In proton therapy, range uncertainties induced by the conversion from x-ray CT (xCT) Hounsfield units (HU) to relative stopping power (RSP) compromise the precision of dose delivery. To reduce range uncertainties induced by HU-converted RSPs, this study investigates optimizing the RSP of individual voxels in xCT iteratively based on multi-projection proton radiography (pRG) acquired using a single amorphous silicon flat panel imager. Time-resolved dose rate functions (DRF) were measured by the imager placed downstream of a test phantom consisting of tissue substitute materials. Water equivalent path lengths (WEPL) in the pRG were derived. By rotating the phantom, multiple pRG projections were acquired at angles from 0 to 358° with an increment of 2°. X-ray CT of the phantom was acquired and co-registered with the pRG acquisition coordinates. RSPs of individual xCT voxels were optimized iteratively by minimizing the difference between the measured WEPLs and the calculated WEPLs by ray tracing with HU-converted RSPs. Pixels in pRGs that exhibited severe proton range mixing were rejected for the optimization. Tikhonov regularization was applied under the assumption that HU-converted RSPs are inaccurate, but the inaccuracy is within a few percent. While ~50% of WEPL pixels were rejected due to severe range mixing in pRG, RSPs of  >90% CT voxels could still be optimized if multiple pRG projections, e.g.  ⩾12, around the phantom are utilized. For tissue substitute materials in a cylindrical phantom, percentage errors of RSPs were reduced from a range of  -8% to  +4% to be within  ±2%. Further optimization, achieved by implementing a material-specific regularization parameter, reduced percent errors to be within  ±0.5%. This study demonstrates the concept of optimizing RSPs of individual CT voxels with multi-projection pRGs acquired by a single flat panel imager, which could be further explored and implemented in proton therapy to reduce range uncertainties.

Purpose: Proton radiography, which images the patients with the same type of particles that they are to be treated with, is a promising approach for image guidance and range uncertainties reduction. This study aimed to realize quality proton radiography by measuring dose rate functions (DRF) in time domain using a single flat panel and retrieve water equivalent path length (WEPL) from them. Methods: An amorphous silicon flat panel (PaxScan™ 4030CB, Varian Medical Systems, Inc., Palo Alto, CA) was placed behind phantoms to measure DRFs from a proton beam modulated by the modulator wheel. To retrieve WEPL and RSP, calibration models based on the intensity of DRFs only, root mean square (RMS) of DRFs only and the intensity weighted RMS were tested. The quality of obtained WEPL images (in terms of spatial resolution and level of details) and the accuracy of WEPL were compared. Results: RSPs for most of the Gammex phantom inserts were retrieved within ± 1% errors by calibration models based on the RMS and intensity weighted RMS. The mean percentage error for all inserts was reduced from 1.08% to 0.75% by matching intensity in the calibration model. In specific cases such as the insert with a titanium rod, the calibration model based on RMS only fails while the that based on intensity weighted RMS is still valid. The quality of retrieved WEPL images were significantly improved for calibration models including intensity matching. Conclusion: For the first time, a flat panel, which is readily available in the beamline for image guidance, was tested to acquire quality proton radiography with WEPL accurately retrieved from it. This technique is promising to be applied for image-guided proton therapy as well as patient specific RSP determination to reduce uncertainties of beam ranges.

Purpose:Studies show that WEPL can be determined from modulated dose rate functions (DRF). However, the previous calibration method based on statistics of the DRF is sensitive to energy mixing of protons due to scattering through different materials (termed as range mixing here), causing inaccuracies in the determination of WEPL. This study intends to explore time‐domain features of the DRF to reduce the effect of range mixing in proton radiography (pRG) by this technique.Methods:An amorphous silicon flat panel (PaxScan™ 4030CB, Varian Medical Systems, Inc., Palo Alto, CA) was placed behind phantoms to measure DRFs from a proton beam modulated by a specially designed modulator wheel. The performance of two methods, the previously used method based on the root mean square (RMS) and the new approach based on time‐domain features of the DRF, are compared for retrieving WEPL and RSP from pRG of a Gammex phantom.Results:Calibration by T80 (the time point for 80% of the major peak) was more robust to range mixing and produced WEPL with improved accuracy. The error of RSP was reduced from 8.2% to 1.7% for lung equivalent material, with the mean error for all other materials reduced from 1.2% to 0.7%. The mean error of the full width at half maximum (FWHM) of retrieved inserts was decreased from 25.85% to 5.89% for the RMS and T80 method respectively. Monte Carlo simulations in simplified cases also demonstrated that the T80 method is less sensitive to range mixing than the RMS method.Conclusion:WEPL images have been retrieved based on single flat panel measured DRFs, with inaccuracies reduced by exploiting time‐domain features as the calibration parameter. The T80 method is validated to be less sensitive to range mixing and can thus retrieve the WEPL values in proximity of interfaces with improved numerical and spatial accuracy for proton radiography.

Purpose: IGRT commissioning and QA are critical components for precise delivery of proton treatment beams to patients. In order to ensure high quality IGRT, a new cone‐based scintillator detector was evaluated for our QA activities for double‐scattered and scanning proton modalities. This allows a routine evaluation of the gantry‐angle dependent position offset between the radiation and imaging. Methods: The cone‐based scintillator detector (XRV‐124, Logos Systems, Int'l CA, USA) features a unique configuration of measuring stereotactic paths of proton and x‐ray beams in a single setup with arbitrary gantry angles. For the beams‐eye‐view (BEV) analysis of x‐ray crosshair images, a cylindrical representation of the cone image was newly developed. The calibration accuracy was evaluated using different CT resolutions for a range of 55 – 95mm in patient's cranial direction and ±9mm in the lateral direction. Energy‐dependent spot sizes (σ) of pencil beams were characterized and compared to measurements by the MatriXX detector (IBA, Germany). Iso‐centric deviations between radiation and x‐ray imaging were characterized as a function of gantry angle. Results: The position calibration of the detector was successfully verified with a reproducible positioning by x‐ray imaging. The measurements were reproducible within clinical tolerances (±1mm). The spot size vs. energy at zero gantry angle measured with the scintillating cone detector agreed with the MatriXX detector measurements within 17%. Conclusion: The new approach to investigate the accuracy of IGRT and pencil beam properties could successfully be implemented into the QA program. The system will improve efficiency in our QA activities for proton treatments.

PURPOSETo evaluate the clinical performance of dual-energy CT (DECT) in determining proton stopping power ratios (SPR) and demonstrate advantages over conventional single-energy CT (SECT).METHODSSECT and DECT scans of tissue-equivalent plastics as well as animal meat samples are performed with a Siemens SOMATOM Definition Flash. The methods of Schneider et al. (1996) and Bourque et al. (2014) are used to determine proton SPR on SECT and DECT images, respectively. Waterequivalent path length (WEPL) measurements of plastics and tissue samples are performed with a 195 MeV proton beam. WEPL values are determined experimentally using the depth-dose shift and dose extinction methods.RESULTSComparison between CT-based and experimental WEPL is performed for 12 tissue-equivalent plastic as well as 6 meat boxes containing animal liver, kidney, heart, stomach, muscle and bones. For plastic materials, results show a systematic improvement in determining SPR with DECT, with a mean absolute error of 0.4% compared to 1.7% for SECT. For the meat samples, preliminary results show the ability for DECT to determine WEPL with a mean absolute value of 1.1% over all meat boxes.CONCLUSIONThis work demonstrates the potential in using DECT for determining proton SPR with plastic materials in a clinical context. Further work is required to show the benefits of DECT for tissue samples. While experimental uncertainties could be a limiting factor to show the benefits of DECT over SECT for the meat samples, further work is required to adapt the DECT formalism in the context of clinical use, where noise and artifacts play an important role.

Purpose:Prior to treating new PBS field, multiple (three) patient‐field‐specific QA measurements are performed: two 2D dose distributions at shallow depth (M1) and at the tumor depth (M2) with treatment hardware at zero gantry angle; one 2D dose distribution at iso‐center (M3) without patient specific devices at the planned gantry angle. This patient‐specific QA could be simplified by the use of MC model. The results of MC model commissioning for a spot‐scanning system and the fully automated TOPAS/MC‐based QA framework will be presented.Methods:We have developed in‐house MC interface to access a TPS (Astroid) database from a computer cluster remotely. Once a plan is identified, the interface downloads information for the MC simulations, such as patient images, apertures points, and fluence maps and initiates calculations in both the patient and QA geometries. The resulting calculations are further analyzed to evaluate the TPS dose accuracy and the PBS delivery.Results:The Monte Carlo model of our system was validated within 2.0 % accuracy over the whole range of the dose distribution (proximal/shallow part, as well as target dose part) due to the location of the measurements. The averaged range difference after commissioning was 0.25 mm over entire treatment ranges, e.g., 6.5 cm to 31.6 cm.Conclusion:As M1 depths range typically from 1 cm to 4 cm from the phantom surface, The Monte Carlo model of our system was validated within +− 2.0 % in absolute dose level over a whole treatment range. The averaged range difference after commissioning was 0.25 mm over entire treatment ranges, e.g., 6.5 cm to 31.6 cm.This work was supported by NIH/NCI under CA U19 21239

Purpose:In pencil beam scanning (PBS), the delivered spot MU, position and size are slightly different at different gantry angles. We investigated the level of delivery uncertainty at different gantry angles through a log file analysis.Methods:34 PBS fields covering full 360 degrees gantry angle spread were collected retrospectively from 28 patients treated at our institution. All fields were delivered at zero gantry angle and the prescribed gantry angle, and measured at isocenter with the MatriXX 2D array detector at the prescribed gantry angle. The machine log files were analyzed to extract the delivered MU per spot and the beam position from the strip ionization chambers in the treatment nozzle. The beam size was separately measured as a function of gantry angle and beam energy. Using this information, the dose was calculated in a water phantom at both gantry angles and compared to the measurement using the 3D γ‐index at 2mm/2%.Results:The spot‐by‐spot difference between the beam position in the log files from the delivery at the two gantry angles has a mean of 0.3 and 0.4 mm and a standard deviation of 0.6 and 0.7 mm for × and y directions, respectively. Similarly, the spot‐by‐spot difference between the MU in the log files from the delivery at the two gantry angles has a mean 0.01% and a standard deviation of 0.7%. These small deviations lead to an excellent agreement in dose calculations with an average γ pass rate for all fields being approximately 99.7%. When each calculation is compared to the measurement, a high correlation in γ was also found.Conclusion:Using machine logs files, we verified that PBS beam delivery at different gantry angles are sufficiently small and the planned spot position and MU. This study brings us one step closer to simplifying our patient‐specific QA.

Purpose: For proton therapy, an accurate model of CT HU to relative stopping power (RSP) conversion is essential. In current practice, validation of these models relies solely on measurements of tissue substitutes with standard compositions. Validation based on real tissue samples would be much more direct and can address variations between patients. This study intends to develop an efficient and accurate system based on the concept of dose extinction to measure WEPL and retrieve RSP in biological tissue in large number of types. Methods: A broad AP proton beam delivering a spread out Bragg peak (SOBP) is used to irradiate the samples with a Matrixx detector positioned immediately below. A water tank was placed on top of the samples, with the water level controllable in sub‐millimeter by a remotely controlled dosing pump. While gradually lowering the water level with beam on, the transmission dose was recorded at 1 frame/sec. The WEPL were determined as the difference between the known beam range of the delivered SOBP (80%) and the water level corresponding to 80% of measured dose profiles in time. A Gammex 467 phantom was used to test the system and various types of biological tissue was measured. Results: RSP for all Gammex inserts, expect the one made with lung‐450 material (<2% error), were determined within ±0.5% error. Depends on the WEPL of investigated phantom, a measurement takes around 10 min, which can be accelerated by a faster pump. Conclusion: Based on the concept of dose extinction, a system was explored to measure WEPL efficiently and accurately for a large number of samples. This allows the validation of CT HU to stopping power conversions based on large number of samples and real tissues. It also allows the assessment of beam uncertainties due to variations over patients, which issue has never been sufficiently studied before.