# Sairos Safai's research while affiliated with Paul Scherrer Institut and other places

## Publications (103)

Article
Full-text available
The objective of this study was to improve the precision of linear energy transfer (LET) measurements using $$\text {Al}_2\text {O}_3\text {:C}$$ Al 2 O 3 :C optically stimulated luminescence detectors (OSLDs) in proton beams, and, with that, improve OSL dosimetry by correcting the readout for the LET-dependent ionization quenching. The OSLDs were...
Article
Purpose/objectives: To develop a normal tissue complication probability (NTCP) model including clinical and dosimetric parameters for high-grade temporal lobe radionecroses (TRN) after pencil beam scanning (PBS) proton therapy (PT). Materials/methods: Data of 299 patients with skull base and Head and Neck tumors treated with PBS PT with a total...
Article
The increased radioresistence of healthy tissues when irradiated at very high dose rates (known as the Flash effect) is a radiobiological mechanism that is currently investigated in order to increase the therapeutic ratio of radiotherapy treatments. To maximize the benefits of the clinical application of Flash, a patient‐specific balance between di...
Article
Purpose: Energy changes in Pencil Beam Scanning (PBS) proton therapy can be a limiting factor in delivery time, hence limiting patient throughput and the effectiveness of motion mitigation techniques requiring fast irradiation. In this study, we investigate the feasibility of performing fast and continuous energy modulation within the momentum acc...
Article
Purpose: In ultra-high dose rate radiotherapy, the FLASH effect can lead to substantially reduced healthy tissue damage without affecting tumour control. While many studies show promising results, the underlying biological mechanisms and the relevant delivery parameters are still largely unknown. It is unclear, particularly for scanned proton ther...
Article
Purpose/Objective(s) Calculation of tumor control probability (TCP) and normal tissue complication probability (NTCP) is becoming increasingly relevant for optimizing treatment strategies, for example the selection of patients for proton therapy. While radiobiological models are typically built and evaluated on the planned treatment dose, no consen...
Article
Purpose/Objective(s) Radiation induced optic neuropathy (RION) is a rare but severe complication of radiotherapy that can lead to visual impairment or blindness. In this retrospective study, we report on RION incidence in a multi-institutional proton therapy cohort (median follow-up - 5.6 years), while determining risk factors that model the probab...
Article
Full-text available
Radiation-induced optic neuropathy (RION) is a rare side effect following radiation therapy involving the optic structures whose onset is, due to the low amount of available data, challenging to predict. We have analyzed a multi-institutional cohort including 289 skull-base cancer patients treated with proton therapy who all received >45 GyRBE to t...
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Background Hypoxia is known to be prevalent in solid tumors such as non-small cell lung cancer (NSCLC) and reportedly correlates with poor prognostic clinical outcome. PET imaging can provide in-vivo hypoxia measurements to support targeted radiotherapy treatment planning. We explore the potential of proton therapy in performing patient-specific do...
Article
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The Polaris product line from Northern Digital Inc. is well known for accurate optical tracking measurements in research and medical environments. The Spectra position sensor, to date often found in image guided radiotherapy suites, has however reached its end-of-life, being replaced by the new Vega model. The performance in static and dynamic meas...
Article
Purpose: The purpose of this work was to provide a flexible platform for FLASH research with protons by adapting a former clinical pencil beam scanning gantry to irradiations with ultra-high dose rates. Methods: PSI Gantry 1 treated patients until December 2018. We optimized the beamline parameters to transport the 250 MeV beam extracted from th...
Article
Recently, proton therapy treatments delivered with ultra-high dose rates have been of high scientific interest, and the Faraday cup is a promising dosimetry tool for such experiments. Different institutes use different Faraday cup designs, and either a high voltage guard ring, or the combination of an electric and a magnetic field is employed to mi...
Article
The response of Al2O3:C optically stimulated luminescence detectors (OSLDs) was investigated in a 250 MeV pencil proton beam. The OSLD response was mapped for a wide range of average dose rates up to 9000 Gy/s, corresponding to a ~150 kGy/s instantaneous dose rate in each pulse. Two setups for ultra-high dose rates (FLASH) experiments are presented...
Article
Purpose Radiation-induced optic neuropathy (RION) is a rare, yet severe complication following radiation therapy for brain, head and neck or skull-base tumors. While several risk factors such as age, metabolic syndrome and delivered dose have been identified, we aimed at expanding the understanding of the mechanisms of interplay regarding dosimetry...
Preprint
Full-text available
Purpose: The purpose of this work was to provide a flexible platform for FLASH research with protons by adapting a former clinical pencil beam scanning gantry to irradiations with ultrahigh dose rates. Methods: PSI Gantry 1 treated patients until December 2018. We optimized the beamline parameters to transport the 250 MeV beam extracted from the PS...
Article
A deeper understanding of biological mechanisms to promote more efficient treatment strategies in proton therapy demands advances in preclinical radiation research. However this is often limited by insufficient availability of adequate infrastructures for precision image guided small animal proton irradiation. The project SIRMIO aims at filling thi...
Article
Full-text available
The Pencil Beam Scanning (PBS) technique in proton therapy uses fast magnets to scan the tumor volume rapidly. Changing the proton energy allows changing to layers in the third dimension, hence scanning the same volume several times. The PBS approach permits adapting the speed and/or current to modulate the delivered dose. We built a simple prototy...
Article
Full-text available
Tumour tracking is an advanced radiotherapy technique for precise treatment of tumours subject to organ motion. In this work, we addressed crucial aspects of dose delivery for its realisation in pencil beam scanning proton therapy, exploring the momentum acceptance and global achromaticity of a Gantry beamline to perform continuous energy regulatio...
Article
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We present the commissioning and quality assurance of our clinical protocol for respiratory gating in pencil beam scanning proton therapy for cancer patients with moving targets. In a novel approach, optical tracking has been integrated in the therapy workflow and used to monitor respiratory motion from multiple surrogates, applied on the patients’...
Article
In this study, a functioning and ventilated anthropomorphic phantom was further enhanced for the purpose of CT and MR imaging of the lung and liver. A deformable lung, including respiratory tract was 3D printed. Within the lung's inner structures is a solid region shaped from a patient's lung tumour and six nitro-glycerine capsules as reference lan...
Article
Objectives Monte Carlo (MC) simulations substantially improve the accuracy of predicted doses. This study aims to determine and quantify the uncertainties of setting up such a MC system. Methods Doses simulated with two Geant4 based MC calculation codes, but independently tuned to the same beam data, have been compared. Different methods of MC mod...
Article
Full-text available
Human cancers exhibit phenotypic diversity that medical imaging can precisely and non-invasively detect. Multiple factors underlying innovations and progresses in the medical imaging field exert diagnostic and therapeutic impacts. The emerging field of radiomics has shown unprecedented ability to use imaging information in guiding clinical decision...
Article
Full-text available
Proton therapy (PT) is a treatment with high dose conformality that delivers a highly-focused radiation dose to solid tumors. Targeted radionuclide therapy (TRT), on the other hand, is a systemic radiation therapy, which makes use of intravenously-applied radioconjugates. In this project, it was aimed to perform an initial dose-searching study for...
Article
Background: This study aimed at evaluating spatially varying instantaneous dose rates for different intensity-modulated proton therapy (IMPT) planning strategies and delivery scenarios, and comparing these with FLASH dose rates (>40 Gy/s). Material and methods: In order to quantify dose rates in three-dimensions, we proposed the ‘dose-averaged dose...
Article
Purpose: Task Group (TG) 224 was established by the American Association of Physicists in Medicine's Science Council under the Radiation Therapy Committee and Work Group on Particle Beams. The group was charged with developing comprehensive quality assurance (QA) guidelines and recommendations for the three commonly employed proton therapy techniq...
Article
The literature is controversial about the scan direction dependency of interplay effects in pencil beam scanning (PBS) treatment of moving targets. A directional effect is supported by many simulation studies, whereas the experimental data are mostly limited to simple geometries, not reflecting realistically clinical treatment plans. We have compar...
Article
For pencil beam scanned (PBS) proton therapy, analytical dose calculation engines are still typically used for the optimisation process, and often for the final evaluation of the plan. Recently however, the suitability of analytical calculations for planning PBS treatments has been questioned. Conceptually, the two main approaches for these analyti...
Article
Patient specific quality assurance is crucial to guarantee safety in proton pencil beam scanning. In current clinical practice, this requires extensive, time consuming measurements. Additionally, these measurements do not consider the influence of density heterogeneities in the patient and are insensitive to delivery errors. In this work, we invest...
Article
In proton therapy, the lateral fall-off is often used to spare critical organs. It is therefore crucial to improve the penumbra for proton pencil beam scanning. However, previous work has shown that collimation may not be necessary for depths of >15 cm in water. As such, in this work we investigate the effectiveness of a thin multi leaf collimator...
Article
We read with interest the study by (Bäumer et al., 2018), in particular that their conclusions are in contrast to those of our earlier paper (Winterhalter et al., 2018), namely that positioning the collimating aperture downstream of the range shifter leads to a superior penumbra. In contrast, we found sharper penumbras for the PSI scanning Gantry w...
Article
For radiotherapy, it is crucial to guarantee that the delivered dose matches the planned dose. Therefore, patient specific quality assurance (QA) of absolute dose distributions is necessary. Here, we investigate the potential of replacing patient specific QA for pencil beam scanned (PBS) proton therapy with Monte Carlo simulations. First, the set-u...
Article
This paper focuses on some dosimetry aspects of proton therapy and pencil beam scanning based on the experience accumulated at Paul Scherrer Institute(PSI). The basic formalism for absolute dosimetry in proton therapy is outlined and the two main techniques and equipment to perform the primary beam monitor chamber calibration are presented. Depth-d...
Article
The aim of this study was to verify the temporal accuracy of the estimated dose distribution by a 4D dose calculation (4DDC) in comparison to measurements. A single-field plan (0.6Gy), optimised for a liver patient case (CTV volume: 403cc), was delivered to a homogeneous PMMA phantom and measured by a high resolution scintillating-CCD system at two...
Article
The lateral fall-off is crucial for sparing organs at risk in proton therapy. It is therefore of high importance to minimize the penumbra for PBS. Three optimisation approaches are investigated: Edge-collimated uniformly weighted spots (collimation), pencil beam optimisation of uncollimated pencil beams (edge-enhancement) and the optimisation of ed...
Article
Two independently configured Monte Carlo simulation engines for pencil beam scanned proton therapy have been compared in both geometric setups and real patient data. Both are based on Geant4.10.02.p01 and have been tuned with the same commissioning data. One however uses Gate7.2, the other TOPAS3.0.p1. In addition, different physics lists were chos...
Article
This paper describes a novel approach to the reference dosimetry of proton pencil beams based on dose-area product (DAP<sub>w</sub>). It depicts the calibration of a large-diameter plane-parallel ionization chamber in terms of dose-area product in a <sup>60</sup>Co beam, the Monte Carlo calculation of beam quality correction factors-in terms of dos...
Article
Full-text available
Background Motion monitoring is essential when treating non-static tumours with pencil beam scanned protons. 4D medical imaging typically relies on the detected body surface displacement, considered as a surrogate of the patient's anatomical changes, a concept similarly applied by most motion mitigation techniques. In this study, we investigate ben...
Article
Motion-induced range changes and incorrectly placed dose spots strongly affect the quality of pencil-beam-scanned (PBS) proton therapy, especially in thoracic tumour sites, where density changes are large. Thus motion-mitigation techniques are necessary, which must be validated in a realistic patient-like geometry. We report on the development and...
Article
Proton therapy, especially in the form of pencil beam scanning (PBS), allows for the delivery of highly conformal dose distributions for complex tumor geometries. However, due to scattering of protons inside the patient, lateral dose gradients cannot be arbitrarily steep, which is of importance in cases with organs at risk (OARs) in close proximity...
Article
The comment by Palmans and Vatnitsky (2016 Phys. Med. Biol. 61 6585-93) shows that the discrepancy of about 3% between Faraday cup dosimetry and reference dosimetry using a cylindrical ionization chamber found in Gomà (2014 Phys. Med. Biol. 59 4961-71) seems to be due to an overestimation of the beam quality correction factors tabulated in IAEA TRS...
Article
Purpose:We aim to compare the performance of discrete spot- or continuous line scanning combined with rescanning in mitigating residual organ motion during gated proton therapy treatments. Methods:The Quasar respiratory phantom was used to move a 2D scintillation detector on a linear trajectory with sinusoidal motion pattern (sin4), 20 mm peak-to-p...
Article
In this work, the performance of a microDiamond detector in a scanned proton beam is studied and its potential role in the dosimetric characterization of proton pencil beams is assessed. The linearity of the detector response with the absorbed dose and the dependence on the dose-rate were tested. The depth-dose curve and the lateral dose profiles o...
Article
The number of proton therapy centers has increased dramatically over the past decade. Currently, there is no comprehensive set of guidelines that addresses quality assurance (QA) procedures for the different technologies used for proton therapy. The AAPM has charged task group 224 (TG-224) to provide recommendations for QA required for accurate and...
Article
This paper presents a method to experimentally validate the beam quality correction factors (k Q ) tabulated in IAEA TRS-398 for proton beams and to determine the k Q of non-tabulated ionization chambers (based on the already tabulated values). The method is based exclusively on ionometry and it consists in comparing the reading of two ionization c...
Article
Pencil beam scanning proton therapy allows the delivery of highly conformal dose distributions by delivering several thousand pencil beams. These beams have to be individually optimised and accurately delivered requiring a significant quality assurance workload. In this work we describe a toolkit for independent dose calculations developed at Paul...
Article
The first goal of this paper is to clarify the reference conditions for the reference dosimetry of clinical proton beams. A clear distinction is made between proton beam delivery systems which should be calibrated with a spread-out Bragg peak field and those that should be calibrated with a (pseudo-)monoenergetic proton beam. For the latter, this p...
Article
Purpose: To estimate the correlation between different dosimetric indices and the clinical outcome, which was recorded at different time points after the treatment, regarding the structure of salivary glands in head & neck cancer radiotherapy.
Article
Purpose: A prototype breathing phantom (named LuCa) has been developed which simulates the anatomy and motion of a patient thorax.In this work, we describe the results of the first commissioning tests with LuCa. Methods: The phantom provides a close representation of the human thorax. The lungs,contained within a tissue-equivalent ribcage and skin,...