Determination of elemental tissue composition following proton treatment using positron emission tomography

Jongmin Cho, Geoffrey Ibbott, Michael Gillin, Carlos Gonzalez-Lepera, Chul Hee Min, Xuping Zhu, Georges El Fakhri, Harald Paganetti, Osama Mawlawi

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Positron emission tomography (PET) has been suggested as an imaging technique for in vivo proton dose and range verification after proton induced-tissue activation. During proton treatment, irradiated tissue is activated and decays while emitting positrons. In this paper, we assessed the feasibility of using PET imaging after proton treatment to determine tissue elemental composition by evaluating the resultant composite decay curve of activated tissue. A phantom consisting of sections composed of different combinations of 1H, 12C, 14N, and 16O was irradiated using a pristine Bragg peak and a 6 cm spread-out Bragg-peak (SOBP) proton beam. The beam ranges defined at 90% distal dose were 10 cm; the delivered dose was 1.6 Gy for the near monoenergetic beam and 2 Gy for the SOBP beam. After irradiation, activated phantom decay was measured using an in-room PET scanner for 30 min in list mode. Decay curves from the activated 12C and 16O sections were first decomposed into multiple simple exponential decay curves, each curve corresponding to a constituent radioisotope, using a least-squares method. The relative radioisotope fractions from each section were determined. These fractions were used to guide the decay curve decomposition from the section consisting mainly of 12C + 16O and calculate the relative elemental composition of 12C and 16O. A Monte Carlo simulation was also used to determine the elemental composition of the 12C + 16O section. The calculated compositions of the 12C + 16O section using both approaches (PET and Monte Carlo) were compared with the true known phantom composition. Finally, two patients were imaged using an in-room PET scanner after proton therapy of the head. Their PET data and the technique described above were used to construct elemental composition (12C and 16O) maps that corresponded to the proton-activated regions. We compared the 12C and 16O compositions of seven ROIs that corresponded to the vitreous humor, adipose/face mask, adipose tissue, and brain tissue with ICRU 46 elemental composition data. The 12C and 16O compositions of the 12C + 16O phantom section were estimated to within a maximum difference of 3.6% for the near monoenergetic and SOBP beams over an 8 cm depth range. On the other hand, the Monte Carlo simulation estimated the corresponding 12C and 16O compositions in the 12C + 16O section to within a maximum difference of 3.4%. For the patients, the 12C and 16O compositions in the seven ROIs agreed with the ICRU elemental composition data, with a mean (maximum) difference of 9.4% (15.2%). The 12C and 16O compositions of the phantom and patients were estimated with relatively small differences. PET imaging may be useful for determining the tissue elemental composition and thereby improving proton treatment planning and verification.

Original languageEnglish
Pages (from-to)3815-3835
Number of pages21
JournalPhysics in medicine and biology
Issue number11
Publication statusPublished - 2013 Jun 7


All Science Journal Classification (ASJC) codes

  • Radiological and Ultrasound Technology
  • Radiology Nuclear Medicine and imaging

Cite this

Cho, J., Ibbott, G., Gillin, M., Gonzalez-Lepera, C., Min, C. H., Zhu, X., El Fakhri, G., Paganetti, H., & Mawlawi, O. (2013). Determination of elemental tissue composition following proton treatment using positron emission tomography. Physics in medicine and biology, 58(11), 3815-3835.