Integration of the M6 Cyberknife in the Moderato Monte Carlo platform and prediction of beam parameters using machine learning

PurposeThis work describes the integration of the M6 Cyberknife in the Moderato Monte Carlo platform, and introduces a machine learning method to accelerate the modelling of a linac.MethodsThe MLC-equipped M6 Cyberknife was modelled and integrated in Moderato, our in-house platform offering independent verification of radiotherapy dose distributions. The model was validated by comparing TPS dose distributions with Moderato and by film measurements. Using this model, a machine learning algorithm was trained to find electron beam parameters for other M6 devices, by simulating dose curves with varying spot size and energy. The algorithm was optimized using cross-validation and tested with measurements from other institutions equipped with a M6 Cyberknife.ResultsOptimal agreement in the Monte Carlo model was reached for a monoenergetic electron beam of 6.75 MeV with Gaussian spatial distribution of 2.4 mm FWHM. Clinical plan dose distributions from Moderato agreed within 2% with the TPS, and film measurements confirmed the accuracy of the model. Cross-validation of the prediction algorithm produced mean absolute errors of 0.1 MeV and 0.3 mm for beam energy and spot size respectively. Prediction-based simulated dose curves for other centres agreed within 3% with measurements, except for one device where differences up to 6% were detected.ConclusionsThe M6 Cyberknife was integrated in Moderato and validated through dose re-calculations and film measurements. The prediction algorithm was successfully applied to obtain electron beam parameters for other M6 devices. This method would prove useful to speed up modelling of new machines in Monte Carlo systems.     

Advanced optimization methods for whole pelvic and local prostate external beam therapy

PurposeRadiation treatment planning inherently involves multiple conflicting planning goals, which makes it a suitable application for multicriteria optimization (MCO). This study investigates a MCO algorithm for VMAT planning (VMAT–MCO) for prostate cancer treatments including pelvic lymph nodes and uses standard inverse VMAT optimization (sVMAT) and Tomotherapy planning as benchmarks.MethodsFor each of ten prostate cancer patients, a two stage plan was generated, consisting of a stage 1 plan delivering 22 Gy to the prostate, and a stage 2 plan delivering 50.4 Gy to the lymph nodes and 56 Gy to the prostate with a simultaneous integrated boost. The single plans were generated by three planning techniques (VMAT–MCO, sVMAT, Tomotherapy) and subsequently compared with respect to plan quality and planning time efficiency.ResultsPlan quality was similar for all techniques, but sVMAT showed slightly better rectum (on average D_mean −7%) and bowel sparing (D_mean −17%) compared to VMAT–MCO in the whole pelvic treatments. Tomotherapy plans exhibited higher bladder dose (D_mean +42%) in stage 1 and lower rectum dose (D_mean −6%) in stage 2 than VMAT–MCO. Compared to manual planning, the planning time with MCO was reduced up to 12 and 38 min for stage 1 and 2 plans, respectively.ConclusionMCO can generate highly conformal prostate VMAT plans with minimal workload in the settings of prostate-only treatments and prostate plus lymph nodes irradiation. In the whole pelvic plan manual VMAT optimization led to slightly improved OAR sparing over VMAT–MCO, whereas for the primary prostate treatment plan quality was equal.     

Combined PET/CT for IMRT treatment planning of NSCLC: Contrast-enhanced CT images for Monte Carlo dose calculation

PurposeCombined PET/CT imaging has been proposed as an integral part of radiotherapy treatment planning (TP). Contrast-enhanced CT (ceCT) images are frequently acquired as part of the PET/CT examination to support target delineation. The aim of this dosimetric planning study was to investigate the error introduced by using a ceCT for intensity modulated radiotherapy (IMRT) TP with Monte Carlo dose calculation for non-small cell lung cancer (NSCLC).Material and methodsNine patients with NSCLC prior to chemo-RT were included in this retrospective study. For each patient non-enhanced, low-dose CT (neCT), ceCT and [¹⁸F]-FDG-PET emission data were acquired within a single examination. Manual contouring and TP were performed on the ceCT. An additional set of independent target volumes was auto-segmented in PET images. Dose distributions were recalculated on the neCT. Differences in dosimetric parameters were evaluated.ResultsDose differences in PTV and lungs were small for all patients. The maximum difference in all PTVs when using ceCT images for dose calculation was ?2.1%, whereas the mean difference was less than ?1.7%. Maximum differences in the lungs ranged from ?1.8% to 2.1% (mean: ?0.1%). In four patients an underestimation of the maximum spinal cord dose between 2% and 3.2% was observed, but treatment plans remained clinically acceptable.ConclusionsMonte Carlo based IMRT planning for NSCLC patients using ceCT allows for correct dose calculation. A direct comparison to neCT-based treatment plans revealed only small dose differences. Therefore, ceCT-based TP is clinically safe as long as the maximum acceptable dose to organs at risk is not approached.     

Assessment of out-of-field doses in radiotherapy treatments of paediatric patients using Monte Carlo methods and measurements

PurposeTo assess out-of-field doses in radiotherapy treatments of paediatric patients, using Monte Carlo methods to implement a new model of the linear accelerator validated against measurements and developing a voxelized anthropomorphic paediatric phantom.MethodsCT images of a physical anthropomorphic paediatric phantom were acquired and a dosimetric planning using a TPS was obtained. The CT images were used to perform the voxelization of the physical phantom using the ImageJ software and later implemented in MCNP. In order to validate the Monte Carlo model, dose measurements of the 6 MV beam and Linac with 120 MLC were made in a clinical setting, using ionization chambers and a water phantom. Afterwards TLD measurements in the physical anthropomorphic phantom were performed in order to assess the out-of-field doses in the eyes, thyroid, c-spine, heart and lungs.ResultsThe Monte Carlo model was validated for in-field and out-of-field doses with average relative differences below 3%. The average relative differences between TLD measurements and Monte Carlo is 14,3% whilst the average relative differences between TLD and TPS is 55,8%. Moreover, organs up to 22.5 cm from PTV center show TLD and MCNP6 relative differences and TLD and TPS relative differences up to 21.2% and 92.0%, respectively.ConclusionsOur study provides a novel model that could be used in clinical research, namely in dose evaluation outside the treatment fields. This is particularly relevant, especially in pediatric patients, for studying new radiotherapy treatment techniques, since it can be used to estimate the development of secondary tumours.     

Precision IORT – Image guided intraoperative radiation therapy (igIORT) using online treatment planning including tissue heterogeneity correction

BackgroundTo the present date, IORT has been eye and hand guided without treatment planning and tissue heterogeneity correction. This limits the precision of the application and the precise documentation of the location and the deposited dose in the tissue. Here we present a set-up where we use image guidance by intraoperative cone beam computed tomography (CBCT) for precise online Monte Carlo treatment planning including tissue heterogeneity correction.Materials and methodsAn IORT was performed during balloon kyphoplasty using a dedicated Needle Applicator. An intraoperative CBCT was registered with a pre-op CT. Treatment planning was performed in Radiance using a hybrid Monte Carlo algorithm simulating dose in homogeneous (MCwater) and heterogeneous medium (MChet). Dose distributions on CBCT and pre-op CT were compared with each other. Spinal cord and the metastasis doses were evaluated.ResultsThe MCwater calculations showed a spherical dose distribution as expected. The minimum target dose for the MChet simulations on pre-op CT was increased by 40% while the maximum spinal cord dose was decreased by 35%. Due to the artefacts on the CBCT the comparison between MChet simulations on CBCT and pre-op CT showed differences up to 50% in dose.ConclusionsigIORT and online treatment planning improves the accuracy of IORT. However, the current set-up is limited by CT artefacts. Fusing an intraoperative CBCT with a pre-op CT allows the combination of an accurate dose calculation with the knowledge of the correct source/applicator position. This method can be also used for pre-operative treatment planning followed by image guided surgery.     

Variance-based sensitivity analysis of biological uncertainties in carbon ion therapy

PurposeBiological models to estimate the relative biological effectiveness (RBE) or the equivalent dose in 2 Gy fractions (EQD2) are needed for treatment planning and plan evaluation in carbon ion therapy. We present a model-independent, Monte Carlo based sensitivity analysis (SA) approach to quantify the impact of different uncertainties on the biological models.Methods and materialsThe Monte Carlo based SA is used for the evaluation of variations in biological parameters. The key property of this SA is the high number of simulation runs, each with randomized input parameters, allowing for a statistical variance-based ranking of the input variations. The potential of this SA is shown in a simplified one-dimensional treatment plan optimization. Physical properties of carbon ion beams (e.g. fragmentation) are simulated using the Monte Carlo code FLUKA. To estimate biological effects of ion beams compared to X-rays, we use the Local Effect Model (LEM) in the framework of the linear-quadratic (LQ) model. Currently, only uncertainties in the output of the biological models are taken into account.Results/conclusionsThe presented SA is suitable for evaluation of the impact of variations in biological parameters. Major advantages are the possibility to access and display the sensitivity of the evaluated quantity on several parameter variations at the same time. Main challenges for later use in three-dimensional treatment plan evaluation are computational time and memory usage. The presented SA can be performed with any analytical or numerical function and hence be applied to any biological model used in carbon ion therapy.     

Validation of Monte Carlo multithreading TOpas 3.6 software in order to simulate the 6 MV Elekta Synergy MLCi2 platform linac

BackgroundMonte Carlo simulation is generally appreciated as an extraordinary technique to investigate particle physics processes and interactions in nuclear medicine and Radiation Therapy. The present task validates a new methodology of Monte Carlo simulation based on the Multithreading technique to reduce CPU time to simulate a 6 MV photon beam provided by the Elekta Synergy MLCi2 platform medical linear accelerator treatment head utilizing TOpas version 3.6 Monte Carlo software and the Slurm Marwan cluster.Materials and methodsThe simulation includes the linear accelerator (LINAC) major components. Calculations are performed for the photon beam with several treatment field sizes varying from 3 × 3 to 10 × 10 cm² at a 100 cm of distance from the source to the surface of the IBA dosimetry water box. The simulation was wholly approved by comparison with experimental distributions. To evaluate simulation accuracy, gamma index formalism for (2%/2mm) and (3%/2mm) criteria, Distance To Agreement DTA, and the estimator standard error ɛ and ɛ_max are used.ResultsGood agreement between simulations and measurements was observed for depth doses and lateral dose profiles, respectively. The gamma index comparisons also highlighted this agreement; more than 97% of the points for all simulations satisfy the quality assurance criteria of (2%/2mm). Regarding calculation performance, the event processing speed is faster using Gate-[mp] compared to TOpas-[mt] mode when running the identical simulation code for both.ConclusionsConsequently, according to the achieved results, the proposed methodology shows the first validation of TOpas in radiotherapy linacs simulations and a reduction in calculation time, capping simulation accuracy as much as possible. For this reason, this software is recommended to be serviceable for Treatment Planning Systems (TPS) purposes.     

Comparison of the RayStation photon Monte Carlo dose calculation algorithm against measured data under homogeneous and heterogeneous irradiation geometries

PurposeThis work compares Monte Carlo dose calculations performed using the RayStation treatment planning system against data measured on a Varian Truebeam linear accelerator with 6 MV and 10 MV FFF photon beams.MethodsThe dosimetric performance of the RayStation Monte Carlo calculations was evaluated in a variety of irradiation geometries employing homogeneous and heterogeneous phantoms. Profile and depth dose comparisons against measurement were carried out in relative mode using the gamma index as a quantitative measure of similarity within the central high dose regions.ResultsThe results demonstrate that the treatment planning system dose calculation engine agrees with measurement to within 2%/1 mm for more than 95% of the data points in the high dose regions for all test cases. A systematic underestimation was observed at the tail of the profile penumbra and out of field, with mean differences generally <0.5 mm or 1% of curve dose maximum respectively. Out of field agreement varied between evaluated beam models.ConclusionsThe RayStation implementation of photon Monte Carlo dose calculations show good agreement with measured data for the range of scenarios considered in this work and is deemed sufficiently accurate for introduction into clinical use.     

Monte Carlo evaluation of the dose calculation algorithm of TomoTherapy for clinical cases in dynamic jaws mode

PurposeFor the TomoTherapy^® system, longitudinal conformation can be improved by selecting a smaller field width but at the expense of longer treatment time. Recently, the TomoEdge^® feature has been released with the possibility to move dynamically the jaws at the edges of the target volume, improving longitudinal penumbra and enabling faster treatments. Such delivery scheme requires additional modeling of treatment delivery. Using a previously validated Monte Carlo model (TomoPen), we evaluated the accuracy of the implementation of TomoEdge in the new dose engine of TomoTherapy for 15 clinical cases.MethodsTomoPen is based on PENELOPE. Particle tracking in the treatment head is performed almost instantaneously by 1) reading a particle from a phase-space file corresponding to the largest field and 2) correcting the weight of the particle depending on the actual jaw and MLC configurations using Monte Carlo pre-generated data. 15 clinical plans (5 head-and-neck, 5 lung and 5 prostate tumors) planned with TomoEdge and with the last release of the treatment planning system (VoLO^®) were re-computed with TomoPen. The resulting dose-volume histograms were compared.ResultsGood agreement was achieved overall, with deviations for the target volumes typically within 2% (D₉₅), excepted for small lung tumors (17 cm³) where a maximum deviation of 4.4% was observed for D₉₅. The results were consistent with previously reported values for static field widths.ConclusionsFor the clinical cases considered in the present study, the introduction of TomoEdge did not impact significantly the accuracy of the computed dose distributions.     

Application of Monte Carlo calculations for validation of a treatment planning system in high dose rate brachytherapy

AimThe accuracy of treatment planning systems is of vital importance in treatment outcomes in brachytherapy. In the current study the accuracy of dose calculations of a high dose rate (HDR) brachytherapy treatment planning system (TPS) was validated using the Monte Carlo method.Materials and methodsThree ⁶⁰Co sources of the GZP6 afterloading brachytherapy system were modelled using MCNP4C Monte Carlo (MC) code. The dose distribution around all the sources was calculated by MC and a dedicated treatment planning system. The results of both methods were compared.ResultsThere was good agreement (<2%) between TPS and MC calculated dose distributions except at a point near the sources (<1 cm) and beyond the tip of the sources.ConclusionsOur study confirmed the accuracy of TPS calculated dose distributions for clinical use in HDR brachytherapy.     

Clinical verification of treatment planning dose calculation in lung SBRT with GATE Monte Carlo simulation code

PurposeThis study aims to use GATE/Geant4 simulation code to evaluate the performance of dose calculations with Anisotropic Analytical Algorithm (AAA) in the context of lung SBRT for complex treatments considering images of patients.MethodsFour cases of non-small cell lung cancer treated with SBRT were selected for this study. Irradiation plans were created with AAA and recalculated end to end using Monte Carlo (MC) method maintaining field configurations identical to the original plans. Each treatment plan was evaluated in terms of PTV and organs at risk (OARs) using dose-volume histograms (DVH). Dosimetric parameters obtained from DVHs were used to compare AAA and MC.ResultsThe comparison between the AAA and MC DVH using gamma analysis with the passing criteria of 3%/3% showed an average passing rate of more than 90% for the PTV structure and 97% for the OARs. Tightening the criteria to 2%/2% showed a reduction in the average passing rate of the PTV to 86%. The agreement between the AAA and MC dose calculations for PTV dosimetric parameters (V₁₀₀; V₉₀; Homogeneity index; maximum, minimum and mean dose; CI_Paddick and D_2cm) was within 18.4%. For OARs, the biggest differences were observed in the spinal cord and the great vessels.ConclusionsIn general, we did not find significant differences between AAA and MC. The results indicate that AAA could be used in complex SBRT cases that involve a larger number of small treatment fields in the presence of tissue heterogeneities.     

Assessing the need for adaptive radiotherapy in head and neck cancer patients using an automatic planning tool

BackgroundUnbiased analysis of the impact of adaptive radiotherapy (ART) is necessary to evaluate dosimetric benefit and optimize clinics’ workflows. The aim of the study was to assess the need for adaptive radiotherapy (ART) in head and neck (H&N) cancer patients using an automatic planning tool in a retrospective planning study.Materials and methodsThirty H&N patients treated with adaptive radiotherapy were analysed. Patients had a CT scan for treatment planning and a verification CT during treatment according to the clinic’s protocol. Considering these images, three plans were retrospectively generated using the iCycle tool to simulate the scenarios with and without adaptation: 1) the optimized plan based on the planning CT; 2) the optimized plan based on the verification CT (ART-plan); 3) the plan obtained by considering treatment plan 1 re-calculated in the verification CT (non-ART plan). The dosimetric endpoints for both target volumes and OAR were compared between scenarios 2 and 3 and the SPIDERplan used to evaluate plan quality.ResultsThe most significant impact of ART was found for the PTVs, which demonstrated decreased D98% in the non-ART plan. A general increase in the dose was observed for the OAR but only the spinal cord showed a statistical significance. The SPIDERplan analysis indicated an overall loss of plan quality in the absence of ART.ConclusionThese results confirm the advantages of ART in H&N patients, especially for the coverage of target volumes. The usage of an automatic planning tool reduces planner-induced bias in the results, guaranteeing that the observed changes derive from the application of ART.     

Dosimetric impact of statistical uncertainty on Monte Carlo dose calculation algorithm in volumetric modulated arc therapy using Monaco TPS for three different clinical cases

AimTo study the dosimetric impact of statistical uncertainty (SU) per plan on Monte Carlo (MC) calculation in Monaco? treatment planning system (TPS) during volumetric modulated arc therapy (VMAT) for three different clinical cases.BackgroundDuring MC calculation SU is an important factor to decide dose calculation accuracy and calculation time. It is necessary to evaluate optimal acceptance of SU for quality plan with reduced calculation time.Materials and methodsThree different clinical cases as the lung, larynx, and prostate treated using VMAT technique were chosen. Plans were generated with Monaco? V5.11 TPS with 2% statistical uncertainty. By keeping all other parameters constant, plans were recalculated by varying SU, 0.5%, 1%, 2%, 3%, 4%, and 5%. For plan evaluation, conformity index (CI), homogeneity index (HI), dose coverage to PTV, organ at risk (OAR) dose, normal tissue receiving dose ≥5 Gy and ≥10 Gy, integral dose (NTID), calculation time, gamma pass rate, calculation reproducibility and energy dependency were analyzed.ResultsCI and HI improve as SU increases from 0.5% to 5%. No significant dose difference was observed in dose coverage to PTV, OAR doses, normal tissue receiving dose ≥5 Gy and ≥10 Gy and NTID. Increase of SU showed decrease in calculation time, gamma pass rate and increase in PTV max dose. No dose difference was seen in calculation reproducibility and dependent on energy.ConclusionFor VMAT plans, SU can be accepted from 1% to 3% per plan with reduced calculation time without compromising plan quality and deliverability by accepting variations in point dose within the target.     

Validation of frame-based positioning accuracy with cone-beam computed tomography in Gamma Knife Icon radiosurgery

BackgroundFrame based positioning accuracy in Gamma Knife (GK) stereotactic radiosurgery (SRS) is extremely high but removal of a post may be necessary to enable the treatment in selected patients.ObjectiveTo verify the positioning accuracy in clinical scenarios with 4 and 3 posts in patients and phantoms using cone-beam CT (CBCT) of Gamma Knife Icon™.MethodsWe analyzed positioning accuracy for 12 patients with standard 4 post setup using pretreatment CBCT (pre-CBCT) on GK Icon™ and report 4 patients with different clinical scenarios (removal of a post). We performed phantom measurements to verify the frame accuracy via CBCT in different clinical scenarios without the influence of the human patient.ResultsMean frame accuracy for 12 patients with 4 posts was 0.35 mm/0.34 degree. Mean motion during treatment was 0.11 mm/0.04 degree. For two of the clinical scenarios where a post was removed, we found acceptable deviations within 0.66 mm/0.61 degree. For 2 patients, a deviation of 2.94 mm/−3.47 degree and 1.85 mm/−0.74 degree was found and replanning was necessary. Phantom measurements showed good agreement when planning MR/CT was performed with 4 or 3 post. Larger deviations of 0.86 mm/0.88 degree were detected when a post was removed after planning MR/CT.ConclusionThe frame accuracy with 4 posts before and during GK treatments is as high as expected. For clinical situations, where a post is removed after planning-CT/MR, pre-treatment position verification is strongly suggested using stereotactic CBCT or the P-CT/MR should be repeated to avoid possible mistreatments.     

Dosimetric and radiobiological comparison of TG-43 and Monte Carlo calculations in 192Ir breast brachytherapy applications

PurposeTo investigate the clinical significance of introducing model based dose calculation algorithms (MBDCAs) as an alternative to TG-43 in ¹⁹²Ir interstitial breast brachytherapy.Materials and methodsA 57 patient cohort was used in a retrospective comparison between TG-43 based dosimetry data exported from a treatment planning system and Monte Carlo (MC) dosimetry performed using MCNP v. 6.1 with plan and anatomy information in DICOM-RT format. Comparison was performed for the target, ipsilateral lung, heart, skin, breast and ribs, using dose distributions, dose-volume histograms (DVH) and plan quality indices clinically used for plan evaluation, as well as radiobiological parameters.ResultsTG-43 overestimation of target DVH parameters is statistically significant but small (less than 2% for the target coverage indices and 4% for homogeneity indices, on average). Significant dose differences (>5%) were observed close to the skin and at relatively large distances from the implant leading to a TG-43 dose overestimation for the organs at risk. These differences correspond to low dose regions (<50% of the prescribed dose), being less than 2% of the prescribed dose. Detected dosimetric differences did not induce clinically significant differences in calculated tumor control probabilities (mean absolute difference <0.2%) and normal tissue complication probabilities.ConclusionWhile TG-43 shows a statistically significant overestimation of most indices used for plan evaluation, differences are small and therefore not clinically significant. Improved MBDCA dosimetry could be important for re-irradiation, technique inter-comparison and/or the assessment of secondary cancer induction risk, where accurate dosimetry in the whole patient anatomy is of the essence.     

Monte Carlo as quality control tool of stereotactic body radiation therapy treatment plans

Purpose/objectiveThe objective of this study was to verify the accuracy of treatment plans of stereotactic body radiation therapy (SBRT) and to verify the feasibility of the use of Monte Carlo (MC) as quality control (QC) on a daily basis.Material/methodsUsing EGSnrc, a MC model of Agility™ linear accelerator was created. Various measurements (Percentage depth dose (PDD), Profiles and Output factors) were done for different fields sizes from 1x1 up to 40x40 (cm²). An iterative model optimization was performed to achieve adequate parameters of MC simulation. 40 SBRT patient’s dosimetry plans were calculated by Monaco™ 3.1.1. CT images, RT-STRUCT and RT-PLAN files from Monaco™ being used as input for Moderato MC code. Finally, dose volume histogram (DVH) and paired t-tests for each contour were used for dosimetry comparison of the Monaco™ and MC.ResultsValidation of MC model was successful, as <2% difference comparing to measurements for all field’s sizes. The main energy of electron source incident on the target was 5.8 MeV, and the full width at half maximum (FWHM) of Gaussian electron source were 0.09 and 0.2 (cm) in X and Y directions, respectively. For 40 treatment plan comparisons, the minimum absolute difference of mean dose of planning treatment planning (PTV) was 0.1% while the maximum was 6.3%. The minimum absolute difference of Max dose of PTV was 0.2% while the maximum was 8.1%.ConclusionSBRT treatment plans of Monaco agreed with MC results. It possible to use MC for treatment plans verifications as independent QC tool.     

A Modified Valley Restrained Monte Carlo Method to Efficiently Search the Low Energy Structures of Peptides

Abstract

A new Monte Carlo sampling scheme, namely the Modified Valley Restrained Monte Carlo procedure, is used to obtain the global energy minimum conformations for polypeptides, such as Met-enkephalin and Melittin. For each peptide, we found close agreement with previous results from both theoretical and experimental studies. The simple idea for controlling the step size according to the Valley Function, provides useful suggestions in searching the global energy minimum structures, and furthermore helps solve the multiple minima problem.