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Title: SU-F-J-199: Predictive Models for Cone Beam CT-Based Online Verification of Pencil Beam Scanning Proton Therapy

Abstract

Purpose: To utilize online CBCT scans to develop models for predicting DVH metrics in proton therapy of head and neck tumors. Methods: Nine patients with locally advanced oropharyngeal cancer were retrospectively selected in this study. Deformable image registration was applied to the simulation CT, target volumes, and organs at risk (OARs) contours onto each weekly CBCT scan. Intensity modulated proton therapy (IMPT) treatment plans were created on the simulation CT and forward calculated onto each corrected CBCT scan. Thirty six potentially predictive metrics were extracted from each corrected CBCT. These features include minimum/maximum/mean over and under-ranges at the proximal and distal surface of PTV volumes, and geometrical and water equivalent distance between PTV and each OARs. Principal component analysis (PCA) was used to reduce the dimension of the extracted features. Three principal components were found to account for over 90% of variances in those features. Datasets from eight patients were used to train a machine learning model to fit these principal components with DVH metrics (dose to 95% and 5% of PTV, mean dose or max dose to OARs) from the forward calculated dose on each corrected CBCT. The accuracy of this model was verified on the datasets from themore » 9th patient. Results: The predicted changes of DVH metrics from the model were in good agreement with actual values calculated on corrected CBCT images. Median differences were within 1 Gy for most DVH metrics except for larynx and constrictor mean dose. However, a large spread of the differences was observed, indicating additional training datasets and predictive features are needed to improve the model. Conclusion: Intensity corrected CBCT scans hold the potential to be used for online verification of proton therapy and prediction of delivered dose distributions.« less

Authors:
; ; ; ; ;  [1];  [2]
  1. The Hospital of the University of Pennsylvania, Philadelphia, PA (United States)
  2. IBA, Louvain-la-neuve (Belgium)
Publication Date:
OSTI Identifier:
22634795
Resource Type:
Journal Article
Resource Relation:
Journal Name: Medical Physics; Journal Volume: 43; Journal Issue: 6; Other Information: (c) 2016 American Association of Physicists in Medicine; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
60 APPLIED LIFE SCIENCES; 61 RADIATION PROTECTION AND DOSIMETRY; ACCURACY; COMPUTERIZED TOMOGRAPHY; DATASETS; HEAD; LARYNX; NECK; NEOPLASMS; ORGANS; PATIENTS; PROTON BEAMS; RADIATION DOSE DISTRIBUTIONS; RADIATION DOSES; RADIOTHERAPY; SIMULATION; TRAINING; VERIFICATION

Citation Formats

Yin, L, Lin, A, Ahn, P, Solberg, T, McDonough, J, Teo, B, and Janssens, G. SU-F-J-199: Predictive Models for Cone Beam CT-Based Online Verification of Pencil Beam Scanning Proton Therapy. United States: N. p., 2016. Web. doi:10.1118/1.4956107.
Yin, L, Lin, A, Ahn, P, Solberg, T, McDonough, J, Teo, B, & Janssens, G. SU-F-J-199: Predictive Models for Cone Beam CT-Based Online Verification of Pencil Beam Scanning Proton Therapy. United States. doi:10.1118/1.4956107.
Yin, L, Lin, A, Ahn, P, Solberg, T, McDonough, J, Teo, B, and Janssens, G. 2016. "SU-F-J-199: Predictive Models for Cone Beam CT-Based Online Verification of Pencil Beam Scanning Proton Therapy". United States. doi:10.1118/1.4956107.
@article{osti_22634795,
title = {SU-F-J-199: Predictive Models for Cone Beam CT-Based Online Verification of Pencil Beam Scanning Proton Therapy},
author = {Yin, L and Lin, A and Ahn, P and Solberg, T and McDonough, J and Teo, B and Janssens, G},
abstractNote = {Purpose: To utilize online CBCT scans to develop models for predicting DVH metrics in proton therapy of head and neck tumors. Methods: Nine patients with locally advanced oropharyngeal cancer were retrospectively selected in this study. Deformable image registration was applied to the simulation CT, target volumes, and organs at risk (OARs) contours onto each weekly CBCT scan. Intensity modulated proton therapy (IMPT) treatment plans were created on the simulation CT and forward calculated onto each corrected CBCT scan. Thirty six potentially predictive metrics were extracted from each corrected CBCT. These features include minimum/maximum/mean over and under-ranges at the proximal and distal surface of PTV volumes, and geometrical and water equivalent distance between PTV and each OARs. Principal component analysis (PCA) was used to reduce the dimension of the extracted features. Three principal components were found to account for over 90% of variances in those features. Datasets from eight patients were used to train a machine learning model to fit these principal components with DVH metrics (dose to 95% and 5% of PTV, mean dose or max dose to OARs) from the forward calculated dose on each corrected CBCT. The accuracy of this model was verified on the datasets from the 9th patient. Results: The predicted changes of DVH metrics from the model were in good agreement with actual values calculated on corrected CBCT images. Median differences were within 1 Gy for most DVH metrics except for larynx and constrictor mean dose. However, a large spread of the differences was observed, indicating additional training datasets and predictive features are needed to improve the model. Conclusion: Intensity corrected CBCT scans hold the potential to be used for online verification of proton therapy and prediction of delivered dose distributions.},
doi = {10.1118/1.4956107},
journal = {Medical Physics},
number = 6,
volume = 43,
place = {United States},
year = 2016,
month = 6
}
  • Purpose: To quantitatively evaluate dosimetric consequence of spot size variations and validate beam-matching criteria for commissioning a pencil beam model for multiple treatment rooms. Methods: A planning study was first conducted by simulating spot size variations to systematically evaluate dosimetric impact of spot size variations in selected cases, which was used to establish the in-air spot size tolerance for beam matching specifications. A beam model in treatment planning system was created using in-air spot profiles acquired in one treatment room. These spot profiles were also acquired from another treatment room for assessing the actual spot size variations between the twomore » treatment rooms. We created twenty five test plans with targets of different sizes at different depths, and performed dose measurement along the entrance, proximal and distal target regions. The absolute doses at those locations were measured using ionization chambers at both treatment rooms, and were compared against the calculated doses by the beam model. Fifteen additional patient plans were also measured and included in our validation. Results: The beam model is relatively insensitive to spot size variations. With an average of less than 15% measured in-air spot size variations between two treatment rooms, the average dose difference was −0.15% with a standard deviation of 0.40% for 55 measurement points within target region; but the differences increased to 1.4%±1.1% in the entrance regions, which are more affected by in-air spot size variations. Overall, our single-room based beam model in the treatment planning system agreed with measurements in both rooms < 0.5% within the target region. For fifteen patient cases, the agreement was within 1%. Conclusion: We have demonstrated that dosimetrically equivalent machines can be established when in-air spot size variations are within 15% between the two treatment rooms.« less
  • Purpose: The purpose of this study is to determine whether organ sparing and target coverage can be simultaneously maintained for pencil beam scanning (PBS) proton therapy treatment of thoracic tumors in the presence of motion, stopping power uncertainties and patient setup variations. Methods: Ten consecutive patients that were previously treated with proton therapy to 66.6/1.8 Gy (RBE) using double scattering (DS) were replanned with PBS. Minimum and maximum intensity images from 4DCT were used to introduce flexible smearing in the determination of the beam specific PTV (BSPTV). Datasets from eight 4DCT phases, using ±3% uncertainty in stopping power, and ±3more » mm uncertainty in patient setup in each direction were used to create 8*12*10=960 PBS plans for the evaluation of ten patients. Plans were normalized to provide identical coverage between DS and PBS. Results: The average lung V20, V5, and mean doses were reduced from 29.0%, 35.0%, and 16.4 Gy with DS to 24.6%, 30.6%, and 14.1 Gy with PBS, respectively. The average heart V30 and V45 were reduced from 10.4% and 7.5% in DS to 8.1% and 5.4% for PBS, respectively. Furthermore, the maximum spinal cord, esophagus and heart dose were decreased from 37.1 Gy, 71.7 Gy and 69.2 Gy with DS to 31.3 Gy, 67.9 Gy and 64.6 Gy with PBS. The conformity index (CI), homogeneity index (HI), and global maximal dose were improved from 3.2, 0.08, 77.4 Gy with DS to 2.8, 0.04 and 72.1 Gy with PBS. All differences are statistically significant, with p values <0.05, with the exception of the heart V45 (p= 0.146). Conclusion: PBS with BSPTV achieves better organ sparing and improves target coverage using a repainting method for the treatment of thoracic tumors. Incorporating motion-related uncertainties is essential This work was supported by the US Army Medical Research and Materiel Command under Contract Agreement No. DAMD17-W81XWH-07-2-0121 and W81XWH-09-2-0174.« less
  • Purpose: Monte Carlo (MC) simulation is typically regarded as the most accurate dose calculation method for proton therapy. Yet for real clinical cases, the overall accuracy also depends on that of the MC beam model. Commissioning a beam model to faithfully represent a real beam requires finely tuning a set of model parameters, which could be tedious given the large number of pencil beams to commmission. This abstract reports an automatic beam-model commissioning method for pencil-beam scanning proton therapy via an optimization approach. Methods: We modeled a real pencil beam with energy and spatial spread following Gaussian distributions. Mean energy,more » and energy and spatial spread are model parameters. To commission against a real beam, we first performed MC simulations to calculate dose distributions of a set of ideal (monoenergetic, zero-size) pencil beams. Dose distribution for a real pencil beam is hence linear superposition of doses for those ideal pencil beams with weights in the Gaussian form. We formulated the commissioning task as an optimization problem, such that the calculated central axis depth dose and lateral profiles at several depths match corresponding measurements. An iterative algorithm combining conjugate gradient method and parameter fitting was employed to solve the optimization problem. We validated our method in simulation studies. Results: We calculated dose distributions for three real pencil beams with nominal energies 83, 147 and 199 MeV using realistic beam parameters. These data were regarded as measurements and used for commission. After commissioning, average difference in energy and beam spread between determined values and ground truth were 4.6% and 0.2%. With the commissioned model, we recomputed dose. Mean dose differences from measurements were 0.64%, 0.20% and 0.25%. Conclusion: The developed automatic MC beam-model commissioning method for pencil-beam scanning proton therapy can determine beam model parameters with satisfactory accuracy.« less
  • Purpose: This study aimed to assess the clinical impact of spot size and the addition of apertures and range compensators on the treatment quality of pencil beam scanning (PBS) proton therapy and to define when PBS could improve on passive scattering proton therapy (PSPT). Methods and Materials: The patient cohort included 14 pediatric patients treated with PSPT. Six PBS plans were created and optimized for each patient using 3 spot sizes (∼12-, 5.4-, and 2.5-mm median sigma at isocenter for 90- to 230-MeV range) and adding apertures and compensators to plans with the 2 larger spots. Conformity and homogeneity indices,more » dose-volume histogram parameters, equivalent uniform dose (EUD), normal tissue complication probability (NTCP), and integral dose were quantified and compared with the respective PSPT plans. Results: The results clearly indicated that PBS with the largest spots does not necessarily offer a dosimetric or clinical advantage over PSPT. With comparable target coverage, the mean dose (D{sub mean}) to healthy organs was on average 6.3% larger than PSPT when using this spot size. However, adding apertures to plans with large spots improved the treatment quality by decreasing the average D{sub mean} and EUD by up to 8.6% and 3.2% of the prescribed dose, respectively. Decreasing the spot size further improved all plans, lowering the average D{sub mean} and EUD by up to 11.6% and 10.9% compared with PSPT, respectively, and eliminated the need for beam-shaping devices. The NTCP decreased with spot size and addition of apertures, with maximum reduction of 5.4% relative to PSPT. Conclusions: The added benefit of using PBS strongly depends on the delivery configurations. Facilities limited to large spot sizes (>∼8 mm median sigma at isocenter) are recommended to use apertures to reduce treatment-related toxicities, at least for complex and/or small tumors.« less
  • Purpose: The main purpose of this study is to investigate the optimum oblique-beam arrangement for bilateral metallic prosthesis prostate cancer treatment in pencil beam scanning (PBS) proton therapy. Methods: A computed tomography dataset of bilateral metallic prosthesis prostate cancer case was selected for this retrospective study. A total of four beams (rightanterior- oblique [RAO], left-anterior-oblique [LAO], left-posterior-oblique [LPO], and right-posterior-oblique [RPO]) were selected for treatment planning. PBS plans were generated using multi-field-optimization technique for a total dose of 79.2 Gy[RBE] to be delivered in 44 fractions. Specifically, five different PBS plans were generated based on 2.5% ± 2 mm rangemore » uncertainty using five different beam arrangements (i)LAO+RAO+LPO+RPO, (ii)LAO+RAO, (iii)LPO+RPO, (iv)RAO+LPO, and (v)LAO+RPO. Each PBS plan was optimized by applying identical dose-volume constraints to the PTV, rectum, and bladder. Treatment plans were then compared based on the dose-volume histograms results. Results: The PTV coverage was found to be greater than 99% in all five plans. The homogeneity index (HI) was found to be almost identical (range, 0.03–0.04). The PTV mean dose was found to be comparable (range, 81.0–81.1 Gy[RBE]). For the rectum, the lowest mean dose (8.0 Gy[RBE]) and highest mean dose (31.1 Gy[RBE]) were found in RAO+LAO plan and LPO+RPO plan, respectively. LAO+RAO plan produced the most favorable dosimetric results of the rectum in the medium-dose region (V50) and high-dose region (V70). For the bladder, the lowest (5.0 Gy[RBE]) and highest mean dose (10.3 Gy[RBE]) were found in LPO+RPO plan and RAO+LAO plan, respectively. Other dosimetric results (V50 and V70) of the bladder were slightly better in LPO+RPO plan than in other plans. Conclusion: Dosimetric findings from this study suggest that two anterior-oblique proton beams arrangement (LAO+RAO) is a more favorable option with the possibility of reducing rectal dose significantly while maintaining comparable target coverage and acceptable bladder dose.« less