1
|
Nishioka K, Hashimoto T, Mori T, Uchinami Y, Kinoshita R, Katoh N, Taguchi H, Yasuda K, Ito YM, Takao S, Tamura M, Matsuura T, Shimizu S, Shirato H, Aoyama H. A Single-Institution Prospective Study To Evaluate the Safety and Efficacy of Real- Time Image-Gated Spot-Scanning Proton Therapy (RGPT) for Prostate Cancer. Adv Radiat Oncol 2024; 9:101464. [PMID: 38560429 PMCID: PMC10981019 DOI: 10.1016/j.adro.2024.101464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 01/30/2024] [Indexed: 04/04/2024] Open
Abstract
Purpose In real-time image-gated spot-scanning proton therapy (RGPT), the dose distribution is distorted by gold fiducial markers placed in the prostate. Distortion can be suppressed by using small markers and more than 2 fields, but additional fields may increase the dose to organs at risk. Therefore, we conducted a prospective study to evaluate the safety and short-term clinical outcome of RGPT for prostate cancer. Methods and Materials Based on the previously reported frequency of early adverse events (AE) and the noninferiority margin of 10%, the required number of cases was calculated to be 43 using the one-sample binomial test by the Southwest Oncology Group statistical tools with the one-sided significance level of 2.5% and the power 80%. Patients with localized prostate cancer were enrolled and 3 to 4 pure gold fiducial markers of 1.5-mm diameter were inserted in the prostate. The prescribed dose was 70 Gy(relative biologic effectiveness) in 30 fractions, and treatment was performed with 3 fields from the left, right, and the back, or 4 fields from either side of slightly anterior and posterior oblique fields. The primary endpoint was the frequency of early AE (≥grade 2) and the secondary endpoint was the biochemical relapse-free survival rate and the frequency of late AE. Results Forty-five cases were enrolled between 2015 and 2017, and all patients completed the treatment protocol. The median follow-up period was 63.0 months. The frequency of early AE (≥grade 2) was observed in 4 cases (8.9%), therefore the noninferiority was verified. The overall 5-year biochemical relapse-free survival rate was 88.9%. As late AE, grade 2 rectal bleeding was observed in 8 cases (17.8%). Conclusions The RGPT for prostate cancer with 1.5-mm markers and 3- or 4- fields was as safe as conventional proton therapy in early AE, and its efficacy was comparable with previous studies.
Collapse
Affiliation(s)
- Kentaro Nishioka
- Radiation Oncology Division, Global Center for Biomedical Science and Engineering, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Takayuki Hashimoto
- Radiation Oncology Division, Global Center for Biomedical Science and Engineering, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Takashi Mori
- Department of Radiation Oncology, Hokkaido University Hospital, Sapporo, Japan
| | - Yusuke Uchinami
- Department of Radiation Oncology, Hokkaido University Hospital, Sapporo, Japan
| | - Rumiko Kinoshita
- Department of Radiation Oncology, Hokkaido University Hospital, Sapporo, Japan
| | - Norio Katoh
- Department of Radiation Oncology, Hokkaido University Faculty of Medicine, Sapporo, Japan
| | - Hiroshi Taguchi
- Department of Radiation Oncology, Hokkaido University Hospital, Sapporo, Japan
| | - Koichi Yasuda
- Department of Radiation Oncology, Hokkaido University Hospital, Sapporo, Japan
| | - Yoichi M. Ito
- Data Science Center, Promotion Unit, Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo, Japan
| | - Seishin Takao
- Proton Beam Therapy Center, Hokkaido University Hospital, Sapporo, Japan
| | - Masaya Tamura
- Proton Beam Therapy Center, Hokkaido University Hospital, Sapporo, Japan
| | - Taeko Matsuura
- Proton Beam Therapy Center, Hokkaido University Hospital, Sapporo, Japan
| | - Shinichi Shimizu
- Department of Carbon Ion Radiotherapy, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hiroki Shirato
- Radiation Oncology Division, Global Center for Biomedical Science and Engineering, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Hidefumi Aoyama
- Department of Radiation Oncology, Hokkaido University Faculty of Medicine, Sapporo, Japan
| |
Collapse
|
2
|
SHIRATO H. Biomedical advances and future prospects of high-precision three-dimensional radiotherapy and four-dimensional radiotherapy. PROCEEDINGS OF THE JAPAN ACADEMY. SERIES B, PHYSICAL AND BIOLOGICAL SCIENCES 2023; 99:389-426. [PMID: 37821390 PMCID: PMC10749389 DOI: 10.2183/pjab.99.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 09/13/2023] [Indexed: 10/13/2023]
Abstract
Biomedical advances of external-beam radiotherapy (EBRT) with improvements in physical accuracy are reviewed. High-precision (±1 mm) three-dimensional radiotherapy (3DRT) can utilize respective therapeutic open doors in the tumor control probability curve and in the normal tissue complication probability curve instead of the one single therapeutic window in two-dimensional EBRT. High-precision 3DRT achieved higher tumor control and probable survival rates for patients with small peripheral lung and liver cancers. Four-dimensional radiotherapy (4DRT), which can reduce uncertainties in 3DRT due to organ motion by real-time (every 0.1-1 s) tumor-tracking and immediate (0.1-1 s) irradiation, have achieved reduced adverse effects for prostate and pancreatic tumors near the digestive tract and with similar or better tumor control. Particle beam therapy improved tumor control and probable survival for patients with large liver tumors. The clinical outcomes of locally advanced or multiple tumors located near serial-type organs can theoretically be improved further by integrating the 4DRT concept with particle beams.
Collapse
Affiliation(s)
- Hiroki SHIRATO
- Global Center for Biomedical Science and Engineering, Faculty of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| |
Collapse
|
3
|
Pakela JM, Knopf A, Dong L, Rucinski A, Zou W. Management of Motion and Anatomical Variations in Charged Particle Therapy: Past, Present, and Into the Future. Front Oncol 2022; 12:806153. [PMID: 35356213 PMCID: PMC8959592 DOI: 10.3389/fonc.2022.806153] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 02/04/2022] [Indexed: 12/14/2022] Open
Abstract
The major aim of radiation therapy is to provide curative or palliative treatment to cancerous malignancies while minimizing damage to healthy tissues. Charged particle radiotherapy utilizing carbon ions or protons is uniquely suited for this task due to its ability to achieve highly conformal dose distributions around the tumor volume. For these treatment modalities, uncertainties in the localization of patient anatomy due to inter- and intra-fractional motion present a heightened risk of undesired dose delivery. A diverse range of mitigation strategies have been developed and clinically implemented in various disease sites to monitor and correct for patient motion, but much work remains. This review provides an overview of current clinical practices for inter and intra-fractional motion management in charged particle therapy, including motion control, current imaging and motion tracking modalities, as well as treatment planning and delivery techniques. We also cover progress to date on emerging technologies including particle-based radiography imaging, novel treatment delivery methods such as tumor tracking and FLASH, and artificial intelligence and discuss their potential impact towards improving or increasing the challenge of motion mitigation in charged particle therapy.
Collapse
Affiliation(s)
- Julia M Pakela
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, United States
| | - Antje Knopf
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.,Department I of Internal Medicine, Center for Integrated Oncology Cologne, University Hospital of Cologne, Cologne, Germany
| | - Lei Dong
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, United States
| | - Antoni Rucinski
- Institute of Nuclear Physics, Polish Academy of Sciences, Krakow, Poland
| | - Wei Zou
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, United States
| |
Collapse
|
4
|
Dosimetric study of the interplay effect using three-dimensional motion phantom in proton pencil beam scanning treatment of moving thoracic tumours. JOURNAL OF RADIOTHERAPY IN PRACTICE 2021. [DOI: 10.1017/s1460396921000479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Abstract
Aim:
The dosimetric and clinical advantages offered by implementation of pencil beam scanning (PBS) proton therapy for moving thoracic tumours is hindered by interplay effect. The purpose of this study is to evaluate the impact of large proton beam spot size along with adaptive aperture (AA) and various motion mitigation techniques on the interplay effect for a range of motion amplitudes in a three-dimensional (3D) respiratory motion phantom.
Materials and Methods:
Point doses using ionisation chamber (IC) and planner dose distributions with radiochromic film were compared against the corresponding treatment planning system (TPS) information. A 3D respiratory motion phantom was scanned either for static or 4D computed tomographic (CT) technique for 6-, 10- and 14-mm motion amplitudes in SI direction. For free breathing (FB) treatment, a tumour was contoured on maximum intensity projection scan and an average scan was used for treatment planning. Each FB treatment was delivered with one, three and five volumetric repaintings (VRs). Three phases (CT40–60%) were extracted from the 4D-CT scans of each motion amplitude for the respiratory-gated treatment and were used for the treatment planning and delivery. All treatment plans were made using AA and robustly optimised with 5-mm set-up and 3·5% density uncertainty. A total of 26 treatment plans were delivered to IC and film using static, dynamic and respiratory-gated treatments combinations. A percent dose difference between IC and TPS for the point dose and gamma indices for film–TPS planner dose comparison was used.
Results:
The dose profile of film and TPS for the static phantom matched well, and percent dose difference between IC and TPS was 0·4%. The percent dose difference for all the gated treatments were below 3·0% except 14-mm motion amplitude-gated treatment. The gamma passing rate was more than 95% for film–TPS comparison for all gated treatment for the investigated gamma acceptance criteria. For FB treatments, the percent dose difference for 6-, 10- and 14-mm motion amplitude was 1·4%, −2·7% and −4·1%, respectively. As the number of VR increased, the percent difference between measured and calculated values decreased. The gamma passing rate met the required tolerance for different acceptance criteria except for the 14-mm motion amplitude FB treatment.
Conclusion:
The PBS technique for the FB thoracic treatments up to 10-mm motion amplitude can be implemented with an acceptable accuracy using large proton beam spot size, AA and robust optimisation. The impact of the interplay effect can be reduced with VR and respiratory-gated treatment and extend the treatable tumour motion amplitude.
Collapse
|
5
|
Tanaka S, Miyamoto N, Matsuo Y, Yoshimura T, Takao S, Matsuura T. First experimental results of gated proton imaging using x-ray fluoroscopy to detect a fiducial marker. Phys Med Biol 2021; 66. [PMID: 34433146 DOI: 10.1088/1361-6560/ac212b] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 08/25/2021] [Indexed: 11/12/2022]
Abstract
Increasing numbers of proton imaging research studies are being conducted for accurate proton range determination in proton therapy treatment planning. However, there is no proton imaging system that deals with motion artifacts. In this study, a gated proton imaging system was developed and the first experimental results of proton radiography (pRG) were obtained for a moving object without motion artifacts. A motion management system using dual x-ray fluoroscopy for detecting a spherical gold fiducial marker was introduced and the proton beam was gated in accordance with the motion of the object. To demonstrate the performance of the gated proton imaging system, gated pRG images of a moving phantom were acquired experimentally, and the motion artifacts clearly were diminished. Also, the factors causing image deteriorations were evaluated focusing on the new gating system developed here, and the main factor was identified as the latency (with a maximum value of 93 ms) between the ideal gating signal according to the actual marker position and the actual gating signal. The possible deterioration due to the latency of the proton imaging system and proton beam irradiation was small owing to appropriate setting of the time structure.
Collapse
Affiliation(s)
- Sodai Tanaka
- Institute for Quantum Medical Science, Quantum Medical Science Directorate, National Institutes for Quantum and Radiological Science and Technology, Chiba, Chiba, 263-8555, Japan
| | - Naoki Miyamoto
- Faculty of Engineering, Hokkaido University, Sapporo, Hokkaido 060-8628, Japan
| | - Yuto Matsuo
- Proton Beam Therapy Center, Hokkaido University Hospital, Sapporo, Hokkaido, 060-8648, Japan
| | - Takaaki Yoshimura
- Faculty of Health Sciences, Hokkaido University, Sapporo, Hokkaido 060-0812, Japan
| | - Seishin Takao
- Faculty of Engineering, Hokkaido University, Sapporo, Hokkaido 060-8628, Japan
| | - Taeko Matsuura
- Faculty of Engineering, Hokkaido University, Sapporo, Hokkaido 060-8628, Japan
| |
Collapse
|
6
|
Hayashi R, Miyazaki K, Takao S, Yokokawa K, Tanaka S, Matsuura T, Taguchi H, Katoh N, Shimizu S, Umegaki K, Miyamoto N. Real-time CT image generation based on voxel-by-voxel modeling of internal deformation by utilizing the displacement of fiducial markers. Med Phys 2021; 48:5311-5326. [PMID: 34260755 DOI: 10.1002/mp.15095] [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: 03/29/2021] [Revised: 06/17/2021] [Accepted: 07/07/2021] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To show the feasibility of real-time CT image generation technique utilizing internal fiducial markers that facilitate the evaluation of internal deformation. METHODS In the proposed method, a linear regression model that can derive internal deformation from the displacement of fiducial markers is built for each voxel in the training process before the treatment session. Marker displacement and internal deformation are derived from the four-dimensional computed tomography (4DCT) dataset. In the treatment session, the three-dimensional deformation vector field is derived according to the marker displacement, which is monitored by the real-time imaging system. The whole CT image can be synthesized by deforming the reference CT image with a deformation vector field in real-time. To show the feasibility of the technique, image synthesis accuracy and tumor localization accuracy were evaluated using the dataset generated by extended NURBS-Based Cardiac-Torso (XCAT) phantom and clinical 4DCT datasets from six patients, containing 10 CT datasets each. In the validation with XCAT phantom, motion range of the tumor in training data and validation data were about 10 and 15 mm, respectively, so as to simulate motion variation between 4DCT acquisition and treatment session. In the validation with patient 4DCT dataset, eight CT datasets from the 4DCT dataset were used in the training process. Two excluded inhale CT datasets can be regarded as the datasets with large deformations more than training dataset. CT images were generated for each respiratory phase using the corresponding marker displacement. Root mean squared error (RMSE), normalized RMSE (NRMSE), and structural similarity index measure (SSIM) between the original CT images and the synthesized CT images were evaluated as the quantitative indices of the accuracy of image synthesis. The accuracy of tumor localization was also evaluated. RESULTS In the validation with XCAT phantom, the mean NRMSE, SSIM, and three-dimensional tumor localization error were 7.5 ± 1.1%, 0.95 ± 0.02, and 0.4 ± 0.3 mm, respectively. In the validation with patient 4DCT dataset, the mean RMSE, NRMSE, SSIM, and three-dimensional tumor localization error in six patients were 73.7 ± 19.6 HU, 9.2 ± 2.6%, 0.88 ± 0.04, and 0.8 ± 0.6 mm, respectively. These results suggest that the accuracy of the proposed technique is adequate when the respiratory motion is within the range of the training dataset. In the evaluation with a marker displacement larger than that of the training dataset, the mean RMSE, NRMSE, and tumor localization error were about 100 HU, 13%, and <2.0 mm, respectively, except for one case having large motion variation. The performance of the proposed method was similar to those of previous studies. Processing time to generate the volumetric image was <100 ms. CONCLUSION We have shown the feasibility of the real-time CT image generation technique for volumetric imaging.
Collapse
Affiliation(s)
- Risa Hayashi
- Graduate School of Engineering, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Koichi Miyazaki
- Faculty of Engineering, Hokkaido University, Sapporo, Hokkaido, Japan.,Department of Medical Physics, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Seishin Takao
- Faculty of Engineering, Hokkaido University, Sapporo, Hokkaido, Japan.,Department of Medical Physics, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Kohei Yokokawa
- Faculty of Engineering, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Sodai Tanaka
- Faculty of Engineering, Hokkaido University, Sapporo, Hokkaido, Japan.,Department of Medical Physics, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Taeko Matsuura
- Faculty of Engineering, Hokkaido University, Sapporo, Hokkaido, Japan.,Department of Medical Physics, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Hiroshi Taguchi
- Department of Radiation Oncology, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Norio Katoh
- Faculty of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Shinichi Shimizu
- Department of Medical Physics, Hokkaido University Hospital, Sapporo, Hokkaido, Japan.,Faculty of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Kikuo Umegaki
- Faculty of Engineering, Hokkaido University, Sapporo, Hokkaido, Japan.,Department of Medical Physics, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Naoki Miyamoto
- Faculty of Engineering, Hokkaido University, Sapporo, Hokkaido, Japan.,Department of Medical Physics, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| |
Collapse
|
7
|
Musielak M, Suchorska WM, Fundowicz M, Milecki P, Malicki J. Future Perspectives of Proton Therapy in Minimizing the Toxicity of Breast Cancer Radiotherapy. J Pers Med 2021; 11:jpm11050410. [PMID: 34068305 PMCID: PMC8153289 DOI: 10.3390/jpm11050410] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 05/10/2021] [Accepted: 05/12/2021] [Indexed: 11/16/2022] Open
Abstract
The toxicity of radiotherapy is a key issue when analyzing the eligibility criteria for patients with breast cancer. In order to obtain better results, proton therapy is proposed because of the more favorable distribution of the dose in the patient’s body compared with photon radiotherapy. Scientific groups have conducted extensive research into the improved efficacy and lower toxicity of proton therapy for breast cancer. Unfortunately, there is no complete insight into the potential reasons and prospects for avoiding undesirable results. Cardiotoxicity is considered challenging; however, researchers have not presented any realistic prospects for preventing them. We compared the clinical evidence collected over the last 20 years, providing the rationale for the consideration of proton therapy as an effective solution to reduce cardiotoxicity. We analyzed the parameters of the dose distribution (mean dose, Dmax, V5, and V20) in organs at risk, such as the heart, blood vessels, and lungs, using the following two irradiation techniques: whole breast irradiation and accelerated partial breast irradiation. Moreover, we presented the possible causes of side effects, taking into account biological and technical issues. Finally, we collected potential improvements in higher quality predictions of toxic cardiac effects, like biomarkers, and model-based approaches to give the full background of this complex issue.
Collapse
Affiliation(s)
- Marika Musielak
- Electro-Radiology Department, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (W.M.S.); (P.M.); (J.M.)
- Greater Poland Cancer Centre, Radiobiology Laboratory, Department of Medical Physics, 61-866 Poznan, Poland
- Correspondence: ; Tel.: +48-505372290
| | - Wiktoria M. Suchorska
- Electro-Radiology Department, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (W.M.S.); (P.M.); (J.M.)
- Greater Poland Cancer Centre, Radiobiology Laboratory, Department of Medical Physics, 61-866 Poznan, Poland
| | | | - Piotr Milecki
- Electro-Radiology Department, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (W.M.S.); (P.M.); (J.M.)
- Greater Poland Cancer Centre, Radiotherapy Ward I, 61-866 Poznan, Poland;
| | - Julian Malicki
- Electro-Radiology Department, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (W.M.S.); (P.M.); (J.M.)
- Greater Poland Cancer Centre, Medical Physics Department, 61-866 Poznan, Poland
| |
Collapse
|
8
|
Czerska K, Emert F, Kopec R, Langen K, McClelland JR, Meijers A, Miyamoto N, Riboldi M, Shimizu S, Terunuma T, Zou W, Knopf A, Rucinski A. Clinical practice vs. state-of-the-art research and future visions: Report on the 4D treatment planning workshop for particle therapy - Edition 2018 and 2019. Phys Med 2021; 82:54-63. [PMID: 33588228 DOI: 10.1016/j.ejmp.2020.12.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 12/09/2020] [Accepted: 12/16/2020] [Indexed: 12/18/2022] Open
Abstract
The 4D Treatment Planning Workshop for Particle Therapy, a workshop dedicated to the treatment of moving targets with scanned particle beams, started in 2009 and since then has been organized annually. The mission of the workshop is to create an informal ground for clinical medical physicists, medical physics researchers and medical doctors interested in the development of the 4D technology, protocols and their translation into clinical practice. The 10th and 11th editions of the workshop took place in Sapporo, Japan in 2018 and Krakow, Poland in 2019, respectively. This review report from the Sapporo and Krakow workshops is structured in two parts, according to the workshop programs. The first part comprises clinicians and physicists review of the status of 4D clinical implementations. Corresponding talks were given by speakers from five centers around the world: Maastro Clinic (The Netherlands), University Medical Center Groningen (The Netherlands), MD Anderson Cancer Center (United States), University of Pennsylvania (United States) and The Proton Beam Therapy Center of Hokkaido University Hospital (Japan). The second part is dedicated to novelties in 4D research, i.e. motion modelling, artificial intelligence and new technologies which are currently being investigated in the radiotherapy field.
Collapse
Affiliation(s)
- Katarzyna Czerska
- Institute of Nuclear Physics Polish Academy of Sciences, PL-31342 Krakow, Poland.
| | - Frank Emert
- Center for Proton Therapy, Paul Scherrer Institute, Switzerland
| | - Renata Kopec
- Institute of Nuclear Physics Polish Academy of Sciences, PL-31342 Krakow, Poland
| | - Katja Langen
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Jamie R McClelland
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Arturs Meijers
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Naoki Miyamoto
- Department of Medical Physics, Hokkaido University Hospital, Sapporo, Hokkaido, Japan; Faculty of Engineering, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Marco Riboldi
- Department of Medical Physics, Ludwig-Maximilians-Universität München, Germany
| | - Shinichi Shimizu
- Department of Medical Physics, Hokkaido University Hospital, Sapporo, Hokkaido, Japan; Department of Radiation Medical Science and Engineering, Faculty of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Toshiyuki Terunuma
- Faculty of Medicine, University of Tsukuba, Japan; Proton Medical Research Center, University of Tsukuba Hospital, Japan
| | - Wei Zou
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Antje Knopf
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Antoni Rucinski
- Institute of Nuclear Physics Polish Academy of Sciences, PL-31342 Krakow, Poland
| |
Collapse
|
9
|
Yoshimura T, Shimizu S, Hashimoto T, Nishioka K, Katoh N, Taguchi H, Yasuda K, Matsuura T, Takao S, Tamura M, Tanaka S, Ito YM, Matsuo Y, Tamura H, Horita K, Umegaki K, Shirato H. Quantitative analysis of treatments using real-time image gated spot-scanning with synchrotron-based proton beam therapy system log data. J Appl Clin Med Phys 2020; 21:10-19. [PMID: 33151643 PMCID: PMC7769392 DOI: 10.1002/acm2.13029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 08/11/2020] [Accepted: 09/01/2020] [Indexed: 01/01/2023] Open
Abstract
A synchrotron-based real-time image gated spot-scanning proton beam therapy (RGPT) system with inserted fiducial markers can irradiate a moving tumor with high accuracy. As gated treatments increase the beam delivery time, this study aimed to investigate the frequency of intra-field adjustments corresponding to the baseline shift or drift and the beam delivery efficiency of a synchrotron-based RGPT system. Data from 118 patients corresponding to 127 treatment plans and 2810 sessions between October 2016 and March 2019 were collected. We quantitatively analyzed the proton beam delivery time, the difference between the ideal beam delivery time based on a simulated synchrotron magnetic excitation pattern and the actual treatment beam delivery time, frequency corresponding to the baseline shift or drift, and the gating efficiency of the synchrotron-based RGPT system according to the proton beam delivery machine log data. The mean actual beam delivery time was 7.1 min, and the simulated beam delivery time in an ideal environment with the same treatment plan was 2.9 min. The average difference between the actual and simulated beam delivery time per session was 4.3 min. The average frequency of intra-field adjustments corresponding to baseline shift or drift and beam delivery efficiency were 21.7% and 61.8%, respectively. Based on our clinical experience with a synchrotron-based RGPT system, we determined the frequency corresponding to baseline shift or drift and the beam delivery efficiency using the beam delivery machine log data. To maintain treatment accuracy within ± 2.0 mm, intra-field adjustments corresponding to baseline shift or drift were required in approximately 20% of cases. Further improvements in beam delivery efficiency may be realized by shortening the beam delivery time.
Collapse
Affiliation(s)
- Takaaki Yoshimura
- Department of Health Sciences and Technology, Faculty of Health Sciences, Hokkaido University, Sapporo, Japan.,Proton Beam Therapy Center, Hokkaido University Hospital, Sapporo, Japan
| | - Shinichi Shimizu
- Department of Radiation Medical Science and Engineering, Faculty of Medicine, Hokkaido University, Sapporo, Japan.,Global Station for Quantum Medical Science and Engineering, Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University, Sapporo, Japan
| | - Takayuki Hashimoto
- Department of Radiation Medical Science and Engineering, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Kentaro Nishioka
- Department of Radiation Medical Science and Engineering, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Norio Katoh
- Global Station for Quantum Medical Science and Engineering, Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University, Sapporo, Japan.,Department of Radiation Oncology, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Hiroshi Taguchi
- Global Station for Quantum Medical Science and Engineering, Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University, Sapporo, Japan.,Department of Radiation Oncology, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Koichi Yasuda
- Global Station for Quantum Medical Science and Engineering, Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University, Sapporo, Japan.,Department of Radiation Oncology, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Taeko Matsuura
- Faculty of Engineering, Hokkaido University, Sapporo, Japan
| | - Seishin Takao
- Proton Beam Therapy Center, Hokkaido University Hospital, Sapporo, Japan
| | - Masaya Tamura
- Proton Beam Therapy Center, Hokkaido University Hospital, Sapporo, Japan
| | - Sodai Tanaka
- Faculty of Engineering, Hokkaido University, Sapporo, Japan
| | - Yoichi M Ito
- Department of Statistical Data Science, The Institute of Statistical Mathematics, Tokyo, Japan
| | - Yuto Matsuo
- Proton Beam Therapy Center, Hokkaido University Hospital, Sapporo, Japan
| | - Hiroshi Tamura
- Proton Beam Therapy Center, Hokkaido University Hospital, Sapporo, Japan
| | - Kenji Horita
- Proton Beam Therapy Center, Hokkaido University Hospital, Sapporo, Japan
| | - Kikuo Umegaki
- Faculty of Engineering, Hokkaido University, Sapporo, Japan
| | - Hiroki Shirato
- Global Station for Quantum Medical Science and Engineering, Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University, Sapporo, Japan.,Department of Proton Beam Therapy, Research Center for Cooperative Projects, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| |
Collapse
|
10
|
Miyamoto N, Yokokawa K, Takao S, Matsuura T, Tanaka S, Shimizu S, Shirato H, Umegaki K. Dynamic gating window technique for the reduction of dosimetric error in respiratory-gated spot-scanning particle therapy: An initial phantom study using patient tumor trajectory data. J Appl Clin Med Phys 2020; 21:13-21. [PMID: 32068347 PMCID: PMC7170289 DOI: 10.1002/acm2.12832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 01/06/2020] [Accepted: 01/14/2020] [Indexed: 11/22/2022] Open
Abstract
Spot‐scanning particle therapy possesses advantages, such as high conformity to the target and efficient energy utilization compared with those of the passive scattering irradiation technique. However, this irradiation technique is sensitive to target motion. In the current clinical situation, some motion management techniques, such as respiratory‐gated irradiation, which uses an external or internal surrogate, have been clinically applied. In surrogate‐based gating, the size of the gating window is fixed during the treatment in the current treatment system. In this study, we propose a dynamic gating window technique, which optimizes the size of gating window for each spot by considering a possible dosimetric error. The effectiveness of the dynamic gating window technique was evaluated by simulating irradiation using a moving target in a water phantom. In dosimetric characteristics comparison, the dynamic gating window technique exhibited better performance in all evaluation volumes with different effective depths compared with that of the fixed gate approach. The variation of dosimetric characteristics according to the target depth was small in dynamic gate compared to fixed gate. These results suggest that the dynamic gating window technique can maintain an acceptable dose distribution regardless of the target depth. The overall gating efficiency of the dynamic gate was approximately equal or greater than that of the fixed gating window. In dynamic gate, as the target depth becomes shallower, the gating efficiency will be reduced, although dosimetric characteristics will be maintained regardless of the target depth. The results of this study suggest that the proposed gating technique may potentially improve the dose distribution. However, additional evaluations should be undertaken in the future to determine clinical applicability by assuming the specifications of the treatment system and clinical situation.
Collapse
Affiliation(s)
- Naoki Miyamoto
- Division of Quantum Science and Engineering, Faculty of Engineering, Hokkaido University, Sapporo, Japan.,Global Station for Quantum Medical Science and Engineering, Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University, Sapporo, Japan.,Department of Medical Physics, Hokkaido University Hospital, Sapporo, Japan
| | - Kouhei Yokokawa
- Division of Quantum Science and Engineering, Faculty of Engineering, Hokkaido University, Sapporo, Japan
| | - Seishin Takao
- Global Station for Quantum Medical Science and Engineering, Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University, Sapporo, Japan.,Department of Medical Physics, Hokkaido University Hospital, Sapporo, Japan
| | - Taeko Matsuura
- Division of Quantum Science and Engineering, Faculty of Engineering, Hokkaido University, Sapporo, Japan.,Global Station for Quantum Medical Science and Engineering, Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University, Sapporo, Japan.,Department of Medical Physics, Hokkaido University Hospital, Sapporo, Japan
| | - Sodai Tanaka
- Division of Quantum Science and Engineering, Faculty of Engineering, Hokkaido University, Sapporo, Japan.,Department of Medical Physics, Hokkaido University Hospital, Sapporo, Japan
| | - Shinichi Shimizu
- Global Station for Quantum Medical Science and Engineering, Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University, Sapporo, Japan.,Department of Medical Physics, Hokkaido University Hospital, Sapporo, Japan.,Department of Radiation Medical Science and Engineering, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Hiroki Shirato
- Global Station for Quantum Medical Science and Engineering, Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University, Sapporo, Japan.,Department of Radiation Medicine, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Kikuo Umegaki
- Division of Quantum Science and Engineering, Faculty of Engineering, Hokkaido University, Sapporo, Japan.,Global Station for Quantum Medical Science and Engineering, Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University, Sapporo, Japan
| |
Collapse
|
11
|
Han Y. Current status of proton therapy techniques for lung cancer. Radiat Oncol J 2019; 37:232-248. [PMID: 31918460 PMCID: PMC6952710 DOI: 10.3857/roj.2019.00633] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 12/26/2019] [Indexed: 12/11/2022] Open
Abstract
Proton beams have been used for cancer treatment for more than 28 years, and several technological advancements have been made to achieve improved clinical outcomes by delivering more accurate and conformal doses to the target cancer cells while minimizing the dose to normal tissues. The state-of-the-art intensity modulated proton therapy is now prevailing as a major treatment technique in proton facilities worldwide, but still faces many challenges in being applied to the lung. Thus, in this article, the current status of proton therapy technique is reviewed and issues regarding the relevant uncertainty in proton therapy in the lung are summarized.
Collapse
Affiliation(s)
- Youngyih Han
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea
| |
Collapse
|
12
|
Yoshimura T, Shimizu S, Hashimoto T, Nishioka K, Katoh N, Inoue T, Taguchi H, Yasuda K, Matsuura T, Takao S, Tamura M, Ito YM, Matsuo Y, Tamura H, Horita K, Umegaki K, Shirato H. Analysis of treatment process time for real-time-image gated-spot-scanning proton-beam therapy (RGPT) system. J Appl Clin Med Phys 2019; 21:38-49. [PMID: 31886616 PMCID: PMC7020995 DOI: 10.1002/acm2.12804] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 10/27/2019] [Accepted: 12/03/2019] [Indexed: 12/16/2022] Open
Abstract
We developed a synchrotron‐based real‐time‐image gated‐spot‐scanning proton‐beam therapy (RGPT) system and utilized it to clinically operate on moving tumors in the liver, pancreas, lung, and prostate. When the spot‐scanning technique is linked to gating, the beam delivery time with gating can increase, compared to that without gating. We aim to clarify whether the total treatment process can be performed within approximately 30 min (the general time per session in several proton therapy facilities), even for gated‐spot‐scanning proton‐beam delivery with implanted fiducial markers. Data from 152 patients, corresponding to 201 treatment plans and 3577 sessions executed from October 2016 to June 2018, were included in this study. To estimate the treatment process time, we utilized data from proton beam delivery logs during the treatment for each patient. We retrieved data, such as the disease site, total target volume, field size at the isocenter, and the number of layers and spots for each field, from the treatment plans. We quantitatively analyzed the treatment process, which includes the patient load (or setup), bone matching, marker matching, beam delivery, patient unload, and equipment setup, using the data obtained from the log data. Among all the cases, 90 patients used the RGPT system (liver: n = 34; pancreas: n = 5; lung: n = 4; and prostate: n = 47). The mean and standard deviation (SD) of the total treatment process time for the RGPT system was 30.3 ± 7.4 min, while it was 25.9 ± 7.5 min for those without gating treatment, excluding craniospinal irradiation (CSI; head and neck: n = 16, pediatric: n = 31, others: n = 15); for CSI (n = 11) with two or three isocenters, the process time was 59.9 ± 13.9 min. Our results demonstrate that spot‐scanning proton therapy with a gating function can be achieved in approximately 30‐min time slots.
Collapse
Affiliation(s)
| | - Shinichi Shimizu
- Department of Radiation OncologyFaculty of MedicineHokkaido UniversitySapporoJapan
- Global Station for Quantum Medical Science and EngineeringGlobal Institution for Collaborative Research and Education (GI‐CoRE)Hokkaido UniversitySapporoJapan
| | - Takayuki Hashimoto
- Department of Radiation MedicineFaculty of MedicineHokkaido UniversitySapporoJapan
| | - Kentaro Nishioka
- Department of Radiation OncologyFaculty of MedicineHokkaido UniversitySapporoJapan
| | - Norio Katoh
- Global Station for Quantum Medical Science and EngineeringGlobal Institution for Collaborative Research and Education (GI‐CoRE)Hokkaido UniversitySapporoJapan
- Department of Radiation OncologyHokkaido University HospitalSapporoJapan
| | - Tetsuya Inoue
- Global Station for Quantum Medical Science and EngineeringGlobal Institution for Collaborative Research and Education (GI‐CoRE)Hokkaido UniversitySapporoJapan
- Department of Radiation OncologyHokkaido University HospitalSapporoJapan
| | - Hiroshi Taguchi
- Global Station for Quantum Medical Science and EngineeringGlobal Institution for Collaborative Research and Education (GI‐CoRE)Hokkaido UniversitySapporoJapan
- Department of Radiation OncologyHokkaido University HospitalSapporoJapan
| | - Koichi Yasuda
- Global Station for Quantum Medical Science and EngineeringGlobal Institution for Collaborative Research and Education (GI‐CoRE)Hokkaido UniversitySapporoJapan
- Department of Radiation OncologyHokkaido University HospitalSapporoJapan
| | | | - Seishin Takao
- Department of Radiation OncologyHokkaido University HospitalSapporoJapan
| | - Masaya Tamura
- Department of Radiation OncologyHokkaido University HospitalSapporoJapan
| | - Yoichi M. Ito
- Department of Statistical Data ScienceThe Institute of Statistical MathematicsTokyoJapan
| | - Yuto Matsuo
- Proton Beam Therapy CenterHokkaido University HospitalSapporoJapan
| | - Hiroshi Tamura
- Proton Beam Therapy CenterHokkaido University HospitalSapporoJapan
| | - Kenji Horita
- Proton Beam Therapy CenterHokkaido University HospitalSapporoJapan
| | - Kikuo Umegaki
- Faculty of EngineeringHokkaido UniversitySapporoJapan
| | - Hiroki Shirato
- Global Station for Quantum Medical Science and EngineeringGlobal Institution for Collaborative Research and Education (GI‐CoRE)Hokkaido UniversitySapporoJapan
- Department of Radiation MedicineFaculty of MedicineHokkaido UniversitySapporoJapan
| |
Collapse
|
13
|
Hashimoto T, Shimizu S, Takao S, Terasaka S, Iguchi A, Kobayashi H, Mori T, Yoshimura T, Matsuo Y, Tamura M, Matsuura T, Ito YM, Onimaru R, Shirato H. Clinical experience of craniospinal intensity-modulated spot-scanning proton therapy using large fields for central nervous system medulloblastomas and germ cell tumors in children, adolescents, and young adults. JOURNAL OF RADIATION RESEARCH 2019; 60:527-537. [PMID: 31111946 PMCID: PMC6640905 DOI: 10.1093/jrr/rrz022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 02/28/2019] [Indexed: 06/09/2023]
Abstract
The outcomes of intensity-modulated proton craniospinal irradiation (ipCSI) are unclear. We evaluated the clinical benefit of our newly developed ipCSI system that incorporates two gantry-mounted orthogonal online X-ray imagers with a robotic six-degrees-of-freedom patient table. Nine patients (7-19 years old) were treated with ipCSI. The prescribed dose for CSI ranged from 23.4 to 36.0 Gy (relative biological effectiveness) in 13-20 fractions. Four adolescent and young adult (AYA) patients (15 years or older) were treated with vertebral-body-sparing ipCSI (VBSipCSI). Myelosuppression following VBSipCSI was compared with that of eight AYA patients treated with photon CSI at the same institution previously. The mean homogeneity index (HI) in the nine patients was 0.056 (95% confidence interval: 0.044-0.068). The mean time from the start to the end of all beam delivery was 37 min 39 s ± 2 min 24 s (minimum to maximum: 22 min 49 s - 42 min 51 s). The nadir white blood cell, hemoglobin, and platelet levels during the 4 weeks following the end of the CSI were significantly higher in the VBSipCSI group than in the photon CSI group (P = 0.0071, 0.0453, 0.0024, respectively). The levels at 4 weeks after the end of CSI were significantly higher in the VBSipCSI group than in the photon CSI group (P = 0.0023, 0.0414, 0.0061). Image-guided ipCSI was deliverable in a reasonable time with sufficient HI. Using VBSipCSI, AYA patients experienced a lower incidence of serious acute hematological toxicity than AYA patients treated with photon CSI.
Collapse
Affiliation(s)
- Takayuki Hashimoto
- Department of Radiation Medicine, Faculty of Medicine, Hokkaido University
- Global Station for Quantum Medical Science and Engineering, Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University
| | - Shinichi Shimizu
- Global Station for Quantum Medical Science and Engineering, Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University
- Department of Radiation Oncology, Faculty of Medicine, Hokkaido University
| | - Seishin Takao
- Global Station for Quantum Medical Science and Engineering, Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University
- Proton Beam Therapy Center, Hokkaido University Hospital
| | - Shunsuke Terasaka
- Department of Neurosurgery, Faculty of Medicine, Hokkaido University
| | - Akihiro Iguchi
- Department of Pediatrics, Faculty of Medicine, Hokkaido University
| | | | - Takashi Mori
- Department of Radiation Oncology, Hokkaido University Hospital
| | | | - Yuto Matsuo
- Proton Beam Therapy Center, Hokkaido University Hospital
| | - Masaya Tamura
- Department of Radiation Medicine, Faculty of Medicine, Hokkaido University
| | - Taeko Matsuura
- Global Station for Quantum Medical Science and Engineering, Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University
- Division of Quantum Science and Engineering, Faculty of Engineering, Hokkaido University
| | - Yoichi M Ito
- Department of Statistical Data Science, The Institute of Statistical Mathematics
| | - Rikiya Onimaru
- Department of Radiation Medicine, Faculty of Medicine, Hokkaido University
| | - Hiroki Shirato
- Department of Radiation Medicine, Faculty of Medicine, Hokkaido University
- Global Station for Quantum Medical Science and Engineering, Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University
| |
Collapse
|
14
|
Fattori G, Klimpki G, Hrbacek J, Zhang Y, Krieger M, Placidi L, Psoroulas S, Weber DC, Lomax AJ, Safai S. The dependence of interplay effects on the field scan direction in PBS proton therapy. Phys Med Biol 2019; 64:095005. [PMID: 30893664 DOI: 10.1088/1361-6560/ab1150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
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 compared increasingly complex treatment fields, from a homogeneous single energy layer to a more modulated lung plan, under identical experimental settings, seeking evidence for differences in motion mitigation due to the selection of primary scanning direction. In total, 120 experimental samples were taken, combining two primary scan directions and three rescanning regimes with different motion scenarios. 4D dose distributions were measured in water with a moving ionisation chamber array and compared to those of a stationary delivery using 2D gamma analysis. Each plan has been verified twice for the same rescanning regime and motion scenario, changing the meandering direction in between to scan perpendicularly to, or along, the target motion. Additionally, machine log files of the lung plan, together with 4DCT data, were used to calculate the dose distribution that such deliveries would have produced in the patient. The primary meandering direction has a clear influence on measured dose distributions when considering a single energy layer. Introducing spot weight modulation and multiple energy layers however, makes the dynamic of interplay more complex and difficult to predict. Overall, gamma (3%/3 mm) differences between scanning along or orthogonal to the target motion follow a normal distribution [Formula: see text] when considering multiple motion scenarios and rescanning regimes. Nevertheless, data spread [Formula: see text] is significant enough such that, for individual experiments and set-ups, a dependency may be observed even if this is not a general result. Patient reconstructed doses follow the same trend, the two primary scan directions producing statistically insignificant differences in dose distributions in terms of conformity or homogeneity. Except for extremely simplified cases of mono-energetic and homogeneous treatment fields, the interplay effect has been found to be only marginally influenced by the choice of the primary scanning direction.
Collapse
Affiliation(s)
- G Fattori
- Paul Scherrer Institute (PSI), Center for Proton Therapy, 5232 Villigen PSI, Switzerland. The author to whom correspondence may be addressed
| | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Giordanengo S, Vignati A, Attili A, Ciocca M, Donetti M, Fausti F, Manganaro L, Milian FM, Molinelli S, Monaco V, Russo G, Sacchi R, Varasteh Anvar M, Cirio R. RIDOS: A new system for online computation of the delivered dose distributions in scanning ion beam therapy. Phys Med 2019; 60:139-149. [PMID: 31000074 DOI: 10.1016/j.ejmp.2019.03.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 02/21/2019] [Accepted: 03/27/2019] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To describe a new system for scanned ion beam therapy, named RIDOS (Real-time Ion DOse planning and delivery System), which performs real time delivered dose verification integrating the information from a clinical beam monitoring system with a Graphic Processing Unit (GPU) based dose calculation in patient Computed Tomography. METHODS A benchmarked dose computation algorithm for scanned ion beams has been parallelized and adapted to run on a GPU architecture. A workstation equipped with a NVIDIA GPU has been interfaced through a National Instruments PXI-crate with the dose delivery system of the Italian National Center of Oncological Hadrontherapy (CNAO) to receive in real-time the measured beam parameters. Data from a patient monitoring system are also collected to associate the respiratory phases with each spot during the delivery of the dose. Using both measured and planned spot properties, RIDOS evaluates during the few seconds of inter-spill time the cumulative delivered and prescribed dose distributions and compares them through a fast γ-index algorithm. RESULTS The accuracy of the GPU-based algorithms was assessed against the CPU-based ones and the differences were found below 1‰. The cumulative planned and delivered doses are computed at the end of each spill in about 300 ms, while the dose comparison takes approximatively 400 ms. The whole operation provides the results before the next spill starts. CONCLUSIONS RIDOS system is able to provide a fast computation of the delivered dose in the inter-spill time of the CNAO facility and allows to monitor online the dose deposition accuracy all along the treatment.
Collapse
Affiliation(s)
- S Giordanengo
- Istituto Nazionale di Fisica Nucleare, Via Giuria 1, 10125 Torino, Italy.
| | - A Vignati
- Istituto Nazionale di Fisica Nucleare, Via Giuria 1, 10125 Torino, Italy
| | - A Attili
- Istituto Nazionale di Fisica Nucleare, Via Giuria 1, 10125 Torino, Italy
| | - M Ciocca
- Centro Nazionale di Adroterapia Oncologica, Strada Campeggi 53, 27100 Pavia, Italy
| | - M Donetti
- Centro Nazionale di Adroterapia Oncologica, Strada Campeggi 53, 27100 Pavia, Italy
| | - F Fausti
- Istituto Nazionale di Fisica Nucleare, Via Giuria 1, 10125 Torino, Italy; Politecnico di Torino, C.so Duca degli Abruzzi 24, 10129 Torino, Italy
| | - L Manganaro
- Istituto Nazionale di Fisica Nucleare, Via Giuria 1, 10125 Torino, Italy; Università di Torino, Via Giuria 1, 10125 Torino, Italy
| | - F M Milian
- Universidade Estadual de Santa Cruz, Rod Jorge Amado, km 16, 45652900 Ilheus, Brazil; Università di Torino, Via Giuria 1, 10125 Torino, Italy
| | - S Molinelli
- Centro Nazionale di Adroterapia Oncologica, Strada Campeggi 53, 27100 Pavia, Italy
| | - V Monaco
- Istituto Nazionale di Fisica Nucleare, Via Giuria 1, 10125 Torino, Italy; Università di Torino, Via Giuria 1, 10125 Torino, Italy
| | - G Russo
- Istituto Nazionale di Fisica Nucleare, Via Giuria 1, 10125 Torino, Italy
| | - R Sacchi
- Istituto Nazionale di Fisica Nucleare, Via Giuria 1, 10125 Torino, Italy; Università di Torino, Via Giuria 1, 10125 Torino, Italy
| | - M Varasteh Anvar
- Istituto Nazionale di Fisica Nucleare, Via Giuria 1, 10125 Torino, Italy; Università di Torino, Via Giuria 1, 10125 Torino, Italy
| | - R Cirio
- Istituto Nazionale di Fisica Nucleare, Via Giuria 1, 10125 Torino, Italy; Università di Torino, Via Giuria 1, 10125 Torino, Italy
| |
Collapse
|
16
|
Mori S, Knopf A, Umegaki K. Motion management in particle therapy. Med Phys 2018; 45:e994-e1010. [DOI: 10.1002/mp.12679] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 10/24/2017] [Accepted: 11/07/2017] [Indexed: 11/08/2022] Open
Affiliation(s)
- Shinichiro Mori
- Research Center for Charged Particle Therapy National Institute of Radiological Sciences Chiba 263‐8555Japan
| | - Antje‐Christin Knopf
- Department of Radiation Oncology University of Groningen University Medical Center Groningen Groningen 9713 GZ The Netherlands
| | - Kikuo Umegaki
- Faculty of Engineering Division of Quantum Science and Engineering Hokkaido University Sapporo 060‐8628 Japan
| |
Collapse
|
17
|
Nishioka K, Prayongrat A, Ono K, Onodera S, Hashimoto T, Katoh N, Inoue T, Kinoshita R, Yasuda K, Mori T, Onimaru R, Shirato H, Shimizu S. Prospective study to evaluate the safety of the world-first spot-scanning dedicated, small 360-degree gantry, synchrotron-based proton beam therapy system. JOURNAL OF RADIATION RESEARCH 2018; 59:i63-i71. [PMID: 29309691 PMCID: PMC5868184 DOI: 10.1093/jrr/rrx083] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Indexed: 05/08/2023]
Abstract
This is a report of a single-institution prospective study evaluating the safety of a spot-scanning dedicated, small 360-degree gantry, synchrotron-based proton beam therapy (PBT) system. Data collection was performed for 56 patients with 59 treatment sites who received proton beam therapy at Hokkaido University Hospital between March 2014 and July 2015. Forty-one patients were male and 15 were female. The median age was 66 years. The primary lesion sites were prostate (n = 17), bone/soft tissue (n = 10), liver (n = 7), lung (n = 6), central nervous system (n = 5), colon (n = 2), pancreas (n = 2), kidney (n = 2) and others (n = 5). Chemotherapy was administered in 11 patients. The prescribed total dose was from 20 to 76 GyE (Radiobiological equivalent dose, RBE = 1.1), with the median dose of 65 GyE in 4 to 35 fractions. No PBT-related Common Terminology Criteria for Adverse Events Grade 4 or 5 toxicities were observed; the incidence of early PBT-related Grade 4 adverse events was 0% (95% confidence interval 0 to 6.38%). The most common Grade 3 toxicities were hematologic toxicity (12.5%) unlikely to be related to the PBT. One patient developed a left femoral neck fracture (Grade 3) at 14.5 months after PBT for chondrosarcoma of the left pelvis. The pathological findings showed no other malignancies, suggesting that it was possibly related to the PBT. In conclusion, the spot-scanning dedicated, synchrotron-based PBT system is feasible, but further studies on its long-term safety and efficacy are warranted.
Collapse
Affiliation(s)
- Kentaro Nishioka
- Department of Radiation Oncology, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Anussara Prayongrat
- Department of Radiation Oncology, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Kota Ono
- Hokkaido University Hospital Clinical Research and Medical Innovation Center
| | - Shunsuke Onodera
- Department of Radiation Oncology, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Takayuki Hashimoto
- Department of Radiation Medicine, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Norio Katoh
- Department of Radiation Oncology, Hokkaido University Hospital
| | - Tetsuya Inoue
- Department of Radiation Oncology, Hokkaido University Hospital
| | | | - Koichi Yasuda
- Department of Radiation Medicine, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Takashi Mori
- Department of Radiation Oncology, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Rikiya Onimaru
- Department of Radiation Medicine, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Hiroki Shirato
- Department of Radiation Medicine, Faculty of Medicine, Hokkaido University, Sapporo, Japan
- Global Station for Quantum Biomedical Science and Engineering, Global Institute for Cooperative Research and Education, Hokkaido University
| | - Shinichi Shimizu
- Department of Radiation Oncology, Faculty of Medicine, Hokkaido University, Sapporo, Japan
- Global Station for Quantum Biomedical Science and Engineering, Global Institute for Cooperative Research and Education, Hokkaido University
- Corresponding author. North-15 West-7, Kita-ku, 0608638, Sapporo, Hokkaido, Japan. Tel: +81-11-706-7798; Fax: +81-11-706-7876;
| |
Collapse
|
18
|
Liu C, Schild SE, Chang JY, Liao Z, Korte S, Shen J, Ding X, Hu Y, Kang Y, Keole SR, Sio TT, Wong WW, Sahoo N, Bues M, Liu W. Impact of Spot Size and Spacing on the Quality of Robustly Optimized Intensity Modulated Proton Therapy Plans for Lung Cancer. Int J Radiat Oncol Biol Phys 2018; 101:479-489. [PMID: 29550033 DOI: 10.1016/j.ijrobp.2018.02.009] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 01/31/2018] [Accepted: 02/05/2018] [Indexed: 12/19/2022]
Abstract
PURPOSE To investigate how spot size and spacing affect plan quality, robustness, and interplay effects of robustly optimized intensity modulated proton therapy (IMPT) for lung cancer. METHODS AND MATERIALS Two robustly optimized IMPT plans were created for 10 lung cancer patients: first by a large-spot machine with in-air energy-dependent large spot size at isocenter (σ: 6-15 mm) and spacing (1.3 σ), and second by a small-spot machine with in-air energy-dependent small spot size (σ: 2-6 mm) and spacing (5 mm). Both plans were generated by optimizing radiation dose to internal target volume on averaged 4-dimensional computed tomography scans using an in-house-developed IMPT planning system. The dose-volume histograms band method was used to evaluate plan robustness. Dose evaluation software was developed to model time-dependent spot delivery to incorporate interplay effects with randomized starting phases for each field per fraction. Patient anatomy voxels were mapped phase-to-phase via deformable image registration, and doses were scored using in-house-developed software. Dose-volume histogram indices, including internal target volume dose coverage, homogeneity, and organs at risk (OARs) sparing, were compared using the Wilcoxon signed-rank test. RESULTS Compared with the large-spot machine, the small-spot machine resulted in significantly lower heart and esophagus mean doses, with comparable target dose coverage, homogeneity, and protection of other OARs. Plan robustness was comparable for targets and most OARs. With interplay effects considered, significantly lower heart and esophagus mean doses with comparable target dose coverage and homogeneity were observed using smaller spots. CONCLUSIONS Robust optimization with a small spot-machine significantly improves heart and esophagus sparing, with comparable plan robustness and interplay effects compared with robust optimization with a large-spot machine. A small-spot machine uses a larger number of spots to cover the same tumors compared with a large-spot machine, which gives the planning system more freedom to compensate for the higher sensitivity to uncertainties and interplay effects for lung cancer treatments.
Collapse
Affiliation(s)
- Chenbin Liu
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, Arizona
| | - Steven E Schild
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, Arizona
| | - Joe Y Chang
- Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Zhongxing Liao
- Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Shawn Korte
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, Arizona
| | - Jiajian Shen
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, Arizona
| | - Xiaoning Ding
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, Arizona
| | - Yanle Hu
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, Arizona
| | - Yixiu Kang
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, Arizona
| | - Sameer R Keole
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, Arizona
| | - Terence T Sio
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, Arizona
| | - William W Wong
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, Arizona
| | - Narayan Sahoo
- Department of Radiation Physics, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Martin Bues
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, Arizona
| | - Wei Liu
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, Arizona.
| |
Collapse
|
19
|
Mohan R, Das IJ, Ling CC. Empowering Intensity Modulated Proton Therapy Through Physics and Technology: An Overview. Int J Radiat Oncol Biol Phys 2017; 99:304-316. [PMID: 28871980 PMCID: PMC5651132 DOI: 10.1016/j.ijrobp.2017.05.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 04/11/2017] [Accepted: 05/02/2017] [Indexed: 01/15/2023]
Abstract
Considering the clinical potential of protons attributable to their physical characteristics, interest in proton therapy has increased greatly in this century, as has the number of proton therapy installations. Until recently, passively scattered proton therapy was used almost entirely. Notably, the overall clinical results to date have not shown a convincing benefit of protons over photons. A rapid transition is now occurring with the implementation of the most advanced form of proton therapy, intensity modulated proton therapy (IMPT). IMPT is superior to passively scattered proton therapy and intensity modulated radiation therapy (IMRT) dosimetrically. However, numerous limitations exist in the present IMPT methods. In particular, compared with IMRT, IMPT is highly vulnerable to various uncertainties. In this overview we identify three major areas of current limitations of IMPT: treatment planning, treatment delivery, and motion management, and discuss current and future efforts for improvement. For treatment planning, we need to reduce uncertainties in proton range and in computed dose distributions, improve robust planning and optimization, enhance adaptive treatment planning and delivery, and consider how to exploit the variability in the relative biological effectiveness of protons for clinical benefit. The quality of proton therapy also depends on the characteristics of the IMPT delivery systems and image guidance. Efforts are needed to optimize the beamlet spot size for both improved dose conformality and faster delivery. For the latter, faster energy switching time and increased dose rate are also needed. Real-time in-room volumetric imaging for guiding IMPT is in its early stages with cone beam computed tomography (CT) and CT-on-rails, and continued improvements are anticipated. In addition, imaging of the proton beams themselves, using, for instance, prompt γ emissions, is being developed to determine the proton range and to reduce range uncertainty. With the realization of the advances described above, we posit that IMPT, thus empowered, will lead to substantially improved clinical results.
Collapse
Affiliation(s)
- Radhe Mohan
- Department of Radiation Physics, MD Anderson Cancer Center, Houston, Texas.
| | - Indra J Das
- Department of Radiation Oncology, New York University Langone Medical Center, New York, New York
| | - Clifton C Ling
- Varian Medical Systems and Department of Radiation Oncology, Stanford University, Stanford, California
| |
Collapse
|
20
|
Consensus Guidelines for Implementing Pencil-Beam Scanning Proton Therapy for Thoracic Malignancies on Behalf of the PTCOG Thoracic and Lymphoma Subcommittee. Int J Radiat Oncol Biol Phys 2017; 99:41-50. [DOI: 10.1016/j.ijrobp.2017.05.014] [Citation(s) in RCA: 145] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 04/05/2017] [Accepted: 05/09/2017] [Indexed: 12/25/2022]
|
21
|
Fujii Y, Matsuura T, Takao S, Matsuzaki Y, Fujii T, Miyamoto N, Umegaki K, Nishioka K, Shimizu S, Shirato H. A simulation study on the dosimetric benefit of real-time motion compensation in spot-scanning proton therapy for prostate. JOURNAL OF RADIATION RESEARCH 2017; 58:591-597. [PMID: 28472381 PMCID: PMC5570041 DOI: 10.1093/jrr/rrx020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 01/30/2017] [Indexed: 06/07/2023]
Abstract
For proton spot scanning, use of a real-time-image gating technique incorporating an implanted marker and dual fluoroscopy facilitates mitigation of the dose distribution deterioration caused by interplay effects. This study explored the advantages of using a real-time-image gating technique, with a focus on prostate cancer. Two patient-positioning methods using fiducial markers were compared: (i) patient positioning only before beam delivery, and (ii) patient positioning both before and during beam delivery using a real-time-gating technique. For each scenario, dose distributions were simulated using the CT images of nine prostate cancer patients. Treatment plans were generated using a single-field proton beam with 3-mm and 6-mm lateral margins. During beam delivery, the prostate was assumed to move by 5 mm in four directions that were perpendicular to the beam direction at one of three separate timings (i.e. after the completion of the first, second and third quartiles of the total delivery of spot irradiation). Using a 3-mm margin and second quartile motion timing, the averaged values for ΔD99, ΔD95, ΔD5 and D5-95 were 5.1%, 3.3%, 3.6% and 9.0%, respectively, for Scenario (i) and 2.1%, 1.5%, 0.5% and 4.1%, respectively, for Scenario (ii). The margin expansion from 3 mm to 6 mm reduced the size of ΔD99, ΔD95, ΔD5 and D5-95 only with Scenario (i). These results indicate that patient positioning during beam delivery is an effective way to obtain better target coverage and uniformity while reducing the target margin when the prostate moves during irradiation.
Collapse
Affiliation(s)
- Yusuke Fujii
- Proton Beam Therapy Center, Hokkaido University Hospital, Kita 14 Nishi 5, Sapporo 060-8648, Japan, Japan
| | - Taeko Matsuura
- Proton Beam Therapy Center, Hokkaido University Hospital, Kita 14 Nishi 5, Sapporo 060-8648, Japan, Japan
- Global Station for Quantum Medical Science and Engineering, Global Institution for Collaborative Research and Education, Hokkaido University, Kita 14 Nishi 5, Sapporo 060-8648, Japan
- Division of Quantum Science and Engineering, Faculty of Engineering, Hokkaido University, Kita 13 Nishi 8, Sapporo 060-8628, Japan
| | - Seishin Takao
- Proton Beam Therapy Center, Hokkaido University Hospital, Kita 14 Nishi 5, Sapporo 060-8648, Japan, Japan
- Global Station for Quantum Medical Science and Engineering, Global Institution for Collaborative Research and Education, Hokkaido University, Kita 14 Nishi 5, Sapporo 060-8648, Japan
- Division of Quantum Science and Engineering, Faculty of Engineering, Hokkaido University, Kita 13 Nishi 8, Sapporo 060-8628, Japan
| | - Yuka Matsuzaki
- Proton Beam Therapy Center, Hokkaido University Hospital, Kita 14 Nishi 5, Sapporo 060-8648, Japan, Japan
| | - Takaaki Fujii
- Proton Beam Therapy Center, Hokkaido University Hospital, Kita 14 Nishi 5, Sapporo 060-8648, Japan, Japan
| | - Naoki Miyamoto
- Department of Medical Physics, Hokkaido University Hospital, Kita 14 Nishi 5, Sapporo 060-8648, Japan
| | - Kikuo Umegaki
- Proton Beam Therapy Center, Hokkaido University Hospital, Kita 14 Nishi 5, Sapporo 060-8648, Japan, Japan
- Global Station for Quantum Medical Science and Engineering, Global Institution for Collaborative Research and Education, Hokkaido University, Kita 14 Nishi 5, Sapporo 060-8648, Japan
- Division of Quantum Science and Engineering, Faculty of Engineering, Hokkaido University, Kita 13 Nishi 8, Sapporo 060-8628, Japan
| | - Kentaro Nishioka
- Proton Beam Therapy Center, Hokkaido University Hospital, Kita 14 Nishi 5, Sapporo 060-8648, Japan, Japan
- Department of Radiation Oncology, Hokkaido University Hospital, Kita 15 Nishi 7, Sapporo 060-8638, Japan
| | - Shinichi Shimizu
- Proton Beam Therapy Center, Hokkaido University Hospital, Kita 14 Nishi 5, Sapporo 060-8648, Japan, Japan
- Global Station for Quantum Medical Science and Engineering, Global Institution for Collaborative Research and Education, Hokkaido University, Kita 14 Nishi 5, Sapporo 060-8648, Japan
- Department of Radiation Oncology, Hokkaido University Hospital, Kita 15 Nishi 7, Sapporo 060-8638, Japan
| | - Hiroki Shirato
- Proton Beam Therapy Center, Hokkaido University Hospital, Kita 14 Nishi 5, Sapporo 060-8648, Japan, Japan
- Global Station for Quantum Medical Science and Engineering, Global Institution for Collaborative Research and Education, Hokkaido University, Kita 14 Nishi 5, Sapporo 060-8648, Japan
- Department of Radiation Oncology, Hokkaido University Hospital, Kita 15 Nishi 7, Sapporo 060-8638, Japan
| |
Collapse
|
22
|
Limited Impact of Setup and Range Uncertainties, Breathing Motion, and Interplay Effects in Robustly Optimized Intensity Modulated Proton Therapy for Stage III Non-small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2016; 96:661-9. [DOI: 10.1016/j.ijrobp.2016.06.2454] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 06/15/2016] [Accepted: 06/22/2016] [Indexed: 12/25/2022]
|
23
|
Kanehira T, Matsuura T, Takao S, Matsuzaki Y, Fujii Y, Fujii T, Ito YM, Miyamoto N, Inoue T, Katoh N, Shimizu S, Umegaki K, Shirato H. Impact of Real-Time Image Gating on Spot Scanning Proton Therapy for Lung Tumors: A Simulation Study. Int J Radiat Oncol Biol Phys 2016; 97:173-181. [PMID: 27856039 DOI: 10.1016/j.ijrobp.2016.09.027] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 08/26/2016] [Accepted: 09/20/2016] [Indexed: 12/25/2022]
Abstract
PURPOSE To investigate the effectiveness of real-time-image gated proton beam therapy for lung tumors and to establish a suitable size for the gating window (GW). METHODS AND MATERIALS A proton beam gated by a fiducial marker entering a preassigned GW (as monitored by 2 fluoroscopy units) was used with 7 lung cancer patients. Seven treatment plans were generated: real-time-image gated proton beam therapy with GW sizes of ±1, 2, 3, 4, 5, and 8 mm and free-breathing proton therapy. The prescribed dose was 70 Gy (relative biological effectiveness)/10 fractions to 99% of the target. Each of the 3-dimensional marker positions in the time series was associated with the appropriate 4-dimensional computed tomography phase. The 4-dimensional dose calculations were performed. The dose distribution in each respiratory phase was deformed into the end-exhale computed tomography image. The D99 and D5 to D95 of the clinical target volume scaled by the prescribed dose with criteria of D99 >95% and D5 to D95 <5%, V20 for the normal lung, and treatment times were evaluated. RESULTS Gating windows ≤ ±2 mm fulfilled the CTV criteria for all patients (whereas the criteria were not always met for GWs ≥ ±3 mm) and gave an average reduction in V20 of more than 17.2% relative to free-breathing proton therapy (whereas GWs ≥ ±4 mm resulted in similar or increased V20). The average (maximum) irradiation times were 384 seconds (818 seconds) for the ±1-mm GW, but less than 226 seconds (292 seconds) for the ±2-mm GW. The maximum increased considerably at ±1-mm GW. CONCLUSION Real-time-image gated proton beam therapy with a GW of ±2 mm was demonstrated to be suitable, providing good dose distribution without greatly extending treatment time.
Collapse
Affiliation(s)
- Takahiro Kanehira
- Department of Radiation Medicine, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Taeko Matsuura
- Proton Beam Therapy Center, Hokkaido University Hospital, Sapporo, Japan; Global Station for Quantum Medical Science and Engineering, Global Institution for Collaborative Research and Education, Hokkaido University, Sapporo, Japan; Division of Quantum Science and Engineering, Faculty of Engineering, Hokkaido University, Sapporo, Japan.
| | - Seishin Takao
- Proton Beam Therapy Center, Hokkaido University Hospital, Sapporo, Japan
| | - Yuka Matsuzaki
- Proton Beam Therapy Center, Hokkaido University Hospital, Sapporo, Japan
| | - Yusuke Fujii
- Proton Beam Therapy Center, Hokkaido University Hospital, Sapporo, Japan
| | - Takaaki Fujii
- Proton Beam Therapy Center, Hokkaido University Hospital, Sapporo, Japan
| | - Yoichi M Ito
- Department of Biostatistics, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Naoki Miyamoto
- Department of Medical Physics, Hokkaido University Hospital, Sapporo, Japan
| | - Tetsuya Inoue
- Department of Radiation Medicine, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Norio Katoh
- Department of Radiation Oncology, Hokkaido University Hospital, Sapporo, Japan
| | - Shinichi Shimizu
- Global Station for Quantum Medical Science and Engineering, Global Institution for Collaborative Research and Education, Hokkaido University, Sapporo, Japan; Department of Radiation Oncology, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kikuo Umegaki
- Proton Beam Therapy Center, Hokkaido University Hospital, Sapporo, Japan; Division of Quantum Science and Engineering, Faculty of Engineering, Hokkaido University, Sapporo, Japan
| | - Hiroki Shirato
- Department of Radiation Medicine, Graduate School of Medicine, Hokkaido University, Sapporo, Japan; Global Station for Quantum Medical Science and Engineering, Global Institution for Collaborative Research and Education, Hokkaido University, Sapporo, Japan
| |
Collapse
|
24
|
Yamada T, Miyamoto N, Matsuura T, Takao S, Fujii Y, Matsuzaki Y, Koyano H, Umezawa M, Nihongi H, Shimizu S, Shirato H, Umegaki K. Optimization and evaluation of multiple gating beam delivery in a synchrotron-based proton beam scanning system using a real-time imaging technique. Phys Med 2016; 32:932-7. [DOI: 10.1016/j.ejmp.2016.06.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 04/28/2016] [Accepted: 06/05/2016] [Indexed: 12/13/2022] Open
|
25
|
Matsuura T, Fujii Y, Takao S, Yamada T, Matsuzaki Y, Miyamoto N, Takayanagi T, Fujitaka S, Shimizu S, Shirato H, Umegaki K. Development and evaluation of a short-range applicator for treating superficial moving tumors with respiratory-gated spot-scanning proton therapy using real-time image guidance. Phys Med Biol 2016; 61:1515-31. [PMID: 26815927 DOI: 10.1088/0031-9155/61/4/1515] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Treatment of superficial tumors that move with respiration (e.g. lung tumors) using spot-scanning proton therapy (SSPT) is a high-priority research area. The recently developed real-time image-gated proton beam therapy (RGPT) system has proven to be useful for treating moving tumors deep inside the liver. However, when treating superficial tumors, the proton's range is small and so is the sizes of range straggling, making the Bragg-peaks extremely sharp compared to those located in deep-seated tumors. The extreme sharpness of Bragg-peaks is not always beneficial because it necessitates a large number of energy layers to make a spread-out Bragg-peak, resulting in long treatment times, and is vulnerable to motion-induced dose deterioration. We have investigated a method to treat superficial moving tumors in the lung by the development of an applicator compatible with the RGPT system. A mini-ridge filter (MRF) was developed to broaden the pristine Bragg-peak and, accordingly, decrease the number of required energy layers to obtain homogeneous irradiation. The applicator position was designed so that the fiducial marker's trajectory can be monitored by fluoroscopy during proton beam-delivery. The treatment plans for three lung cancer patients were made using the applicator, and four-dimensional (4D) dose calculations for the RGPT were performed using patient respiratory motion data. The effect of the MRF on the dose distributions and treatment time was evaluated. With the MRF, the number of energy layers was decreased to less than half of that needed without it, whereas the target volume coverage values (D99%, D95%, D50%, D2%) changed by less than 1% of the prescribed dose. Almost no dose distortion was observed after the 4D dose calculation, whereas the treatment time decreased by 26%-37%. Therefore, we conclude that the developed applicator compatible with RGPT is useful to solve the issue in the treatment of superficial moving tumors with SSPT.
Collapse
Affiliation(s)
- Taeko Matsuura
- Proton Beam Therapy Center, Hokkaido University Hospital, North-15 West-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan. Global Station for Quantum Medical Science and Engineering, Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University, Sapporo 060-8648, Japan. Faculty of Engineering, Hokkaido University, North-13 West-8, Kita-ku, Sapporo, Hokkaido, 060-8628, Japan
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Takao S, Miyamoto N, Matsuura T, Onimaru R, Katoh N, Inoue T, Sutherland KL, Suzuki R, Shirato H, Shimizu S. Intrafractional Baseline Shift or Drift of Lung Tumor Motion During Gated Radiation Therapy With a Real-Time Tumor-Tracking System. Int J Radiat Oncol Biol Phys 2016; 94:172-180. [DOI: 10.1016/j.ijrobp.2015.09.024] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 09/08/2015] [Indexed: 10/23/2022]
|
27
|
Zhang Y, Knopf AC, Weber DC, Lomax AJ. Improving 4D plan quality for PBS-based liver tumour treatments by combining online image guided beam gating with rescanning. Phys Med Biol 2015; 60:8141-59. [DOI: 10.1088/0031-9155/60/20/8141] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
28
|
Tumour Movement in Proton Therapy: Solutions and Remaining Questions: A Review. Cancers (Basel) 2015; 7:1143-53. [PMID: 26132317 PMCID: PMC4586762 DOI: 10.3390/cancers7030829] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Revised: 06/10/2015] [Accepted: 06/18/2015] [Indexed: 12/25/2022] Open
Abstract
Movement of tumours, mostly by respiration, has been a major problem for treating lung cancer, liver tumours and other locations in the abdomen and thorax. Organ motion is indeed one component of geometrical uncertainties that includes delineation and target definition uncertainties, microscopic disease and setup errors. At present, minimising motion seems to be the easiest to implement in clinical practice. If combined with adaptive approaches to correct for gradual anatomical variations, it may be a practical strategy. Other approaches such as repainting and tracking could increase the accuracy of proton therapy delivery, but advanced 4D solutions are needed. Moreover, there is a need to perform clinical studies to investigate which approach is the best in a given clinical situation. The good news is that existing and emerging technology and treatment planning systems as will without doubt lead in the forthcoming future to practical solutions to tackle intra-fraction motion in proton therapy. These developments may also improve motion management in photon therapy as well.
Collapse
|
29
|
Preliminary analysis for integration of spot-scanning proton beam therapy and real-time imaging and gating. Phys Med 2014; 30:555-8. [DOI: 10.1016/j.ejmp.2014.04.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 03/30/2014] [Accepted: 04/02/2014] [Indexed: 11/18/2022] Open
|
30
|
Shimizu S, Miyamoto N, Matsuura T, Fujii Y, Umezawa M, Umegaki K, Hiramoto K, Shirato H. A proton beam therapy system dedicated to spot-scanning increases accuracy with moving tumors by real-time imaging and gating and reduces equipment size. PLoS One 2014; 9:e94971. [PMID: 24747601 PMCID: PMC3991640 DOI: 10.1371/journal.pone.0094971] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 03/20/2014] [Indexed: 01/04/2023] Open
Abstract
Purpose A proton beam therapy (PBT) system has been designed which dedicates to spot-scanning and has a gating function employing the fluoroscopy-based real-time-imaging of internal fiducial markers near tumors. The dose distribution and treatment time of the newly designed real-time-image gated, spot-scanning proton beam therapy (RGPT) were compared with free-breathing spot-scanning proton beam therapy (FBPT) in a simulation. Materials and Methods In-house simulation tools and treatment planning system VQA (Hitachi, Ltd., Japan) were used for estimating the dose distribution and treatment time. Simulations were performed for 48 motion parameters (including 8 respiratory patterns and 6 initial breathing timings) on CT data from two patients, A and B, with hepatocellular carcinoma and with clinical target volumes 14.6 cc and 63.1 cc. The respiratory patterns were derived from the actual trajectory of internal fiducial markers taken in X-ray real-time tumor-tracking radiotherapy (RTRT). Results With FBPT, 9/48 motion parameters achieved the criteria of successful delivery for patient A and 0/48 for B. With RGPT 48/48 and 42/48 achieved the criteria. Compared with FBPT, the mean liver dose was smaller with RGPT with statistical significance (p<0.001); it decreased from 27% to 13% and 28% to 23% of the prescribed doses for patients A and B, respectively. The relative lengthening of treatment time to administer 3 Gy (RBE) was estimated to be 1.22 (RGPT/FBPT: 138 s/113 s) and 1.72 (207 s/120 s) for patients A and B, respectively. Conclusions This simulation study demonstrated that the RGPT was able to improve the dose distribution markedly for moving tumors without very large treatment time extension. The proton beam therapy system dedicated to spot-scanning with a gating function for real-time imaging increases accuracy with moving tumors and reduces the physical size, and subsequently the cost of the equipment as well as of the building housing the equipment.
Collapse
Affiliation(s)
- Shinichi Shimizu
- Department of Radiation Oncology, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Naoki Miyamoto
- Department of Medical Physics, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Taeko Matsuura
- Section of Medical Physics, Hokkaido University Hospital Proton Beam Therapy Center, Sapporo, Hokkaido, Japan
- * E-mail:
| | - Yusuke Fujii
- Hitachi, Ltd., Hitachi Research Laboratory, Omika, Ibaraki, Japan
| | - Masumi Umezawa
- Hitachi, Ltd., Hitachi Research Laboratory, Omika, Ibaraki, Japan
| | - Kikuo Umegaki
- Division of Quantum Science and Engineering, Hokkaido University Graduate School of Engineering, Sapporo, Hokkaido, Japan
| | - Kazuo Hiramoto
- Hitachi, Ltd., Research & Development Group, Omika, Ibaraki, Japan
| | - Hiroki Shirato
- Department of Radiation Oncology, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| |
Collapse
|