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A novel phase-space source implementation has been designed for GPU-based Monte Carlo dose calculation engines. Due to the parallelized nature of GPU hardware, it is essential to simultaneously transport particles of the same type and similar energies but separated spatially to yield a high efficiency. We present three methods for phase-space implementation that have been integrated into the most recent version of the GPU-based Monte Carlo radiotherapy dose calculation package gDPM v3.0. The first method is to sequentially read particles from a patient-dependent phase-space and sort them on-the-fly based on particle type and energy. The second method supplements this with a simple secondary collimator model and fluence map implementation so that patient-independent phase-space sources can be used. Finally, as the third method (called the phase-space-let, or PSL, method) we introduce a novel strategy to pre-process patient-independent phase-spaces and bin particles by type, energy and position. Position bins located outside a rectangular region of interest enclosing the treatment field are ignored, substantially decreasing simulation time. The three methods were validated in absolute dose against BEAMnrc/DOSXYZnrc and compared using gamma-index tests (2%/2mm above the 10% isodose). It was found that the PSL method has the optimal balance between accuracy and efficiency and thus is used as the default method in gDPM v3.0. Using the PSL method, open fields of 4x4, 10x10 and 30x30 cm2 in water resulted in gamma passing rates of 99.96%, 99.92% and 98.66%, respectively. Relative output factors agreed within 1%. An IMRT patient plan using the PSL method resulted in a passing rate of 97%, and was calculated in 50 seconds using a single GPU compared to 8.4 hours (per CPU) for BEAMnrc/DOSXYZnrc., Comment: 19 pages, 6 figures

The gamma-index test has been commonly adopted to quantify the degree of agreement between a reference dose distribution and an evaluation dose distribution. Monte Carlo (MC) simulation has been widely used for the radiotherapy dose calculation for both clinical and research purposes. The goal of this work is to investigate both theoretically and experimentally the impact of the MC statistical fluctuation on the gamma-index test when the fluctuation exists in the reference, the evaluation, or both dose distributions. To the first order approximation, we theoretically demonstrated in a simplified model that the statistical fluctuation tends to overestimate gamma-index values when existing in the reference dose distribution and underestimate gamma-index values when existing in the evaluation dose distribution given the original gamma-index is relatively large for the statistical fluctuation. Our numerical experiments using clinical photon radiation therapy cases have shown that 1) when performing a gamma-index test between an MC reference dose and a non-MC evaluation dose, the average gamma-index is overestimated and the passing rate decreases with the increase of the noise level in the reference dose; 2) when performing a gamma-index test between a non-MC reference dose and an MC evaluation dose, the average gamma-index is underestimated when they are within the clinically relevant range and the passing rate increases with the increase of the noise level in the evaluation dose; 3) when performing a gamma-index test between an MC reference dose and an MC evaluation dose, the passing rate is overestimated due to the noise in the evaluation dose and underestimated due to the noise in the reference dose. We conclude that the gamma-index test should be used with caution when comparing dose distributions computed with Monte Carlo simulation.

Using fiducial markers on patient's body surface to predict the tumor location is a widely used approach in lung cancer radiotherapy. The purpose of this work is to propose an algorithm that automatically identifies a sparse set of locations on the patient's surface with the optimal prediction power for the tumor motion. The sparse selection of markers on the external surface and the assumed linear relationship between the marker motion and the internal tumor motion are represented by a prediction matrix. Such a matrix is determined by solving an optimization problem, where the objective function contains a sparsity term that penalizes the number of markers chosen on the patient's surface. The performance of our algorithm has been tested on realistic clinical data of four lung cancer patients. Thoracic 4DCT scans with 10 phases are used for the study. On a reference phase, a grid of points are casted on the patient's surface (except for patient's back) and propagated to other phases via deformable image registration of the corresponding CT images. Tumor locations at each phase are also manually delineated. We use 9 out of 10 phases of the 4DCT images to identify a small group of surface markers that are most correlated with the motion of the tumor, and find the prediction matrix at the same time. The 10th phase is then used to test the accuracy of the prediction. It is found that on average 6 to 7 surface markers are necessary to predict tumor locations with a 3D error of about 1mm. In addition, the selected marker locations lie closely in those areas where surface point motion has a high correlation with the tumor motion. Our method can automatically select sparse locations on patient's external surface and estimate a correlation matrix based on 4DCT, so that the selected surface locations can be used to place fiducial markers to optimally predict internal tumor motions.

Monte Carlo (MC) simulation is commonly considered to be the most accurate dose calculation method in radiotherapy. However, its efficiency still requires improvement for many routine clinical applications. In this paper, we present our recent progress towards the development a GPU-based MC dose calculation package, gDPM v2.0. It utilizes the parallel computation ability of a GPU to achieve high efficiency, while maintaining the same particle transport physics as in the original DPM code and hence the same level of simulation accuracy. In GPU computing, divergence of execution paths between threads can considerably reduce the efficiency. Since photons and electrons undergo different physics and hence attain different execution paths, we use a simulation scheme where photon transport and electron transport are separated to partially relieve the thread divergence issue. High performance random number generator and hardware linear interpolation are also utilized. We have also developed various components to handle fluence map and linac geometry, so that gDPM can be used to compute dose distributions for realistic IMRT or VMAT treatment plans. Our gDPM package is tested for its accuracy and efficiency in both phantoms and realistic patient cases. In all cases, the average relative uncertainties are less than 1%. A statistical t-test is performed and the dose difference between the CPU and the GPU results is found not statistically significant in over 96% of the high dose region and over 97% of the entire region. Speed up factors of 69.1 ~ 87.2 have been observed using an NVIDIA Tesla C2050 GPU card against a 2.27GHz Intel Xeon CPU processor. For realistic IMRT and VMAT plans, MC dose calculation can be completed with less than 1% standard deviation in 36.1~39.6 sec using gDPM., Comment: 18 pages, 5 figures, and 3 tables