Loma Linda University Medical Center Dept. of Radiation Medicine

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1 Loma Linda University Medical Center Dept. of Radiation Medicine and Northern Illinois University Dept. of Physics and Dept. of Computer Science Presented by George Coutrakon, PhD NIU Physics Dept.

2 Collaborators Northern Illinois University Bela Erdelyi, Nick Karonis, Kirk Duffin(image reconstruction) Victor Rykalin, Jerry Blazey, Vishnu Zutshi( detector hardware) Univ. of Santa Cruz, Physics Dept. HartmutSadrozinski, Ford Hurley (1 st prototype detector ) University of Wollongong, Radiological Physics. Scott Penfold ( image reconstruction) Loma Linda University Medical Center, California Reinhard Schulte, Vladimir Bashkirov, Ford Hurley California State San Bernerdino Keith Schubert ( Computer Science Dept.)

3

4 Uncertainty in RLSP from XCT data can exceed 5% (Moyers, Medical Dosimetry, Oct 2010)

5 Why does X-ray CT give ambiguities for relative stopping powers? Two materials with different composition, A and Z, can have the same X-ray absorption coefficient but different relative stopping powers which is required to calculate dose in the patient for proton therapy Reason: the X-ray mass absorption coefficient is linear with electron density, but also varies in a complicated way with A ( atomic weight) and Z ( atomic number) X-rays: µ=ρ e [ f((a,z,e γ ) + g(a,z,eγ)] for each voxel Hounsfield Unit = 1000 (µ/µ water ) for each voxel Protons : de/dx = ρ e (Z/A)/β 2 [ log(2m e β 2 /I(1-β 2 )) -β 2 ] Conventional solution: Use tissue substitutes to measure µ in X-ray CT scanner and then measure relative de/dx (RSP) in proton beam, plot data points and then interpolate.

6 RSP WEPL Relative Dose

7

8 The importance of relative stopping power in accurate dose and range determination For heterogeneous materials, the water equivalent path length or WEPL for each proton is related to relative stopping power (RSP), relative to water For the j th track through the i th voxel Knowing the entrance and exit proton energy, the quantity WEPL can be determined. Then solve for RSP s RSP(l) is then used in Tx planning to look up the correct dose in each voxel from the spread out Bragg curve in water.

9 CsI Calorimeter response vs. WEPL of tissue equivalent polystyrene blocks for E(in) =200 MeV, E(out)>50 MeV Data from LLUMC August y = x x L (mm) Response

10 Advantages of pct over X-ray CT Decrease the range error from 3% to 1% for better electron density map for proton T x Planning => better dose accuracy to target volume. Range error is caused by RSP error Reduce or eliminate CT artifacts due to metal/dental implants with high Z materials Lower dose ( factor 5) to patient relative to X-ray CT pct imaging could replace Cone Beam CT for patient alignment verification before Treatment

11 Matrix Equation for finding de/dx in each voxel WEPL i = A ij RSP j is equation for the i th track A ij is the the path length, dl, through the j th voxel ij For the i th track Reconstruction problem is solving for RSP j How many tracks are needed to get 1% RSP resolution in each voxel? Answer: 100 tracks per voxel How many 1 mm 3 voxels in a 23 cm head diameter with 20 cm length? Answer :10E7 voxels => 10E9 tracks

12 Density Resolution per voxel vs. dose Data from Schulte et. al., Medical Physics, April 2005

13 Proton CT Detector Layout Four tracker detectors are also shown but not labeled. The inner tracking detectors are 15 cm from the center of the phantom and the outer ones are 30 cm from the center of the phantom.

14 High Level pct detector specs for a head scanner Design for maximum head size 23 cm diameter by 20 cm long (sup/inf direction) Number of 1 mm cubic voxels = 10E7 Number of protons/voxel =100 ( for 1% density res.) Total Number protons = 10E9 Data rate capability = 2 MHz ( protons per second) Total scan time = 7.5 minutes Total number of gantry angles => Continuous Gantry speed = 1/10 RPM

15 Specs on current pct Scanner Maximum data rate is 100 khz 2 hours for a small head ( 14 cm diam.) using LLUMC synchrotron; much larger time for 20 cm area 2 scans for each adult size head Imaging area 9 x 18 cm Position resolution ; 0.24 mm Si Strip pitch CsI Energy resolution 1% above 100 MeV

16 Silicon Strip detector (1 of 8) and 18 channel CsI calorimeter

17 Track reconstruction and WEPL Calibration y = x x L (mm) Response

18 CsI calorimeter resolution vs. proton energy

19

20 Readout Scheme for pct

21 Trigger Scheme for Data Acquisition

22 Prototype pct detector built by Loma Linda University Medical Center Northern Illinois University Univ. of California, Santa Cruz

23 Lucy phantom for 1 st 3D image reconstruction using 200 MeV protons. Phantom is 14 cm polystyrene sphere

24 1 st 3D pct image slices from prototype detector (87.5 million tracks) Proton CT ( on left) X-ray CT ( on right)

25 Reconstructed Stopping powers data from Penfold RSP (measured) RSP (true) Polystyrene Bone Lucite Air

26

27 Relative stopping power, electron density and water equivalent thickness (WET)

28 S(I medium,β)/s(i water,β) vs. proton velocity in v/c where de/dx=s/ρ Relative Stopping Power for Bone (ylw) and Muscle (blue) Relative Stopping P ower Velocity

29 Relative ρ e and RLSP

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