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Register a new userEvaluation of plastic materials for range shifting, range compensation, and solid-phantom dosimetry in carbon-ion radiotherapy
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Added by
Nobuyuki Kanematsu Ph.D.
Publication date
2012
fields
Physics
and research's language is
English
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Purpose: Beam range control is the essence of radiotherapy with heavy charged particles. In conventional broad-beam delivery, fine range adjustment is achieved by insertion of range shifting and compensating materials. In dosimetry, solid phantoms are often used for convenience. These materials should ideally be equivalent to water. In this study, we evaluated dosimetric water equivalence of four common plastics, HDPE, PMMA, PET, and POM. Methods: Using the Bethe formula for energy loss, the Gottschalk formula for multiple scattering, and the Sihver formula for nuclear interactions, we calculated the effective densities of the plastics for these interactions. We experimentally measured variation of the Bragg peak of carbon-ion beams by insertion of HDPE, PMMA, and POM, which were compared with analytical model calculations. Results: The theoretical calculation resulted in slightly reduced multiple scattering and severely increased nuclear interactions for HDPE, compared to water and the other plastics. The increase in attenuation of carbon ions for 20-cm range shift was experimentally measured to be 8.9% for HDPE, 2.5% for PMMA, and 0.0% for POM while PET was theoretically estimated to be in between PMMA and POM. The agreement between the measurements and the calculations was about 1% or better. Conclusions: For carbon-ion beams, POM was dosimetrically indistinguishable from water and the best of the plastics examined in this study. The poorest was HDPE, which would reduce the Bragg peak by 0.45% per 1-cm range shift, although with marginal superiority for reduced multiple scattering. Between the two clear plastics, PET would be superior to PMMA in dosimetric water equivalence.
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item[Purpose] A recent study revealed that polyethylene (PE) would cause extra carbon-ion attenuation per range shift by 0.45%/cm due to compositional differences in nuclear interactions. The present study aims to assess the influence of PE range compensators on tumor dose in carbon-ion radiotherapy. item[Methods] Carbon-ion radiation was modeled to be composed of primary carbon ions and secondary particles, for each of which the dose and the relative biological effectiveness (RBE) were estimated at a tumor depth in the middle of spread-out Bragg peak. Assuming exponential behavior for attenuation and yield of these components with depth, the PE effect on dose was calculated for clinical carbon-ion beams and was partly tested by experiment. The two-component model was integrated into a treatment-planning system and the PE effect was estimated in two clinical cases. item[Results] The attenuation per range shift by PE was 0.1%--0.3%/cm in dose and 0.2%--0.4%/cm in RBE-weighted dose, depending on energy and range-modulation width. This translates into reduction of RBE-weighted dose by up to 3% in extreme cases. In the treatment-planning study, however, the effect on RBE-weighted dose to tumor was typically within 1% reduction. item[Conclusions] The extra attenuation of primary carbon ions in PE was partly compensated by increased secondary particles for tumor dose. In practical situations, the PE range compensators would normally cause only marginal errors as compared to intrinsic uncertainties in treatment planning, patient setup, beam delivery, and clinical response.
In carbon-ion radiotherapy, single-beam delivery each day in alternate directions has been commonly practiced for operational efficiency, taking advantage of the Bragg peak and the relative biological effectiveness (RBE) for uniform dose conformation to a tumor. The treatment plans are usually evaluated with total RBE-weighted dose, which is however deficient in relevance to the biological effect in the linear-quadratic model due to its quadratic-dose term, or the dose-fractionation effect. In this study, we reformulate the extrapolated response dose (ERD), or synonymously BED, which normalizes the dose-fractionation and cell-repopulation effects as well as the RBE of treating radiation, based on inactivation of a single model cell system and a typical treating radiation in carbon-ion RT. The ERD distribution virtually represents the biological effect of the treatment regardless of radiation modality or fractionation scheme. We applied the ERD formulation to simplistic model treatments and to a preclinical survey for hypofractionation based on an actual prostate-cancer treatment of carbon-ion radiotherapy. The proposed formulation was demonstrated to be practical and to offer theoretical implications. In the prostate-cancer case, the ERD distribution was very similar to the RBE-weighted-dose distribution of the actual treatment in 12 fractions. With hypofractionation, while the RBE-weighted-dose distribution varied significantly, the ERD distribution was nearly invariant, implying that the carbon-ion radiotherapy would be insensitive to fractionation. However, treatment evaluation with simplistic biological dose is intrinsically limited and must be complemented in practice somehow by clinical experiences and biology experiments.
While spatial dose conformity delivered to a target volume has been pushed to its practical limits with advanced treatment planning and delivery, investigations in novel temporal dose delivery are unfolding new mechanisms. Recent advances in ultra-high dose radiotherapy, abbreviated as FLASH, indicate the potential for reduction in healthy tissue damage while preserving tumor control. FLASH therapy relies on very high dose rate of > 40Gy/sec with sub-second temporal beam modulation, taking a seemingly opposite direction from the conventional paradigm of fractionated therapy. FLASH brings unique challenges to dosimetry, beam control, and verification, as well as complexity of radiobiological effective dose through altered tissue response. In this review, we compare the dosimetric methods capable of operating under high dose rate environments. Due to excellent dose-rate independence, superior spatial (~<1 mm) and temporal (~ns) resolution achievable with Cherenkov and scintillation-based detectors, we show that luminescent detectors have a key role to play in the development of FLASH-RT, as the field rapidly progresses towards clinical adaptation. Additionally, we show that the unique ability of certain luminescence-based methods to provide tumor oxygenation maps in real-time with submillimeter resolution can elucidate the radiobiological mechanisms behind the FLASH effect. In particular, such techniques will be crucial for understanding the role of oxygen in mediating the FLASH effect.
Monitoring the dose delivered during proton and carbon ion therapy is still a matter of research. Among the possible solutions, several exploit the measurement of the single photon emission from nuclear decays induced by the irradiation. To fully characterize such emission the detectors need development, since the energy spectrum spans the range above the MeV that is not traditionally used in medical applications. On the other hand, a deeper understanding of the reactions involving gamma production is needed in order to improve the physic models of Monte Carlo codes, relevant for an accurate prediction of the prompt-gamma energy spectrum.This paper describes a calibration technique tailored for the range of energy of interest and reanalyzes the data of the interaction of a 80MeV/u fully stripped carbon ion beam with a Poly-methyl methacrylate target. By adopting the FLUKA simulation with the appropriate calibration and resolution a significant improvement in the agreement between data and simulation is reported.
Carbon-ion radiotherapy (CIRT) is generally evaluated with the dose weighted by relative biological effectiveness (RBE), while the radiation quality varying in the body of each patient is ignored for lack of such distribution. In this study, we attempted to develop a method to estimate linear energy transfer (LET) for a treatment planning system that only handled physical and RBE-weighted doses. The LET taken from a database of clinical broad beams was related to the RBE per energy with two polyline fitting functions for spread-out Bragg peak (SOBP) and for entrance depths, which would be selected by RBE threshold per energy per modulation. The LET estimation was consistent with the original calculation typically within a few keV/{mu}m except for the overkill at the distal end of SOBP. The CIRT treatments can thus be related to the knowledge obtained in radiobiology experiments that used LET to represent radiation quality.
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