recalculates a planned dose distribution on the patient CT data set to verify the dose distribution represented by the treatment planning system. The plan is then delivered in a pre-treatment setting and logs of spot position and dose monitors, which are integrated into the treatment nozzle, are recorded. A computational routine compares the delivery log to the DICOM spot map used by the Monte Carlo calculation to ensure that the delivered parameters at the machine match the calculated plan. Measurements of dose planes using independent detector arrays, which historically are the standard approach to patient-specific QA, are not performed for every patient. The nozzle-integrated detectors are rigorously validated using independent detectors in regular QA intervals. The measured data are compared to the expected delivery patterns. The dose monitor reading deviations are reported in a histogram, while the spot position discrepancies are plotted vs. spot number to facilitate independent analysis of both random and systematic deviations. Action thresholds are linked to accuracy of the commissioned delivery system. Even when plan delivery is acceptable, the Monte Carlo second check system has identified dose calculation issues which would not have been illuminated using traditional, phantom-based measurement techniques. The efficiency and sensitivity of our patient-specific QA program has been improved by implementing a procedure which independently verifies patient dose calculation accuracy and plan delivery fidelity. Such an approach to QA requires holistic integration and maintenance of patient-specific and patient-independent QA.
Project description:Dosimetric quality assurance (QA) of the new Elekta Unity (MR-linac) will differ from the QA performed of a conventional linac due to the constant magnetic field, which creates an electron return effect (ERE). In this work we aim to validate PRESAGE® dosimetry in a transverse magnetic field, and assess its use to validate the research version of the Monaco TPS of the MR-linac. Cylindrical samples of PRESAGE® 3D dosimeter separated by an air gap were irradiated with a cobalt-60 unit, while placed between the poles of an electromagnet at 0.5 T and 1.5 T. This set-up was simulated in EGSnrc/Cavity Monte Carlo (MC) code and relative dose distributions were compared with measurements using 1D and 2D gamma criteria of 3% and 1.5 mm. The irradiation conditions were adapted for the MR-linac and compared with Monaco TPS simulations. Measured and EGSnrc/Cavity simulated profiles showed good agreement with a gamma passing rate of 99.9% for 0.5 T and 99.8% for 1.5 T. Measurements on the MR-linac also compared well with Monaco TPS simulations, with a gamma passing rate of 98.4% at 1.5 T. Results demonstrated that PRESAGE® can accurately measure dose and detect the ERE, encouraging its use as a QA tool to validate the Monaco TPS of the MR-linac for clinically relevant dose distributions at tissue-air boundaries.
Project description:This work describes a patient-specific dosimetry quality assurance (QA) program for intensity modulated radiation therapy (IMRT) using ViewRay, the first commercial magnetic resonance imaging-guided RT device.The program consisted of: (1) a 1-dimensional multipoint ionization chamber measurement using a customized 15-cm(3) cube-shaped phantom; (2) 2-dimensional (2D) radiographic film measurement using a 30- × 30- × 20-cm(3) phantom with multiple inserted ionization chambers; (3) quasi-3D diode array (ArcCHECK) measurement with a centrally inserted ionization chamber; (4) 2D fluence verification using machine delivery log files; and (5) 3D Monte Carlo (MC) dose reconstruction with machine delivery files and phantom CT.Ionization chamber measurements agreed well with treatment planning system (TPS)-computed doses in all phantom geometries where the mean ± SD difference was 0.0% ± 1.3% (n=102; range, -3.0%-2.9%). Film measurements also showed excellent agreement with the TPS-computed 2D dose distributions where the mean passing rate using 3% relative/3 mm gamma criteria was 94.6% ± 3.4% (n=30; range, 87.4%-100%). For ArcCHECK measurements, the mean ± SD passing rate using 3% relative/3 mm gamma criteria was 98.9% ± 1.1% (n=34; range, 95.8%-100%). 2D fluence maps with a resolution of 1 × 1 mm(2) showed 100% passing rates for all plan deliveries (n=34). The MC reconstructed doses to the phantom agreed well with planned 3D doses where the mean passing rate using 3% absolute/3 mm gamma criteria was 99.0% ± 1.0% (n=18; range, 97.0%-100%), demonstrating the feasibility of evaluating the QA results in the patient geometry.We developed a dosimetry program for ViewRay's patient-specific IMRT QA. The methodology will be useful for other ViewRay users. The QA results presented here can assist the RT community to establish appropriate tolerance and action limits for ViewRay's IMRT QA.
Project description:PURPOSE:To compare the risks of radiogenic second cancers and cardiac mortality in 17 pediatric medulloblastoma patients treated with passively scattered proton or field-in-field photon craniospinal irradiation (CSI). MATERIAL/METHODS:Standard of care photon or proton CSI treatment plans were created for all 17 patients in a commercial treatment planning system (TPS) (Eclipse version 8.9; Varian Medical Systems, Palo Alto, CA) and prescription dose was 23.4 or 23.4 Gy (RBE) to the age specific target volume at 1.8 Gy/fraction. The therapeutic doses from proton and photon CSI plans were estimated from TPS. Stray radiation doses were determined from Monte Carlo simulations for proton CSI and from measurements and TPS for photon CSI. The Biological Effects of Ionization Radiation VII report and a linear model based on childhood cancer survivor data were used for risk predictions of second cancer and cardiac mortality, respectively. RESULTS:The ratios of lifetime attributable risk (RLARs) (proton/photon) ranged from 0.10 to 0.22 for second cancer incidence and ranged from 0.20 to 0.53 for second cancer mortality, respectively. The ratio of relative risk (RRR) (proton/photon) of cardiac mortality ranged from 0.12 to 0.24. The RLARs of both cancer incidence and mortality decreased with patient's age at exposure (e), while the RRRs of cardiac mortality increased with e. Girls had a significantly higher RLAR of cancer mortality than boys. CONCLUSION:Passively scattered proton CSI provides superior predicted outcomes by conferring lower predicted risks of second cancer and cardiac mortality than field-in-field photon CSI for all medulloblastoma patients in a large clinically representative sample in the United States, but the magnitude of superiority depends strongly on the patients' anatomical development status.