basic physics of proton therapy
TRANSCRIPT
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University of Florida Proton Therapy Institute
BasicPhysics of Proton Therapy
Roelf Slopema
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overview
I. basic interactionsI. basic interactions
energy lossi scattering
nuclear interactions
II. clinical beams
pdd lateral penumbra lateral penumbra
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interactions / energy loss
Primarily protons lose energy in coulomb interactionswith the outer-shell electrons of the target atoms.
• excitation and ionization of atoms
• loss per interaction small ‘continuously slowing down’
• range secondary e+ <1mm dose absorbed locally
• no significant deflection protons by electrons• no significant deflection protons by electrons
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interactions / energy loss
Ene g loss is gi en b Bethe Bloch eq ationEnergy loss is given by Bethe-Bloch equation:
+ corrections
Tmax max energy transfer to free electron
Tmax max energy transfer to free electron• to first order: –dE/dx 1/speed2
• max electron energy: T 4 T m c2 / m c2• max electron energy: Tmax 4 T mec2 / mpc2
T=200 MeV Tmax 0.4 MeV range 1.4mmbut most electrons far lower energy….but most electrons far lower energy
Equations from Review of particle physics, C. Amsler et al., Physics Letters B667, 1 (2008)
in practice we use range-energy tables and measured depth dose curves.
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stopping power
water
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stopping power
water
p+
200MeV
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Bragg peak
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Bragg peak
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Bragg peak
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William Bragg
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W.H. Bragg and R. Kleeman, On the ionization curves of radium, Philosophical Magazine S6 (1904), 726-738
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stopping power
Graph based on NIST data
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interactions / scattering
P i il d l iPrimarily protons scatter due to elastic coulomb interactions with the target nuclei.
• many, small angle deflections
• full description Moliere, gaussian approx. Highland
p proton momentum L target thickness
0 1/pv 1/(2*T) T<<938MeV
material dependence: 1/L -0 5
v proton speed LR target radiation length
material dependence: 0 1/LR0.5
1 g/cm2 of water (LR =36.1 g/cm2) 0=5mrad for T=200MeV
1 g/cm2 of lead (LR = 6.37 g/cm2) 0=14mrad for T=200MeV
Highland neglects large-angle tails, but works well in many situations… Equation from Gottschalk (Passive beam spreading)
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radial spread in water
Approximation: 0.02 x range
Calculation using Highland’s equation.
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radial spread in water
Same general shape applies to different (relevant) materials.
Calculation using Highland’s equation.
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interactions / nuclear
About 20% of the incident protons have a nonelasticnuclear interaction with the target nuclei.
• reduction of proton fluence with depth shape Bragg peak
• secondaries: charged (p,d,,recoils) ~60% of energy absorbed ‘locally’ neutral (n,) ~40% of energy absorbed ‘surroundings’
• production of unstable recoil particles (activation) radiation safety dose verification using PET/CT
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interactions / nuclear
Relevant channels
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nuclear interactions
Graph courtesy Harald Paganetti.
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nuclear buildup
~10% over 4cm
E=222MeV (R=31g/cm2), uniform-scanning beam
Measurement of uniform-scanning beam.
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Robert Wilson
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R.R. Wilson, Radiology 47(1946), 487-491
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clinical beams / pdd
By adding Bragg peaks that are shifted in depth and weighted, a ‘spreadout Bragg peak’ (SOBP) is created.
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clinical beams / pdd
By varying the number of peaks, the extent of the uniform region (modulation) can be varied.
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clinical beams / pdd
90%
Range
Modulation width
…alternative definitions of modulation width are not uncommon…
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clinical beams / pdd
technical implementation of SOBP creation:• energy stacking: energy change upstream of nozzle
• range modulator wheel• range modulator wheel
id filt• ridge filter
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clinical beams / pdd
Distal-end optimizationDistal end optimization
w1 ↓ : ‘shoulder’
→ better uniformity
w1 ↑ : ‘dip&bump’w1 ↑ : dip&bump
→ sharper distal fall-off …but higher RBE for low energies…
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clinical beams / pdd
Spilling of beam on multiple steps
Spot size small compared to RM step widthSpo s s a o pa d o s p d
Spot size large compared to RM step width
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skin dose
note: for clinical beams, no skin sparing like in photonsnote: for clinical beams, no skin sparing like in photons
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skin dose
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distal fall-off
Sharp distal fall-off typically not very relevant in clinical practice, because of range uncertainty (beam is not stopped at critical structure).
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proton vs. photon pdd
15MV h t t (R 20 M 10)15MV photons protons (R=20,M=10)
10cm
30cm10cm1 field
30cm
water
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proton vs. photon pdd
15MV h t t (R 20 M 10)15MV photons protons (R=20,M=10)
2 fields
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proton vs. photon pdd
15MV h t t (R 20 M 10)15MV photons protons (R=20,M=10)
4 fields
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proton vs. photon pdd Non-target dose
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proton vs. photon pdd
the intrinsic properties of the proton pdd …
the absence of dose distal to the uniform region and the lower dose proximal to the uniform region
… result in a lower integral non-target dose
→ allowing for a larger flexibility in the selection (number and direction) of beams( )
→ allowing for a larger flexibility in distributing the non-target dose
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integral dose
Graph courtesy of Zuofeng Li
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conforming pdd
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conforming pdd
p+
Theoretical calculations.
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conforming pdd beams with range compensator& fixed modulation
compensation for…
• shape distal end• shape distal end
Theoretical calculations.
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conforming pdd beams with range compensator& fixed modulation
compensation for…
• shape distal end• shape distal end
• shape entrance
Theoretical calculations.
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conforming pdd beams with range compensator& fixed modulation
compensation for…
• shape distal end• shape distal end
• shape entrance
• inhomogeneities
but…
• no proximal conformityno proximal conformity
• scattering from RC leads to hot/cold spots/ p
Theoretical calculations.
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range compensator
lucite wax
Photos courtesy MGH/LLUMC
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compensator scatter 6 cm.H20
3 cm.H20
5 cm
In clinical cases RC gradients smaller…
UFPTI measurement and tx planning data.
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conforming pdd pencil beam scanning
fluence optimized per energy layer beam only turned on inside target
• better proximal conformity• better proximal conformity
• no compensator scatter
compensator
Theoretical calculations.
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clinical beams / penumbraLateral penumbra is defined byLateral penumbra is defined by…
beams with aperture
• angular spread protons at aperture (geometric source) system design: source size, source position
air gap
• scattering in range compensator
• in-patient scattering
beams without aperture (scanning)p ( g)
• in-air spot size
• in-patient scattering• in-patient scattering
• optimized fluence pattern
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aperture
brass (milled) cerrobend (poured)
Photos courtesy MGH/LLUMC
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clinical penumbra
Tx planning calculations
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clinical penumbra
Tx planning calculations
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air gap & penumbra
Tx planning calculations
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scanning penumbra
uniform proton fluence‘edge-enhanced’ proton fluence
Graph courtesy E. Pedroni
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proton vs. photon lateral penumbra
• the proton penumbra depends on system design and setup parameters
• in general, the proton penumbra is not significantly sharper than the photon penumbra
• the low-dose ‘tails’ of the proton field are not as pronounced as for photon fields
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1954: John Lawrence treats first patients at Berkeley
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References
historical• On the ionization curves of radium, W.H. Bragg and R. Kleeman, Philosophical M i S6 726 738 1904Magazine S6 726-738, 1904• Radiological use of fast protons, R.R. Wilson, Radiology 47 487-491, 1946• Moliere’s theory of multiple scattering, H.A. Bethe, Phys. Rev. 89 1256-1266, 1953stopping power / Bragg peakstopping power / Bragg peak• An analytical approximation of the Bragg curve for therapeutic proton beams, T. Bortfeld, Med. Phys 24 (12), December 1997scattering• Some practical remarks on multiple scattering, V.L. Highland, Nucl. Instr. Meth. 129 497-499, 1975• Multiple Coulomb scattering of 160 MeV protons, Gottschalk et al, Nucl. Instrum. Method B 74 467–90, 1993,books on proton therapy• passive beam spreading in proton therapy, B. Gottschalk, http://huhepl.harvard.edu/˜gottschalk
proton therapy and radio surgery H Breuer and B Smit Springer (2000)• proton therapy and radio-surgery, H. Breuer and B. Smit, Springer (2000)