Fetal dose from proton pencil beam scanning craniospinal irradiation during pregnancy: a Monte Carlo study

Objective: We conducted a Monte Carlo study to comprehensively investigate the fetal dose resulting from proton pencil beam scanning (PBS) craniospinal irradiation (CSI) during pregnancy. Approach: The gestational-age dependent pregnant phantom series developed at the University of Florida (UF) were converted into DICOM-RT format (CT images and structures) and imported into a treatment planning system (TPS) (Eclipse v15.6) commissioned to a IBA PBS nozzle. A proton PBS CSI plan (prescribed dose: 36 Gy) was created on the phantoms. The TOPAS MC code was used to simulate the proton PBS CSI on the phantoms, for which MC beam properties at the nozzle exit (spot size, spot divergence, mean energy, and energy spread) were matched to IBA PBS nozzle beam measurement data. We calculated mean absorbed doses for 28 organs and tissues and whole body of the fetus at eight gestational ages (8, 10, 15, 20, 25, 30, 35, and 38 weeks). For contextual purposes, the fetal organ/tissue doses from the treatment planning CT scan of the mother’s head and torso were estimated using the National Cancer Institute dosimetry system for CT (NCICT, Version 3) considering a low-dose CT protocol (CTDIvol: 8.97 mGy). Main Results: The majority of the fetal organ/tissue doses from the proton PBS CSI treatment fell within a range of 3 to 6 mGy. The fetal organ/tissue doses for the 38-week phantom showed the largest variation with the doses ranging from 2.9 mGy (adrenals) to 8.2 mGy (eye lenses) while the smallest variation ranging from 3.2 mGy (oesophagus) to 4.4 mGy (brain) was observed for the doses for the 20-week phantom. The fetal whole-body dose ranged from 3.7 mGy (25 weeks) to 5.8 mGy (8 weeks). Most of the fetal doses from the planning CT scan fell within a range of 7 to 13 mGy, approximately 2-to-9 times lower than the fetal dose equivalents of the proton PBS CSI treatment (assuming a quality factor of 7). Significance: The fetal organ/tissue doses observed in the present work will be useful for one of the first clinically informative predictions on the magnitude of fetal dose during proton PBS CSI during pregnancy.

A novel range telescope concept for proton CT

Proton beam therapy can potentially offer improved treatment for cancers of the head and neck and in paediatric patients. There has been asharp uptake of proton beam therapy in recent years as improved delivery techniques and patient benefits are observed. However, treatments are currently planned using conventional x-ray CT images due to the absence of devices able to perform high quality proton computed tomography(pCT) under realistic clinical conditions. A new plastic-scintillator-based range telescope concept, named ASTRA, is proposed here to measure the proton’s energy loss in a pCT system. Simulations conducted using GEANT4 yield an expected energy resolution of 0.7%. If calorimetric information is used the energy resolution could be further improved to about 0.5%. In addition, the ability of ASTRA to track multiple protons simultaneously is presented. Due to its fast components, ASTRA is expected to reach unprecedented data collection rates, similar to 10^8 protons/s.The performance of ASTRA has also been tested by simulating the imaging of phantoms. The results show excellent image contrast and relative stopping power reconstruction.

Monte Carlo investigation of electron fluence perturbation in MRI-guided radiotherapy beams using six commercial radiation detectors

With the integration of MRI-linacs to the clinical workflow, the understanding and characterization of detector response in reference dosimetry in magnetic fields are required. The magnetic field perturbs the electron fluence (Fe), and the degree of perturbation depends on the irradiation conditions and the detector type. This work evaluates the magnetic field impact on the electron fluence spectra in several detectors to provide a deeper understanding of detector response in these conditions. Monte Carlo calculations of Fe are performed in six detectors (solid-state: PTW60012 and PTW60019, ionization chambers: PTW30013, PTW31010, PTW31021, and PTW31022) placed in water and irradiated by an Elekta Unity 7 MV FFF photon beam with small and reference fields, at 0 T and 1.5 T. Three chamber-axis orientations are investigated: parallel or perpendicular (two possibilities: FL towards the stem or the tip) to the magnetic field and perpendicular to the beam. One orientation for the solid-state detector is studied: parallel to the beam and perpendicular to the magnetic field. Additionally, Fe spectra are calculated in modified detector geometries to identify the underlying physical mechanisms behind the fluence perturbations. The total Fe is reduced up to 1.24% in the farmer chamber, at 1.5 T, in the parallel orientation. The interplay between the gyration radius and the farmer chamber cavity length significantly affects Fe in the perpendicular orientation; the total fluence varies up to 5.12% in magnetic fields. For the small-cavity chambers, the maximal variation in total Fe is 0.19%, for the reference field, in the parallel orientation. . In contrast, significant small-field effects occur; the total Fe is reduced between 9.86% to 14.50% at 1.5T (with respect to 0T) depending on the orientation. The magnetic field strongly impacted the solid-state detectors in both field sizes, probably due to the high-density extracameral components. The maximal reductions of total Fe are 15.06±0.09% (silicon) and 16.00±0.07% (microDiamond). This work provides insights into detector response in magnetic fields by illustrating the interplay between several factors causing dosimetric perturbation effects: 1) chamber and magnetic field orientation, 2) cavity size and shape, 3) extracameral components, 4) air gaps and their asymmetry, 5) electron energy. Low-energy electron trajectories are more susceptible to change in magnetic fields, and generally, they are associated with detector response perturbation.

TBS-BAO: fully automated beam angle optimization for IMRT guided by a total-beam-space reference plan

Properly selected beam angles contribute to the quality of radiotherapy treatment plans. However, the Beam Angle Optimization (BAO) problem is difficult to solve to optimality due to its non-convex discrete nature with many local minima. In this study, we propose TBS-BAO, a novel approach for solving the BAO problem, and test it for non-coplanar robotic CyberKnife radiotherapy for prostate cancer. First, an ideal Pareto-optimal reference dose distribution is automatically generated using a priori multi-criterial fluence map optimization (FMO) to generate a plan that includes all candidate beams (total-beam-space, TBS). Then, this ideal dose distribution is reproduced as closely as possible in a subsequent segmentation/beam angle optimization step (SEG/BAO), while limiting the number of allowed beams to a user-selectable preset value. SEG/BAO aims at a close reproduction of the ideal dose distribution. For each of 33 prostate SBRT patients, 18 treatment plans with different pre-set numbers of allowed beams were automatically generated with the proposed TBS-BAO. For each patient, the TBS-BAO plans were then compared to a plan that was automatically generated with an alternative BAO method (Erasmus-iCycle) and to a high-quality manually generated plan. TBS-BAO was able to automatically generate plans with clinically feasible numbers of beams (∽25), with a quality highly similar to corresponding 91-beam ideal reference plans. Compared to the alternative Erasmus-iCycle BAO approach, similar plan quality was obtained for 25-beam segmented plans, while computation times were reduced from 10.7 hours to 4.8/1.5 hours, depending on the applied pencil-beam resolution in TBS-BAO. 25-beam TBS-BAO plans had similar quality as manually generated plans with on average 48 beams, while delivery times reduced from 22.3 to 18.4/18.1 min. TBS reference plans could effectively steer the discrete non-convex BAO.

An iterative image-based inter-frame motion compensation method for dynamic brain PET imaging

As a non-invasive imaging tool, Positron Emission Tomography (PET) plays an important role in brain science and disease research. Dynamic acquisition is one way of brain PET imaging. Its wide application in clinical research has often been hindered by practical challenges, such as patient involuntary movement, which could degrade both image quality and the accuracy of the quantification. This is even more obvious in scans of patients with neurodegeneration or mental disorders. Conventional motion compensation methods were either based on images or raw measured data, were shown to be able to reduce the effect of motion on the image quality. As for a dynamic PET scan, motion compensation can be challenging as tracer kinetics and relatively high noise can be present in dynamic frames. In this work, we propose an image-based inter-frame motion compensation approach specifically designed for dynamic brain PET imaging. Our method has an iterative implementation that only requires reconstructed images, based on which the inter-frame subject movement can be estimated and compensated. The method utilized tracer-specific kinetic modelling and can deal with simple and complex movement patterns. The synthesized phantom study showed that the proposed method can compensate for the simulated motion in scans with 18F-FDG, 18F-Fallypride and 18F-AV45. Fifteen dynamic 18F-FDG patient scans with motion artifacts were also processed. The quality of the recovered image was superior to the one of the non-corrected images and the corrected images with other image-based methods. The proposed method enables retrospective image quality control for dynamic brain PET imaging, hence facilitates the applications of dynamic PET in clinics and research.

Fast magnetic resonance elastography with multiphase radial encoding and harmonic motion sparsity based reconstruction

Objective: To achieve fast magnetic resonance elastography (MRE) at a low frequency for better shear modulus estimation of the brain. Approach: We proposed a multiphase radial DENSE MRE (MRD-MRE) sequence and an improved GRASP algorithm utilizing the sparsity of the harmonic motion (SH-GRASP) for fast MRE at 20 Hz. For the MRD-MRE sequence, the initial position encoded by one spatial modulation of magnetization (SPAMM) was decoded by an arbitrary number of readout blocks without increasing the number of phase offsets. Based on the harmonic motion, a modified total variation and temporal Fourier transform were introduced to utilize the sparsity in the temporal domain. Both phantom and brain experiments were carried out and compared with that from multiphase Cartesian DENSE-MRE (MCD-MRE), and conventional gradient echo sequence (GRE-MRE). Reconstruction performance was also compared with GRASP and compressed sensing. Main results: Results showed the scanning time of a fully sampled image with four phase offsets for MRD-MRE was only 1/5 of that from GRE-MRE. The wave patterns and estimated stiffness maps were similar to those from MCD-MRE and GRE-MRE. With SH-GRASP, the total scan time could be shortened by additional 4 folds, achieving a total acceleration factor of 20. Better metric values were also obtained using SH-GRASP for reconstruction compared with other algorithms. Significance: The MRD-MRE sequence and SH-GRASP algorithm can be used either in combination or independently to accelerate MRE, showing the potentials for imaging the brain as well as other organs.

The magnetic field dependent displacement effect and its correction in reference and relative dosimetry

Objective This study investigates the perturbation correction factors of air-filled ionization chambers regarding their depth and magnetic field dependence. Focus has been placed on the displacement or gradient correction factor Pgr. Besides, the shift of the effective point of measurement Peff that can be applied to account for the gradient effect has been compared between the cases with and without magnetic field. Approach The perturbation correction factors have been simulated by stepwise modifications of the models of three ionization chambers (Farmer 30013, Semiflex 3D 31021 and PinPoint 3D 31022, all from PTW Freiburg). A 10 cm x 10 cm 6 MV photon beam perpendicular to the chamber’s axis was used. A 1.5 T magnetic field was aligned parallel to the chamber’s axis. The correction factors were determined between 0.4 and 20 cm depth. The shift of Peff from the chamber's reference point Pref, ∆z, was determined by minimizing the variation of the ratio between dose-to-water Dw(zref+∆z) and the dose-to-air Dair(zref) along the depth. Main Results The perturbation correction factors with and without magnetic field are depth dependent in the build-up region but can be considered as constant beyond the depth of dose maximum. Additionally, the correction factors are modified by the magnetic field. Pgr at the reference depth is found to be larger in 1.5 T magnetic field than in the magnetic field free case, where an increase of up to 1% is obserbed for the largest chamber (Farmer 30013). The magnitude of ∆z for all chambers decreases by 40% in a 1.5 T magnetic field with the sign of ∆z remains negative. Significance In reference dosimetry, the change of Pgr in a magnetic field can be corrected by applying the magnetic field correction factor kB Qmsr when the chamber is positioned with its Pref at the depth of measurement. However, due to the depth dependence of the perturbation factors, it is more convenient to apply the ∆z-shift during chamber positioning in relative dosimetry.

Using inverse Laplace transform in positronium lifetime imaging

Positronium (Ps) lifetime imaging is gaining attention to bring out additional biomedical information from positron emission tomography (PET). The lifetime of Ps in vivo can change depending on the physical and chemical environments related to some diseases. Due to the limited sensitivity, Ps lifetime imaging may require merging some voxels for statistical accuracy. This paper presents a method for separating the lifetime components in the voxel to avoid information loss due to averaging. The mathematics for this separation is the inverse Laplace transform (ILT), and the authors examined an iterative numerical ILT algorithm using Tikhonov regularization, namely CONTIN, to discriminate a small lifetime difference due to oxygen saturation. The separability makes it possible to merge voxels without missing critical information on whether they contain abnormally long or short lifetime components. The authors conclude that ILT can compensate for the weaknesses of Ps lifetime imaging and extract the maximum amount of information.

Alpha particle microdosimetry calculations using a shallow neural network

A shallow neural network was trained to accurately calculate the microdosimetric parameters, <z1> and <z1 2> (the first and second moments of the single-event specific energy spectra, respectively) for use in alpha-particle microdosimetry calculations. The regression network of four inputs and two outputs was created in MATLAB and trained on a data set consisting of both previously published microdosimetric data and recent Monte Carlo simulations. The input data consisted of the alpha-particle energies (3.97–8.78 MeV), cell nuclei radii (2–10 µm), cell radii (2.5–20 µm), and eight different source-target configurations. These configurations included both single cells in suspension and cells in geometric clusters. The mean square error (MSE) was used to measure the performance of the network. The sizes of the hidden layers were chosen to minimize MSE without overfitting. The final neural network consisted of two hidden layers with 13 and 20 nodes, respectively, each with tangential sigmoid transfer functions, and was trained on 1932 data points. The overall training/validation resulted in a MSE = 3.71×10-7. A separate testing data set included input values that were not seen by the trained network. The final test on 892 separate data points resulted in a MSE = 2.80×10-7. The 95th percentile testing data errors were within ±1.4% for <z1> outputs and ±2.8% for <z1 2> outputs, respectively. Cell survival was also predicted using actual vs. neural network generated microdosimetric moments and showed overall agreement within ±3.5%. In summary, this trained neural network can accurately produce microdosimetric parameters used for the study of alpha-particle emitters. The network can be exported and shared for tests on independent data sets and new calculations.

FID-calibrated simultaneous multi-slice fast spin echo with long trains of hard pulses

Objective: To develop a novel, free-induction-decay (FID)-calibrated single-shot simultaneous multi-slice fast spin echo (SMS-FSE) with very long hard pulse trains for high encoding efficiency and low energy deposition. Approach: The proposed single-shot SMS-FSE employs a mixed pulse configuration in which a long excitation pulse that is spatially multi-band (MB) selective is used in conjunction with short spatially nonselective refocusing pulses. To alleviate energy deposition to tissues while reducing signal modulation along the echo train, variable low flip angles with signal prescription are utilized in the refocusing pulse train. A time-efficient FID-calibration and correction method is introduced before aliased voxels in the slice direction are resolved. Simulations and experiments are performed to demonstrate the feasibility of the proposed method as an alternative to conventional HASTE for generating T2-weighted images. Main results: Compared with conventional HASTE, the proposed method enhances imaging speed effectively by an MB factor up to 5 without apparent loss of image contrast while successfully eliminating FID artifacts. Significance: We successfully demonstrated the feasibility of the proposed method as an encoding- and energy-efficient alternative to conventional HASTE for generation of T2-weighted contrast.