Table of contents

The biennial MMND (formerly MMD) - IPCT workshops, founded in collaboration with Memorial Sloan Kettering Cancer Center (MSKCC) in 2001, has become an important international multidisciplinary forum for the discussion of advanced dosimetric technology for radiation therapy quality assurance (QA) and space science, as well as advanced technologies for prostate cancer treatment.

In more recent years, the interests of participants and the scope of the workshops have extended far beyond prostate cancer treatment alone to include all aspects of radiation therapy, radiation science and technology. We therefore decided to change the name in 2016 to Innovative Technologies in Radiation Oncology (ITRO). MMND ITRO 2016 was held on 26-31 January, 2016 at the beautiful Wrest Point Hotel in Hobart, Tasmania and attracted an outstanding international faculty and nearly 200 delegates from 18 countries (http://mmnditro2016.com/)

The MMND 2016 program continued to cover advanced medical physics aspects of IMRT, IGRT, VMAT, SBRT, MRI LINAC, innovative brachytherapy, and synchrotron MRT. The demand for sophisticated real time and high temporal and spatial resolution (down to the submillimetre scale) dosimetry methods and instrumentation for end–to-end QA for these radiotherapy technologies is increasing. Special attention was paid to the contribution of advanced imaging and the application of nanoscience to the recent improvements in imaging and radiotherapy.

The last decade has seen great progress in charged particle therapy technology which has spread throughout the world and attracted strong current interest in Australia. This demands a better understanding of the fundamental aspects of ion interactions with biological tissue and the relative biological effectiveness (RBE) of protons and heavy ions. The further development of computational and experimental micro-and nano-dosimetry for ions has important application in radiobiology based treatment planning and space radiation hazard prediction. New compact accelerator technologies for the delivery of proton and heavy ion therapy and relevant QA dosimetry instrumentation were an additional focus of MMND 2016.

The ITRO program this year was dedicated to clinical aspects of innovative SBRT for cancer treatment. It represented a unique opportunity to learn from didactic lectures as well as case based discussions with world leaders in the field in the relaxed atmosphere of Hobart.

As well as the outstanding scientific program, MMND ITRO 2016 included an Australian beach BBQ to celebrate Australia Day on the evening of 26^th January and an exciting social program on 29^th January followed by the conference dinner and great Australian hospitality.

The MMND workshop represents an important next step for improving current cancer treatments with radiation and the development of new radiation based cancer treatments.

Details of the committees can be found in the PDF

Details of the conference programme can be found in the PDF.

All papers published in this volume of Journal of Physics: Conference Series have been peer reviewed through processes administered by the proceedings Editors. Reviews were conducted by expert referees to the professional and scientific standards expected of a proceedings journal published by IOP Publishing.

The biannual MMND (former MMD) - IPCT workshops was founded in collaboration between the Centre for Medical Radiation Physics, University of Wollongong and the Memorial Sloan Kettering Cancer Center (MSKCC) in 2001 and has become an important international multidisciplinary forum for the discussion of advanced quality assurance (QA) dosimetry technology for radiation therapy and space science, as well as advanced technologies for clinical cancer treatment.

Accurate, efficient auto-segmentation methods are essential for the clinical efficacy of adaptive radiotherapy delivered with highly conformal techniques. Current atlas based auto-segmentation techniques are adequate in this respect, however fail to account for inter-observer variation. An atlas-based segmentation method that incorporates inter-observer variation is proposed. This method is validated for a whole breast radiotherapy cohort containing 28 CT datasets with CTVs delineated by eight observers. To optimise atlas accuracy, the cohort was divided into categories by mean body mass index and laterality, with atlas' generated for each in a leave-one-out approach. Observer CTVs were merged and thresholded to generate an auto-segmentation model representing both inter-observer and inter-patient differences. For each category, the atlas was registered to the left-out dataset to enable propagation of the auto-segmentation from atlas space. Auto-segmentation time was recorded. The segmentation was compared to the gold-standard contour using the dice similarity coefficient (DSC) and mean absolute surface distance (MASD). Comparison with the smallest and largest CTV was also made. This atlas-based auto-segmentation method incorporating inter-observer variation was shown to be efficient (<4min) and accurate for whole breast radiotherapy, with good agreement (DSC>0.7, MASD <9.3mm) between the auto-segmented contours and CTV volumes.

Three alternative methodologies to the Computed-Tomography Dose Index for the evaluation of Cone-Beam Computed Tomography dose are compared, the Cone-Beam Dose Index, IAEA Human Health Report No. 5 recommended methodology and the AAPM Task Group 111 recommended methodology. The protocols were evaluated for Pelvis and Thorax scan modes on Varian® On-Board Imager and Truebeam kV XI imaging systems. The weighted planar average dose was highest for the AAPM methodology across all scans, with the CBDI being the second highest overall. A 17.96% and 1.14% decrease from the TG-111 protocol to the IAEA and CBDI protocols for the Pelvis mode and 18.15% and 13.10% decrease for the Thorax mode were observed for the XI system. For the OBI system, the variation was 16.46% and 7.14% for Pelvis mode and 15.93% to the CBDI protocol in Thorax mode respectively.

An 11-year-old girl with an arteriovenous malformation (AVM) was referred for Gamma Knife treatment. As this would be the first paediatric treatment in Australia, additional investigations were undertaken into out of field dose to assure the best possible long term outcome for the patient. A phantom was constructed from water equivalent materials to simulate the patient. A target volume was defined to emulate the size and location of the AVM visible in diagnostic images. An ionisation chamber and EBT3 Gafchromic film were used to record absorbed dose at strategic points both on the surface and at depth within the phantom. On the day of treatment, EBT3 Gafchromic film was used to conduct in vivo dosimetry. The pre-treatment phantom measurements matched the planning system for the cranial section (the only modelled section) and no measurable dose above background was detected in the extracranial sites. In vivo measurements of the lenses returned doses of up to 2 cGy for imaging and 8 cGy for treatment which was also consistent with the planned dose. Dose to the thyroid, chest and abdomen was not measurable above background.

EBT3 film offers high spatial resolution and low energy dependence, making it a suitable choice for quality assurance where high dose gradients are present, such as the case for SBRT. This work presents a simple method to adjust scanner settings so that dose response becomes linear. This linearity eliminates the need to obtain a calibration curve and associated uncertainties in curve fitting. Relative dosimetry can be performed after dose normalization to a reference point. Linearity is also a more robust condition than calibration curve with respect to scanner warm-up conditions, resulting in reduced uncertainty in dose measurement. An in-house developed program reads the film scan and a 2D dose map then constructs both to virtual films using grayscale values. Film intensity value was normalized to dose at reference point. Relative dosimetry was performed by comparing the two resulting images. Patient specific quality assurance was conducted for two SBRT cases. In both plans more than 95% gamma function points passed the gamma criteria of 2%/3mm.

This paper describes applications of a novel superconducting solenoidal separator, with magnetic fields up to 8 Tesla, for studies of nuclear reactions using the Heavy Ion Accelerator Facility at the Australian National University.

The new era of intra-fraction dose tracking in radiation therapy delivery demands new dosimetry methods, whereby a moving frame of reference as a function of time may be required. This introduces a new paradigm into radiation therapy dose verification. The term we propose to describe this is dynamic dosimaging, which by our definition is tracking the location of a dosimeter array in real time during on-line radiation dose acquisition.

While Gold Nanoparticles (GNPs) have been extensively studied as radiosensitisers in recent years, there is a lack of studies of their impact on targets outside of the cell's nuclear DNA. We present Monte Carlo simulations of the energy deposited by X-ray irradiation in mitochondria in cells with and without cytoplasmic GNPs. These simulations show that the presence of GNPs within the cytoplasm can significantly increase (3-4 fold) the number of ionisation clusters of both small and large sizes. As these clusters are strongly associated with DNA damage, these results suggest that mitochondrial DNA may be a significant target for GNP radiosensitisation when the nanoparticles cannot penetrate the cell nucleus.

Microbeam Radiation Therapy (MRT) involves the use of a spatially fractionated beam of synchrotron generated X-rays to treat tumours. MRT treatment is delivered via an array of high dose 'peaks' separated by low dose 'valleys'. A good Peak to Valley Dose Ratio (PVDR) is an important indicator of successful treatment outcomes. MRT dosimetry requires a radiation hard detector with high spatial resolution, large dynamic range, which is ideally real-time and tissue equivalent. We have developed a Silicon Strip Detector (SSD) and very recently, a new 3D MESA SSD to meet the very stringent requirements of MRT dosimetry. We have compared these detectors through the characterisation of the MRT radiation field at the Australian Synchrotron Imaging and Medical Beamline. The EPI SSD was able to measure the microbeam profiles and PVDRs, however the effective spatial resolution was limited by the detector alignment options available at the time. The geometry of the new 3D MESA SSD is less sensitive to this alignment restriction was able to measure the microbeam profiles within 2 μm of that expected. The 3D MESA SSD measured PVDRs were possibly affected by undesired and slow charge collection outside the sensitive volume and additional scattering from the device substrate.

Proton stopping power in hydrogen is calculated using a hybrid method. A two-centre convergent close-coupling method is used for calculations involving the proton fraction of the beam, while the Born approximation is used for the hydrogen fraction. For proton-hydrogen collisions rearrangement processes are explicitly included via a two-centre expansion. Hydrogen-hydrogen collisions are calculated including one- and two-electron processes. Despite using the first-order approximation in the hydrogen-hydrogen channel, overall reasonably good agreement with experiment is seen above 100 keV.

Synchrotron radiation is unique in its ability to deliver dose at high dose rates using kiloelectronvolt photons. We are investigating the use of Tantalum pentoxide (Ta₂O₅) nano-structured particles (NSPs) that are to date unexplored in synchrotron radiation fields as they have high atomic number (Z=73) are biocompatible and are therefore potential radio sensitizers. We exposed cell culture flasks containing 9L gliosarcoma tumour cells or Madin-Darby Canine Kidney (MDCK) non-tumour cells to the NSPs and treated the cells using a broad synchrotron beam (140 keV median energy; average dose rate of 50 Gy/s) at the Australian Synchrotron. We compare the results with those from similar cells treated using a conventional 150 kV_p orthovoltage field (dose rate of 0.0127 Gy/s). The results reveal that the high dose-rate synchrotron irradiation is more effective at killing the 9L cells relative to the MDCK cells than the orthovoltage irradiation. On the other hand, the NSPs are more effective at radiosensitizing the 9L cells compared to the MDCK cells in the orthovoltage radiation field, which is due to the NSP energy dependence in the kilovoltage energy range. Both the dose rate and energy spectrum need to be considered in future studies with synchrotron activation radiotherapy (SART).

Rapid retrospective biodosimetry methods are essential for the fast triage of persons occupationally or accidentally exposed to ionizing radiation. Identification and detection of a radiation specific molecular 'footprint' should provide a sensitive and reliable measurement of radiation exposure. Here we discuss conventional (cytogenetic) methods of detection and assessment of radiation exposure in comparison to emerging approaches such as gene expression signatures and DNA damage markers. Furthermore, we provide an overview of technical and logistic details such as type of sample required, time for sample preparation and analysis, ease of use and potential for a high throughput analysis.

The properties of light nuclei such as ⁶Li, ⁷Li, ⁹Be and ¹²C, and their reaction outcomes are known to be strongly influenced by their underlying α-cluster structure. Reaction models do not yet exist to allow accurate predictions of outcomes following a collision of these nuclei with another nucleus. As a result, reaction models within GEANT, and nuclear fusion models do not accurately describe measured products or cross sections. Recent measurements at the Australian National University have shown new reaction modes that lead to breakup of ⁶Li, ⁷Li into lighter clusters, again presenting a further challenge to current models. The new observations and subsequent model developments will impact on accurate predictions of reaction outcomes of ¹²C - a three α-cluster nucleus – that is used in heavy ion therapy.

The high spatial and temporal resolution 2D monolithic silicon detector arrays M512 and DUO for quality assurance (QA) in real time motion adaptive radiotherapy (ART) have been developed. The DUO array possesses a spatial resolution of 0.2 mm and has demonstrated agreement within 5% with EBT3 film measurements of 6MV linac beam profiles for field sizes 1 × 1 cm² and SRS cone diameter 0.5 cm. Dynamic characterisation of the M512 for QA in real time ART evaluated the performance of M512 for small fields while the detector experiences periodic motion. It was demonstrated with M512 that MLC tracking with Calypso electromagnetic array compensates for the periodic motion and improves the agreement between static and dynamic beam profiles for field size 1 × 1 cm² from within 75% in the penumbra to within 11% agreement. The dynamic profile is returned to a similar distribution as the static case.

A Geant4 Monte Carlo simulation study was carried out to characterise a novel silicon strip detector, the Dose Magnifying Glass (DMG), for use in proton therapy Quality Assurance. We investigated the possibility to use DMG to determine the energy of the incident proton beam. The advantages of DMG are quick response, easy operation and high spatial resolution. In this work we theoretically proved that DMG can be used for QA in the determination of the energy of the incident proton beam, for ocular and prostate cancer therapy. The study was performed by means of Monte Carlo simulations Experimental measurements are currently on their way to confirm the results of this simulation study.

Nowadays, one of the biggest challenges consists in using high intensity laser-target interaction to generate high-energy ions for medical purposes, eventually replacing the old paradigm of acceleration characterized by huge and complex machines. In order to investigate the feasibility of using laser-driven ion beams for multidisciplinary application, a dedicated beam transport line will be installed at the ELI-Beamlines facility in Prague (CZ), as a part of the User-oriented ELIMAIA beam-line dedicated to ion acceleration and their potential applications. The beam-line section dedicated to transport and dosimetric endpoints is called ELIMED (ELI-Beamlines MEDical and multidisciplinary applications) and will be developed by the INFN-LNS.

Stereotactic Ablative Body Radiotherapy (SABR) is an extension of the concepts of Stereotactic Radiosurgery from intracranial procedures to extracranial targets. This brings with it new technological challenges for set-up of a SABR program and continuing quality assurance. Compared with intracranial procedures SABR requires consideration of motion and inhomogeneities and has to deal with a much larger variety of targets ranging from lung to liver, kidney and bone. To meet many of the challenges virtually all advances in modern radiotherapy, such as Intensity Modulated and Image Guided Radiation Therapy (IMRT and IGRT) are used. Considering the few fractions and high doses per fraction delivered to complex targets it is not surprising that patient specific quality control is considered essential for safe delivery. Given the variety of targets and clinical scenarios we employ different strategies for different patients to ensure that the most important aspects of the treatment are appropriately tested, be it steep dose gradients, inhomogeneities or the delivery of dose in the presence of motion. The current paper reviews the different approaches and phantoms utilised at Peter MacCallum Cancer Centre for SABR QA.

Laser-accelerated proton beams exhibit remarkably different beam characteristics as compared to conventionally accelerated ion beams. About 10⁵ to 10⁷ particles per MeV and msr are accelerated quasi-instantaneously within about 1 ps. The resulting energy spectrum typically shows an exponentially decaying distribution. Our planned approach to determine the energy spectrum of the particles generated in each pulse is to exploit the time-of-flight (TOF) difference of protons with different kinetic energies at 1 m distance from the laser-target interaction. This requires fast and sensitive detectors. We therefore tested two prototype silicon detectors, developed at the Centre for Medical Radiation Physics at the University of Wollongong with a current amplifier, regarding their suitability for TOF-spectrometry in terms of sensitivity and timing properties. For the latter, we illuminated the detectors with short laser pulses, measured the signal current and compared it to the signal of a fast photodiode. The comparison revealed that the timing properties of both prototypes are not yet sufficient for our purpose. In contrast, our results regarding the detectors' sensitivity are promising. The lowest detectable proton flux at 10 MeV was found to be 25 protons per ns on the detector. With this sensitivity and with a smaller pixelation of the detectors, the timing properties can be improved for new prototypes, making them potential candidates for TOF-spectrometry of laser-accelerated particle beams.

Due to the high LET and dense ionisation tracks associated with ions, microdosimetric approaches have been used in carbon ion therapy to assess field quality and calculate radiobiological quantities for a variety of cell lines. There is however a lack of instrumentation for simple and routine use in a clinical environment, important for determination of RBE which provides accurate treatment planning and delivery in hadron therapy. In this study, a 10 μm thick silicon microdosimeter with 3D sensitive volumes has been used to investigate the effect of motion on the RBE and field quality of a typical ¹²C ion therapy beam. For a passively scattered 290 MeV/u ¹²C beam with 6 cm spread-out Bragg peak (SOBP), variations in biological dose along the SOBP were observed, as well as a significant changes to particle LET when incident on a moving target.

The purpose of this study is to investigate the directional dependence of a two dimensional monolithic detector array (M512) under 6 MV photon irradiation and to evaluate the effect of field size on angular dependence. Square fields of sizes: 3x3 cm² and 10x10 cm² were measured at the iso-centre of a cylindrical phantom. Beam angles with incidences from 0⁰- 180⁰ in increments of 15⁰ were used to investigate the central pixel angular response of M512, normalized to the pixel response for normal (0°) beam incidence. The angular response of the detector was compared to the response of EBT3 radiochromic film in the identical geometric orientation. The maximum angular dependence was observed at the angle 90°±15° to be -18.62% and -17.70% for the field sizes 3x3 cm² and 10x10 cm², respectively. The angular dependence of M512 showed no significant difference between field sizes of 3x3 cm² and 10x10 cm² (p>0.05). The maximum dose difference measured by the central pixel of M512 and EBT3 for all angles are -20% for 3x3 cm² field size and -18.58% for the 10x10 cm² field. The diode array's size and packaging effects the angular response of the detector. The angular correction factor is necessary to apply to increase accuracy in dosimetry for arc treatment delivery.

We present the workflow of the offline-PET based range verification method used at the Heidelberg Ion Beam Therapy Center, detailing the functionalities of an in-house developed software application, SimInterface14, with which range analysis is performed. Moreover, we introduce the design of a decision support system assessing uncertainties and facilitating physicians in decisions making for plan adaptation.

We evaluate the impact of an air gap and optimization of this air gap for the MP512 silicon detector array when operated in dosimetry mode for small photon field measurements in solid water. We present output factor measurements for 6MV and 10 MV photon beams with the square field sizes ranging from 0.5 to 10 cm². The size of the air gap above the MP512 detector was changed from 0.5, 1.0, 1.2, 2.0 and 2.6 mm. We compare the output factors measurements of the MP512 with EBT3 film and the MOSkin dosimeter. For the two photon energies investigated, we find that the output factor measured by the MP512 reduce with increasing air gap and reducing of field size. The reduction in output factor is most pronounced for the 0.5 and 1 cm² field sizes. The air gap of 0.5 mm and 1.2 mm showed good agreement with the EBT3 film and MOSkin output factor for 6 and 10 MV photon fields, respectively. The negligible effect on dosimetry for the field sizes larger than 4x4 cm² demonstrates that the electronic disequilibrium caused by small air gap only influences the dosimetry measurements for small fields. The study shows that the output factor reduction is enhanced by increasing of air gap and demonstrates that the optimal air gap for the MP512 at 6 and 10 MV photon fields is 0.5mm.

The OpenPET is the world's first open-type 3D PET scanner for PET image-guided particle therapy such as in situ dose verification and direct tumour tracking. Even with a full-ring geometry, the OpenPET has an open gap between its two detector rings through which the treatment beam passes. Following the initial proposal of the dual-ring OpenPET (DROP), the single-ring OpenPET (SROP) was also proposed as a more efficient geometry than DROP in terms of manufacturing cost and sensitivity. A small SROP prototype was developed and feasibility of visualizing a 3D distribution of beam stopping positions inside a phantom was shown with the help of radioisotope particle beams, used as primary beams. Following these results, a full-size whole-body SROP prototype was developed.

Seven randomized clinical trials have tested the use of moderate hypofractionation (2.1-3.5 Gy per fraction) compared to conventional fractionation (1.8-2.0 Gy per fraction) in radiotherapy for localized prostate cancer. The trails find that moderate hypofractionation results in acceptable PSA-control and morbidities that are comparable to conventional fractionation schedules. Extrapolation of the results from the earliest randomized trials indicated a low α/β- values for prostate cancer, but the more recent – and large – studies suggest that the value is moderately or considerably higher. Moderate hypofractionation schedules (ie. 20 x 3 Gy) are now being implemented in routine practice. They are cost-effective and convinient, but they are not consistantly concordant with fractionation sensitivity parameters extrapolated from clinical trials on moderate hypofractionation of prostate cancer.

The management of patients with recurrent head and neck cancers is complex. Concerns over toxicity with re-irradiation have limited its use in the clinical setting. Stereotactic Body Radiation Therapy (SBRT) has emerged as a highly conformal and precise type of radiotherapy and has the advantage of sparing normal tissue. Although SBRT is an attractive treatment modality, its use in the clinic is limited, given the technically challenging nature of the procedure. In this review, we attempt to provide a comprehensive overview of the role of re-irradiation in patients with recurrent head and neck cancers, with particular attention to the advent of SBRT and its use with systemic therapies such as cetuximab.

Charged particle therapy delivered using scanned pencil beams shows the potential to produce better dose conformity than conventional radiotherapy, although the dose distributions are more sensitive to anatomical changes and patient motion. Therefore, the introduction of engines to monitor the dose as it is being delivered is highly desirable, in order to enhance the development of adaptive treatment techniques in hadrontherapy. A tool for fast dose distributions analysis is presented, which integrates on GPU a Fast Forward Planning, a Fast Image Deformation algorithm, a fast computation of Gamma-Index and Dose-Volume Histogram. The tool is being interfaced with the Dose Delivery System and the Optical Tracking System of a synchrotron-based facility to investigate the feasibility to quantify, spill by spill, the effects of organ movements on dose distributions during treatment deliveries with protons and carbon-ions. The dose calculation and comparison times for a patient treated with protons on a 61.3 cm³ planning target volume, a CT matrix of 512x512x125 voxels, and a computation matrix of 170x170x125 voxels are within 1 s per spill. In terms of accuracy, the absolute dose differences compared with benchmarked Treatment Planning System results are negligible (<10^-4 Gy).

This review summarizes the hierarchy of potential dose inaccuracies in lung SABR in terms of their expected clinical impact. The two main terms are targeting accuracy and adequacy of the dose calculation algorithm. One can associate dose-errors at the 50-100% (zero order) and 10-20% (first order) levels with the former and the latter, respectively. At the first order level, strong evidence exists that using dose algorithms which do not account for 3D density scaling is associated with diminished local control. On the other hand, the second-order target dose-errors due to either static approximations to full 4D calculations, or interplay during modulated delivery, are rather unlikely to rise above 5% (conservatively, ≤ 1% tumor control probability change).

Metastases of the spinal column are common amongst cancer patients with approximately 18,000 new cases in North America each year that require urgent treatment. Historically radiation therapy doses have been limited due to the proximity of the spinal cord. However as image guidance and localization techniques have improved it has become possible to deliver higher radiation doses to the tumour whilst sparing the spinal cord. This paper presents some of the techniques undertaken at our center.

Gel dosimeters are manufactured from radiation sensitive chemicals which, upon irradiation, polymerize as a function of the absorbed radiation dose. These gel dosimeters have the capacity to record radiation dose distribution in three-dimensions (3D) compared to one and two-dimensional dosimeters. 3D dosimeters are radiologically soft-tissue equivalent and may be evaluated using magnetic resonance imaging (MRI), optical-computerized tomography (optical-CT), x-ray CT, ultrasound or vibrational spectroscopy.

The themes and trends of the radiation dosimetry research field were bibliometrically explored by way of co-occurrence term maps using the titles and abstracts text corpora from the Web of Science database for the period from 2011 to 2015. Visualisation of similarities was used by way of the VOSviewer visualization tool to generate cluster maps of radiation dosimetry knowledge domains and the associated citation impact of topics within the domains. Heat maps were then generated to assist in the understanding of active growth areas, research trends, and emerging and hot topics.

Whole brain radiation therapy has been the traditional treatment of choice for patients with multiple brain metastases. Although stereotactic radiosurgery is widely accepted for the management to up to 4 brain metastases, its use is still controversial in cases of 5 or more brain metastases. Randomized trials have suggested that stereotactic radiosurgery alone is appropriate in up to 4 metastases without concomitant whole brain radiation. Level 1 evidence also suggests that withholding whole brain radiation may also reduce the impact of radiation on neurocognitive function and also may even offer a survival advantage. A recent analysis of a large multicentre prospective database has suggested that there are no differences in outcomes such as the likelihood of new metastasis or leptomeningeal disease in cases of 2-10 brain metastases, nor in overall survival. Hence in the era of prolonged survival with stage IV cancer, stereotactic radiosurgery is a reasonable alternative to whole brain radiation in order to minimize the impact of treatment upon quality of life without sacrificing overall survival.

The outcome of radiotherapy depends on potential efficiency of accelerators and their related accessories. In charged particle therapy before the 1990s, accelerators that were primarily installed for physics research had been shared, which however had limited flexibility for clinical use. Therapy-dedicated facility was first constructed at Loma Linda University for PBT in 1990 and at NIRS for CIRT in 1993. Currently, there are more than 56 facilities for PBT, 6 for CIRT, and 6 for PBT/CIRT, and even more facilities are under construction or active planning. CIRT has beneficial property for cancer therapy because, as compared with photon therapy, it offers superior dose distributions by exhibiting a Bragg peak in the body and, as compared with PBT, it has higher radiobiological effectiveness. The number of potential candidates for charged particle therapy is estimated to range from 0.018% to 0.035% of all irradiated cancer patients. In CIRT at NIRS, Japan, more than 9,000 patients have been treated with promising results in non-SCC tumors and photon-resistant types of tumors at various sites. It is of note that in CIRT a significant reduction in overall treatment time and fractions has been successfully achieved.

Transmission type detectors can provide a measure of the energy fluence and if they are real-time systems that do not significantly attenuate the radiation beam have a distinct advantage over the current method as Quality Assurance (QA) could in principle be done during the actual patient treatment. The use of diode arrays in QA holds much promise due to real-time operation and feedback when compared to other methods e.g. films which are not real-time. The goal of this work is to describe the characterization of the radiation response of a silicon diode array called the Magic Plate (MP) when operated in transmission mode (MPTM). The response linearity of MPTM was excellent (R2=1). When the MP was placed in linac block tray position; the change in PDD at phantom surface (SSD 100 cm) for a 10 × 10 cm² was -0.037 %, -0.178 % and -0.949 % for 6 MV, 10 MV and 18 MV beams. Therefore, MP does not provide a significant increase in skin dose to the patient and the percentage depth doses showed an excellent agreement with and without MPTM for 6 MV, 10 MV and 18 MV beams.

Two Dimensional (2D) silicon diode arrays are often implemented in radiation therapy quality assurance (QA) applications due to their advantages such as: real-time operation (compared to the films), large dynamic range and small size (compared to ionization chambers). The Centre for Medical Radiation Physics, University of Wollongong has developed a multifunctional 2D silicon diode array known as the Magic Plate (MP) for real-time applications and is suitable as a transmission detector for photon flunce mapping (MPTM) or for in phantom dose mapping (MPDM). The paper focusses on the characterisation of the MPDM in terms of output factor and square field beam profiling in 6 MV, 10 MV and 18 MV clinical photon fields. We have found excellent agreement with three different ion chambers for all measured parameters with output factors agreeing within 1.2% and field profiles agreeing within 3% and/or 3mm. This work has important implications for the development of the MP when operating in transmission mapping mode.

The Australian MRI-Linac consists of a fixed horizontal photon beam combined with a MRI. Commissioning required PDD and profiles measured in a horizontal set-up using a combination of water tank measurements and gafchromic film. To validate the methodology, measurements were performed comparing PDD and profiles measured with the gantry angle set to 0 and 90° on a conventional linac. Results showed agreement to within 2.0% for PDD measured using both film and the water tank at gantry 90° relative to PDD acquired using gantry 0°. Profiles acquired using a water tank at both gantry 0 and 90° showed agreement in FWHM to within 1 mm. The agreement for both PDD and profiles measured at gantry 90° relative to gantry 0° curves indicates that the methodology described can be used to acquire the necessary beam data for horizontal beam lines and in particular, commissioning the Australian MRI-linac.

The Calypso tracking system (Varian, Palo Alto, CA, USA) is used to track the prostate isocenter on patients undergoing prostate radiotherapy after implantation of electromagnetic transponders. Aim of this study was to assign 226 recorded prostate tracks to different patterns of prostate intrafraction motion (i.e. stable target (ST), continuous target drift (CTD) and irregular wave motion (IWM)) and excursion (i.e. transient excursion (TE), persistent excursion (PE) and high-frequency excursion (HFE)). Relative frequencies of STs, CTDs and IWMs were 51.8%, 44.6% and 3.6%, respectively. TEs, PEs and HFEs were revealed in 9.4%, 5.4% and 14.3% cases, respectively, with maximum values of 8.0 mm, 8.7 mm and 15.5 mm, respectively. The equation D(t) = 8.0*10^-3 mm/s * t + 0.93 mm was established to calculate the average prostate drift D with time t. Intrafraction prostate motion and excursions can be significant and should be in particular taken into account with treatment deliveries that require a prolonged treatment time, as for instance stereotactic body radiotherapy (SBRT) or hadrontherapy.

This paper presents a new version of the 3D mesa "bridge" microdosimeter comprised of an array of 4248 silicon cells fabricated on 10 µm thick silicon-on-insulator substrate. This microdosimeter has been designed to overcome limitations existing in previous generation silicon microdosimeters and it provides well-defined sensitive volumes and high spatial resolution. The charge collection characteristics of the new 3D mesa microdosimeter were investigated using the ANSTO heavy ion microprobe, utilizing 5.5 MeV He²⁺ ions. Measurement of microdosimetric quantities allowed for the determination of the Relative Biological Effectiveness of 290 MeV/u and 350 MeV/u ¹²C heavy ion therapy beams at the Heavy Ion Medical Accelerator in Chiba (HIMAC), Japan. The microdosimetric RBE obtained showed good agreement with the tissue-equivalent proportional counter. Utilizing the high spatial resolution of the SOI microdosimeter, the LET spectra for 70 MeV ¹²C⁺⁶ ions, like those present at the distal edge of 290 and 350 MeV/u beams, were obtained as the ions passed through thin layers of polyethylene film. This microdosimeter can provide useful information about the lineal energy transfer (LET) spectra downstream of the protective layers used for shielding of electronic devices for single event upset prediction.

In the recent years, irradiation with swift light ions - from protons up to oxygen -has become an established method in tumour radiotherapy.A prerequisite for successful treatment is the sufficient knowledge of physical and radiobiological processes down to the microscopic or even nanoscopic scale. This report summarizes recent developments. In particular the application of ions other than protons and carbon will be addressed, as well as modelling approaches on the nanoscale.