Sensitivity study of proton radiography and comparison with kV and MV x-ray imaging using GEANT4 Monte Carlo simulations

The imaging sensitivity of proton radiography has been studied and compared with kV and MV x-ray imaging using Monte Carlo simulations. A phantom was specifically modeled using 21 different material inserts with densities ranging from 0.001 to 1.92 g cm(-3). These simulations were run using the MGH double scattered proton beam, scanned pencil proton beams from 200 to 490 MeV, as well as pure 50 keV, 100 keV, 1MeV and 2MeV gamma x-ray beams. In order to compare the physics implied in both proton and photon radiography without being biased by the current state of the art in detector technology, the detectors were considered perfect. Along with spatial resolution, the contrast-to-noise ratio was evaluated and compared for each material. These analyses were performed using radiographic images that took into account the following: only primary protons, both primary and secondary protons, and both contributions while performing angular and energetic cuts. Additionally, tissue-to-tissue contrasts in an actual lung cancer patient case were studied for simulated proton radiographs and compared against the original kV x-ray image which corresponds to the current patient set-up image in the proton clinic. This study highlights the poorer spatial resolution of protons versus x-rays for radiographic imaging purposes, and the excellent density resolution of proton radiography. Contrasts around the tumor are higher using protons in a lung cancer patient case. The high-density resolution of proton radiography is of great importance for specific tumor diagnostics, such as in lung cancer, where x-ray radiography operates poorly. Furthermore, the use of daily proton radiography prior to proton therapy would ameliorate patient set-up while reducing the absorbed dose delivered through imaging.