RANGE ADAPTIVE PROTON THERAPY FOR PROSTATE CANCER

Purpose: The rapid distal falloff of a proton beam allows for sparing of normal tissues distal to the target. However proton beams that aim directly towards critical structures are avoided due to concerns of range uncertainties, such as CT number conversion and anatomy variations. We propose to eliminate range uncertainty and enable prostate treatment with a single anterior beam by detecting the proton’s range at the prostate-rectal interface and adaptively adjusting the range in vivo and in real-time. Materials and Methods: A prototype device, consisting of an endorectal liquid scintillation detector and dual-inverted Lucite wedges for range compensation, was designed to test the feasibility and accuracy of the technique. Liquid scintillation filled volume was fitted with optical fiber and placed inside the rectum of an anthropomorphic pelvic phantom. Photodiode-generated current signal was generated as a function of proton beam distal depth, and the spatial resolution of this technique was calculated by relating the variance in detecting proton spills to its maximum penetration depth. The relative water-equivalent thickness of the wedges was measured in a water phantom and prospectively tested to determine the accuracy of range corrections. Treatment simulation studies were performed to test the potential dosimetric benefit in sparing the rectum. Results: The spatial resolution of the detector in phantom measurement was 0.5 mm. The precision of the range correction was 0.04 mm. The residual margin to ensure CTV coverage was 1.1 mm. The composite distal margin for 95% treatment confidence was 2.4 mm. Planning studies based on a previously estimated 2mm margin (90% treatment confidence) for 27 patients showed a rectal sparing up to 51% at 70 Gy and 57% at 40 Gy relative to IMRT and bilateral proton treatment. Conclusion: We demonstrated the feasibility of our design. Use of this technique allows for proton treatment using a single anterior beam, significantly reducing the rectal dose.

DUAL ENERGY COMPUTED TOMOGRAPHY FOR PROTON THERAPY TREATMENT PLANNING

Proton radiation therapy is gaining popularity because of the unique characteristics of its dose distribution, e.g., high dose-gradient at the distal end of the percentage-depth-dose curve (known as the Bragg peak). The high dose-gradient offers the possibility of delivering high dose to the target while still sparing critical organs distal to the target. However, the high dose-gradient is a double-edged sword: a small shift of the highly conformal high-dose area can cause the target to be substantially under-dosed or the critical organs to be substantially over-dosed. Because of that, large margins are required in treatment planning to ensure adequate dose coverage of the target, which prevents us from realizing the full potential of proton beams. Therefore, it is critical to reduce uncertainties in the proton radiation therapy. One major uncertainty in a proton treatment is the range uncertainty related to the estimation of proton stopping power ratio (SPR) distribution inside a patient. The SPR distribution inside a patient is required to account for tissue heterogeneities when calculating dose distribution inside the patient. In current clinical practice, the SPR distribution inside a patient is estimated from the patient’s treatment planning computed tomography (CT) images based on the CT number-to-SPR calibration curve. The SPR derived from a single CT number carries large uncertainties in the presence of human tissue composition variations, which is the major drawback of the current SPR estimation method. We propose to solve this problem by using dual energy CT (DECT) and hypothesize that the range uncertainty can be reduced by a factor of two from currently used value of 3.5%. A MATLAB program was developed to calculate the electron density ratio (EDR) and effective atomic number (EAN) from two CT measurements of the same object. An empirical relationship was discovered between mean excitation energies and EANs existing in human body tissues. With the MATLAB program and the empirical relationship, a DECT-based method was successfully developed to derive SPRs for human body tissues (the DECT method). The DECT method is more robust against the uncertainties in human tissues compositions than the current single-CT-based method, because the DECT method incorporated both density and elemental composition information in the SPR estimation. Furthermore, we studied practical limitations of the DECT method. We found that the accuracy of the DECT method using conventional kV-kV x-ray pair is susceptible to CT number variations, which compromises the theoretical advantage of the DECT method. Our solution to this problem is to use a different x-ray pair for the DECT. The accuracy of the DECT method using different combinations of x-ray energies, i.e., the kV-kV, kV-MV and MV-MV pair, was compared using the measured imaging uncertainties for each case. The kV-MV DECT was found to be the most robust against CT number variations. In addition, we studied how uncertainties propagate through the DECT calculation, and found general principles of selecting x-ray pairs for the DECT method to minimize its sensitivity to CT number variations. The uncertainties in SPRs estimated using the kV-MV DECT were analyzed further and compared to those using the stoichiometric method. The uncertainties in SPR estimation can be divided into five categories according to their origins: the inherent uncertainty, the DECT modeling uncertainty, the CT imaging uncertainty, the uncertainty in the mean excitation energy, and SPR variation with proton energy. Additionally, human body tissues were divided into three tissue groups – low density (lung) tissues, soft tissues and bone tissues. The uncertainties were estimated separately because their uncertainties were different under each condition. An estimate of the composite range uncertainty (2s) was determined for three tumor sites – prostate, lung, and head-and-neck, by combining the uncertainty estimates of all three tissue groups, weighted by their proportions along typical beam path for each treatment site. In conclusion, the DECT method holds theoretical advantages in estimating SPRs for human tissues over the current single-CT-based method. Using existing imaging techniques, the kV-MV DECT approach was capable of reducing the range uncertainty from the currently used value of 3.5% to 1.9%-2.3%, but it is short to reach our original goal of reducing the range uncertainty by a factor of two. The dominant source of uncertainties in the kV-MV DECT was the uncertainties in CT imaging, especially in MV CT imaging. Further reduction in beam hardening effect, the impact of scatter, out-of-field object etc. would reduce the Hounsfeld Unit variations in CT imaging. The kV-MV DECT still has the potential to reduce the range uncertainty further.

Treatment planning aspects and Monte Carlo methods in proton therapy

Over the last years, the interest in proton radiotherapy is rapidly increasing. Protons provide superior physical properties compared with conventional radiotherapy using photons. These properties result in depth dose curves with a large dose peak at the end of the proton track and the finite proton range allows sparing the distally located healthy tissue. These properties offer an increased flexibility in proton radiotherapy, but also increase the demand in accurate dose estimations. To carry out accurate dose calculations, first an accurate and detailed characterization of the physical proton beam exiting the treatment head is necessary for both currently available delivery techniques: scattered and scanned proton beams. Since Monte Carlo (MC) methods follow the particle track simulating the interactions from first principles, this technique is perfectly suited to accurately model the treatment head. Nevertheless, careful validation of these MC models is necessary. While for the dose estimation pencil beam algorithms provide the advantage of fast computations, they are limited in accuracy. In contrast, MC dose calculation algorithms overcome these limitations and due to recent improvements in efficiency, these algorithms are expected to improve the accuracy of the calculated dose distributions and to be introduced in clinical routine in the near future.

A new PET prototype for proton therapy: comparison of data and Monte Carlo simulations

Ion beam therapy is a valuable method for the treatment of deep-seated and radio-resistant tumors thanks to the favorable depth-dose distribution characterized by the Bragg peak. Hadrontherapy facilities take advantage of the specific ion range, resulting in a highly conformal dose in the target volume, while the dose in critical organs is reduced as compared to photon therapy. The necessity to monitor the delivery precision, i.e. the ion range, is unquestionable, thus different approaches have been investigated, such as the detection of prompt photons or annihilation photons of positron emitter nuclei created during the therapeutic treatment. Based on the measurement of the induced β+ activity, our group has developed various in-beam PET prototypes: the one under test is composed by two planar detector heads, each one consisting of four modules with a total active area of 10 × 10 cm2. A single detector module is made of a LYSO crystal matrix coupled to a position sensitive photomultiplier and is read-out by dedicated frontend electronics. A preliminary data taking was performed at the Italian National Centre for Oncological Hadron Therapy (CNAO, Pavia), using proton beams in the energy range of 93–112 MeV impinging on a plastic phantom. The measured activity profiles are presented and compared with the simulated ones based on the Monte Carlo FLUKA package.

Ion cascade acceleration from the interaction of a relativistic femtosecond laser pulse with a narrow thin target

Particle-in-cell simulations are performed to study the acceleration of ions due to the interaction of a relativistic femtosecond laser pulse with a narrow thin target. The numerical results show that ions can be accelerated in a cascade by two electrostatic fields if the width of the target is smaller than the laser beam waist. The first field is formed in front of the target by the central part of the laser beam, which pushes the electron layer inward. The major part of the abaxial laser energy propagates along the edges to the rear side of the target and pulls out some hot electrons from the edges of the target, which form another electrostatic field at the rear side of the target. The ions from the front surface are accelerated stepwise by these two electrostatic fields to high energies at the rear side of the target. The simulations show that the largest ion energy gain for a narrow target is about four times higher than in the case of a wide target. (c) 2006 American Institute of Physics.

Ion acceleration with mixed solid targets interacting with circularly polarized lasers

The interaction of a circularly polarized laser pulse with a mixed solid target containing two species of ions is studied by particle in cell simulations and analytical model. After the interaction tends to be stable, it is demonstrated that the acceleration is more efficient for the heavier ions than that in plasmas containing a single kind of heavy ion and the acceleration efficiency is higher when its proportion is lower. To obtain monoenergetic heavy-ion beams, a sandwich target with a thin mixed ion layer between two light ion layers and a microstructured target are proposed. The influences of parameters of the laser pulse and target on ion acceleration are discussed in detail. It is found that, when the target is thick enough, a cold target is more appropriate for heavy-ion acceleration than a warm target, and the velocity of the reflected heavy ions is proportional to the laser amplitude.

Direct acceleration of solid-density plasma bunch by ultraintense laser

The interaction of a petawatt laser with a small solid-density plasma bunch is studied by particle-in-cell simulation. It is shown that when irradiated by a laser of intensity >10(21) W/cm(2), a dense plasma bunch of micrometer size can be efficiently accelerated. The kinetic energy of the ions in the high-density region of the plasma bunch can exceed ten MeV at a density in the 10(23)-cm(-3) level. Having a flux density orders of magnitude higher than that of the traditional charged-particle pulses, the laser-accelerated plasma bunch can have a wide range of applications. In particular, such a dense energetic plasma bunch impinging on the compressed fuel in inertial fusion can significantly enhance the nuclear-reaction cross section and is thus a promising alternative for fast ignition.

Ultrafast laser-driven microlens to focus and energy-select mega-electron volt protons

We present a technique for simultaneous focusing and energy selection of high-current, mega-electron volt proton beams With the use of radial, transient electric fields (107 to 1010 volts per meter) triggered on the inner walls of a hollow microcylinder by an intense subpicosecond laser pulse. Because of the transient nature of the focusing fields, the proposed method allows selection of a desired range out of the spectrum of the polyenergetic proton beam. This technique addresses current drawbacks of laser-accelerated proton beams, such as their broad spectrum and divergence at the source.

Measurement of highly transient electrical charging following high-intensity laser-solid interaction

The multi-million-electron-volt proton beams accelerated during high-intensity laser-solid interactions have been used as a particle probe to investigate the electric charging of microscopic targets laser-irradiated at intensity similar to10(19) W cm(2). The charge-up, detected via the proton deflection with high temporal and spatial resolution, is due to the escape of energetic electrons generated during the interaction. The analysis of the data is supported by three- dimensional tracing of the proton trajectories. (C) 2003 American Institute of Physics.

Analysis of Latent Tracks for MeV protons in CR-39

For protons of energy up to a few MeV, the temporal evolution of etched latent tracks in CR-39 nuclear track detector has been numerically modeled by assuming that the electronic energy loss of the protons governs the latent track formation. The technique is applied in order to obtain the energy spectrum of high intensity laser driven proton beams, with high accuracy. The precise measurement of the track length and areal track density have been achieved by scanning short etched, highly populated CR-39 employing atomic force microscope.

Radiation pressure acceleration of thin foils with circularly polarized laser pulses

A new regime is described for radiation pressure acceleration of a thin foil by an intense laser beam of above 10(20) W cm(-2). Highly monoenergetic proton beams extending to giga-electron-volt energies can be produced with very high efficiency using circularly polarized light. The proton beams have a very small divergence angle (< 4 degrees). This new method allows the construction of ultra-compact proton and ion accelerators with ultra-short particle bursts.

Ultrahigh-intensity laser-produced plasmas as a compact heavy ion injection source

The possibility of using high-intensity laser-produced plasmas as a source of energetic ions for heavy ion accelerators is addressed. Experiments have shown that neon ions greater than 6 MeV can be produced from gas jet plasmas, and well-collimated proton beams greater than 20 MeV have been produced from high-intensity Laser solid interactions. The proton beams from the back of thin targets appear to be more collimated and reproducible than are high-energy ions generated in the ablated plasma at the front of the target and may be more suitable for ion injection applications. Lead ions have been produced at energies up to 430 MeV.

Investigations of ultrafast charge dynamics in laser-irradiated targets by a self probing technique employing laser driven protons

The divergent and broadband proton beams produced by the target normal sheath acceleration mechanism provide the unique opportunity to probe, in a point-projection imaging scheme, the dynamics of the transient electric and magnetic fields produced during laser-plasma interactions. Commonly such experimental setup entails two intense laser beams, where the interaction produced by one beam is probed with the protons produced by the second. We present here experimental studies of the ultra-fast charge dynamics along a wire connected to laser irradiated target carried out by employing a ‘self’ proton probing arrangement – i.e. by connecting the wire to the target generating the probe protons. The experimental data shows that an electromagnetic pulse carrying a significant amount of charge is launched along the wire, which travels as a unified pulse of 10s of ps duration with a velocity close to speed of light. The experimental capabilities and the analysis procedure of this specific type of proton probing technique are discussed.

Radiological protection and nuclear engineering studies in multi-MW target systems

Tese de doutoramento, Física, Universidade de Lisboa, Faculdade de Ciências, 2014

Comparison of SRIM, MCNPX and GEANT simulations with experimental data for thick Al absorbers

Proton computerized tomography deals with relatively thick targets like the human head or trunk. In this case precise analytical calculation of the proton final energy is a rather complicated task, thus the Monte Carlo simulation stands out as a solution. We used the GEANT4.8.2 code to calculate the proton final energy spectra after passing a thick Al absorber and compared it with the same conditions of the experimental data. The ICRU49, Ziegler85 and Ziegler2000 models from the low energy extension pack were used. The results were also compared with the SRIM2008 and MCNPX2.4 simulations, and with solutions of the Boltzmann transport equation in the Fokker-Planck approximation. (C) 2009 Elsevier Ltd. All rights reserved.