skip to main content
OSTI.GOV title logo U.S. Department of Energy
Office of Scientific and Technical Information

Title: SU-F-T-136: Breath Hold Lung Phantom Study in Using CT Density Versus Relative Stopping Power Ratio for Proton Pencil Beam Scanning System

Abstract

Purpose: To evaluate mass density effects of CT conversion table and its variation in current treatment planning system of spot scanning proton beam using an IROC proton lung phantom for this study. Methods: A proton lung phantom study was acquired to Imaging and Radiation Oncology Core Houston (IROC) Quality Assurance Center. Inside the lung phantom, GAF Chromic films and couples of thermal luminescent dosimeter (TLD) capsules embedded in specified PTV and adjacent structures to monitor delivered dosage and 3D dose distribution profiles. Various material such as cork (Lung), blue water (heart), Techron HPV (ribs) and organic material of balsa wood and cork as dosimetry inserts within phantom of solid water (soft tissue). Relative stopping power (RLSP) values were provided. Our treatment planning system (TPS) doesn’t require SP instead relative density was converted relative to water. However lung phantom was irradiated by planning with density override and the results were compared with IROC measurements. The second attempt was conducted without density override and compared with IROC’s. Results: The higher passing rate of imaging and measurement results of the lung phantom irradiation met the criteria by IROC without density override. The film at coronal plane was found to be shift due tomore » inclined cylinder insertion. The converted CT density worked as expected to correlate relative stopping power. Conclusion: The proton lung phantom provided by IROC is a useful tool to qualify our commissioned proton pencil beam delivery with TPS within reliable confidence. The relative mass stopping power ratios of materials were converted from the relative physical density relative to water and the results were satisfied.« less

Authors:
; ;  [1]
  1. Willis-Knighton Medical Center, Shreveport, LA (United States)
Publication Date:
OSTI Identifier:
22642377
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; BEAM SCANNERS; BIOMEDICAL RADIOGRAPHY; LUNGS; MATERIALS; PHANTOMS; PLANNING; PROTON BEAMS; QUALITY ASSURANCE; RADIATION DOSE DISTRIBUTIONS; STOPPING POWER; WATER

Citation Formats

Syh, J, Wu, H, and Rosen, L. SU-F-T-136: Breath Hold Lung Phantom Study in Using CT Density Versus Relative Stopping Power Ratio for Proton Pencil Beam Scanning System. United States: N. p., 2016. Web. doi:10.1118/1.4956272.
Syh, J, Wu, H, & Rosen, L. SU-F-T-136: Breath Hold Lung Phantom Study in Using CT Density Versus Relative Stopping Power Ratio for Proton Pencil Beam Scanning System. United States. doi:10.1118/1.4956272.
Syh, J, Wu, H, and Rosen, L. 2016. "SU-F-T-136: Breath Hold Lung Phantom Study in Using CT Density Versus Relative Stopping Power Ratio for Proton Pencil Beam Scanning System". United States. doi:10.1118/1.4956272.
@article{osti_22642377,
title = {SU-F-T-136: Breath Hold Lung Phantom Study in Using CT Density Versus Relative Stopping Power Ratio for Proton Pencil Beam Scanning System},
author = {Syh, J and Wu, H and Rosen, L},
abstractNote = {Purpose: To evaluate mass density effects of CT conversion table and its variation in current treatment planning system of spot scanning proton beam using an IROC proton lung phantom for this study. Methods: A proton lung phantom study was acquired to Imaging and Radiation Oncology Core Houston (IROC) Quality Assurance Center. Inside the lung phantom, GAF Chromic films and couples of thermal luminescent dosimeter (TLD) capsules embedded in specified PTV and adjacent structures to monitor delivered dosage and 3D dose distribution profiles. Various material such as cork (Lung), blue water (heart), Techron HPV (ribs) and organic material of balsa wood and cork as dosimetry inserts within phantom of solid water (soft tissue). Relative stopping power (RLSP) values were provided. Our treatment planning system (TPS) doesn’t require SP instead relative density was converted relative to water. However lung phantom was irradiated by planning with density override and the results were compared with IROC measurements. The second attempt was conducted without density override and compared with IROC’s. Results: The higher passing rate of imaging and measurement results of the lung phantom irradiation met the criteria by IROC without density override. The film at coronal plane was found to be shift due to inclined cylinder insertion. The converted CT density worked as expected to correlate relative stopping power. Conclusion: The proton lung phantom provided by IROC is a useful tool to qualify our commissioned proton pencil beam delivery with TPS within reliable confidence. The relative mass stopping power ratios of materials were converted from the relative physical density relative to water and the results were satisfied.},
doi = {10.1118/1.4956272},
journal = {Medical Physics},
number = 6,
volume = 43,
place = {United States},
year = 2016,
month = 6
}
  • Purpose: The purpose of this study is to evaluate any effects of converted CT density variation in treatment planning system (TPS) of spot scanning proton therapy with an IROC proton prostate phantom at our new ProteusOne Proton Therapy Center. Methods: A proton prostate phantom was requested from the Imaging and Radiation Oncology Core Houston (IROC), The University of Texas MD Anderson Cancer Center, Houston, TX, where GAF Chromic films and couples of thermo luminescent dosemeter (TLD) capsules in target and adjacent structures were embedded for imaging and dose monitoring. Various material such as PVC, PBT HI polystyrene as dosimetry insertsmore » and acrylic were within phantom. Relative stopping power (SP) were provided. However our treatment planning system (TPS) doesn’t require SP instead relative density was converted relative to water in TPS. Phantom was irradiated and the results were compared with IROC measurements. The range of relative density was converted from SP into relative density of water as a new assigned material and tested. Results: The summary of TLD measurements of the prostate and femoral heads were well within 2% of the TPS and met the criteria established by IROC. The film at coronal plane was found to be shift in superior-inferior direction due to locking position of cylinder insert was off and was corrected. The converted CT density worked precisely to correlated relative stopping power. Conclusion: The proton prostate phantom provided by IROC is a useful methodology to evaluate our new commissioned proton pencil beam and TPS within certain confidence in proton therapy. The relative stopping power was converted into relative physical density relatively to water and the results were satisfied.« less
  • Purpose: The safe clinical implementation of pencil beam scanning (PBS) proton therapy for lung tumors is complicated by the delivery uncertainties caused by breathing motion. The purpose of this feasibility study was to investigate whether a voluntary breath-hold technique could limit the delivery uncertainties resulting from interfractional motion. Methods and Materials: Data from 15 patients with peripheral lung tumors previously treated with stereotactic radiation therapy were included in this study. The patients had 1 computed tomographic (CT) scan in voluntary breath-hold acquired before treatment and 3 scans during the treatment course. PBS proton treatment plans with 2 fields (2F) andmore » 3 fields (3F), respectively, were calculated based on the planning CT scan and subsequently recalculated on the 3 repeated CT scans. Recalculated plans were considered robust if the V{sub 95%} (volume receiving ≥95% of the prescribed dose) of the gross target volume (GTV) was within 5% of what was expected from the planning CT data throughout the simulated treatment. Results: A total of 14/15 simulated treatments for both 2F and 3F met the robustness criteria. Reduced V{sub 95%} was associated with baseline shifts (2F, P=.056; 3F, P=.008) and tumor size (2F, P=.025; 3F, P=.025). Smaller tumors with large baseline shifts were also at risk for reduced V{sub 95%} (interaction term baseline/size: 2F, P=.005; 3F, P=.002). Conclusions: The breath-hold approach is a realistic clinical option for treating lung tumors with PBS proton therapy. Potential risk factors for reduced V{sub 95%} are small targets in combination with large baseline shifts. On the basis of these results, the baseline shift of the tumor should be monitored (eg, through image guided therapy), and appropriate measures should be taken accordingly. The intrafractional motion needs to be investigated to confirm that the breath-hold approach is robust.« less
  • Purpose: The breath-hold (BH) technique has been suggested to mitigate motion and reduce target coverage degradation due to motion effects. The aim of this study was to investigate the effect of inter-BH residual motion on the dose distribution for pencil beam scanned (PBS) proton therapy of locally-advanced lung cancer patients. Methods: A dataset of visually-guided BH CT scans was acquired (10 scans per patient) taken from five lung cancer patients: three intra-fractionally repeated CT scans on treatment days 2,16 and 31, in addition to the day 0 planning CT scan. Three field intensity-modulated proton therapy (IMPT) plans were constructed onmore » the planning CT scan. Dose delivery on fraction 2, 16 and 31 were simulated on the three consecutive CT scans, assuming BH duration of 20s and soft tissue match. The dose was accumulated in the planning CT using deformable image registration, and scaled to simulate the full treatment of 66Gy(RBE) in 33 fractions. Results: The mean dose to the lungs and heart, and maximum dose to the spinal cord and esophagus were within 1% of the planned dose. The CTV V95% decreased and the inhomogeneity (D5%–D95%) increased on average 4.1% (0.4–12.2%) and 5.8% (2.2–13.4%), respectively, over the five patient cases. Conclusion: The results showed that the BH technique seems to spare the OARs in spite of inter-BH residual motion. However, small degradation of target coverage occurred for all patients, with 3/5 patients having a decrease in V95% ≤1%. For the remaining two patients, where V95% decreased up to 12%, the cause could be related to treatment related anatomical changes and, as in photon therapy, plan adaptation may be necessary to ensure target coverage. This study showed that BH could be a potential treatment option to reliably mitigate motion for the treatment of locally-advanced lung cancer using PBS proton therapy.« less
  • Purpose: Deep inspiration breath-hold techniques (DIBH) have been shown to carry significant dosimetric advantages in conventional radiotherapy of left-sided breast cancer. The purpose of this study is to evaluate the use of DIBH techniques for post-mastectomy radiation therapy (PMRT) using proton pencil beam scanning (PBS). Method: Ten PMRT patients, with or without breast implant, underwent two helical CT scans: one with free breathing and the other with deep inspiration breath-hold. A prescription of 50.4 Gy(RBE) to the whole chest wall and lymphatics (axillary, supraclavicular, and intramammary nodes) was considered. PBS plans were generated for each patient’s CT scan using Astroid,more » an in-house treatment planning system, with the institution conventional clinical PMRT parameters; that is, using a single en-face field with a spot size varying from 8 mm to 14 mm as a function of energy. Similar optimization parameters were used in both plans in order to ensure appropriate comparison. Results: Regardless of the technique (free breathing or DIBH), the generated plans were well within clinical acceptability. DIBH allowed for higher target coverage with better sparing of the cardiac structures. The lung doses were also slightly improved. While the use of DIBH techniques might be of interest, it is technically challenging as it would require a fast PBS delivery, as well as the synchronization of the beam delivery with a gating system, both of which are not currently available at the institution. Conclusion: DIBH techniques display some dosimetric advantages over free breathing treatment for PBS PMRT patients, which warrants further investigation. Plans will also be generated with smaller spot sizes (2.5 mm to 5.5 mm and 5 mm to 9 mm), corresponding to new generation machines, in order to further quantify the dosimetric advantages of DIBH as a function of spot size.« less
  • Purpose: To characterize the dose distributions of Cyberknife and intensity-modulated-proton-therapy (IMPT). Methods: A total of 20 patients previously treated with Cyberknife were selected. The original planning-target-volume (PTV) was used in the ‘IMPT-ideal’ plan assuming a comparable image-guidance with Cyberknife. A 3mm expansion was made to create the proton-PTV for the ‘IMPT-3mm’ plan representing the current proton-therapy where a margin of 3mm is used to account for the inferior image-guidance. The proton range uncertainty was taken-care in beam-design by adding the proximal- and distal-margins (3%water-equivalent-depth+1mm) for both proton plans. The IMPT plans were generated to meet the same target coverage asmore » the Cyberknife-plans. The plan quality of IMPT-ideal and IMPT-3mm were compared to the Cyberknife-plan. To characterize plan quality, we defined the ratio(R) of volumes encompassed by the selected isodose surfaces for Cyberknife and IMPT plans (VCK/VIMPT). Comparisons were made for both Cyberknife versus IMPT-ideal and Cyberknife versusIMPT-3mm to further discuss the impact of setup error margins used in proton therapy and the correlation with target size and location. Results: IMPT-ideal plans yield comparable plan quality as CK plans and slightly better OAR sparing while the IMPT-3mm plan results in a higher dose to the OARs, especially for centralized tumors. Comparing to the IMPT-ideal plans, a slightly larger 80% (Ravg=1.05) dose cloud and significantly larger 50% (Ravg=1.3) and 20% (Ravg=1.60) dose clouds are seen in CK plans. However, the 3mm expansion results in a larger high and medium dose clouds in IMPT-3mm plans (Ravg=0.65 for 80%-isodose; Ravg=0.93 for 50%-isodose). The trend increases with the size of the target and the distance from the brainstem to the center of target. Conclusion: Cyberknife is more preferable for treating centralized targets and proton therapy is advantageous for the large and peripheral targets. Advanced image guidance would improve the efficacy of proton therapy for intracranial treatments.« less