Demonstration and characterisation of a novel dual-scattering system for very high energy electrons
Abstract:
This article describes the design and implementation of the first known prototype of a dual-scattering system for the delivery of a uniform VHEE beam with transverse dimensions suitable for pre-clinical and potential future clinical use. The results presented in this article are the first experimental characterisation of beam flattening with dual-scattering foils in the VHEE regime, confirmed with both profile measurements with a YAG screen and radiochromic EBT3 films. Polylactic acid and aluminium dual-scattering systems were designed using TOPAS Monte-Carlo simulations and multi-objective minimisation methods. Studies to test the success of the scattering systems in providing beam magnification and uniformity were carried out at the 200 MeV CERN Linear Electron Accelerator for Research (CLEAR) facility. A generalised super-Gaussian function was used to model the final beam, and comparisons were made with the simulations used for the design. Transverse profiles with uniform components were measured with each of the scattering systems and quantified with super-Gaussian fitting. The uniformity of the in-air profiles suggested that the superficial dose contributions from X-rays were low. This study demonstrated that magnified VHEE beam profiles with uniform components could be generated and measured at CLEAR. The results from this study were used as a basis for the design of future experiments. Similar systems and design methods could be employed by future clinical VHEE facilities to provide conformal treatment.Modification of the microstructure of the CERN- CLEAR-VHEE beam at the picosecond scale modifies ZFE morphogenesis but has no impact on hydrogen peroxide production
Multidisciplinary Collaboration and Novel Technological Advances in Hadron Therapy
Spatially fractionated radiotherapy with very high energy electron pencil beam scanning
Abstract:
Objective. To evaluate spatially fractionated radiation therapy (SFRT) for very-high-energy electrons (VHEEs) delivered with pencil beam scanning. Approach. Radiochromic film was irradiated at the CERN linear electron accelerator for research using 194 MeV electrons with a step-and-shoot technique, moving films within a water tank. Peak-to-valley dose ratios (PVDRs), depths of convergence (PVDR ⩽ 1.1), peak doses, and valley doses assessed SFRT dose distribution quality. A Monte Carlo (MC) model of the pencil beams was developed using TOPAS and applied to a five-beam VHEE SFRT treatment for a canine glioma patient, compared to a clinical 6 MV VMAT plan. The plans were evaluated based on dose-volume histograms, mean dose, and maximum dose to the planning target volume (PTV) and organs at risks (OARs). Main results. Experimental PVDR values were maximized at 15.5 ± 0.1 at 12 mm depth for 5 mm spot spacing. A DOC of 76.5, 70.7, and 56.6 mm was found for 5, 4, and 3 mm beamlet spacings, respectively. MC simulations and experiments showed good agreement, with maximum relative dose differences of 2% in percentage depth dose curves and less than 3% in beam profiles. Simulated PVDR values reached 180 ± 4, potentially achievable with reduced leakage dose. VHEE SFRT plans for the canine glioma patient showed a decrease in mean dose (>16%) to OARs while increasing the PTV mean dose by up to 15%. Lowering beam energy enhanced PTV dose homogeneity and reduced OAR maximum doses. Significance. The presented work demonstrates that pencil beam scanning SFRT with VHEEs could treat deep-seated tumors such as head and neck cancer or lung lesions, though small beam size and leakage dose may limit the achievable PVDR.Access to diagnostic imaging and radiotherapy technologies for patients with cancer in the Baltic countries, eastern Europe, central Asia, and the Caucasus: a comprehensive analysis
Abstract:
Background: Only 10–40% of patients with cancer in low-income and middle-income countries were able to access curative or palliative radiotherapy in 2015. We aimed to assess the current status of diagnostic imaging and radiotherapy services in the Baltic countries, eastern Europe, central Asia, and the Caucasus by collecting and analysing local data.
Methods: This Access to Radiotherapy (ART) comprehensive analysis used data from 12 countries: the three Baltic countries (Estonia, Latvia, and Lithuania), two countries in eastern Europe (Moldova and Ukraine), four countries in central Asia (Kazakhstan, Kyrgyzstan, Tajikistan, and Uzbekistan), and three countries in the Caucasus (Armenia, Azerbaijan, and Georgia), referred to here as the ART countries. We were not able to obtain engagement from Turkmenistan. The primary outcome was to update the extent of shortfalls in the availability of diagnostic imaging and radiotherapy technologies and radiotherapy human resources for patients with cancer in former Soviet Union countries. Following the methods of previous similar studies, we developed three questionnaires—targeted towards radiation oncologists, regulatory authorities, and researchers—requesting detailed information on the availability of these resources. Authors from participating countries sent two copies of the appropriate questionnaire to each of 107 identified institutions and coordinated data collection at the national level. Questionnaires were distributed in English and Russian and responses in both languages were accepted. Two virtual meetings held on May 30 and June 1, 2022, were followed by an in-person workshop held in Almaty, Kazakhstan, in September, 2022, attended by representatives from all participating countries, to discuss and further validate the data submitted up to this point. The data were collected on a dedicated web page, developed by the International Cancer Expert Corps, and were then extracted and analysed.
Findings: Data were collected between May 10 and Nov 30, 2022. 81 (76%) of the 107 institutions contacted, representing all 12 ART countries, submitted 167 completed questionnaires. The Baltic countries, which are defined as high-income countries, had more diagnostic imaging equipment and radiotherapy human resources (eg, Latvia [1·74] and Lithuania [1·47] have a much higher number of radiation oncologists per 100 000 population than the other ART countries, all of which had <1 radiation oncologist per 100 000 population) and greater radiotherapy technological capacities (higher numbers of linear accelerators and, similar to Georgia, high total external beam radiotherapy capacity) than the other ART countries, as well as high cancer detection rates (Latvia 311 cases per 100 000 population, Lithuania 292, and Estonia 288 vs, for example, 178 in Armenia, 144 in Ukraine, and 72 in Kazakhstan) and low cancer mortality-to-cancer incidence ratios (Estonia 0·43, Latvia 0·49, and Lithuania 0·48; lower than all but Kazakhstan [0·41]). The highest cancer mortality-to-cancer incidence ratios were reported by Moldova (0·71) and Georgia (0·74).
Interpretation: Our findings show that the number of cancer cases, availability of diagnostic imaging equipment, radiation oncologists and radiotherapy capacity, and cancer mortality-to-cancer incidence ratios all vary substantially across the countries studied, with the three high-income, well resourced Baltic countries performing better in all metrics than the included countries in eastern Europe, central Asia, and the Caucasus. These data highlight the challenges faced by many countries in this study, and might help to justify increased investment of financial, human, and technological resources, with the aim to improve cancer treatment outcomes.
Funding: US Department of Energy's National Nuclear Security Administration's Office of Radiological Security.