Calculation algorithms in radiation

therapy treatment planning systems

Colleen DesRosiers, Ph.D.
AAMD Region III annual meeting, Indianapolis, Indiana
April 12, 2013
Learning Objectives
1. The learner will be able to describe the different
types of algorithms used in treatment planning
systems
2. The learner will be able to identify strengths
and weakness of algorithms used in treatment
planning systems
3. The learner will be able to identify reasons for
disagreement between monitor unit calculations
generated by treatment planning systems and
by monitor unit check programs.
Image from: http://oeaeuprrp.blogspot.com/2011/09/workshop-how-to-write-and-assess.html
http://toons.beck-cartoons.info/?section=tooned
I am not the expert
1. Khan, FM Gerbi, BJ Treatment Planning in Radiation Oncology, 3
rd
edition, 2012
2. Khan, The Physics of Radiation Therapy, 4
th
edition, 2010
3. Murlidhar, KR, Murthy, NP, Raju, AK, Sresty, NVNM. Comparative study
of convolution, superposition, and fast superposition algorithms in
conventional radiotherapy, three-dimensional conformal radiotherapy,
and intensity modulated radiotherapy techniques for various sites, done
on CMS XIO planning system J Med Phys [serial online] 2009
[cited 2013 Apr 1];34:12-22.
4. Ahnesj , Anders, Basic modeling concepts in treatment planning dose
dose calculations, fluence, raytracing, kernels, etc- Uppsala University,
Sweden, 2013
5. Ahnesj , Anders Patient dose calculation models in TPS.
More references
6. Wiesmeyer MD, Miften MM. A multigrid approach for accelerating three-
dimensional photon dose calculation Med Phys 1999; 26 :1149 (Abstract)
7. Mackie TR, Bielajew AF, Rogers DWO, Battista J J . Generation of photon energy
deposition kernels using the EGS Monte Carlo code. Phys Med Biol 1988;33:1-20.
8. Sharpe MB, Battista J J . Dose calculations using convolution and superposition
principles: The orientation of dose spread kernels in divergent X-ray beams. Med
Phys 1993;20:1685-94.
9. Mackie TR, Scrimger J W, Battista J J . A convolution method of calculating dose for
15 MV X-rays. Med Phys 1985;12:188-96
10. Gagn, I, Zavgorodni, S. Evaluation of the analytical anisotropic algorithm in an
extreme waterlung interface phantom using Monte Carlo dose calculations.
J ournal of Applied Clinical Medical Physics, vol. 8, (1), Winter 2007
11. Das, I, Cheng, C.W., Srivastava, S, et al. Variability of Low-Z Inhomogeneity
Correction in IMRT/SBRT: A Multi-Institutional Collaborative Study AAPM annual
meeting 2008
Acknowledgments
Vadim Moskvin, Ph.D
Indra Das, Ph.D.
algorithm \al-g-ri-thm\
1. a procedure for solving a
mathematical problem in a finite
number of steps that frequently
involves repetition of an operation;
2. a step-by-step procedure for solving
a problem or accomplishing some
end especially by a computer
From: http://www.merriam-webster.com/dictionary/
Where, in the planning system, do we
find algorithms?
MU calculations
Isodose distributions
DVH generation
IMRT optimization
DRR generation
Brachytherapy calculations
Any process that occurs when the user does not
dictate each step (e.g. generating a 3D image from a
series of slices, placing a margin around a structure,
etc.)
In the beginning
Calculations were performed
strictly based on empirical
(directly measured) data in
tabular format.
Isodose curves were generated
based on PDD and profile data
Corrections based on patient
were very simplistic, depth
corrections only (attenuation)
Most advanced
Monte Carlo method
Histories of millions of photons and
secondary electrons are traced to calculate
dose deposition based on physics
interactions in matter
Monte Carlo method is the most accurate
method for dose calculation but requires the
greatest processing time. Most calculation
algorithms use pre-calculated MC kernels.
4. Ahnesj , Anders
Monte Carlo terms
Random number generator (RNG) the random
number generator selects a number between 0 and 1
to determine the path of the particle (photon)
History the tracking of a single particle (how is the
photon losing energy as it passes through the medium)
Phase space characterizes position in 6D
Events PE, CE, PP, electron interactions
More Monte Carlo terms
Sampling the draw of the parameters of events from
the probability distributions using RNG
Scoring acquiring the value of the parameter of
interest during the simulation
Estimator mathematical and algorithmical description
of the scoring method
Kernel Pencil or point; a Monte Carlo simulation that
has been scored of a small pencil beam which
incorporates the events in that path, or that occur at a
point
Photon interactions
or events in Monte Carlo terms
1. Photoelectric effect photon transfers all energy to
electron, ejected, increases with Z
3
and decreases with E
3
2. Compton effect dominant at therapy energies, results in
scattered photons and secondary electrons, decreases slowly with
E and is independent of Z
3. Pair Production results in the creation of electron/positron
pair, annihilation, dependent on Z
2
and E
2
.
Which lead to Electron interactions ionization, excitation,
bremsstrahlung, ultimately dose deposition
(There are other effects that contribute to dose, such as neutron
production, which may or may not be modeled)
Monte Carlo method
MC method uses known probabilities and probability
distributions in sampling to predict results of interactions
(events) (e.g. Compton: Klein-Nishina coefficients)
MC utilizes the Law of Large Numbers (LLN)
Theorem: The average of the results obtained from a large number of trials should
be close to the expected value, and will tend to become closer as more trials are
performed.
The convergence of the Monte Carlo method follows the
Central Limit Theorem (CLT)
Example: 2 Gy dose in 3x3x3 mm voxel could be delivered by 10
11
photons
crossed this voxel. However, simulation of 10
11
photons multiplied on field size will
take infinite amount of time. According to LLN, we can simulate 10
7
photons for
whole field and get results according to CLT with 1% accuracy.
Monte Carlo method
Direct Monte Carlo method
o Particle trajectory is simulated in details on the even-
by-even basis with the maximum accuracy in details.
o Binary estimator is used.
Example: General-purpose code algorithms, PENELOPE, EGSnrc, FLUKA
Specialized Monte Carlo method
o Variance reduction based simulation or certain
simplifications in the transport description
o Weighted estimator is used.
Example: FLUKA and MCNPX neutron transport module, MMC used in TPS,
DPM electron-photon code.
Monte Carlo code uses programming
subroutines and interaction
probabilities to calculate dose
Why does MC method work?
As the number of photons required for dose delivery
decreases, dose delivery uncertainty increases
Example: a quarter landed on heads or tails
Probability = 50%
If the quarter is flipped 10 times
If the quarter is flipped 100 times
If the quarter is flipped 10
11
times
If only a few photons were needed to deliver dose, the
MC method would not be accurate
So, if MC is the most accurate method for
calculation, why develop other algorithms?
1. Time! Processing time makes
MC calculations impractical for
clinic as the TPS engine, but
may serve well for treatment
plan verification.
2. Since the cost associated with
higher performance computing
has decreased over the years,
more sophisticated algorithms
employing MC calculations are
clinically available.
Khan, 2010 (1)
Two atoms are sitting in a field of ionizing radiation.
One atom says, "I think I lost an electron."
The other says, "Are you sure?"
The first atom says, "I'm positive!"
On the light side
Phase Space
Phase space is a 6 dimensional
characterization of the particles
) , , , , , ( 6
) , , (
E z y x D
z y x r
u =
=
Monte Carlo accuracy - Modeling
Highly dependent on
the modeling of the
components of the
accelerator head
Where can secondary
electrons be
produced? Where can
scatter occur? Where
does the calculation
start?
http://health-7.com/imgs/20/7507.jpg
Monte Carlo input
Finite photon source size
Open fluence distribution
Fluence modulation
Head scatter sources
flattening filter
collimators
wedges
Monitor back scatter
Collimator leakage, including
MLC interleaf leakage
shape of MLC leaf ends
Beam spectra
Spectral changes
Electron contamination
Monte Carlo Codes
EGS4
EGSnrc
GEANT
PENELOPE
MCNP
MCNPx
FLUKA
Different types of calculation
algorithms
Semi-empirically based
Model based
Direct Monte Carlo
Hybrid
Give me 30 minutes and I can confuse
anyone. I dont need to prepare.
Lech Papiez, Ph.D.
Indiana University
Dr. Papiez response to a request to give a talk on
algorithms to medical residents on the same
day of the request.
Why do we need calculation algorithms?
Measurements are performed under specific conditions:
- Fixed square fields
- Fixed depths
- Homogenous medium (water)
- Flat surface
Monte Carlo based algorithms and the simplest of
empirically based algorithms reasonably agree in
homogeneous media
Physical Density
Material Density
(g/cm
3
)
Relative to
water
Impact
Air 0.0012 1/800 Attenuation and
scattering
Lung 0.2-0.3 1/5 Attenuation and
scattering
Water(soft
tissue)
1.000 1.000
Bone 1.600 1.6X (Attenuation
and scattering)
Titanium 4.5 4.5X Attenuation
Steel 7.5 7.5X Attenuation
Semi Empirical (also called Correction
or Factor based)
Based on measured data
PDD
Profile
TAR
ETAR
Batho
Power Law
Clarkson
Photon dose calculation methods
Dose engines
Method
characteristics
Remarks
Monte Carlo
Explicit particle transport
simulation
+Accurate
- Noisy distributions
Standard research tool,
clinical use under
development
Point kernel methods
Convolution/superposition ,
Collapsed Cone
Implicit particle transport
+Accurate
- Minor systematic errors
Current workhorse for
accurate calculations in
lung.
Pencil Kernel Methods
Heterogeneity impact
through corrections
The workhorse for many
applications
Scatter dose estimations
Semi pencil kernel
metods
Often used for factor
based calculation
schemes
1D heterogeneity corrections
Models what happen
along the incident beam
direction only
Can be used to correct
dose calculated with any
method for heterogeneities
Model
Based
Factor
Based
Ahnesj, 2013 (4)
Calculation algorithms for TPS (photons)
Elekta XiO
Clarkson
FFT Convolution
Multigrid Convolution
Superposition
Fast Superposition
Phillips Pinnacle
Collapsed Cone Convolution
Pencil Beam
Varian ECLIPSE
AAA Collapsed Cone Convolution
Pencil Beam
Model based algorithms
Empirically based algorithms rely on measurement,
corrections performed based on patient
characteristics
Model based algorithms rely less on measured data,
more on predictions of dose distribution (equations,
probabilities)
No clear distinction!
Empirical based algorithms use models for
corrections and model based algorithms use some
measured data.
Pencil Beam algorithm (Convolution)
Monte Carlo kernels
Spatially invariant (non-divergent)
Scatter not modeled well
- Lateral scatter not considered
- Heterogeneity correction largely attenuation
correction only (generally convolved with Batho or
other correction)
- Generally a hybrid algorithm (modeled with semi-
empirical correction)
Monte Carlo kernel Summation of
kernels
In the pencil beam algorithm, kernels are spatially
invariant, i.e., parallel to surface, non-divergent,
source of some inaccuracy
Homogeneous media Inhomogeneous media
Pencil beam algorithm predictions
Changes in side scatter not modeled
Attenuation correction only
High density
heterogeneity
Low density
heterogeneity
Inhomogeneous
media
High density
heterogeneity
Low density
heterogeneity
Increased areas of
scatter not modeled
Will result in higher
MUs than is needed
Decreased areas of
scatter not modeled
Will result in lower MUs
Convolution knvlo

oSHn
A coil or twist, esp. one of many
A thing that is complex and difficult to follow
a mathematical operation on two functions f
and g, producing a third function that is typically
viewed as a modified version of one of the
original functions.
It is based on theory of Laplace transformation
of functions.
http://en.wikipedia.org/wiki/Convolution
Convolution-Superposition method
(Collapsed Cone, Superposition)
Most commonly used and widely accepted
algorithm class in radiotherapy planning
systems.
Primary photons are treated separately from
scattered photons and electrons set in motion
Convolution-Superposition algorithms
Point kernels (finer resolution than pencil kernels)
Consideration of divergence
Consideration of lateral scatter
Consideration of energy spectrum
Consideration of primary/secondary interactions with
inhomogeneous media
Effects of collimator, flattening filter
Less averaging than pencil beam
Equations
( ) ( ) ( )
( )
( )
( ) scatter for ally simplistic accounts '
mass in the released energy total TERMA,
' ' ) (
' '
3
3
=
=
=
=
}
r r A
r T
r d r r A r T
r d r r A r r D
p
p

( ) ( ) ( )
( ) ( )
( )
site photon the to source the from distance
radiologic the is and site photon primary the to site deposition
dose the from distance radiologic the is ' where
' ' ) (
' '
'
3
'
3
r
r r
r d r r A r T
r d r r A r r D
r
r r
r r r p

=
=

Convolution
Equation
Convolution-
Superposition
Equation
Data and Clinical Examples
Experimental geometry for the treatment planning and measurement.
The phantom consists of 14.4 cm of lung equivalent material (Cork,
=0.25g/cm
3
) sandwiched between slabs of solid water. Measurements
were made at various depth with micro-chamber
Treatment Planning and
Measurements
Das et al., 2008 (11)
medium
Charged particle equilibrium (CPE)
Pencil beam algorithm does
not accurately account for
secondary electron
production, calculations at
the tissue/lung interface are
not accurate.
Region of non-
equilibrium
From Khan, 2010 (2)
Plot = Di/Dh
CMS-XiO, 6 MV
0.4
0.6
0.8
1.0
1.2
1.4
1.6
1.8
0 2 4 6 8 10 12 14 16 18 20
Depth(cm)
C
o
r
r
e
c
t
i
o
n

F
a
c
t
o
r

(
D
i
/
D
h
)
1x1
2x2
3x3
4x4
5x5
6x6
8x8
10x10
Pencil Beam
Convolution
Pencil Beam
CMS-XiO, 6 MV
0.4
0.6
0.8
1.0
1.2
1.4
1.6
1.8
0 2 4 6 8 10 12 14 16 18 20
Depth(cm)
C
o
r
r
e
c
t
i
o
n

F
a
c
t
o
r

(
D
i
/
D
h
)
1x1
2x2
3x3
4x4
5x5
6x6
8x8
10x10
Superposition
MonteCarlo, 6MV
0.4
0.6
0.8
1.0
1.2
1.4
1.6
1.8
0 2 4 6 8 10 12 14 16 18 20
Depth(cm)
C
o
r
r
e
c
t
i
o
n

F
a
c
t
o
r

(
D
i
/
D
h
)
1x1
2x2
3x3
4x4
3x3
6x6
PENELOPE, MC
Superposition
Monte Carlo
Das et al., 2008 (11)
Lung Case
1. SBRT case
10 fields
2. 1 cm volume
3. 6 MV
4. AAA and Pencil
beam
5. Heterogeneity
corrections
on
AAA
100% White
95%
90%
80%
Calculation verification
program predicts 11.3%
higher dose than AAA with
same MUs
Pencil Beam
100% White
95%
90%
80%
Calculation verification
program agrees well with
Pencil beam (.01%)
Comparison of isodose curves
AAA Pencil Beam
Max dose = 100.8%
80% volume = 42.4 cc
Max dose = 102.2%
80% volume = 57.7 cc
The 80% volume generated in PBC is 36% greater than AAA
Spine Case High Z
APPA spine
6 MV beams
High density implanted
devices, 3000+ HU
Bone measured density
values = 900-1500 HU
AAA and Pencil Beam
Heterogeneity
corrections on
AAA MU
sum = 206
Pencil Beam
MU
sum = 208
AAA edge of heterogeneity PBC edge of heterogeneity
PBC results in 10% higher dose at edge of high Z
heterogeneity
AAA inside heterogeneity PBC inside heterogeneity
PBC results in 10% higher dose inside the high Z
heterogeneity
Spine case
No implant
APPA
16 MV photons
200 cGy anterior
to vertebral body
No difference in
MUs between
AAA and PBC
Heterogeneity
corrections on
AAA PBC
Less than 1% difference in dose calculated to cord
AAA PBC
Less than 1% difference in calculated dose in bone
Summary
Algorithms are step by step processes which are used
in planning systems (and otherwise) to complete
specific tasks.
The simplest of algorithms perform as accurately as the
most sophisticated algorithms for ideal conditions.
Time is a critical factor in the development of treatment
planning algorithms.
Heterogeneities pose the greatest challenge to
predicting accurate dose distributions in patients
Summary (cont.)
The Monte Carlo method is the most accurate method
for calculating dose in heterogeneities. The most
accurate currently available algorithms incorporate
Monte Carlo kernels.
Discrepancies in calculations more likely to arise from
low density media than from high density media
Safer to rely on your convolution-superposition
algorithm than your verification calculation, since your
verification calculation uses a simpler, less accurate
algorithm
www.pythian.com
The academic portion of
the lecture is now
complete.
An Irish blessing for the Medical
Dosimetrist
May your first optimization meet your dose constraint
If not, may you meet with a little dose paint
May your calcd and your plan MUs always agree
May you need not replan for a re-drawn GTV
May your MD not change his mind post approval
And your user rights never suffer removal
May your IMRT QA turn out right
And you get to go home while there is still light
Questions?
http://crippledcollie.com/wordpress/wp-content/uploads/2012/08/deer-in-headlights.jpg