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van Marlen P, van de Water S, Slotman BJ, Dahele M, Verbakel W. Technical note: Dosimetry and FLASH potential of UHDR proton PBS for small lung tumors: Bragg-peak-based delivery versus transmission beam and IMPT. Med Phys 2024; 51:7580-7588. [PMID: 38795376 DOI: 10.1002/mp.17185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 04/19/2024] [Accepted: 05/04/2024] [Indexed: 05/27/2024] Open
Abstract
BACKGROUND High-energy transmission beams (TBs) are currently the main delivery method for proton pencil beam scanning ultrahigh dose-rate (UHDR) FLASH radiotherapy. TBs place the Bragg-peaks behind the target, outside the patient, making delivery practical and achievement of high dose-rates more likely. However, they lead to higher integral dose compared to conventional intensity-modulated proton therapy (IMPT), in which Bragg-peaks are placed within the tumor. It is hypothesized that, when energy changes are not required and high beam currents are possible, Bragg-peak-based beams can not only achieve more conformal dose distributions than TBs, but also have more FLASH-potential. PURPOSE This works aims to verify this hypothesis by taking three different Bragg-peak-based delivery techniques and comparing them with TB and IMPT-plans in terms of dosimetry and FLASH-potential for single-fraction lung stereotactic body radiotherapy (SBRT). METHODS For a peripherally located lung target of various sizes, five different proton plans were made using "matRad" and inhouse-developed algorithms for spot/energy-layer/beam reduction and minimum monitor unit maximization: (1) IMPT-plan, reference for dosimetry, (2) TB-plan, reference for FLASH-amount, (3) pristine Bragg-peak plan (non-depth-modulated Bragg-peaks), (4) Bragg-peak plan using generic ridge filter, and (5) Bragg-peak plan using 3D range-modulated ridge filter. RESULTS Bragg-peak-based plans are able to achieve sufficient plan quality and high dose-rates. IMPT-plans resulted in lowest OAR-dose and integral dose (also after a FLASH sparing-effect of 30%) compared to both TB-plans and Bragg-peak-based plans. Bragg-peak-based plans vary only slightly between themselves and generally achieve lower integral dose than TB-plans. However, TB-plans nearly always resulted in lower mean lung dose than Bragg-peak-based plans and due to a higher amount of FLASH-dose for TB-plans, this difference increased after including a FLASH sparing-effect. CONCLUSION This work indicates that there is no benefit in using Bragg-peak-based beams instead of TBs for peripherally located, UHDR stereotactic lung radiotherapy, if lung dose is the priority.
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Affiliation(s)
- Patricia van Marlen
- Department of Radiation Oncology, Amsterdam UMC, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Steven van de Water
- Department of Radiation Oncology, Amsterdam UMC, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Ben J Slotman
- Department of Radiation Oncology, Amsterdam UMC, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Max Dahele
- Department of Radiation Oncology, Amsterdam UMC, Cancer Center Amsterdam, Amsterdam, the Netherlands
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Lin B, Li Y, Liu B, Fu S, Lin Y, Gao H. Cardinality-constrained plan-quality and delivery-time optimization method for proton therapy. Med Phys 2024; 51:4567-4580. [PMID: 38861654 DOI: 10.1002/mp.17249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 05/02/2024] [Accepted: 05/29/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND While minimizing plan delivery time is beneficial for proton therapy in terms of motion management, patient comfort, and treatment throughput, it often poses a tradeoff with optimizing plan quality. A key component of plan delivery time is the energy switching time, which is approximately proportional to the number of energy layers, that is, the cardinality. PURPOSE This work aims to develop a novel optimization method that can efficiently compute the pareto surface between plan quality and energy layer cardinality, for the planner to navigate through this quality-and-efficiency tradeoff and select the appropriate plan of a balanced tradeoff. METHODS A new IMPT method CARD is proposed that (1) explicitly incorporates the minimization of energy layer cardinality as an optimization objective, and (2) automatically generates a set of plans sequentially with a descending order in number of energy layers. The energy layer cardinality is penalized through the l1,0-norm regularization with an upper bound, and the upper bound is monotonically decreased to compute a series of treatment plans with gradually decreased energy layer cardinality on the quality-and-efficiency pareto surface. For any given treatment plan, the plan optimality is enforced using dose-volume planning objectives and the plan deliverability is imposed through minimum-monitor-unit (MMU) constraints, with optimization solution algorithm based on iterative convex relaxation. RESULTS The new method CARD was validated in comparison with the benchmark plan of all energy layers (P0), and a state-of-the-art method called MMSEL, using prostate, head-and-neck (HN), lung, pancreas, liver and brain cases. While labor-intensive and time-consuming manual parameter tuning was needed for MMSEL to generate plans of predefined energy layer cardinality, CARD automatically and efficiently computed all plans with sequentially decreasing predefined energy layer cardinality all at once. With the acceptable plan quality (i.e., no more than 110% of total optimization objective value from P0), CARD achieved the reduction of number of energy layers to 52% (from 77 to 40), 48% (from 135 to 65), 59% (from 85 to 50), 67% (from 52 to 35), 80% (from 50 to 40), and 30% (from 66 to 20), for prostate, HN, lung, pancreas, liver, and brain cases, respectively, compared to P0, with overall better plan quality than MMSEL. Moreover, due to the nonconvexity of the MMU constraint, CARD provided the similar or even smaller optimization objective than P0, at the same time with fewer number of energy layers, that is, 55 versus 77, 85 versus 135, 45 versus 52, and 25 versus 66 for prostate, HN, pancreas, and brain cases, respectively. CONCLUSIONS We have developed a novel optimization algorithm CARD that can efficiently and automatically compute a series of treatment plans of any given energy layer sequentially, which allows the planner to navigate through the plan-quality and energy-layer-cardinality tradeoff and select the appropriate plan of a balanced tradeoff.
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Affiliation(s)
- Bowen Lin
- Department of Intervention Medicine, The Second Hospital of Shandong University, Jinan, Shandong, China
| | - Yuliang Li
- Department of Intervention Medicine, The Second Hospital of Shandong University, Jinan, Shandong, China
| | - Bin Liu
- Department of Intervention Medicine, The Second Hospital of Shandong University, Jinan, Shandong, China
| | - Shujun Fu
- Department of Intervention Medicine, The Second Hospital of Shandong University, Jinan, Shandong, China
- School of Mathematics, Shandong University, Jinan, Shandong, China
| | - Yuting Lin
- Department of Radiation Oncology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Hao Gao
- Department of Radiation Oncology, University of Kansas Medical Center, Kansas City, Kansas, USA
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Schilling A, Aehle M, Alme J, Barnaföldi GG, Bodova T, Borshchov V, van den Brink A, Eikeland V, Feofilov G, Garth C, Gauger NR, Grøttvik O, Helstrup H, Igolkin S, Keidel R, Kobdaj C, Kortus T, Leonhardt V, Mehendale S, Ningappa Mulawade R, Harald Odland O, O'Neill G, Papp G, Peitzmann T, Pettersen HES, Piersimoni P, Protsenko M, Rauch M, Ur Rehman A, Richter M, Röhrich D, Santana J, Seco J, Songmoolnak A, Sudár Á, Tambave G, Tymchuk I, Ullaland K, Varga-Kofarago M, Volz L, Wagner B, Wendzel S, Wiebel A, Xiao R, Yang S, Zillien S. Uncertainty-aware spot rejection rate as quality metric for proton therapy using a digital tracking calorimeter. Phys Med Biol 2023; 68:194001. [PMID: 37652034 DOI: 10.1088/1361-6560/acf5c2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 08/31/2023] [Indexed: 09/02/2023]
Abstract
Objective.Proton therapy is highly sensitive to range uncertainties due to the nature of the dose deposition of charged particles. To ensure treatment quality, range verification methods can be used to verify that the individual spots in a pencil beam scanning treatment fraction match the treatment plan. This study introduces a novel metric for proton therapy quality control based on uncertainties in range verification of individual spots.Approach.We employ uncertainty-aware deep neural networks to predict the Bragg peak depth in an anthropomorphic phantom based on secondary charged particle detection in a silicon pixel telescope designed for proton computed tomography. The subsequently predicted Bragg peak positions, along with their uncertainties, are compared to the treatment plan, rejecting spots which are predicted to be outside the 95% confidence interval. The such-produced spot rejection rate presents a metric for the quality of the treatment fraction.Main results.The introduced spot rejection rate metric is shown to be well-defined for range predictors with well-calibrated uncertainties. Using this method, treatment errors in the form of lateral shifts can be detected down to 1 mm after around 1400 treated spots with spot intensities of 1 × 107protons. The range verification model used in this metric predicts the Bragg peak depth to a mean absolute error of 1.107 ± 0.015 mm.Significance.Uncertainty-aware machine learning has potential applications in proton therapy quality control. This work presents the foundation for future developments in this area.
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Affiliation(s)
- Alexander Schilling
- Center for Technology and Transfer (ZTT), University of Applied Sciences Worms, D-67549 Worms, Germany
- Chair for Scientific Computing, University of Kaiserslautern-Landau, D-67663 Kaiserslautern, Germany
| | - Max Aehle
- Chair for Scientific Computing, University of Kaiserslautern-Landau, D-67663 Kaiserslautern, Germany
| | - Johan Alme
- Department of Physics and Technology, University of Bergen, NO-5007 Bergen, Norway
| | | | - Tea Bodova
- Department of Physics and Technology, University of Bergen, NO-5007 Bergen, Norway
| | | | | | - Viljar Eikeland
- Department of Physics and Technology, University of Bergen, NO-5007 Bergen, Norway
| | | | - Christoph Garth
- Scientific Visualization Lab, University of Kaiserslautern-Landau, D-67663 Kaiserslautern, Germany
| | - Nicolas R Gauger
- Chair for Scientific Computing, University of Kaiserslautern-Landau, D-67663 Kaiserslautern, Germany
| | - Ola Grøttvik
- Department of Physics and Technology, University of Bergen, NO-5007 Bergen, Norway
| | - Håvard Helstrup
- Department of Computer Science, Electrical Engineering and Mathematical Sciences, Western Norway University of Applied Sciences, NO-5020 Bergen, Norway
| | | | - Ralf Keidel
- Center for Technology and Transfer (ZTT), University of Applied Sciences Worms, D-67549 Worms, Germany
- Chair for Scientific Computing, University of Kaiserslautern-Landau, D-67663 Kaiserslautern, Germany
| | - Chinorat Kobdaj
- Institute of Science, Suranaree University of Technology, Nakhon Ratchasima, Thailand
| | - Tobias Kortus
- Center for Technology and Transfer (ZTT), University of Applied Sciences Worms, D-67549 Worms, Germany
| | - Viktor Leonhardt
- Scientific Visualization Lab, University of Kaiserslautern-Landau, D-67663 Kaiserslautern, Germany
| | - Shruti Mehendale
- Department of Physics and Technology, University of Bergen, NO-5007 Bergen, Norway
| | - Raju Ningappa Mulawade
- Center for Technology and Transfer (ZTT), University of Applied Sciences Worms, D-67549 Worms, Germany
| | - Odd Harald Odland
- Department of Physics and Technology, University of Bergen, NO-5007 Bergen, Norway
- Department of Oncology and Medical Physics, Haukeland University Hospital, NO-5021 Bergen, Norway
| | - George O'Neill
- Department of Physics and Technology, University of Bergen, NO-5007 Bergen, Norway
| | - Gábor Papp
- Institute for Physics, Eötvös Loránd University, 1/A Pázmány P. Sétány, H-1117 Budapest, Hungary
| | - Thomas Peitzmann
- Institute for Subatomic Physics, Utrecht University/Nikhef, Utrecht, Netherlands
| | | | - Pierluigi Piersimoni
- Department of Physics and Technology, University of Bergen, NO-5007 Bergen, Norway
- UniCamillus-Saint Camillus International University of Health Sciences, Rome, Italy
| | - Maksym Protsenko
- Research and Production Enterprise 'LTU' (RPELTU), Kharkiv, Ukraine
| | - Max Rauch
- Department of Physics and Technology, University of Bergen, NO-5007 Bergen, Norway
| | - Attiq Ur Rehman
- Department of Physics and Technology, University of Bergen, NO-5007 Bergen, Norway
| | - Matthias Richter
- Department of Physics and Technology, University of Bergen, NO-5007 Bergen, Norway
| | - Dieter Röhrich
- Department of Physics and Technology, University of Bergen, NO-5007 Bergen, Norway
| | - Joshua Santana
- Center for Technology and Transfer (ZTT), University of Applied Sciences Worms, D-67549 Worms, Germany
| | - Joao Seco
- Department of Biomedical Physics in Radiation Oncology, DKFZ-German Cancer Research Center, Heidelberg, Germany
- Department of Physics and Astronomy, Heidelberg University, Heidelberg, Germany
| | - Arnon Songmoolnak
- Department of Physics and Technology, University of Bergen, NO-5007 Bergen, Norway
- Institute of Science, Suranaree University of Technology, Nakhon Ratchasima, Thailand
| | - Ákos Sudár
- Wigner Research Centre for Physics, Budapest, Hungary
- Budapest University of Technology and Economics, Budapest, Hungary
| | - Ganesh Tambave
- Center for Medical and Radiation Physics (CMRP), National Institute of Science Education and Research (NISER), Bhubaneswar, India
| | - Ihor Tymchuk
- Research and Production Enterprise 'LTU' (RPELTU), Kharkiv, Ukraine
| | - Kjetil Ullaland
- Department of Physics and Technology, University of Bergen, NO-5007 Bergen, Norway
| | | | - Lennart Volz
- Biophysics, GSI Helmholtz Center for Heavy Ion Research GmbH, Darmstadt, Germany
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Boris Wagner
- Department of Physics and Technology, University of Bergen, NO-5007 Bergen, Norway
| | - Steffen Wendzel
- Center for Technology and Transfer (ZTT), University of Applied Sciences Worms, D-67549 Worms, Germany
| | - Alexander Wiebel
- Center for Technology and Transfer (ZTT), University of Applied Sciences Worms, D-67549 Worms, Germany
| | - RenZheng Xiao
- Department of Physics and Technology, University of Bergen, NO-5007 Bergen, Norway
- College of Mechanical & Power Engineering, China Three Gorges University, Yichang, People's Republic of China
| | - Shiming Yang
- Department of Physics and Technology, University of Bergen, NO-5007 Bergen, Norway
| | - Sebastian Zillien
- Center for Technology and Transfer (ZTT), University of Applied Sciences Worms, D-67549 Worms, Germany
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Wang W, Liu X, Yang Z, Liao Y, Li P, Zhao R, Qin B. Improving delivery efficiency using spots and energy layers reduction algorithms based on a large momentum acceptance beamline. Med Phys 2023; 50:5189-5200. [PMID: 37099491 DOI: 10.1002/mp.16420] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 04/06/2023] [Accepted: 04/06/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND Intensity-modulated proton therapy (IMPT) is a well-known delivery method of proton therapy. Besides higher plan quality, reducing the delivery time is also essential to IMPT plans. It can enhance patient comfort, reduce treatment costs, and improve delivery efficiency. From the perspective of treatment efficacy, it contributes to mitigating the intra-fractional motions and improving the accuracy of radiotherapy, especially for moving tumors. PURPOSE However, there is a tradeoff problem between the plan quality and delivery time. We consider the potential of a large momentum acceptance (LMA) beamline and apply the spots and energy layers reduction method to reduce the delivery time. METHODS The delivery time for each field consists of the energy layer switching time, spot traveling time, and dose delivery time. The larger momentum spread and higher intensity beam offered by the LMA beamline contribute to reducing the total delivery time compared to the conventional beamline. In addition to the dose fidelity term, an L1 and logarithm items were added to the objective function to increase the sparsity of the low-weighted spots and energy layers. After that, the low-weighted spots and layers were iteratively excluded in the reduced plan, which reduced the energy layer switching time and spot traveling time. We used the standard, reduced, and LMA-reduced plans to validate the proposed method and tested it on prostate and nasopharyngeal cases. Then, we compared and evaluated the plan quality, treatment time, and plan robustness against delivery uncertainty. RESULTS Compared with the standard plans, the number of spots in the LMA-reduced plans was on average reduced by 13 400 (95.6%) for prostate cases and by 48 300 (80.7%) for nasopharyngeal cases and the number of energy layers was on average reduced by 49 (61.3%) for prostate cases and by 97 (50.5%) for nasopharyngeal cases. And, the delivery time of the LMA-reduced plans was shortened from 34.5 to 8.6 s for prostate cases and from 163.8 to 53.6 s for nasopharyngeal cases. The LMA-reduced plans had comparable robustness to the spot monitor unit (MU) error compared with the standard plans, but the LMA-reduced plans became more sensitive to spot position uncertainty. CONCLUSION The delivery efficiency can be significantly improved using the LMA beamline and spots and energy layers reduction strategies. The method is promising to improve the efficiency of motion mitigation strategies for treating moving tumors.
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Affiliation(s)
- Wei Wang
- State Key Laboratory of Advanced Electromagnetic Engineering and Technology, School of Electrical and Electronic Engineering, Huazhong University of Science and Technology, Wuhan, China
| | - Xu Liu
- State Key Laboratory of Advanced Electromagnetic Engineering and Technology, School of Electrical and Electronic Engineering, Huazhong University of Science and Technology, Wuhan, China
| | - Zhiyong Yang
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yicheng Liao
- State Key Laboratory of Advanced Electromagnetic Engineering and Technology, School of Electrical and Electronic Engineering, Huazhong University of Science and Technology, Wuhan, China
| | - Peilun Li
- State Key Laboratory of Advanced Electromagnetic Engineering and Technology, School of Electrical and Electronic Engineering, Huazhong University of Science and Technology, Wuhan, China
| | - Runxiao Zhao
- State Key Laboratory of Advanced Electromagnetic Engineering and Technology, School of Electrical and Electronic Engineering, Huazhong University of Science and Technology, Wuhan, China
| | - Bin Qin
- State Key Laboratory of Advanced Electromagnetic Engineering and Technology, School of Electrical and Electronic Engineering, Huazhong University of Science and Technology, Wuhan, China
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Zhu YN, Zhang X, Lin Y, Lominska C, Gao H. An orthogonal matching pursuit optimization method for solving minimum-monitor-unit problems: Applications to proton IMPT, ARC and FLASH. Med Phys 2023; 50:4710-4720. [PMID: 37427749 PMCID: PMC11031273 DOI: 10.1002/mp.16577] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 05/22/2023] [Accepted: 06/11/2023] [Indexed: 07/11/2023] Open
Abstract
BACKGROUND The intensities (i.e., number of protons in monitor unit [MU]) of deliverable proton spots need to be either zero or meet a minimum-MU (MMU) threshold, which is a nonconvex problem. Since the dose rate is proportionally associated with the MMU threshold, higher-dose-rate proton radiation therapy (RT) (e.g., efficient intensity modulated proton therapy (IMPT) and ARC proton therapy, and high-dose-rate-induced FLASH effect needs to solve the MMU problem with larger MMU threshold, which however makes the nonconvex problem more difficult to solve. PURPOSE This work will develop a more effective optimization method based on orthogonal matching pursuit (OMP) for solving the MMU problem with large MMU thresholds, compared to state-of-the-art methods, such as alternating direction method of multipliers (ADMM), proximal gradient descent method (PGD), or stochastic coordinate descent method (SCD). METHODS The new method consists of two essential components. First, the iterative convex relaxation (ICR) method is used to determine the active sets for dose-volume planning constraints and decouple the MMU constraint from the rest. Second, a modified OMP optimization algorithm is used to handle the MMU constraint: the non-zero spots are greedily selected via OMP to form the solution set to be optimized, and then a convex constrained subproblem is formed and can be conveniently solved to optimize the spot weights restricted to this solution set via OMP. During this iterative process, the new non-zero spots localized via OMP will be adaptively added to or removed from the optimization objective. RESULTS The new method via OMP is validated in comparison with ADMM, PGD and SCD for high-dose-rate IMPT, ARC, and FLASH problems of large MMU thresholds, and the results suggest that OMP substantially improved the plan quality from PGD, ADMM and SCD in terms of both target dose conformality (e.g., quantified by max target dose and conformity index) and normal tissue sparing (e.g., mean and max dose). For example, in the brain case, the max target dose for IMPT/ARC/FLASH was 368.0%/358.3%/283.4% respectively for PGD, 154.4%/179.8%/150.0% for ADMM, 134.5%/130.4%/123.0% for SCD, while it was <120% in all scenarios for OMP; compared to PGD/ADMM/SCD, OMP improved the conformity index from 0.42/0.52/0.33 to 0.65 for IMPT and 0.46/0.60/0.61 to 0.83 for ARC. CONCLUSIONS A new OMP-based optimization algorithm is developed to solve the MMU problems with large MMU thresholds, and validated using examples of IMPT, ARC, and FLASH with substantially improved plan quality from ADMM, PGD, and SCD.
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Affiliation(s)
- Ya-Nan Zhu
- Institute of Natural Sciences and School of Mathematics, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaoqun Zhang
- Institute of Natural Sciences and School of Mathematics, Shanghai Jiao Tong University, Shanghai, China
| | - Yuting Lin
- Department of Radiation Oncology, University of Kansas Medical Center, Kansas City, Missouri, USA
| | - Chris Lominska
- Department of Radiation Oncology, University of Kansas Medical Center, Kansas City, Missouri, USA
| | - Hao Gao
- Department of Radiation Oncology, University of Kansas Medical Center, Kansas City, Missouri, USA
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Knäusl B, Lebbink F, Fossati P, Engwall E, Georg D, Stock M. Patient Breathing Motion and Delivery Specifics Influencing the Robustness of a Proton Pancreas Irradiation. Cancers (Basel) 2023; 15:cancers15092550. [PMID: 37174016 PMCID: PMC10177445 DOI: 10.3390/cancers15092550] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/24/2023] [Accepted: 04/28/2023] [Indexed: 05/15/2023] Open
Abstract
Motion compensation strategies in particle therapy depend on the anatomy, motion amplitude and underlying beam delivery technology. This retrospective study on pancreas patients with small moving tumours analysed existing treatment concepts and serves as a basis for future treatment strategies for patients with larger motion amplitudes as well as the transition towards carbon ion treatments. The dose distributions of 17 hypofractionated proton treatment plans were analysed using 4D dose tracking (4DDT). The recalculation of clinical treatment plans employing robust optimisation for mitigating different organ fillings was performed on phased-based 4D computed tomography (4DCT) data considering the accelerator (pulsed scanned pencil beams delivered by a synchrotron) and the breathing-time structure. The analysis confirmed the robustness of the included treatment plans concerning the interplay of beam and organ motion. The median deterioration of D50% (ΔD50%) for the clinical target volume (CTV) and the planning target volume (PTV) was below 2%, while the only outlier was observed for ΔD98% with -35.1%. The average gamma pass rate over all treatment plans (2%/ 2 mm) was 88.8% ± 8.3, while treatment plans for motion amplitudes larger than 1 mm performed worse. For organs at risk (OARs), the median ΔD2% was below 3%, but for single patients, essential changes, e.g., up to 160% for the stomach were observed. The hypofractionated proton treatment for pancreas patients based on robust treatment plan optimisation and 2 to 4 horizontal and vertical beams showed to be robust against intra-fractional movements up to 3.7 mm. It could be demonstrated that the patient's orientation did not influence the motion sensitivity. The identified outliers showed the need for continuous 4DDT calculations in clinical practice to identify patient cases with more significant deviations.
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Affiliation(s)
- Barbara Knäusl
- Department of Radiation Oncology, Medical University of Vienna, 1090 Vienna, Austria
- MedAustron Ion Therapy Centre, Medical Physics, 2700 Wiener Neustadt, Austria
| | - Franciska Lebbink
- Department of Radiation Oncology, Medical University of Vienna, 1090 Vienna, Austria
- MedAustron Ion Therapy Centre, Medical Physics, 2700 Wiener Neustadt, Austria
| | - Piero Fossati
- MedAustron Ion Therapy Centre, Medical Physics, 2700 Wiener Neustadt, Austria
- Division Medical Physics, Karl Landsteiner University of Health Sciences, 2700 Wiener Neustadt, Austria
| | | | - Dietmar Georg
- Department of Radiation Oncology, Medical University of Vienna, 1090 Vienna, Austria
| | - Markus Stock
- MedAustron Ion Therapy Centre, Medical Physics, 2700 Wiener Neustadt, Austria
- Division Medical Physics, Karl Landsteiner University of Health Sciences, 2700 Wiener Neustadt, Austria
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Maradia V, Colizzi I, Meer D, Weber DC, Lomax AJ, Actis O, Psoroulas S. Universal and dynamic ridge filter for pencil beam scanning particle therapy: a novel concept for ultra-fast treatment delivery. Phys Med Biol 2022; 67. [DOI: 10.1088/1361-6560/ac9d1f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 10/24/2022] [Indexed: 11/07/2022]
Abstract
Abstract
Objective. In pencil beam scanning particle therapy, a short treatment delivery time is paramount for the efficient treatment of moving targets with motion mitigation techniques (such as breath-hold, rescanning, and gating). Energy and spot position change time are limiting factors in reducing treatment time. In this study, we designed a universal and dynamic energy modulator (ridge filter, RF) to broaden the Bragg peak, to reduce the number of energies and spots required to cover the target volume, thus lowering the treatment time. Approach. Our RF unit comprises two identical RFs placed just before the isocenter. Both RFs move relative to each other, changing the Bragg peak’s characteristics dynamically. We simulated different Bragg peak shapes with the RF in Monte Carlo simulation code (TOPAS) and validated them experimentally. We then delivered single-field plans with 1 Gy/fraction to different geometrical targets in water, to measure the dose delivery time using the RF and compare it with the clinical settings. Main results. Aligning the RFs in different positions produces different broadening in the Bragg peak; we achieved a maximum broadening of 2.5 cm. With RF we reduced the number of energies in a field by more than 60%, and the dose delivery time by 50%, for all geometrical targets investigated, without compromising the dose distribution transverse and distal fall-off. Significance. Our novel universal and dynamic RF allows for the adaptation of the Bragg peak broadening for a spot and/or energy layer based on the requirement of dose shaping in the target volume. It significantly reduces the number of energy layers and spots to cover the target volume, and thus the treatment time. This RF design is ideal for ultra-fast treatment delivery within a single breath-hold (5–10 s), efficient delivery of motion mitigation techniques, and small animal irradiation with ultra-high dose rates (FLASH).
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