ICTP SChool On MEdical PHysics For

RAdiation THerapy:
DOsimetry And TReatment PLanning For BAsic And ADvanced
APplications
13 - 24 April 2015
Miramare, Trieste, Italy

Treatment Planning Systems

G. Hartmann
EFOMP & German Cancer Research Center (DKFZ)
[email protected]
1. Introduction: Treatment Planning & dose calculation

2. Key elements for a 3D dose calculation engine:

- voxel model of the patient
- beam model
- ray tracing algorithm
- dose calculation algorithm
- optimization strategies
- MC tracking
An idealistic picture showing a treatment with external radiation

Delivery of a high dose of radiation requires thorough planning

Radiation delivery requires the whole process consisting of
a chain of single procedures to be planned!

clinical evaluation treatment planning:

simulation and dose calculation
treatment planning:
3D imaging evaluation and selection
dosimetry verification
and checks

treatment
therapeutic decision

localization of target volume

and organs at risk patient
positioning
follow-up
evaluation
 Steps of the treatment planning process, the
professionals involved in each step and the QA
activities associated with these steps (IAEA TRS 430)

TPS related activity

This lesson deals explicitly with that component of the
treatment planning process that makes use of the
computer.

It is also frequently referred to as:

Computerized Treatment Planning.

Such Treatment Planning Systems (TPS) are now

always used in external beam radiation therapy and also
in brachytherapy to generate beam shapes and dose
distributions with the intent to maximize tumor control and
minimize normal tissue complications.
Main elements of a TPS

1. Import of patient data (DICOM Format)

2. Establishment of the beam model Imaging
3. Generation of the individual patient model part
4. Definition of target volume(s) and OARs
5. Definition of irradiation parameters
6. Dose calculation
7. Plan evaluation, Optimization
8. Dose prescription and determination of monitor units
9. Export of treatment parameters
10. Documentation
Dose calculations have evolved
from simple 2D models through
3D models to 3D Monte-Carlo
techniques, and increased
computing power continues to
increase the calculation speed.

Monte Carlo simulation of an

electron beam produced in
the accelerator head.
 Voxel model of the patient

From a series of CT
images we can
establish a patient
model that consists
of cuboidal blocks
each with an
individual density.

These cuboidal
blocks are normally
referred to as voxels
 Voxel model of the patient

CT-numbers
In order to adjust the dose (HU)

calculation to an individual
patient, we need:

the contours of patient, CTV,

and anatomical structures relative
electron
the information of tissue density

inhomogeneities.

Inside the patient, the relative

electron density of each voxel
can be determined from the
patient CT data set.
 Beam model

The modern approach utilizes the

natural divider between

- the radiation sources inside

the treatment head

- and the patient or the phantom.

dose or fluence

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Beam model: treatment head
A complete model requires:
• Finite photon source size
• Open fluence distribution
• Fluence modulation
– Step&shot
– Dynamic
– Wedges
• Head scatter sources
– flattening filter
– collimators
– wedges
• Monitor back scatter
• Collimator leakage, including
– MLC interleaf leakage
– shape of MLC leaf ends
• Beam spectra
Schematic drawing of an • Spectral changes
accelerator head (from A. Ahnesjö) • Electron contamination
5.2  Beam model and ray tracing

A (rather simple) method of dose calculation:

D0 D1 ???
For a ray of photons:
The dose D0 is known −µ
at a certain point P0 at the surface
= ⋅
Where d is the
radiological path
from P0 to P1

If this method is applied within a voxel array, it is frequently

referred to as ray tracing
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Ray tracing

The term “Ray tracing” is frequently used to determine the

radiological path length through a voxel array representing
a patient (with relative densities ρ11, ρ12, ρ13, …).

The geometrical path d

within the patient:
d
d1
ρ11 d2
ρ12 ρ13
The radiological path dradiol
ρ21 ρ22d3 ρ23 within the patient (simplified):
d4

ρ31 ρ32 d5 ρ33

dradiol =
d1ρ11 + d2ρ12 + d3ρ22 + d 4ρ23 + d5ρ33
Ray Tracing
In order to determine the radiological path dradiol through the
patient, one has to determine – voxel by voxel – the
segments dijk in each single voxel I,j,k in the 3D space.

Consider a
voxel with index i,j,k

segment di,j,k
 Ray Tracing

In a general formulation, the radiological path dradiol is

( )
=∑ ∑ ∑ ⋅

For photons:

µ
=∑ ∑ ∑ ⋅
µ

It is obvious that the evaluation of this equation scales with

the number of voxels = Ni x Nj x Nk
(for instance: 256 x 256 x 64 = 4 106 iterations
Ray Tracing

However, there are algorithms of ray tracing which are

much faster:

Fast calculation of Fast Algorithm for

the exact radiological computer control of
path for a three- a digital plotter CT
dimensional CT
J. E. Bresenham
Robert L. Siddon
IBM Systems Journal Vol.4 No. 1 1965
Ray Tracing: Siddon’s algorithm (illustrated in 2D)

Consider the intersection points of the geometrical path d:

p1

p2

p3

dy
p4 p5

= ( ) +( )
p6

dx
Ray Tracing: Siddon’s algorithm (illustrated in 2D)

………… as being intersections with the equally spaced

vertical and horizontal lines (distance: a) in blue and green:
X coordinates of the
intersection points:
= = + ⋅
X
p1
=( − )
p2 Y coordinates of the
a intersection points:
p3
= = + ⋅
dy =( − )
p4 p5
The αx,i and αy,i can be merged into a
common series of increasing values:
p6
{α} = { [α α ]}
Y dx {α α α }
Ray Tracing: Siddon’s algorithm

Therefore the individual distance dm can be calculated as:

= ⋅[ − − ] with = ( ) +( )
In a similar way, the indices of each voxel i and j can be
also obtained from the sequence of {α α α}

⎛ ⎡ α −α − ⎤ ⎞
= ⎜ + ⎢ ⋅ ⎥⎦ ⎟
⎝ ⎣ ⎠

⎛ ⎡ α −α − ⎤ ⎞
= ⎜ + ⎢ ⋅ ⎥⎦ ⎟
⎝ ⎣ ⎠
Ray Tracing: Siddon’s algorithm

The charm of this algorithm is:

It does not scale with the number of voxels Ni x Nj x Nk but

with number of planes (Ni+1)+(Nj+1)+(Nk+1).

For instance:
Instead of 256 x 256 x 64 = 4 million iterations we need
only (256+1)+(256+1)+(64+1) = 579 iterations
Beam model: treatment head

⎛ E µ ⎞ ⎡ J ⎤
Terma ∫ E ⎜⎝ ρ ⎟⎠ ⋅ dE
Φ ⋅ ⎢ kg ⎥
⎣ ⎦

⎛ E µtr ⎞ ⎡ J ⎤
Kerma
Φ ⋅
∫ E ⎜⎝ ρ ⎟ ⋅ dE ⎢ kg ⎥
⎠ ⎣ ⎦

⎛ E µen ⎞ ⎡ J ⎤
Collision Kerma Φ ⋅
∫ E ⎜⎝ ρ ⎟ ⋅ dE ⎢ kg ⎥
⎠ ⎣ ⎦

A “Fluence engine“ would provide

the required knowledge to calculate,
for instance collision kerma
 The beam model can also be considered as a fluence
engine:
The width, shape and other radiative
properties of the source must be taken
into account

Collimators can be raytraced, or

approximated as ideal beam blockers

For each element, find the contributions

from the relevant sources

Calculate the value of a fluence matrix

element
Dose calculation algorithm
5.2  
Superposition and Point kernel
What is a point kernel?

Imagine a water absorber

and a point at a certain
depth.

Imagine that many photons

are coming all along a vertical
path and are all interacting
at this point only.

A point kernel represents

the energy transport and
dose deposition of secondary
particles stemming from
that point of interactions.
Point kernels are extremely useful for the superposition
method.
The superposition principle is summarized in the following
Figure:

The dose at a point P(x,y,z)

can be considered as the
sum of the contributions
of the energy launched at a
distance from P dV2
i.e. in volume elements dV3
dV1
dV(x0,y0,z0).

This elementary energy originates from P(x,y,z)

the energy fluence p(x0,y0,z0) of the
primary photons impinging on dV and
the photon interactions within dV.
5.2   Model based methods

We denote the scatter energy per unit primary photon fluence

launched at dV and reaching P as:

s(x,x0, y,y0, z,z0)

Then the dose at P(x,y,z) is

fluence scattered energy

at x',y',z' from x',y',z'
absorbed at x,y,z
5.2   Model based methods

We can summarize this by the following statement:

The dose deposition is viewed as a superposition of
appropriately weighted responses to point irradiations.

These responses are referred to as point kernels.

These kernels usually are not accessible through

measurements but can be calculate by use of Monte Carlo
particle transport codes (example).

Under conditions where the kernels are spatially invariant, the

superpositions can be efficiently evaluated by means of
convolutions.
Dose calculation methods

There are various methods of kernel implementation:

point kernel
pencil kernel
collapsed cone
etc. ….
Dose calculation methods

There are various methods of kernel implementation:

point kernel
pencil kernel
collapsed cone
etc. ….

Each of them has advantages and disadvantages, in

particular when applied to structures with lateral borders
and such with low density (Lung).
Optimization

Examples:
Which treatment parameters can/should be optimized:
In IMRT: Intensity maps for each beam
or
weights of beams segments

Further parameters:
Beam angles
Number of beams
Type of radiation
Energy
Optimization

What is needed in IMRT:

Intensity maps for each beam
or
weights of beams segments
Key elements for a 3D dose calculation engine:
Optimization/IMRT
Key elements for a 3D dose calculation engine:
Optimization/IMRT
Optimization
Fluence and tracking Alternative definition:

dA

r dN dL(r )
Φ(r) = Φ(r ) =
dA dV
Monte Carlo simulations of particle transport processes are
a faithful simulation of physical reality because:

• particles are “born” according to distributions

describing the source,
• they travel certain distances:
a) to the next point of interaction, or
• b) going through the entire voxel without an
interaction
• scatter into another energy and/or direction
according to the corresponding differential cross
section, possibly producing new particles that
have to be transported as well.
This methods requires a tracking of each individual particle
through a certain geometry, and the summation over a
large number of particles.
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Individual particle tracking within the Monte Carlo method

The path length within a volume of interest and thus the fluence can be
determined by the following procedure:

direction
u,v,w

We start with a photon which

has a direction according to the
3 directional cosines

u in direction x,
v in direction y,
w in direction z

and which is entering a volume (voxel) at x0, y0, z0.

39  
Individual particle tracking within the Monte Carlo method

Step 1: The track lenght d to the next interaction of an individual photon

– starting from the entry point –
can be anywhere.
For an individual photon it must be taken from a distribution
determined by the
mean free path length dmfp

This is accomplished by a very

simple method:

=− ⋅ ()

dsample = distance to the next interaction for this individual photon

dmfp = distance to the next interaction on average
r = random number out of the interval {0,1}
40  
Individual particle tracking within the Monte Carlo method

Step 2:
Also calculate the geometrical path length dgeo within V

41  
Step 3: Make a differentiation between

Case 1: dsample < dgeo Case 2: dsample > dgeo

The interaction occurred within the voxel.No interaction within the voxel.
Take dsample for the track length
Take dgeo for the track length

42  
Individual particle tracking within the Monte Carlo method

Step 4 in case that an interaction occured:

Determine energy and direction of the new

photon (if produced) and continue tracking, now
starting at the point of interaction

Step 4 in case that no interaction occured:

Go to adjacent voxel and determine the next

dsample,next as:

dsample,next = dsample – dgeo

Step 5:
Repeat everything for any voxel and any new photon
43  
Tracking in Monte Carlo Codes

More generally speaking, the term tracking can be used to

describe the procedure of subsequently determining the
trajectories in the six dimensional phase space between
each two interactions.

The six dimensions are (x;Ω;E)

where:

q x = (x1; x2; x3) are the spatial coordinate variable,

q Ω is the particle direction which is a point on a unit

sphere S with the angles coordinates ϕ and θ
q E is the energy variable.
44  
 Summary: Treament Planning Systems

1) Computerized treatment planning is a part (however, an

important part) within clinical treatment planning which
consists of an entire chain of many steps:
2) Dose calculation again is a apart only within the
treatment planning system.
3) Main methods of calculations are:
ray tracing through a voxel geometry
superposition using different kernel types
tracking and energy scoring using MC
4) One should al least know the characteristics of a certain
dose calculation method with respect to the requirement
of an individual patient.