Dual-energy CT for range prediction in proton and ion therapy


Dual-energy CT for range prediction in proton and ion therapy

Möhler, C.; Wohlfahrt, P.; Richter, C.; Jäkel, O.; Greilich, S.

Purpose/Objective:

Proton and ion therapy require accurate prediction of particle ranges in tissue. In current clinical practice, computed tomography (CT) images are voxel-wise converted to ion-stopping power ratio maps using direct heuristic relations. The general validity of these approaches is, however, limited due to the different physical regimes of photon and ion interaction. Using a more sophisticated method based on dual-energy CT (DECT), which provides access to the physical quantities influencing photon attenuation, Hünemohr et al. (2014) reported an improved ion-range prediction for homogeneous tissue surrogates. Here, we present a major modification of the latter method, enabling a proper treatment of heterogeneities and mixtures on several structural levels, which represent a crucial feature of the realistic clinical situation.

Material and Methods:

We treat the stopping-power ratio as the product of the electron density relative to water and a correction factor that implicitly involves the logarithmic dependence on the mean excitation energy (I-value). The relative electron density, being an important parameter in both photon and ion energy loss, can be derived directly from DECT scans using a universal and robust method. The correction factor, however, has to be determined with an empirical method. For this purpose, we propose to use the information from CT images that is complementary to the relative electron density, i.e. the electronic photon absorption cross section relative to water. Using the attenuation sum rule and Bragg’s additivity rule, the relative cross sections and correction factors were calculated for single elements, tissue base materials like water, lipid, etc. and tabulated real tissues.

Results:

For a therapeutic beam energy of 200 MeV/u, the correction factor varies between 1.15 and 0.70 for single elements with atomic numbers between 1 and 100. Building up compounds from a certain number of elements, a maximum spread of possible values for the correction factor can be quoted for a given relative cross section, due to the mathematical structure of the variable space. In practice, this could be used as an uncertainty estimate for a given calibration. The accessible variable space is drastically reduced by admitting only tissue base materials such as water, lipids and hydroxylapatite. The space is further reduced by admitting only mixtures of real tissue materials. For human tissue, the correction factor is thus limited overall to a small range around one (0.96 - 1.02).

Conclusions:

With the definition of the correction factor in the stopping-power ratio prediction and its relation to the relative cross section, a mathematically rigorous treatment of tissue mixtures was made possible. Such mixtures influence CT imaging of patients e.g. in the form of volume averaging in a CT voxel. This thorough treatment of mixtures, like the one presented here, is thus essential for the clinical applicability of DECT-based ion-range prediction.

Keywords: dual-energy CT; proton therapy

  • Poster
    ESTRO 35 - annual meeting, 29.04.-03.05.2016, Turin, Italy
  • Abstract in refereed journal
    Radiotherapy and Oncology 119(2016)Suppl.1, S869-S870

Permalink: https://www.hzdr.de/publications/Publ-23878
Publ.-Id: 23878