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A simple robust optimizer has been developed that can produce patient-specific calibration curves to convert x-ray computed tomography (CT) numbers to relative stopping powers (HU-RSPs) for proton therapy treatment planning. The difference between a digitally reconstructed radiograph water-equivalent path length (DRRWEPL) map through the x-ray CT dataset and a proton radiograph (set as the ground truth) is minimized by optimizing the HU-RSP calibration curve. The function of the optimizer is validated with synthetic datasets that contain no noise and its robustness is shown against CT noise. Application of the procedure is then demonstrated on a plastic and a real tissue phantom, with proton radiographs produced using a single detector. The mean errors using generic/optimized calibration curves between the DRRWEPL map and the proton radiograph were 1.8/0.4% for a plastic phantom and -2.1/ - 0.2% for a real tissue phantom. It was then demonstrated that these optimized calibration curves offer a better prediction of the water equivalent path length at a therapeutic depth. We believe that these promising results are suggestive that a single proton radiograph could be used to generate a patient-specific calibration curve as part of the current proton treatment planning workflow.
To develop an accurate phenomenological model of the cubic spline path estimate of the proton path, accounting for the initial proton energy and water equivalent thickness (WET) traversed. Monte Carlo (MC) simulations were used to calculate the path of protons crossing various WET (10-30 cm) of different material (LN300, water and CB2-50% CaCO3) for a range of initial energies (180-330 MeV). For each MC trajectory, cubic spline trajectories (CST) were constructed based on the entrance and exit information of the protons and compared with the MC using the root mean square (RMS) metric. The CST path is dependent on the direction vector magnitudes (|P0,1|). First, |P0,1| is set to the proton path length (with factor Λ(Norm)(0,1) = 1.0). Then, two optimal factor Λ(0,1) are introduced in |P0,1|. The factors are varied to minimize the RMS difference with MC paths for every configuration. A set of Λ(opt)(0,1) factors, function of WET/water equivalent path length (WEPL), that minimizes the RMS are presented. MTF analysis is then performed on proton radiographs of a line-pair phantom reconstructed using the CST trajectories. Λ(opt)(0,1) was fitted to the WET/WEPL ratio using a quadratic function (Y = A + BX(2) where A = 1.01,0.99, B = 0.43,- 0.46 respectively for Λ(opt)(0), Λ(opt)(1)). The RMS deviation calculated along the path, between the CST and the MC, increases with the WET. The increase is larger when using Λ(Norm)(0,1) than Λ(opt)(0,1) (difference of 5.0% with WET/WEPL = 0.66). For 230/330 MeV protons, the MTF10% was found to increase by 40/16% respectively for a thin phantom (15 cm) when using the Λ(opt)(0,1) model compared to the Λ(Norm)(0,1) model. Calculation times for Λ(opt)(0,1) are scaled down compared to MLP and RMS deviation are similar within standard deviation.B ased on the results of this study, using CST with the Λ(opt)(0,1) factors reduces the RMS deviation and increases the spatial resolution when reconstructing proton trajectories.
Proton beam therapy benefits from the Bragg peak and delivers highly conformal dose distributions. However, the location of the end-of-range is subject to uncertainties related to the accuracy of the relative proton stopping power estimates and thereby the water-equivalent path length (WEPL) along the beam. To remedy the range uncertainty, an in vivo measurement of the WEPL through the patient, i.e. a proton-range radiograph, is highly desirable. Towards that goal, we have explored a novel method of proton radiography based on the time-resolved dose measured by a flat panel imager (FPI). A 226 MeV pencil beam and a custom-designed range modulator wheel (MW) were used to create a time-varying broad beam. The proton imaging technique used exploits this time dependency by looking at the dose rate at the imager as a function of time. This dose rate function (DRF) has a unique time-varying dose pattern at each depth of penetration. A relatively slow rotation of the MW (0.2 revolutions per second) and a fast image acquisition (30 frames per second, ~33 ms sampling) provided a sufficient temporal resolution for each DRF. Along with the high output of the CsI:Tl scintillator, imaging with pixel binning (2 × 2) generated high signal-to-noise data at a very low radiation dose (~0.1 cGy). Proton radiographs of a head phantom and a Gammex CT calibration phantom were taken with various configurations. The results of the phantom measurements show that the FPI can generate low noise and high spatial resolution proton radiographs. The WEPL values of the CT tissue surrogate inserts show that the measured relative stopping powers are accurate to ~2%. The panel did not show any noticeable radiation damage after the accumulative dose of approximately 3831 cGy. In summary, we have successfully demonstrated a highly practical method of generating proton radiography using an x-ray flat panel imager.
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