1
|
Kraan AC, Susini F, Moglioni M, Battistoni G, Bersani D, Carra P, Cerello P, De Gregorio A, Ferrero V, Fiorina E, Franciosini G, Morrocchi M, Muraro S, Patera V, Pennazio F, Retico A, Rosso V, Sarti A, Schiavi A, Sportelli G, Traini G, Vischioni B, Vitolo V, Bisogni MG. In-beam PET treatment monitoring of carbon therapy patients: Results of a clinical trial at CNAO. Phys Med 2024; 125:104493. [PMID: 39137617 DOI: 10.1016/j.ejmp.2024.104493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 06/26/2024] [Accepted: 07/25/2024] [Indexed: 08/15/2024] Open
Abstract
PURPOSE Carbon ion therapy treatments can be monitored non-invasively with in-beam Positron Emission Tomography (PET). At CNAO the INSIDE in-beam PET scanner has been used in a clinical trial (NCT03662373) to monitor cancer treatments with proton and carbon therapy. In this work we present the analysis results of carbon therapy data, acquired during the first phase of the clinical trial, analyzing data of nine patients treated at CNAO for various malignant tumors in the head-and-neck region. MATERIALS AND METHODS The patient group contained two patients requiring replanning, and seven patients without replanning, based on established protocols. For each patient the PET images acquired along the course of treatment were compared with a reference, applying two analysis methods: the beam-eye-view (BEV) method and the γ-index analysis. Time trends in several parameters were investigated, as well as the agreement with control CTs, if available. RESULTS Regarding the BEV-method, the average sigma value σ was 3.7 mm of range difference distributions for patients without changes (sensitivity of the INSIDE detector). The 3D-information obtained from the BEV analysis was partly in agreement with what was observed in the control CT. The data quality and quantity was insufficient for a definite interpretation of the time trends. CONCLUSION We analyzed carbon therapy data acquired with the INSIDE in-beam PET detector using two analysis methods. The data allowed to evaluate sensitivity of the INSIDE detector for carbon therapy and to make several recommendations for the future.
Collapse
Affiliation(s)
- Aafke Christine Kraan
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, Largo Bruno Pontecorvo 3, 56127 Pisa, Italy.
| | - Filippo Susini
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, Largo Bruno Pontecorvo 3, 56127 Pisa, Italy; Università di Pisa, Dipartimento di Fisica, Largo Bruno Pontecorvo 3, 56127 Pisa, Italy
| | - Martina Moglioni
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, Largo Bruno Pontecorvo 3, 56127 Pisa, Italy; Università di Pisa, Dipartimento di Fisica, Largo Bruno Pontecorvo 3, 56127 Pisa, Italy
| | - Giuseppe Battistoni
- Istituto Nazionale di Fisica Nucleare, Sezione di Milano, Via Giovanni Celoria 16, 20133 Milano, Italy
| | - Davide Bersani
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, Largo Bruno Pontecorvo 3, 56127 Pisa, Italy; Università di Pisa, Dipartimento di Fisica, Largo Bruno Pontecorvo 3, 56127 Pisa, Italy
| | - Pietro Carra
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, Largo Bruno Pontecorvo 3, 56127 Pisa, Italy; Università di Pisa, Dipartimento di Fisica, Largo Bruno Pontecorvo 3, 56127 Pisa, Italy
| | - Piergiorgio Cerello
- Istituto Nazionale di Fisica Nucleare, Sezione di Torino, Via Pietro Giuria 1, 10125 Torino, Italy
| | - Angelica De Gregorio
- Sapienza università di Roma, Dipartimento di Fisica, Piazzale Aldo Moro 2, 00185 Roma, Italy; Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Piazzale Aldo Moro 2, 00185 Roma, Italy
| | - Veronica Ferrero
- Istituto Nazionale di Fisica Nucleare, Sezione di Torino, Via Pietro Giuria 1, 10125 Torino, Italy
| | - Elisa Fiorina
- Istituto Nazionale di Fisica Nucleare, Sezione di Torino, Via Pietro Giuria 1, 10125 Torino, Italy
| | - Gaia Franciosini
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Piazzale Aldo Moro 2, 00185 Roma, Italy; Sapienza università di Roma, Dipartimento di Scienze di Base e Applicate per l'Ingegneria, Via A. Scarpa 14, 00161 Roma, Italy
| | - Matteo Morrocchi
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, Largo Bruno Pontecorvo 3, 56127 Pisa, Italy; Università di Pisa, Dipartimento di Fisica, Largo Bruno Pontecorvo 3, 56127 Pisa, Italy
| | - Silvia Muraro
- Istituto Nazionale di Fisica Nucleare, Sezione di Milano, Via Giovanni Celoria 16, 20133 Milano, Italy
| | - Vincenzo Patera
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Piazzale Aldo Moro 2, 00185 Roma, Italy; Sapienza università di Roma, Dipartimento di Scienze di Base e Applicate per l'Ingegneria, Via A. Scarpa 14, 00161 Roma, Italy
| | - Francesco Pennazio
- Istituto Nazionale di Fisica Nucleare, Sezione di Torino, Via Pietro Giuria 1, 10125 Torino, Italy
| | - Alessandra Retico
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, Largo Bruno Pontecorvo 3, 56127 Pisa, Italy
| | - Valeria Rosso
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, Largo Bruno Pontecorvo 3, 56127 Pisa, Italy; Università di Pisa, Dipartimento di Fisica, Largo Bruno Pontecorvo 3, 56127 Pisa, Italy
| | - Alessio Sarti
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Piazzale Aldo Moro 2, 00185 Roma, Italy; Sapienza università di Roma, Dipartimento di Scienze di Base e Applicate per l'Ingegneria, Via A. Scarpa 14, 00161 Roma, Italy
| | - Angelo Schiavi
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Piazzale Aldo Moro 2, 00185 Roma, Italy; Sapienza università di Roma, Dipartimento di Scienze di Base e Applicate per l'Ingegneria, Via A. Scarpa 14, 00161 Roma, Italy
| | - Giancarlo Sportelli
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, Largo Bruno Pontecorvo 3, 56127 Pisa, Italy; Università di Pisa, Dipartimento di Fisica, Largo Bruno Pontecorvo 3, 56127 Pisa, Italy
| | - Giacomo Traini
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Piazzale Aldo Moro 2, 00185 Roma, Italy
| | - Barbara Vischioni
- CNAO National Center for Oncological Hadrontherapy, Via Erminio Borloni 1, 27100 Pavia, Italy
| | - Viviana Vitolo
- CNAO National Center for Oncological Hadrontherapy, Via Erminio Borloni 1, 27100 Pavia, Italy
| | - Maria Giuseppina Bisogni
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, Largo Bruno Pontecorvo 3, 56127 Pisa, Italy; Università di Pisa, Dipartimento di Fisica, Largo Bruno Pontecorvo 3, 56127 Pisa, Italy
| |
Collapse
|
2
|
Yang D, Zhu XR, Chen M, Ma L, Cheng X, Grosshans DR, Lu W, Shao Y. Investigation of intra-fractionated range guided adaptive proton therapy: I. On-line PET imaging and range measurement. Phys Med Biol 2024; 69:155005. [PMID: 38861997 DOI: 10.1088/1361-6560/ad56f4] [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: 02/29/2024] [Accepted: 06/11/2024] [Indexed: 06/13/2024]
Abstract
Objective.Develop a prototype on-line positron emission tomography (PET) scanner and evaluate its capability of on-line imaging and intra-fractionated proton-induced radioactivity range measurement.Approach.Each detector consists of 32 × 32 array of 2 × 2 × 30 mm3Lutetium-Yttrium Oxyorthosilicate scintillators with single-scintillator-end readout through a 20 × 20 array of 3 × 3 mm2Silicon Photomultipliers. The PET can be configurated with a full-ring of 20 detectors for conventional PET imaging or a partial-ring of 18 detectors for on-line imaging and range measurement. All detector-level readout and processing electronics are attached to the backside of the system gantry and their output signals are transferred to a field-programable-gate-array based system electronics and data acquisition that can be placed 2 m away from the gantry. The PET imaging performance and radioactivity range measurement capability were evaluated by both the offline study that placed a radioactive source with known intensity and distribution within a phantom and the online study that irradiated a phantom with proton beams under different radiation and imaging conditions.Main results.The PET has 32 cm diameter and 6.5 cm axial length field-of-view (FOV), ∼2.3-5.0 mm spatial resolution within FOV, 3% sensitivity at the FOV center, 18%-30% energy resolution, and ∼9 ns coincidence time resolution. The offline study shows the PET can determine the shift of distal falloff edge position of a known radioactivity distribution with the accuracy of 0.3 ± 0.3 mm even without attenuation and scatter corrections, and online study shows the PET can measure the shift of proton-induced positron radioactive range with the accuracy of 0.6 ± 0.3 mm from the data acquired with a short-acquisition (60 s) and low-dose (5 MU) proton radiation to a human head phantom.Significance.This study demonstrated the capability of intra-fractionated PET imaging and radioactivity range measurement and will enable the investigation on the feasibility of intra-fractionated, range-shift compensated adaptive proton therapy.
Collapse
Affiliation(s)
- Dongxu Yang
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX 75057, United States of America
| | - Xiaorong R Zhu
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, TX 77000, United States of America
| | - Mingli Chen
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX 75057, United States of America
| | - Lin Ma
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX 75057, United States of America
| | - Xinyi Cheng
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX 75057, United States of America
| | - David R Grosshans
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77000, United States of America
| | - Weiguo Lu
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX 75057, United States of America
| | - Yiping Shao
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX 75057, United States of America
| |
Collapse
|
3
|
Shiraishi S, Yamanaka M, Shiba S, Tokuuye K. Assessing alimentary tract radiation in liver cancer treatment with proton beam therapy: a PET/CT imaging study. Jpn J Clin Oncol 2024:hyae085. [PMID: 38943456 DOI: 10.1093/jjco/hyae085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 06/13/2024] [Indexed: 07/01/2024] Open
Abstract
BACKGROUND Proton beams deposit energy along their path, abruptly stopping and generating various radioactive particles, including positrons, along their trajectory. In comparison with traditional proton beam therapy, scanning proton beam therapy is effective in delivering proton beams to irregularly shaped tumors, reducing excessive radiation exposure to the alimentary tract during the treatment of liver cancer. METHODS In this study, we utilized positron emission tomography/computed tomography (PET/CT) imaging to assess the total amount of radiation to the alimentary tract during liver cancer treatment with proton beam therapy, involving the administration of complex irradiation in 13 patients. RESULTS This approach resulted in the prevention of excess radiation. The planned radiation restraint doses for the colon exhibited a significant correlation with the PET values of the colon (correlation coefficient 0.8384, P = .0003). Likewise, the scheduled radiation restraint doses for the gastroduodenum were correlated with the PET values of the gastroduodenum (correlation coefficient 0.5397, P = .0569). CONCLUSIONS PET/CT conducted after proton beam therapy is useful for evaluating excess radiation in the alimentary tract. Proton beam therapy in liver cancer, assessed via PET/CT, effectively reduced alimentary tract radiation, which is vital for optimizing treatments and preventing excess exposure.
Collapse
Affiliation(s)
- Sachika Shiraishi
- Department of Radiation Oncology, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura-City, Kanagawa 247-8533, Japan
- Department of Radiology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan
| | - Masashi Yamanaka
- Department of Medical Physics, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura-City, Kanagawa 247-8533, Japan
| | - Shintaro Shiba
- Department of Radiation Oncology, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura-City, Kanagawa 247-8533, Japan
| | - Koichi Tokuuye
- Department of Radiation Oncology, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura-City, Kanagawa 247-8533, Japan
- Department of Radiology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan
| |
Collapse
|
4
|
Kraan AC, Moglioni M, Battistoni G, Bersani D, Berti A, Carra P, Cerello P, Ciocca M, Ferrero V, Fiorina E, Mazzoni E, Morrocchi M, Muraro S, Orlandi E, Pennazio F, Retico A, Rosso V, Sportelli G, Vischioni B, Vitolo V, Bisogni MG. Using the gamma-index analysis for inter-fractional comparison of in-beam PET images for head-and-neck treatment monitoring in proton therapy: A Monte Carlo simulation study. Phys Med 2024; 120:103329. [PMID: 38492331 DOI: 10.1016/j.ejmp.2024.103329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 02/13/2024] [Accepted: 03/07/2024] [Indexed: 03/18/2024] Open
Abstract
GOAL In-beam Positron Emission Tomography (PET) is a technique for in-vivo non-invasive treatment monitoring for proton therapy. To detect anatomical changes in patients with PET, various analysis methods exist, but their clinical interpretation is problematic. The goal of this work is to investigate whether the gamma-index analysis, widely used for dose comparisons, is an appropriate tool for comparing in-beam PET distributions. Focusing on a head-and-neck patient, we investigate whether the gamma-index map and the passing rate are sensitive to progressive anatomical changes. METHODS/MATERIALS We simulated a treatment course of a proton therapy patient using FLUKA Monte Carlo simulations. Gradual emptying of the sinonasal cavity was modeled through a series of artificially modified CT scans. The in-beam PET activity distributions from three fields were evaluated, simulating a planar dual head geometry. We applied the 3D-gamma evaluation method to compare the PET images with a reference image without changes. Various tolerance criteria and parameters were tested, and results were compared to the CT-scans. RESULTS Based on 210 MC simulations we identified appropriate parameters for the gamma-index analysis. Tolerance values of 3 mm/3% and 2 mm/2% were suited for comparison of simulated in-beam PET distributions. The gamma passing rate decreased with increasing volume change for all fields. CONCLUSION The gamma-index analysis was found to be a useful tool for comparing simulated in-beam PET images, sensitive to sinonasal cavity emptying. Monitoring the gamma passing rate behavior over the treatment course is useful to detect anatomical changes occurring during the treatment course.
Collapse
Affiliation(s)
- Aafke Christine Kraan
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, Largo Bruno Pontecorvo 3, Pisa, 56127, Italy
| | - Martina Moglioni
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, Largo Bruno Pontecorvo 3, Pisa, 56127, Italy; Dipartimento di Fisica, Università di Pisa, Largo Bruno Pontecorvo 3, Pisa, 56127, Italy.
| | - Giuseppe Battistoni
- Istituto Nazionale di Fisica Nucleare, Sezione di Milano, Via Giovanni Celoria 16, Milano, 20133, Italy
| | - Davide Bersani
- Istituto Nazionale di Fisica Nucleare, Sezione di Torino, Via Pietro Giuria 1, Torino, 10125, Italy
| | - Andrea Berti
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, Largo Bruno Pontecorvo 3, Pisa, 56127, Italy; Dipartimento di Fisica, Università di Pisa, Largo Bruno Pontecorvo 3, Pisa, 56127, Italy
| | - Pietro Carra
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, Largo Bruno Pontecorvo 3, Pisa, 56127, Italy; Dipartimento di Fisica, Università di Pisa, Largo Bruno Pontecorvo 3, Pisa, 56127, Italy
| | - Piergiorgio Cerello
- Istituto Nazionale di Fisica Nucleare, Sezione di Torino, Via Pietro Giuria 1, Torino, 10125, Italy
| | - Mario Ciocca
- Centro Nazionale di Adroterapia Oncologica, Strada Privata Campeggi 53, Pavia, 27100, Italy
| | - Veronica Ferrero
- Istituto Nazionale di Fisica Nucleare, Sezione di Torino, Via Pietro Giuria 1, Torino, 10125, Italy
| | - Elisa Fiorina
- Istituto Nazionale di Fisica Nucleare, Sezione di Torino, Via Pietro Giuria 1, Torino, 10125, Italy
| | - Enrico Mazzoni
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, Largo Bruno Pontecorvo 3, Pisa, 56127, Italy
| | - Matteo Morrocchi
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, Largo Bruno Pontecorvo 3, Pisa, 56127, Italy; Dipartimento di Fisica, Università di Pisa, Largo Bruno Pontecorvo 3, Pisa, 56127, Italy
| | - Silvia Muraro
- Istituto Nazionale di Fisica Nucleare, Sezione di Milano, Via Giovanni Celoria 16, Milano, 20133, Italy
| | - Ester Orlandi
- Centro Nazionale di Adroterapia Oncologica, Strada Privata Campeggi 53, Pavia, 27100, Italy
| | - Francesco Pennazio
- Istituto Nazionale di Fisica Nucleare, Sezione di Torino, Via Pietro Giuria 1, Torino, 10125, Italy
| | - Alessandra Retico
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, Largo Bruno Pontecorvo 3, Pisa, 56127, Italy
| | - Valeria Rosso
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, Largo Bruno Pontecorvo 3, Pisa, 56127, Italy; Dipartimento di Fisica, Università di Pisa, Largo Bruno Pontecorvo 3, Pisa, 56127, Italy
| | - Giancarlo Sportelli
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, Largo Bruno Pontecorvo 3, Pisa, 56127, Italy; Dipartimento di Fisica, Università di Pisa, Largo Bruno Pontecorvo 3, Pisa, 56127, Italy
| | - Barbara Vischioni
- Centro Nazionale di Adroterapia Oncologica, Strada Privata Campeggi 53, Pavia, 27100, Italy
| | - Viviana Vitolo
- Centro Nazionale di Adroterapia Oncologica, Strada Privata Campeggi 53, Pavia, 27100, Italy
| | - Maria Giuseppina Bisogni
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, Largo Bruno Pontecorvo 3, Pisa, 56127, Italy; Dipartimento di Fisica, Università di Pisa, Largo Bruno Pontecorvo 3, Pisa, 56127, Italy
| |
Collapse
|
5
|
Zapien-Campos B, Ahmadi Ganjeh Z, Both S, Dendooven P. Measurement of the 12C(p,n) 12N reaction cross section below 150 MeV. Phys Med Biol 2024; 69:075025. [PMID: 38382103 DOI: 10.1088/1361-6560/ad2b97] [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: 10/06/2023] [Accepted: 02/21/2024] [Indexed: 02/23/2024]
Abstract
Objective. Proton therapy currently faces challenges from clinical complications on organs-at-risk due to range uncertainties. To address this issue, positron emission tomography (PET) of the proton-induced11C and15O activity has been used to provide feedback on the proton range. However, this approach is not instantaneous due to the relatively long half-lives of these nuclides. An alternative nuclide,12N (half-life 11 ms), shows promise for real-timein vivoproton range verification. Development of12N imaging requires better knowledge of its production reaction cross section.Approach. The12C(p,n)12N reaction cross section was measured by detecting positron activity of graphite targets irradiated with 66.5, 120, and 150 MeV protons. A pulsed beam delivery with 0.7-2 × 108protons per pulse was used. The positron activity was measured during the beam-off periods using a dual-head Siemens Biograph mCT PET scanner. The12N production was determined from activity time histograms.Main results. The cross section was calculated for 11 energies, ranging from 23.5 to 147 MeV, using information on the experimental setup and beam delivery. Through a comprehensive uncertainty propagation analysis, a statistical uncertainty of 2.6%-5.8% and a systematic uncertainty of 3.3%-4.6% were achieved. Additionally, a comparison between measured and simulated scanner sensitivity showed a scaling factor of 1.25 (±3%). Despite this, there was an improvement in the precision of the cross section measurement compared to values reported by the only previous study.Significance. Short-lived12N imaging is promising for real-timein vivoverification of the proton range to reduce clinical complications in proton therapy. The verification procedure requires experimental knowledge of the12N production cross section for proton energies of clinical importance, to be incorporated in a Monte Carlo framework for12N imaging prediction. This study is the first to achieve a precise measurement of the12C(p,n)12N nuclear cross section for such proton energies.
Collapse
Affiliation(s)
- Brian Zapien-Campos
- Particle Therapy Research Center (PARTREC), Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Zahra Ahmadi Ganjeh
- Particle Therapy Research Center (PARTREC), Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Stefan Both
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Peter Dendooven
- Particle Therapy Research Center (PARTREC), Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| |
Collapse
|
6
|
Tattenberg S, Liu P, Mulhem A, Cong X, Thome C, Ding X. Impact of and interplay between proton arc therapy and range uncertainties in proton therapy for head-and-neck cancer. Phys Med Biol 2024; 69:055015. [PMID: 38324904 DOI: 10.1088/1361-6560/ad2718] [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: 09/01/2023] [Accepted: 02/07/2024] [Indexed: 02/09/2024]
Abstract
Objective. Proton therapy reduces the integral dose to the patient compared to conventional photon treatments. However,in vivoproton range uncertainties remain a considerable hurdle. Range uncertainty reduction benefits depend on clinical practices. During intensity-modulated proton therapy (IMPT), the target is irradiated from only a few directions, but proton arc therapy (PAT), for which the target is irradiated from dozens of angles, may see clinical implementation by the time considerable range uncertainty reductions are achieved. It is therefore crucial to determine the impact of PAT on range uncertainty reduction benefits.Approach. For twenty head-and-neck cancer patients, four different treatment plans were created: an IMPT and a PAT treatment plan assuming current clinical range uncertainties of 3.5% (IMPT3.5%and PAT3.5%), and an IMPT and a PAT treatment plan assuming that range uncertainties can be reduced to 1% (IMPT1%and PAT1%). Plans were evaluated with respect to target coverage and organ-at-risk doses as well as normal tissue complication probabilities (NTCPs) for parotid glands (endpoint: parotid gland flow <25%) and larynx (endpoint: larynx edema).Main results. Implementation of PAT (IMPT3.5%-PAT3.5%) reduced mean NTCPs in the nominal and worst-case scenario by 3.2 percentage points (pp) and 4.2 pp, respectively. Reducing range uncertainties from 3.5% to 1% during use of IMPT (IMPT3.5%-IMPT1%) reduced evaluated NTCPs by 0.9 pp and 2.0 pp. Benefits of range uncertainty reductions subsequently to PAT implementation (PAT3.5%-PAT1%) were 0.2 pp and 1.0 pp, with considerably higher benefits in bilateral compared to unilateral cases.Significance. The mean clinical benefit of implementing PAT was more than twice as high as the benefit of a 3.5%-1% range uncertainty reduction. Range uncertainty reductions are expected to remain beneficial even after PAT implementation, especially in cases with target positions allowing for full leveraging of the higher number of gantry angles during PAT.
Collapse
Affiliation(s)
- Sebastian Tattenberg
- Laurentian University, Sudbury P3E 2C6, Ontario, Canada
- Northern Ontario School of Medicine University, Sudbury P3E 2C6, Ontario, Canada
- TRIUMF, 4004 Wesbrook Mall, Vancouver V6T 2A3, British Columbia, Canada
| | - Peilin Liu
- Department of Radiation Oncology, William Beaumont University Hospital, Corewell Health, 3601 W 13 Mile Road, MI, United States of America
| | - Anthony Mulhem
- Department of Radiation Oncology, William Beaumont University Hospital, Corewell Health, 3601 W 13 Mile Road, MI, United States of America
- Department of Human Biology, Michigan State University, Natural Science Building, 288 Farm Ln, East Lansing, MI 48824, United States of America
| | - Xiaoda Cong
- Department of Radiation Oncology, William Beaumont University Hospital, Corewell Health, 3601 W 13 Mile Road, MI, United States of America
| | - Christopher Thome
- Laurentian University, Sudbury P3E 2C6, Ontario, Canada
- Northern Ontario School of Medicine University, Sudbury P3E 2C6, Ontario, Canada
| | - Xuanfeng Ding
- Department of Radiation Oncology, William Beaumont University Hospital, Corewell Health, 3601 W 13 Mile Road, MI, United States of America
| |
Collapse
|
7
|
Yamamoto S, Watabe H, Nakanishi K, Yabe T, Yamaguchi M, Kawachi N, Kamada K, Yoshikawa A, Miyake M, Tanaka KS, Kataoka J. A triple-imaging-modality system for simultaneous measurements of prompt gamma photons, prompt x-rays, and induced positrons during proton beam irradiation. Phys Med Biol 2024; 69:055012. [PMID: 38385258 DOI: 10.1088/1361-6560/ad25c6] [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: 06/19/2023] [Accepted: 02/01/2024] [Indexed: 02/23/2024]
Abstract
Objective. Prompt gamma photon, prompt x-ray, and induced positron imaging are possible methods for observing a proton beam's shape from outside the subject. However, since these three types of images have not been measured simultaneously nor compared using the same subject, their advantages and disadvantages remain unknown for imaging beam shapes in therapy. To clarify these points, we developed a triple-imaging-modality system to simultaneously measure prompt gamma photons, prompt x-rays, and induced positrons during proton beam irradiation to a phantom.Approach. The developed triple-imaging-modality system consists of a gamma camera, an x-ray camera, and a dual-head positron emission tomography (PET) system. During 80 MeV proton beam irradiation to a polymethyl methacrylate (PMMA) phantom, imaging of prompt gamma photons was conducted by the developed gamma camera from one side of the phantom. Imaging of prompt x-rays was conducted by the developed x-ray camera from the other side. Induced positrons were measured by the developed dual-head PET system set on the upper and lower sides of the phantom.Main results. With the proposed triple-imaging-modality system, we could simultaneously image the prompt gamma photons and prompt x-rays during proton beam irradiation. Induced positron distributions could be measured after the irradiation by the PET system and the gamma camera. Among these imaging modalities, image quality was the best for the induced positrons measured by PET. The estimated ranges were actually similar to those imaged with prompt gamma photons, prompt x-rays and induced positrons measured by PET.Significance. The developed triple-imaging-modality system made possible to simultaneously measure the three different beam images. The system will contribute to increasing the data available for imaging in therapy and will contribute to better estimating the shapes or ranges of proton beam.
Collapse
Affiliation(s)
| | - Hiroshi Watabe
- Cyclotron and Radioisotope Center, Tohoku University, Japan
| | - Kohei Nakanishi
- Department of Integrated Health Science, Nagoya University Graduate School of Medicine, Japan
| | - Takuya Yabe
- Takasaki Institute for Advanced Quantum Science, Foundational Quantum Technology Research Directorate, National Institutes for Quantum Science and Technology (QST), Japan
| | - Mitsutaka Yamaguchi
- Takasaki Institute for Advanced Quantum Science, Foundational Quantum Technology Research Directorate, National Institutes for Quantum Science and Technology (QST), Japan
| | - Naoki Kawachi
- Takasaki Institute for Advanced Quantum Science, Foundational Quantum Technology Research Directorate, National Institutes for Quantum Science and Technology (QST), Japan
| | - Kei Kamada
- New Industry Creation Hatchery Center (NICHe), Tohoku University, Japan
| | - Akira Yoshikawa
- New Industry Creation Hatchery Center (NICHe), Tohoku University, Japan
| | | | - Kazuo S Tanaka
- Faculty of Science and Engineering, Waseda University, Japan
| | - Jun Kataoka
- Faculty of Science and Engineering, Waseda University, Japan
| |
Collapse
|
8
|
Lane SA, Slater JM, Yang GY. Image-Guided Proton Therapy: A Comprehensive Review. Cancers (Basel) 2023; 15:cancers15092555. [PMID: 37174022 PMCID: PMC10177085 DOI: 10.3390/cancers15092555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 04/24/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023] Open
Abstract
Image guidance for radiation therapy can improve the accuracy of the delivery of radiation, leading to an improved therapeutic ratio. Proton radiation is able to deliver a highly conformal dose to a target due to its advantageous dosimetric properties, including the Bragg peak. Proton therapy established the standard for daily image guidance as a means of minimizing uncertainties associated with proton treatment. With the increasing adoption of the use of proton therapy over time, image guidance systems for this modality have been changing. The unique properties of proton radiation present a number of differences in image guidance from photon therapy. This paper describes CT and MRI-based simulation and methods of daily image guidance. Developments in dose-guided radiation, upright treatment, and FLASH RT are discussed as well.
Collapse
Affiliation(s)
- Shelby A Lane
- James M. Slater, MD Proton Treatment and Research Center, Loma Linda University, Loma Linda, CA 92354, USA
| | - Jason M Slater
- James M. Slater, MD Proton Treatment and Research Center, Loma Linda University, Loma Linda, CA 92354, USA
| | - Gary Y Yang
- James M. Slater, MD Proton Treatment and Research Center, Loma Linda University, Loma Linda, CA 92354, USA
| |
Collapse
|