Proton dosimetry at NPL

Mark Bailey, Hugo Bouchard, David Crossley, Simon Duane, Kamran Fathi, Sebastian Galer, Andrzej Kacperek*, Nigel Lee, Bo Li, Hugo Palmans, Lauren Petrie, Giuseppe Schettino, Sverine Rossomme, Peter Sharpe, David Shipley, Russell Thomas
Introduction
Proton beams exhibit better dose characteristics than x-rays for radiotherapy. Proton therapy is not new but has become much cheaper in the last decade. Emerging new accelerator technologies such as laser induced beams, dielectric wall accelerators and fixed field alternating gradient accelerators promise a further lowering of costs for proton therapy. The NHS has committed 250M for two high-energy proton therapy facilities. In order to make the most out of this modality (highest treatment outcome with minimal side effects) dosimetric accuracy similar to x-ray therapy is required and improved reference dosimetry is needed.

Aims
Establish primary standards for proton dosimetry Improve reference dosimetry Establish correction factors for ionisation chambers  Establish energy-response relationships for alanine and radiochromic film and propose procedures to correct measurements with these detectors  Characterise the water-equivalence of phantom materials and tissue substitutes  Define new quantities accounting with the stochastic distribution of energy deposition at the micro- and nano-scale Support dosimetry for proton therapy in UK & abroad Modern implementation of proton therapy (Siemens)

Design and development of primary standard calorimeters:

Design and development of microdosimetric calorimeters:

Collaborations
Clatterbridge Cancer Centre, Wirral, UK University of Surrey, Guildford, UK University of Birmingham, UK University College of London, UK University of Liverpool, UK University of rhus, Denmark University of Stockholm, Sweden University of Vienna, Austria Universit catholique de Louvain, Belgium Ion Beam Applications (IBA), Belgium German Cancer Research Institute, Heidelberg, Germany MedAustron, Wiener Neustadt, Austria Slovak Institute of Metrology, Slovakia International Atomic Energy Agency, Vienna, Austria Above: The dose curve as a function of depth for protons (blue curve) showing the typical Bragg peak. By modifying the range or energy, the Bragg peak will reach different depths (black curves). Summing these Bragg peaks with appropriate weights results in a flat dose profile (spread-out Bragg peak, red curve)

Methods
 Development and characterisation (correction factors, heat transfer, dose-to-graphite to dose-to-water conversion) of graphite calorimeters for proton dosimetry Measurement of relative response of suitable detectors  Measurement of energy-response relationships of ionisation chambers (ion recombination), alanine dosimeters and radiochromic film dosimeters Monte Carlo simulations of beam lines and beam output Monte Carlo simulation of detector perturbation correction factors Cavity theory for ionisation chambers  Adapting methods for high-dose per pulse regimes (e.g. from laser induced particle beams) Design, development and Monte Carlo simulation of SQUID based

Advantage of proton therapy

Below: Blue and green curves show depth dose curves for two opposing beams of x-rays (left) and proton spread-out Bragg peaks (right). The sum in red shows that for the same target dose protons deliver much smaller doses outside the target region (delimited by dashed lines).

Initial recombination of a Markus ion chamber as a function of residual range (left) and energy variation of all interaction quantities affecting ion chamber response as a function of energy (right)

Reconstruction of proton depth dose curve from cylindrical ion chamber measurement compared with plane-parallel chamber measurement using NPL developed model (left) and Monte Carlo calculated wall perturbation correction factors for Farmer type cylindrical ion chambers (right)

Funding
Response of alanine compared to an ion chamber as a function of depth (left) and relative dose response of radiochromic film as a function of energy (right): SR project light-ion dosimetry  SR-ER project on microbolometry and ROS probes for gold nanoparticle enhanced radiotherapy and SR/UoS doctoral NIHR i4i projects on microbolometry NMS EMRP - JRP7, MetrExtRT, BioQuaRT LIBRA: EPSRC basic technology grant (contract) Monte Carlo calculated fluence correction factors for conversion to dose-to-water from dose-to-water-equivalent-plastic (left) and for dose-to-graphite (right).

Key Achievements
n  Worlds first graphite calorimeter for reference dosimetry of therapeutic proton beams, prospect of worlds first primary standard for proton dosimetry n Characterisation of alanine as a reference dosimeter and mailed audit tool for proton dosimetry n  Calculation and measurement of ionisation chamber perturbation factors n  Developed Monte Carlo simulation capabilities using the PTRAN, MCNPX, GEANT4 and FLUKA codes n  New research program on novel SQUID-based detector development for microdosimetry of ion beams

Publications
A. Ableitinger, , H. Palmans, P. Sharpe et al., Dosimetry auditing procedure with alanine dosimeters for light ion beam therapy: results of a pilot study, Radiother. Oncol. 108(1) 99-106, 2013 P. Andreo, J. Wulff, D. T. Burns and H. Palmans, Consistency in reference radiotherapy dosimetry: resolution of an apparent conundrum when 60Co is the reference quality for charged- particle and photon beams, Phys. Med. Biol. 58(19) 6593-6621, 2013 H. Palmans, L. Al-Sulaiti, P. Andreo et al., Fluence correction factors for graphite calorimetry in a low-energy clinical proton beam: I. Analytical and Monte Carlo simulations, Phys. Med. Biol. 58(10) 3481-3499, 2013 L. Al-Sulaiti, D. Shipley, R. Thomas et al., Water equivalence of some plastic-water phantom materials for clinical proton beam dosimetry, Appl. Radiat. Isotop. 70 10521057, 2012 A. Lhr, , H. Palmans, S. Rossomme and N. Bassler, Fluence correction factors and stopping power ratios for clinical ion beams Acta Oncol. 50(6) 797-805, 2011 D. Kirby, S. Green, , and H. Palmans, Radiochromic film spectroscopy of laser-accelerated proton beams using the FLUKA code and dosimetry traceable to primary standards, Laser Part. Beams 29(2) 231-239, 2011 S. Galer, L. Hao, J. Gallop et al., Design concept for a novel SQUID-based microdosimeter, Radiat. Prot. Dos. 143(2-4) 427-431, 2011 C. P. Karger, O. Jkel, H. Palmans and T. Kanai, Dosimetry for Ion Beam Radiotherapy, Phys. Med. Biol. 55(21) R193-R234, 2010 L Al-Sualiti, D Shipley, R Thomas et al., Water equivalence of various materials for clinical proton dosimetry by experiment and Monte Carlo simulation, Nucl. Instrum. Meth. A 619 344-347, 2010 C. Baker, D. Shipley, H. Palmans and A. Kacperek, Monte Carlo modelling of a clinical proton beam-line for the treatment of ocular tumors, Nucl. Instr. Meth. A 562 10051008, 2006 H. Palmans, R. Thomas, D. Shipley and Andrzej Kacperek, Light-ion beam dosimetry, NPL report DQL-RD-003 (Teddington: National Physical Laboratory) 2006 (ISSN 17440637) H. Palmans, R. Thomas and A. Kacperek, Ion recombination correction in the Clatterbridge Centre of Oncology clinical proton beam, Phys. Med. Biol. 51 903-917, 2006 H. Palmans and F. Verhaegen, Assigning nonelastic nuclear interaction cross sections to Hounsfield Units for Monte Carlo treatment planning of proton beams, Phys. Med. Biol., 50 991-1000, 2005 H. Palmans, R. Thomas, M. Simon et al., A small-body portable graphite calorimeter for dosimetry in low-energy clinical proton beams, Phys. Med. Biol. 49 3737-3749, 2004 H. Palmans, Effect of alanine energy response and phantom material on depth dose measurements in ocular proton beams, Technol Cancer Res Treat. 2 579-86, 2003

(*Clatterbridge Centre for Oncology, **Lead Scientist)