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Background This article is a summary of the quantitative imaging subgroup of the 2017 AAPM Practical Big Data Workshop (PBDW-2017) on progress and challenges in big data applied to cancer treatment and research supplemented by a draft white paper following an American Association of Physicists in Medicine FOREM meeting on Imaging Genomics in 2014. Aims The goal of PBDW-2017 was to close the gap between theoretical vision and practical experience with encountering and solving challenges in curating and analyzing data. Conclusions Recommendations based on the meetings are summarized.

To determine k Q msr, Q o f msr, f o correction factors for machine-specific reference (msr) conditions by Monte Carlo (MC) simulations for reference dosimetry of TomoTherapy static beams for ion chambers Exradin A1SL, A12; PTW 30006, 31010 Semiflex, 31014 PinPoint, 31018 microLion; NE 2571. Methods: For the calibration of TomoTherapy units, reference conditions specified in current codes of practice like IAEA/TRS-398 and AAPM/TG-51 cannot be realized. To cope with this issue, Alfonso [Med. Phys. 35, 5179-5186 (2008)] described a new formalism introducing msr factors k Q msr, Q o f msr, f o for reference dosimetry, applicable to static TomoTherapy beams. In this study, those factors were computed directly using MC simulations for Q 0 corresponding to a simplified 60Co beam in TRS-398 reference conditions (at 10 cm depth). The msr conditions were a 10 × 5 cm 2 TomoTherapy beam, source-surface distance of 85 cm and 10 cm depth. The chambers were modeled according to technical drawings using the egs++ package and the MC simulations were run with the egs-chamber user code. Phase-space files used as the source input were produced using PENELOPE after simulation of a simplified 60Co beam and the TomoTherapy treatment head modeled according to technical drawings. Correlated sampling, intermediate phase-space storage, and photon cross-section enhancement variance reduction techniques were used. The simulations were stopped when the combined standard uncertainty was below 0.2%. Results: Computed k Q msr, Q o f msr, f o values were all close to one, in a range from 0.991 for the PinPoint chamber to 1.000 for the Exradin A12 with a statistical uncertainty below 0.2%. Considering a beam quality Q defined as the TPR 20,10 for a 6 MV Elekta photon beam (0.661), the additional correction k Q msr, Q f msr, f ref to kQ, Q o defined in Alfonso [Med. Phys. 35, 5179-5186 (2008)] formalism was in a range from 0.997 to 1.004. Conclusion: The MC computed factors in this study are in agreement with measured factors for chamber types already studied in literature. This work provides msr correction factors for additional chambers used in reference dosimetry. All of them were close to one (within 1%).

Purpose: Original TomoTherapy systems may involve a trade-off between conformity and treatment speed, the user being limited to three slice widths (1.0, 2.5, and 5.0 cm). This could be overcome by allowing the jaws to define arbitrary fields, including very small slice widths (

Purpose: Every year, new radiotherapy techniques including stereotactic radiosurgery using linear accelerators give rise to new applications of Monte Carlo(MC) modeling. Accurate modeling requires knowing the size of the electron spot, one of the few parameters to tune in MC models. The resolution of integrated megavoltage imaging systems, such as the tomotherapy system, strongly depends on the photon spot size which is closely related to the electron spot. The aim of this article is to clarify the relationship between the electron spot size and the photon spot size (i.e., thefocal spot size) for typical incident electron beam energies and target thicknesses. Methods: Three electron energies (3, 5.5, and 18 MeV), four electron spot sizes ( FWHM = 0 , 0.5, 1, and 1.5 mm), and two tungsten target thicknesses (0.15 and 1 cm) were considered. The formation of the photon beam within the target was analyzed through electron energy deposition with depth, as well as photon production at several phase-space planes placed perpendicular to the beam axis, where only photons recorded for the first time were accounted for. Photon production was considered for “newborn” photons intersecting a 45 × 45 cm 2 plane at the isocenter (85 cm from source). Finally, virtual source position and “effective” focal spot size were computed by backprojecting all the photons from the bottom of the target intersecting a 45 × 45 cm 2 plane. The virtual source position and focal spot size were estimated at the plane position where the latter is minimal. Results: In the relevant case of considering only photons intersecting the 45 × 45 cm 2 plane, the results unambiguously showed that the effective photon spot is created within the first 0.25 mm of the target and that electron and focal spots may be assumed to be equal within 3–4%. Conclusions: In a good approximation photon spot size equals electron spot size for high energy X-ray treatments delivered by linear accelerators.

Several compact proton accelerator systems for use in proton therapy have recently been proposed. Of paramount importance to the development of such an accelerator system is the maximum kinetic energy of protons, immediately prior to entry into the patient, that must be reached by the treatment system. The commonly used value for the maximum kinetic energy required for a medical proton accelerator is 250 MeV, but it has not been demonstrated that this energy is indeed necessary to treat all or most patients eligible for proton therapy. This article quantifies the maximum kinetic energy of protons, immediately prior to entry into the patient, necessary to treat a given percentage of patients with rotational proton therapy, and examines the impact of this energy threshold on the cost and feasibility of a compact, gantry-mounted proton accelerator treatment system. One hundred randomized treatment plans from patients treated with IMRT were analyzed. The maximum radiological pathlength from the surface of the patient to the distal edge of the treatment volume was obtained for 180 degrees continuous arc proton therapy and for 180 degrees split arc proton therapy (two 90 degrees arcs) using CT# profiles from the Pinnacle (Philips Medical Systems, Madison, WI) treatment planning system. In each case, the maximum kinetic energy of protons, immediately prior to entry into the patient, that would be necessary to treat the patient was calculated using proton range tables for various media. In addition, Monte Carlo simulations were performed to quantify neutron production in a water phantom representing a patient as a function of the maximum proton kinetic energy achievable by a proton treatment system. Protons with a kinetic energy of 240 MeV, immediately prior to entry into the patient, were needed to treat 100% of patients in this study. However, it was shown that 90% of patients could be treated at 198 MeV, and 95% of patients could be treated at 207 MeV. Decreasing the proton kinetic energy from 250 to 200 MeV decreases the total neutron energy fluence produced by stopping a monoenergetic pencil beam in a water phantom by a factor of 2.3. It is possible to significantly lower the requirements on the maximum kinetic energy of a compact proton accelerator if the ability to treat a small percentage of patients with rotational therapy is sacrificed. This decrease in maximum kinetic energy, along with the corresponding decrease in neutron production, could lower the cost and ease the engineering constraints on a compact proton accelerator treatment facility.

The use of small fields in radiotherapy techniques has increased substantially, in particular in stereotactic treatments and large uniform or nonuniform fields that are composed of small fields such as for intensity modulated radiation therapy (IMRT). This has been facilitated by the increased availability of standard and add-on multileaf collimators and a variety of new treatment units. For these fields, dosimetric errors have become considerably larger than in conventional beams mostly due to two reasons; (i) the reference conditions recommended by conventional Codes of Practice (CoPs) cannot be established in some machines and (ii) the measurement of absorbed dose to water in composite fields is not standardized. In order to develop standardized recommendations for dosimetry procedures and detectors, an international working group on reference dosimetry of small and nonstandard fields has been established by the International Atomic Energy Agency (IAEA) in cooperation with the American Association of Physicists in Medicine (AAPM) Therapy Physics Committee. This paper outlines a new formalism for the dosimetry of small and composite fields with the intention to extend recommendations given in conventional CoPs for clinical reference dosimetry based on absorbed dose to water. This formalism introduces the concept of two new intermediate calibration fields: (i) a static machine-specific reference field for those modalities that cannot establish conventional reference conditions and (ii) a plan-class specific reference field closer to the patient-specific clinical fields thereby facilitating standardization of composite field dosimetry. Prior to progressing with developing a CoP or other form of recommendation, the members of this IAEA working group welcome comments from the international medical physics community on the formalism presented here.

Organ motion and injury to adjacent structures limit curative treatment of intraabdominal tumors with external beam radiotherapy. We evaluated the use of Laparoscopically Implanted Tissue Expander Radiotherapy (LITE-RT) to exclude critical structures during irradiation of the urinary bladder in two dogs with transitional cell carcinoma (TCC) using helical tomotherapy. Dogs had histologically confirmed bladder TCC with no metastasis. A custom-shaped tissue expander was placed between the colon and bladder laparoscopically in one dog and during laparotomy in the other. The prescribed radiation dose was 45 Gy to 98% volume of the bladder in 18 fractions of 2.5 Gy. Tumor response and normal tissue effects were monitored with cystoscopy and colonic biopsies before treatment and 3, 6, and 15 months after treatment. Based on treatment plans from inflated vs. deflated tissue expander CT images, there was a mean dose reduction to the colon of 53% and 31% for the two dogs. Interfractional target repositioning was possible by using volumetric megavoltage computed tomography helical tomotherapy. Both dogs had no clinical signs of chronic colitis but did experience mild cystitis during treatment. Tissue expanders became detached, requiring an additional surgery for reattachment, in both dogs. One dog developed a fibrous adhesion resulting in bladder rupture during inflation, which necessitated early device removal. One dog was euthanized for tumor-associated ureteral obstruction at 8 months while the other is alive at 21 months. We conclude that LITE-RT shows promise in treatment of canine bladder TCC due to lack of acute colitis and enteritis.

Feasibility of delivering a simultaneously integrated boost to canine nasal tumors using helical tomotherapy to improve tumor control probability (TCP) via an increase in total biological equivalent uniform dose (EUD) was evaluated. Eight dogs with varying size nasal tumors (5.8-110.9 cc) were replanned to 42 Gy to the nasal cavity and integrated dose boosts to gross disease of 45.2, 48.3, and 51.3 Gy in 10 fractions. EUD values were calculated for tumors and mean normalized total doses (NTD(mean)) for organs at risk (OAR). Normal Tissue Complication Probability (NTCP) values were obtained for OARs, and estimated TCP values were computed using a logistic dose-response model and based on deliverable EUD boost doses. Significant increases in estimated TCP to 54%, 74%, and 86% can be achieved with 10%, 23%, and 37% mean relative EUD boosts to the gross disease, respectively. NTCP values for blindness of either eye and for brain necrosis were < 0.01% for all boosts. Values for cataract development were 31%, 42%, and 46% for studied boost schemas, respectively. Average NTD(mean) to eyes and brain for mean EUD boosts were 10.2, 11.3, and 12.1 Gy3, and 7.5, 7.2, and 7.9 Gy2, respectively. Using helical tomotherapy, simultaneously integrated dose boosts can be delivered to increase the estimated TCP at 1-year without significantly increasing the NTD(mean) to eyes and brain. Delivery of these treatments in a prospective trial may allow quantification of a dose-response relationship in canine nasal tumors.

Current dosimetric protocols based on the absorbed dose (AAPM TG-51 and IAEA TRS-398 protocols) require calibration measurements under reference conditions. For some radiotherapy systems, this requirement cannot be met, and calibration has to be performed under nonreference experimental conditions. In order to solve this problem, both protocols can be extended by inclusion of the measured-to-reference conversion factor, k(mr). In order to determine this factor, basic dosimetric quantities, like stopping power ratios, mass attenuation coefficients and chamber correction factors have to be calculated. If measurements are not feasible, accurate Monte Carlo modeling is required. The extension of the protocols is illustrated using the case of the helical tomotherapy radiation unit, where the typical calibration measurement conditions are the 10 x 5 cm2 field size and the 85 cm surface source distance, limited by the system design. It was calculated that the k(mr) factor for this conditions is close to unity (0.997+/-0.001). In addition, the deviation of the measurement conditions from the reference conditions results in the change of the quality conversion factor (approximately 0.995-0.998, depending on the ionization chamber used). This change is the same regardless of the used calibration protocol. For smaller field sizes the corrections become more significant, resulting in the total correction factor compared to the reference conditions of up to 1.5% for the smallest considered field size of 2 x 2 cm2.

Similar to conventional conformal radiotherapy, during lung tomotherapy, a motion margin has to be set for respiratory motion. Consequently, large volume of normal tissue is irradiated by intensive radiation. To solve this problem, we have developed a new motion mitigation method by incorporating target motion into treatment optimization. In this method, the delivery-breathing correlation is determined prior to treatment plan optimization. Beamlets are calculated by using the CT images at the corresponding breathing phases from a dynamic (four-dimensional) image sequence. With the displacement vector fields at different breathing phases, a set of deformed beamlets is obtained by mapping the dose to the primary phase. Optimization incorporating motion is then performed by using the deformed beamlets obtained by dose mapping. During treatment delivery, the same breathing-delivery correlation can be reproduced by instructing the patient to breathe following a visually displayed guiding cycle. This method was tested using a computer-simulated deformable phantom and a real lung case. Results show that treatment optimization incorporating motion achieved similar high dose conformality on a mobile target compared with static delivery. The residual motion effects due to imperfect breathing tracking were also analyzed.

Multileaf collimators (MLCs) have advanced past their original design purpose as a replacement for field shaping cerrobend blocks. Typically, MLCs incorporate an interlocking tongue-and-groove design between adjacent leaves to minimize leakage between leaves. They are beginning to be used to provide intensity modulation for conformal three-dimensional radiation therapy. It is possible that a critical target volume may receive an underdose due to the region of overlap if adjacent leaves are allowed to alternate between the open and closed positions, as they might if intensity modulation is employed. This work demonstrates the magnitude of that effect for a commercially available one-dimensional temporally modulated MLC. The magnitude of the transmission between leaves as a function of leaf separation was also studied, as well as the transmission as a function of leaf rotation away from the source. The results of this work were used for the design of a tomotherapy MLC. The radiation leakage considerations for a tomotherapy MLC are discussed.

Stopping-power ratios are a function of field size and vary with accelerators. To investigate how these variations affect relative output factor measurements made using ion chambers for electron beams, especially for small fields, (L/rho)air(water) is calculated using the Monte Carlo technique for different field sizes, beam energies, and accelerators and is compared to the data in TG-21 or TG-25, which are for mono-energetic broad beams. For very small field sizes defined by cutouts, if the change in (L/rho)air(water) with dmax is ignored (i.e., TG-25 is not carefully followed), there is an overestimate of relative output factors by up to 3%. Ignoring the field-size effect on stopping-power ratio adds an additional overestimate of up to one-half percent, and using mono-energetic stopping-power ratio data instead of realistic beam data gives another error, but in the opposite direction, of up to 0.7%. Due to the cancellation of these latter two errors, following TG-25 with (L/rho)air(water) data for broad mono-energetic beams will give the correct answer for the ROF measurement within 0.4% compared to using (L/rho)air(water) data for which the field-size effect is considered for realistic electron beams.

The objective of this study was to document the utility of computed tomography (CT) and a three-dimensional (3-D) radiotherapy treatment planning system for assessing the development of acute radiation pneumonitis in a canine model. Fourteen dogs were randomly assigned to a nonirradiated control group or one of three radiation dose groups receiving a single fraction of either 12, 15, or 18 Gy delivered to two-thirds of the right hemithorax. CT and survey radiographs were performed in all dogs prior to and at defined intervals for up to 13 weeks following irradiation. All images were subjectively evaluated for development of radiation pneumonitis and CT images were quantitatively analyzed. Radiation pneumonitis was detected earlier with CT images than with radiographs. Quantitatively, functional lung volume and radiation pneumonitis lesion volume on CT images changed over time in all irradiated dogs. However, there was no statistically significant difference between the three radiation dose groups, but a marked difference between irradiated dogs and nonirradiated controls. These data suggest that CT is superior to survey radiography for the evaluation and quantification of acute radiation pneumonitis in this canine model. Quantification of acute radiation pneumonitis suggests future promise for evaluating the efficacy of modifiers to lessen the effects of irradiating normal lung tissue in this canine model.

Using Monte Carlo simulations we have studied the electron mean energy, Eo, and the most probable energy, Eo,p, at the phantom surface and their relationships with half-value depth, R50, and the practical range, Rp, for a variety of beams from five commercial medical accelerators with an energy range of 5-50 MeV. It is difficult to obtain a relation between R50 and Eo for all electrons at the surface because the number of scattered lower-energy electrons varies with the machine design. However, using only direct electrons to calculate Eo, there is a relationship which is in close agreement with that calculated using monoenergetic beams by Rogers and Bielajew [Med. Phys. 13, 687-694 (1986)]. We show that the empirical formula Eo,p = 0.22 + 1.98Rp + 0.0025R2p describes accurately the relationship between Rp and Eo,p for clinical beams of energies from 5 to 50 MeV with an accuracy of 3%. The electron mean energy, Ed, is calculated as a function of depth in water as well as plastic phantoms and is compared both with the relation, Ed = Eo (1-d/Rp), employed in AAPM protocols and with values in the IAEA Code of Practice. The conventional relations generally overestimate Ed over the entire therapeutic depth, e.g., the AAPM and IAEA overestimate Ed at dmax by up to 20% for an 18 MeV beam from a Clinac 2100C. It is also found that at all depths mean energies are 1%-3% higher near the field edges than at the central axis. We calculated depth-scaling factors for plastic phantoms by scaling the depth in plastics to the water-equivalent depth where the mean energies are equal. The depth-scaling factor is constant with depth in a given beam but there is a small variation ( < 1.5%) depending on the incident beam energies. Depth-scaling factors as a function of R50 in plastic or water are presented for clear polystyrene, white polystyrene and PMMA phantom materials. The calculated depth-scaling factor is found to be equal to R50water/R50plastic. This is just the AAPM definition of effective density but there are up to 2% discrepancies between our calculated values and those recommended by the AAPM and the IAEA protocols. We find that the depth-scaling factors obtained by using the ratio of continuous-slowing-down ranges are inaccurate and overestimate our calculated values by 1%-2% in all cases. We also find that for accurate work, it is incorrect to use a simple 1/r2 correction to convert from parallel beam depth-dose curves to point source depth-dose curves, especially for high-energy beams.

This paper describes BEAM, a general purpose Monte Carlo code to simulate the radiation beams from radiotherapy units including high-energy electron and photon beams, 60Co beams and orthovoltage units. The code handles a variety of elementary geometric entities which the user puts together as needed (jaws, applicators, stacked cones, mirrors, etc.), thus allowing simulation of a wide variety of accelerators. The code is not restricted to cylindrical symmetry. It incorporates a variety of powerful variance reduction techniques such as range rejection, bremsstrahlung splitting and forcing photon interactions. The code allows direct calculation of charge in the monitor ion chamber. It has the capability of keeping track of each particle's history and using this information to score separate dose components (e.g., to determine the dose from electrons scattering off the applicator). The paper presents a variety of calculated results to demonstrate the code's capabilities. The calculated dose distributions in a water phantom irradiated by electron beams from the NRC 35 MeV research accelerator, a Varian Clinac 2100C, a Philips SL75-20, an AECL Therac 20 and a Scanditronix MM50 are all shown to be in good agreement with measurements at the 2 to 3% level. Eighteen electron spectra from four different commercial accelerators are presented and various aspects of the electron beams from a Clinac 2100C are discussed. Timing requirements and selection of parameters for the Monte Carlo calculations are discussed.

The EGS4 Monte Carlo code has been used to simulate the emission and energy deposition in H2O about point sources of monoenergetic electrons and radionuclides of potential use in radioimmunotherapy. The radiations studied were 0.05, 0.1, 0.5, 1.0, 2.0, and 3.0 MeV monoenergetic electrons and 32P, 67Cu, 90Y, 105Rh, 131I, 153Sm, 186Re, and 188Re beta particles and conversion and Auger electrons. Ten batches of 10,000 electrons (or 10,000 radionuclide decays) each were started isotropically at a point in an infinite homogeneous H2O phantom. The parameter-reduced electron-step transport algorithm (PRESTA) version of the EGS4 Monte Carlo code was used to follow these and their progeny, scoring the energy deposited in thin spherical shells. The scaled dose kernels are calculated and compared to kernels available in the literature. These previously published kernels either completely ignore secondary electrons or are based on a Monte Carlo code which improperly sampled the Landau energy straggling distribution.

Purpose: The increased use of small photon fields in stereotactic and intensity modulated radiotherapy has raised the need for standardizing the dosimetry of such fields using procedures consistent with those for conventional radiotherapy. An international working group, established by the IAEA in collaboration with AAPM and IPEM, is finalising a Code of Practice for the dosimetry of small static photon fields. Methods: Procedures for reference dosimetry in non‐standard machine specific reference (msr) fields are provided following the formalism of Alfonso et al., Med. Phys. 35 (2008). Recommended correction factors are based on experiment data or Monte Carlo simulated data reported in the literature. They are tabulated for suitable detectors for specific machines such as CyberKnife, GammaKnife and TomoTherapy as well as for generic rectangular fields defined by multi‐leaf collimators and circular fields 4010 defined by cones. Results: Reference dosimetry using ionization chambers in machines that cannot establish a conventional 10 cm × 10 cm reference field is based on either a direct calibration in the msr field traceable to primary standards or a calibration in a reference field and a generic correction factor or the product of a correction factor for a virtual reference field and a correction factor for the difference between the msr and virtual fields. For the latter method, procedures are provided for determining the beam quality in non‐reference conditions. For the measurement of field output factors in small fields, procedures for connecting large field measurements using ionization chambers to small field measurements using high‐resolution detectors such as diodes, diamond, liquid ion chambers, organic scintillators and radiochromic film are given. Conclusions: A new Code of Practice will be published by the IAEA in the near future. Further research to measure or calculate missing data according to well‐defined procedures will be strongly encouraged by the publication of this document.

Purpose: To characterize and parametrically study the key components of a dielectric wall accelerator through electromagnetic modeling and particle tracking. Methods: Electromagnetic and particle tracking simulations were performed using a commercial code (CST Microwave Studio, CST Inc.) utilizing the finite integration technique. A dielectric wall accelerator consists of a series of stacked transmission lines sequentially fired in synchrony with an ion pulse. Numerous properties of the stacked transmission lines, including geometric, material, and electronic properties, were analyzed and varied in order to assess their impact on the transverse and axial electric fields. Additionally, stacks of transmission lines were simulated in order to quantify the parasitic effect observed in closely packed lines. Particle tracking simulations using the particle-in-cell method were performed on the various stacks to determine the impact of the above properties on the resultant phase space of the ions. Results: Examination of the simulation results show that novel geometries can shape the accelerating pulse in order to reduce the energy spread and increase the average energy of accelerated ions. Parasitic effects were quantified for various geometries and found to vary with distance from the end of the transmission line and along the beam axis. An optimal arrival time of an ion pulse relative to the triggering of the transmission lines for a given geometry was determined through parametric study. Benchmark simulations of single transmission lines agree well with published experimental results. Conclusion: This work characterized the behavior of the transmission lines used in a dielectric wall accelerator and used this information to improve them in novel ways. Utilizing novel geometries, we were able to improve the accelerating gradient and phase space of the accelerated particle bunch. Through simulation, we were able to discover and optimize design issues with the device at low cost. Funding: Morgridge Institute for Research, Madison WI; Conflict of Interest: Dr. Mackie is an investor and board member at CPAC, a company developing compact accelerator designs similar to those discussed in this work, but designs discussed are not directed by CPAC. Funding: Morgridge Institute for Research, Madison WI; Conflict of Interest: Dr. Mackie is an investor and board member at CPAC, a company developing compact accelerator designs similar to those discussed in this work, but designs discussed are not directed by CPAC.

Purpose: This paper presents a concept for a proton therapy system capable of delivering intensity modulated proton therapy using a fan beam of protons. This system would allow present and future gantry-based facilities to deliver state-of-the-art proton therapy with the greater normal tissue sparing made possible by intensity modulation techniques. Methods: A method for producing a divergent fan beam of protons using a pair of electromagnetic quadrupoles is described and particle transport through the quadrupole doublet is simulated using a commercially available software package. To manipulate the fan beam of protons, a modulation device is developed. This modulator inserts or retracts acrylic leaves of varying thickness from subsections of the fan beam. Each subsection, or beam channel, creates what effectively becomes a beam spot within the fan area. Each channel is able to provide 0–255 mm of range shift for its associated beam spot, or stop the beam and act as an intensity modulator. Results of particle transport simulations through the quadrupole system are incorporated into the MCNPX Monte Carlo transport code along with a model of the range and intensity modulation device. Several design parameters were investigated and optimized, culminating in the ability to create topotherapy treatment plans using distal-edge tracking on both phantom and patient datasets. Results: Beam transport calculations show that a pair of electromagnetic quadrupoles can be used to create a divergent fan beam of 200 MeV protons over a distance of 2.1 m. The quadrupole lengths were 30 and 48 cm, respectively, with transverse field gradients less than 20 T/m, which is within the range of water-cooled magnets for the quadrupole radii used. MCNPX simulations of topotherapy treatment plans suggest that, when using the distal edge tracking delivery method, many delivery angles are more important than insisting on narrow beam channel widths in order to obtain conformal target coverage. Overall, the sharp distal falloff of a proton depth-dose distribution was found to provide sufficient control over the dose distribution to meet objectives, even with coarse lateral resolution and channel widths as large as 2 cm. Treatment plans on both phantom and patient data show that dose conformity suffers when treatments are delivered from less than approximately ten angles. Treatment time for a sample prostate delivery is estimated to be on the order of 10 min, and neutron production is estimated to be comparable to that found for existing collimated systems. Conclusions: Fan beam proton therapy is a method of delivering intensity modulated proton therapy which may be employed as an alternative to magnetic scanning systems. A fan beam of protons can be created by a set of quadrupole magnets and modified by a dual-purpose range and intensity modulator. This can be used to deliver inversely planned treatments, with spot intensities optimized to meet user defined dose objectives. Additionally, the ability of a fan beam delivery system to effectively treat multiple beam spots simultaneously may provide advantages as compared to spot scanning deliveries.

Purpose: Pencil beam algorithms are commonly used for proton therapy dose calculations. Szymanowski and Oelfke [“Two-dimensional pencil beam scaling: An improved proton dose algorithm for heterogeneous media,” Phys. Med. Biol. 47, 3313–3330 (2002) doi: 10.1088/0031-9155/47/18/304.] developed a two-dimensional (2D) scaling algorithm which accurately models the radial pencil beam width as a function of depth in heterogeneous slab geometries using a scaled expression for the radial kernel width in water as a function of depth and kinetic energy. However, an assumption made in the derivation of the technique limits its range of validity to cases where the input expression for the radial kernel width in water is derived from a local scattering power model. The goal of this work is to derive a generalized form of 2D pencil beam scaling that is independent of the scattering power model and appropriate for use with any expression for the radial kernel width in water as a function of depth. Methods: Using Fermi-Eyges transport theory, the authors derive an expression for the radial pencil beam width in heterogeneous slab geometries which is independent of the proton scattering power and related quantities. The authors then perform test calculations in homogeneous and heterogeneous slab phantoms using both the original 2D scaling model and the new model with expressions for the radial kernel width in water computed from both local and nonlocal scattering power models, as well as a nonlocal parameterization of Moliere scattering theory. In addition to kernel width calculations, dose calculations are also performed for a narrow Gaussian proton beam. Results: Pencil beam width calculations indicate that both 2D scaling formalisms perform well when the radial kernel width in water is derived from a local scattering power model. Computing the radial kernel width from a nonlocal scattering model results in the local 2D scaling formula under-predicting the pencil beam width by as much as 1.4 mm (21%) at the depth of the Bragg peak for a 220 MeV proton beam in homogeneous water. This translates into a 32% dose discrepancy for a 5 mm Gaussian proton beam. Similar trends were observed for calculations made in heterogeneous slab phantoms where it was also noted that errors tend to increase with greater beam penetration. The generalized 2D scaling model performs well in all situations, with a maximum dose error of 0.3% at the Bragg peak in a heterogeneous phantom containing 3 cm of hard bone. Conclusions: The authors have derived a generalized form of 2D pencil beam scaling which is independent of the proton scattering power model and robust to the functional form of the radial kernel width in water used for the calculations. Sample calculations made with this model show excellent agreement with expected values in both homogeneous water and heterogeneous phantoms.

Purpose: To characterize the cubic spline path (CSP) estimate for quantitative reconstruction of protoncomputed tomography (pCT) image, compared with those using the most‐likely path (MLP) estimate and the real path. Method and Materials:Monte Carlo simulation of proton projections onto a Shepp‐Logan phantom was performed using the GEANT4 simulation toolkit. The real proton paths were recorded during the simulation. Entrance and exit information of each proton were stored and used for CSP and MLP estimation. A Bayesian inference‐based probability map was generated to evaluate the relative probability of CSP and real path, which are compared with that of MLP. Inter‐path distance between CSP and the real path was evaluated at different depths. Protonstopping powerimages were reconstructed using CSP, MLP, and the real path, respectively. The quantitative accuracy of the reconstructed images was evaluated. Integral depth dose and Bragg peak were predicted on the stopping powerimagereconstructed using CSP. Results: CSP performs almost identically to the real path in terms of its relative probability. Specifically, probabilities of more than 80% of all CSP pixels fall within 90% of the MLP probability. 75% of the CSP pixels at maximum inter‐distance to MLP are within 90% of MLP probability. The direct comparison between CSP and the simulated real path shows that 95% of the CSP pixels are within one pixel of the simulated real path. Reconstruction using the path estimates or the real path shows no significant difference in average stopping power or noise. Bragg peak location as predicted on imagesreconstructed using CSP agrees with that from simulation within 1 mm accuracy. Conclusion: As verified from relative path probability distribution, inter‐path distance distribution, and Bragg peak prediction, CSP as a proton path estimate is sufficient for quantitative pCT reconstruction at even very low imaging dose levels.

Purpose: To study the feasibility of protoncomputed tomography(CT)reconstruction using compressed sensing (CS) and prior image constrained compressed sensing (PICCS). ProtonCTimages can be used for pre‐therapy planning, image guidance and registration verification. Method and Materials: Projections of 200 MeV proton beams onto an ellipsoid phantom was simulated using Geant4 Monte Carlo simulation toolkit. The position and energy of the entrance and exit protons were recorded. Straight‐line path (SLP) estimation was used to represent proton paths, and simultaneous algebraic reconstruction technique (SART) with CS was used to reconstruct a protonstopping powerimage for a 2‐mm thick slice of the phantom. PICCS was used to reconstruct the image from highly undersampled data with an accurate and well‐registered prior image. A Gradient transform was used to yield a sparse data set for CS and PICCS. Results: SART with CS reconstructed a 320×320 protonstopping powerimage of the central slice of the phantom after 10 iterations. A proton/pixel ratio of 0.2 is sufficient to reconstruct an image of correct geometry. The average protonstopping power of the reconstructed materials cortical bone, water, and air were found to agree with the expected values from ICRU Report 49 within 8.3%, 0.6%, and 3.8% respectively. Employing a prior image and PICCS in the reconstruction, a proton/pixel ratio as low as 0.05 was found to be sufficient, and the reconstruction time of less than 2 minutes was achieved using a serial algorithm. Reconstruction artifacts in the images were minimal. Conclusion: With CS, or with PICCS plus a prior image, SART can reconstruct a protonCTimage of good quality within minutes. This paves the road to a clinically feasible approach toward low‐dose pre‐proton therapy treatment planning and image guidance using a fast‐reconstructed protonCTimage with a well‐registered kV‐CT prior image.

Purpose: Previous work on partial breast irradiation in the prone position has lead to the development of a new treatment modality made specifically for the breast. Current methods often utilize a modified two‐tangent approach meaning beams are delivered around the body. This device, on the other hand, takes advantage of the unique geometry of the prone breast by rotating around it to deliver a highly targeted dose to the PTV, while sparing the normal breast tissue and other non‐breast structures. This device will involve helical tomotherapy but on a rotated axis. This will allow many more angles to be utilized compared to the standard methods. Method and Materials: Several technical and clinical aspects of this device have been explored. The technical aspects include the design of a new target, shielding requirements, and energy fluence distributions. The clinical aspects researched include dose distribution comparisons from several different potential energies and the determination of patient selection criteria. Results: These investigations have shown that a 4MV x‐ray beam created from a beryllium target would be the optimal design. Since the breast is a thin structure, a higher energy is not need. However if the energy is any lower, the skindose will increase. Beryllium targets are ideal for this machine since the forward output is roughly 70% that of tungsten for field sizes up to 10 cm, but the lateral energy fluence is significantly less. Conclusions: This machine is able to produce brachytherapy like PBI dose distributions that consist of highly conformal doses to the target and low doses to the non‐target structures. It is also able to achieve this without the additional surgery required for brachytherapy procedures. In addition, a large percentage of breast patients would be eligible for this treatment, since it is able to deliver dose close to the chestwall.

Arrays were generated using the Monte Carlo method representing the energy absorbed throughout waterlike phantoms from charged particles and scatter radiation set in motion by primary interactions at one location. The resulting ‘‘dose spread arrays’’ were normalized to the collision fraction of the kinetic energy released by the primary photons. These arrays are convolved with the relative primary fluence interacting in a phantom to obtain three‐dimensional dose distributions. The method gives good agreement for the 15‐MV x‐ray dose in electronic disequilibrium situations, such as the buildup region, near beam boundaries, and near low‐density heterogeneities.

We have measured the radiation dose in simple heterogeneous phantoms and compared our results with those obtained by various methods of computation. Dose data were obtained both within and distal to simulated regions of lung in order to test the ratio of tissue-air ratios (TAR), Batho, and equivalent TAR methods. These procedures are used routinely in manual and computer-aided planning of radiation therapy, but have been validated primarily for cobalt-60 radiation. Tests performed with 6- and 15-MV x rays reveal that incorrect doses can be computed within or near to a low-density medium, particularly when the field size is small. In these cases, electronic equilibrium is not achieved in the lateral direction, thereby violating an implicit assumption of all the above calculation methods. We quantify the errors in dose calculation for simple slab phantoms, and support our interpretation with a Monte Carlo simulation in which the energy transported by charged particles away from sites of x-ray interactions is considered directly.