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Zhang G, Gao W, Peng H. Design of static and dynamic ridge filters for FLASH-IMPT: a simulation study. Med Phys 2022; 49:5387-5399. [PMID: 35595708 DOI: 10.1002/mp.15717] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 05/10/2022] [Accepted: 05/10/2022] [Indexed: 11/08/2022] Open
Abstract
PURPOSE This paper focused on the design and optimization of ridge filter-based intensity-modulated proton therapy (IMPT), and its potential applications for FLASH. Differing from the standard pencil beam scanning (PBS) mode, no energy/layer switching is required and total treatment time can be shortened. METHODS Unique dose influence matrices were generated as a proton beam traverse through slabs of different thicknesses (i.e. modulation by different layers). To establish the references for comparison, conventional IMPT plans (single field) were created using a large-scale non-linear solver. The spot weights from the reference IMPT plans were used as inputs for optimizing the design of ridge filters. Two designs were evaluated: model A (static) and model B (dynamic). The ridge filters designs were first verified (by GEANT4 simulation) in a water phantom and then in a H&N case. Direct comparison was made between the GEANT4 simulation results of two models and their respective references, with regard to plan quality, dose-averaged dose rate (DADR), and total treatment time. RESULTS In both the water phantom and the H&N case, two models are able to modulate dose distributions with high conformity, showing no significant difference relative to the reference plans. Dose rate volume histograms (DRVHs) suggest that in order to achieve a dose rate of 40 Gy/s over 90% PTV, the beam intensity needs to be 2.5×1011 protons/s for both models. For a fraction dose of 10 Gy, the total treatment time (including both irradiation time and dead time) can be shortened by a factor of 4.9 (model A) and 6.5 (model B), relative to the reference plans. CONCLUSION Two proposed designs (both static and dynamic) can be used for PBS-IMPT requiring no layer switching. They are promising candidates for FLASH-IMPT capable of reducing treatment time and achieving high dose rates, while maintaining dose conformity simultaneously. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Guoliang Zhang
- Department of Medical Physics, School of Physics and Technology, Wuhan University
| | - Wenchao Gao
- Cancer Radiation Therapy Center, Fifth Medical Center of Chinese PLA General Hospital
| | - Hao Peng
- Department of Medical Physics, School of Physics and Technology, Wuhan University.,ProtonSmart Inc
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2
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Zhao L, Liu G, Chen S, Shen J, Zheng W, Qin A, Yan D, Li X, Ding X. Developing an accurate model of spot-scanning treatment delivery time and sequence for a compact superconducting synchrocyclotron proton therapy system. Radiat Oncol 2022; 17:87. [PMID: 35525993 PMCID: PMC9077949 DOI: 10.1186/s13014-022-02055-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 04/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A new compact superconducting synchrocyclotron single-room proton solution delivers pulsed proton beams to each spot through several irradiation bursts calculated by an iterative layer delivery algorithm. Such a mechanism results in a new beam parameter, burst switching time (BST) in the total beam delivery time (BDT) which has never been studied before. In this study, we propose an experimental approach to build an accurate BDT and sequence prediction model for this new proton solution. METHODS Test fields and clinical treatment plans were used to investigate each beam delivery parameter that impacted BDT. The machine delivery log files were retrospectively analyzed to quantitatively model energy layer switching time (ELST), spot switching time (SSWT), spot spill time (SSPT), and BST. A total of 102 clinical IMPT treatment fields' log files were processed to validate the accuracy of the BDT prediction model in comparison with the result from the current commercial system. Interplay effect is also investigated as a clinical application by comparing this new delivery system model with a conventional cyclotron accelerator model. RESULTS The study finds that BST depends on the amount of data to be transmitted between two sequential radiation bursts, including a machine irradiation log file of the previous burst and a command file to instruct the proton system to deliver the next burst. The 102 clinical treatment fields showed that the accuracy of each component of the BDT matches well between machine log files and BDT prediction model. More specifically, the difference of ELST, SSWT, SSPT, and BST were (- 3.1 ± 5.7)%, (5.9 ± 3.9)%, (2.6 ± 8.7)%, and (- 2.3 ± 5.3)%, respectively. The average total BDT was about (2.1 ± 3.0)% difference compared to the treatment log files, which was significantly improved from the current commercial proton system prediction (58 ± 15)%. Compared to the conventional cyclotron system, the burst technique from synchrocyclotron effectively reduced the interplay effect in mobile tumor treatment. CONCLUSION An accurate BDT and sequence prediction model was established for this new clinical compact superconducting synchrocyclotron single-room proton solution. Its application could help users of similar facilities better assess the interplay effect and estimate daily patient treatment throughput.
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Affiliation(s)
- Lewei Zhao
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, 48073, USA
| | - Gang Liu
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, 48073, USA.,Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Shupeng Chen
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, 48073, USA
| | - Jiajian Shen
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, AZ, 85054, USA
| | - Weili Zheng
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, 48073, USA
| | - An Qin
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, 48073, USA
| | - Di Yan
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, 48073, USA
| | - Xiaoqiang Li
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, 48073, USA
| | - Xuanfeng Ding
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, 48073, USA.
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3
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Farr J, Grilj V, Malka V, Sudharsan S, Schippers M. Ultra‐High dose rate radiation production and delivery systems intended for FLASH. Med Phys 2022; 49:4875-4911. [PMID: 35403262 PMCID: PMC9544515 DOI: 10.1002/mp.15659] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 02/21/2022] [Accepted: 03/15/2022] [Indexed: 11/05/2022] Open
Abstract
Higher dose rates, a trend for radiotherapy machines, can be beneficial in shortening treatment times for radiosurgery and mitigating the effects of motion. Recently, even higher doses (e.g., 100 times greater) have become targeted because of their potential to generate the FLASH effect (FE). We refer to these physical dose rates as ultra‐high (UHDR). The complete relationship between UHDR and the FE is unknown. But UHDR systems are needed to explore the relationship further and to deliver clinical UHDR treatments, where indicated. Despite the challenging set of unknowns, the authors seek to make reasonable assumptions to probe how existing and developing technology can address the UHDR conditions needed to provide beam generation capable of producing the FE in preclinical and clinical applications. As a preface, this paper discusses the known and unknown relationships between UHDR and the FE. Based on these, different accelerator and ionizing radiation types are then discussed regarding the relevant UHDR needs. The details of UHDR beam production are discussed for existing and potential future systems such as linacs, cyclotrons, synchrotrons, synchrocyclotrons, and laser accelerators. In addition, various UHDR delivery mechanisms are discussed, along with required developments in beam diagnostics and dose control systems.
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Affiliation(s)
- Jonathan Farr
- Applications of Detectors and Accelerators to Medicine Meyrin 1217 Switzerland
| | - Veljko Grilj
- Lausanne University Hospital Lausanne 1011 Switzerland
| | - Victor Malka
- Weizmann Institute of Science Rehovot 7610001 Israel
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4
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Yap J, De Franco A, Sheehy S. Future Developments in Charged Particle Therapy: Improving Beam Delivery for Efficiency and Efficacy. Front Oncol 2021; 11:780025. [PMID: 34956897 PMCID: PMC8697351 DOI: 10.3389/fonc.2021.780025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 11/16/2021] [Indexed: 01/09/2023] Open
Abstract
The physical and clinical benefits of charged particle therapy (CPT) are well recognized. However, the availability of CPT and complete exploitation of dosimetric advantages are still limited by high facility costs and technological challenges. There are extensive ongoing efforts to improve upon these, which will lead to greater accessibility, superior delivery, and therefore better treatment outcomes. Yet, the issue of cost remains a primary hurdle as utility of CPT is largely driven by the affordability, complexity and performance of current technology. Modern delivery techniques are necessary but limited by extended treatment times. Several of these aspects can be addressed by developments in the beam delivery system (BDS) which determines the overall shaping and timing capabilities enabling high quality treatments. The energy layer switching time (ELST) is a limiting constraint of the BDS and a determinant of the beam delivery time (BDT), along with the accelerator and other factors. This review evaluates the delivery process in detail, presenting the limitations and developments for the BDS and related accelerator technology, toward decreasing the BDT. As extended BDT impacts motion and has dosimetric implications for treatment, we discuss avenues to minimize the ELST and overview the clinical benefits and feasibility of a large energy acceptance BDS. These developments support the possibility of advanced modalities and faster delivery for a greater range of treatment indications which could also further reduce costs. Further work to realize methodologies such as volumetric rescanning, FLASH, arc, multi-ion and online image guided therapies are discussed. In this review we examine how increased treatment efficiency and efficacy could be achieved with improvements in beam delivery and how this could lead to faster and higher quality treatments for the future of CPT.
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Affiliation(s)
- Jacinta Yap
- School of Physics, University of Melbourne, Melbourne, VIC, Australia
| | - Andrea De Franco
- IFMIF Accelerator Development Group, Rokkasho Fusion Institute, National Institutes for Quantum Science and Technology, Aomori, Japan
| | - Suzie Sheehy
- School of Physics, University of Melbourne, Melbourne, VIC, Australia
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5
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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.
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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
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6
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Deisher AJ, Whitaker TJ, Beltran CJ, Foote RL, Haddock MG, Mahajan A. Technical Delivery Parameters of 2000 Proton Treatment Courses. Int J Part Ther 2020; 6:27-34. [PMID: 32582812 DOI: 10.14338/ijpt-19-00066.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Accepted: 01/07/2020] [Indexed: 11/21/2022] Open
Abstract
Purpose To summarize the technical delivery parameters of proton plans delivered at the Mayo Clinic in Rochester, Minnesota. Materials and Methods The database of treated patient proton plans was queried to extract field parameters such as gantry angle, patient support angle, minimum and maximum water-equivalent depth (WED) treated, number of layers, field size, patient orientation, and monitor units. The plans were analyzed in aggregate, by disease site, and by fractionation. Results There were 2963 proton plans for 2023 distinct treatment sites delivered between June 2015 and September 2018. The mean number of fields per plan was 2.8. The mean number of energy layers per field was 51.9. The mean monitor unit per field was 117.4. The median maximum field dimension was 12.4 cm; 95% of the fields had a maximum dimension < 28.7 cm, and the maximum field dimension was 39.8 cm. The median maximum field WED was 16.4 cm; 95% of the fields reached a maximum WED of ≤ 26.4 cm, and the maximum field WED was 32.4 cm. Conclusion A large variety of disease sites were treated using the maximum field size (40 cm) and WED (32.4 cm) capabilities of our half-gantry system.
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Affiliation(s)
- Amanda J Deisher
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | | | - Chris J Beltran
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Robert L Foote
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | | | - Anita Mahajan
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
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7
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Schreuder AN, Shamblin J. Proton therapy delivery: what is needed in the next ten years? Br J Radiol 2020; 93:20190359. [PMID: 31692372 PMCID: PMC7066946 DOI: 10.1259/bjr.20190359] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 10/10/2019] [Accepted: 11/01/2019] [Indexed: 12/25/2022] Open
Abstract
Proton radiation therapy has been used clinically since 1952, and major advancements in the last 10 years have helped establish protons as a major clinical modality in the cancer-fighting arsenal. Technologies will always evolve, but enough major breakthroughs have been accomplished over the past 10 years to allow for a major revolution in proton therapy. This paper summarizes the major technology advancements with respect to beam delivery that are now ready for mass implementation in the proton therapy space and encourages vendors to bring these to market to benefit the cancer population worldwide. We state why these technologies are essential and ready for implementation, and we discuss how future systems should be designed to accommodate their required features.
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Affiliation(s)
- Andries N. Schreuder
- Provision Center for Proton therapy – Knoxville, 6450 Provision Cares way, Knoxville, TN 37909, USA
| | - Jacob Shamblin
- ProNova Solutions, LLC, 330 Pellissippi Place, Maryville, TN 37804, USA
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8
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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.
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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
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9
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Yokokawa K, Furusaka M, Matsuura T, Hirayama S, Umegaki K. A new SOBP-formation method by superposing specially shaped Bragg curves formed by a mini-ridge filter for spot scanning in proton beam therapy. Phys Med 2019; 67:70-76. [DOI: 10.1016/j.ejmp.2019.10.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 08/30/2019] [Accepted: 10/21/2019] [Indexed: 12/11/2022] Open
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10
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Gelover E, Deisher AJ, Herman MG, Johnson JE, Kruse JJ, Tryggestad EJ. Clinical implementation of respiratory-gated spot-scanning proton therapy: An efficiency analysis of active motion management. J Appl Clin Med Phys 2019; 20:99-108. [PMID: 30972922 PMCID: PMC6523004 DOI: 10.1002/acm2.12584] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 03/11/2019] [Accepted: 03/17/2019] [Indexed: 12/20/2022] Open
Abstract
Purpose The aim of this work is to describe the clinical implementation of respiratory‐gated spot‐scanning proton therapy (SSPT) for the treatment of thoracic and abdominal moving targets. The experience of our institution is summarized, from initial acceptance and commissioning tests to the development of standard clinical operating procedures for simulation, motion assessment, motion mitigation, treatment planning, and gated SSPT treatment delivery. Materials and methods A custom respiratory gating interface incorporating the Real‐Time Position Management System (RPM, Varian Medical Systems, Inc., Palo Alto, CA, USA) was developed in‐house for our synchrotron‐based delivery system. To assess gating performance, a motion phantom and radiochromic films were used to compare gated vs nongated delivery. Site‐specific treatment planning protocols and conservative motion cutoffs were developed, allowing for free‐breathing (FB), breath‐holding (BH), or phase‐gating (Ph‐G). Room usage efficiency of BH and Ph‐G treatments was retrospectively evaluated using beam delivery data retrieved from our record and verify system and DICOM files from patient‐specific quality assurance (QA) procedures. Results More than 70 patients were treated using active motion management between the launch of our motion mitigation program in October 2015 and the end date of data collection of this study in January 2018. During acceptance procedures, we found that overall system latency is clinically‐suitable for Ph‐G. Regarding room usage efficiency, the average number of energy layers delivered per minute was <10 for Ph‐G, 10‐15 for BH and ≥15 for FB, making Ph‐G the slowest treatment modality. When comparing to continuous delivery measured during pretreatment QA procedures, the median values of BH treatment time were extended from 6.6 to 9.3 min (+48%). Ph‐G treatments were extended from 7.3 to 13.0 min (+82%). Conclusions Active motion management has been crucial to the overall success of our SSPT program. Nevertheless, our conservative approach has come with an efficiency cost that is more noticeable in Ph‐G treatments and should be considered in decision‐making.
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Affiliation(s)
- Edgar Gelover
- Department of Radiation Oncology, Mayo Clinic Rochester, Rochester, MN, USA
| | - Amanda J Deisher
- Department of Radiation Oncology, Mayo Clinic Rochester, Rochester, MN, USA
| | - Michael G Herman
- Department of Radiation Oncology, Mayo Clinic Rochester, Rochester, MN, USA
| | - Jedediah E Johnson
- Department of Radiation Oncology, Mayo Clinic Rochester, Rochester, MN, USA
| | - Jon J Kruse
- Department of Radiation Oncology, Mayo Clinic Rochester, Rochester, MN, USA
| | - Erik J Tryggestad
- Department of Radiation Oncology, Mayo Clinic Rochester, Rochester, MN, USA
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11
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Ringbæk TP, Weber U, Santiago A, Iancu G, Wittig A, Grzanka L, Bassler N, Engenhart-Cabillic R, Zink K. Validation of new 2D ripple filters in proton treatments of spherical geometries and non-small cell lung carcinoma cases. Phys Med Biol 2018; 63:245020. [PMID: 30523868 DOI: 10.1088/1361-6560/aaede9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A ripple filter (RiFi) is a passive energy modulator used in scanned particle therapy to broaden the Bragg peak, thus lowering the number of accelerator energies required for homogeneous target coverage, which significantly reduces the irradiation time. As we have previously shown, a new 6 mm thick RiFi with 2D groove shapes produced with 3D printing can be used in carbon ion treatments with a similar target coverage and only a marginally worse planning conformity compared to treatments with in-use 3 mm thick RiFis of an older 1D design. Where RiFis are normally not used with protons due to larger scattering and straggling effects, this new design would be beneficial in proton therapy too. Measurements of proton Bragg curves and lateral beam profiles were carried out for different RiFi designs and thicknesses as well as for no RiFi at the Heidelberg Ionenstrahl-Therapiezentrum. Base data for proton treatment planning were generated with the Monte Carlo code SHIELD-HIT12A with and without the 2D 6 mm RiFi. Plans on spherical targets in water were calculated with TRiP98 for a systematic RiFi performance analysis and for comparisons with carbon ion plans for the same respective energy depth step sizes. Plans for 9 stage I static non small cell lung cancer patients were calculated with Eclipse 13.7.15. Dose-volume-histograms, spatial dose distributions and dosimetric indexes were used for plan evaluation. Measurements confirm the functionality of the new 2D RiFi design, which reduces the beam spot size compared to 1D RiFis of the same thickness. Planning studies show that a 6 mm thick 2D RiFi could be used in proton therapy to lower the irradiation time. Although slightly worse planning conformity and dose homogeneity were found for plans with the RiFi compared to plans without, satisfactory results within the planning objective were obtained for all cases.
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Affiliation(s)
- Toke Printz Ringbæk
- University of Applied Science, Gießen-Friedberg, Germany. Department of Radiotherapy and Radiation Oncology, Philipps University, Marburg, Germany. Author to whom any correspondence should be addressed
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12
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Wang X, Li Y, Zhang X, Li H, Miyazaki K, Fujimoto R, Akiyama H, Gillin MT, Poenisch F, Sahoo N, Grosshans D, Gunn B, Frank SJ, Wang P, Lang J, Hou Q, Zhu XR. Synchrotron-Based Pencil Beam Scanning Nozzle with an Integrated Mini-Ridge Filter: A Dosimetric Study to Optimize Treatment Delivery. Cancers (Basel) 2017; 9:E170. [PMID: 29236051 PMCID: PMC5742818 DOI: 10.3390/cancers9120170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 12/05/2017] [Accepted: 12/11/2017] [Indexed: 12/26/2022] Open
Abstract
A mini-ridge filter is often used to widen the Bragg peak in the longitudinal direction at low energies but not high energies. To facilitate the clinical use of a mini-ridge filter, we performed a planning study for the feasibility of a mini-ridge filter as an integral part of the synchrotron nozzle (IMRF). Dose models with and without IMRF were commissioned in a commercial Treatment planning system (TPS). Dosimetric characteristics in a homogenous water phantom were compared between plans with and without IMRF for a fixed spread-out Bragg peak width of 4 cm with distal ranges varying from 8 to 30 g/cm². Six clinical cases were then used to compare the plan quality between plans. The delivery efficiency was also compared between plans in both the phantom and the clinical cases. The Bragg peak width was increased by 0.18 cm at the lowest energy and by only about 0.04 cm at the highest energy. The IMRF increased the spot size (σ) by up to 0.1 cm at the lowest energy and by only 0.02 cm at the highest energy. For the phantom, the IMRF negligibly affected dose at high energies but increased the lateral penumbra by up to 0.12 cm and the distal penumbra by up to 0.06 cm at low energies. For the clinical cases, the IMRF slightly increased dose to the organs at risk. However, the beam delivery time was reduced from 18.5% to 47.1% for the lung, brain, scalp, and head and neck cases, and dose uniformities of target were improved up to 2.9% for these cases owing to the reduced minimum monitor unit effect. In conclusion, integrating a mini-ridge filter into a synchrotron nozzle is feasible for improving treatment efficiency without significantly sacrificing the plan quality.
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Affiliation(s)
- Xianliang Wang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77054, USA.
- Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, Chengdu 610041, China.
- Key Laboratory of Radiation Physics and Technology, Institute of Nuclear Science and Technology, Sichuan University, Chengdu 610064, China.
| | - Yupeng Li
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77054, USA.
| | - Xiaodong Zhang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77054, USA.
| | - Heng Li
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77054, USA.
| | - Koichi Miyazaki
- Research & Development Group, Hitachi, Ltd., Hitachi-shi, Ibaraki-ken 3178511, Japan.
| | - Rintaro Fujimoto
- Research & Development Group, Hitachi, Ltd., Hitachi-shi, Ibaraki-ken 3178511, Japan.
| | - Hiroshi Akiyama
- Healthcare Business Unit, Particle Therapy Division, Hitachi, Ltd., Hitachi-shi, Ibaraki-ken 3178511, Japan.
| | - Michael T Gillin
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77054, USA.
| | - Falk Poenisch
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77054, USA.
| | - Narayan Sahoo
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77054, USA.
| | - David Grosshans
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
| | - Brandon Gunn
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
| | - Steven Jay Frank
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
| | - Pei Wang
- Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, Chengdu 610041, China.
| | - Jinyi Lang
- Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, Chengdu 610041, China.
| | - Qing Hou
- Key Laboratory of Radiation Physics and Technology, Institute of Nuclear Science and Technology, Sichuan University, Chengdu 610064, China.
| | - Xiaorong Ronald Zhu
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77054, USA.
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13
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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.
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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
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14
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Ringbæk TP, Weber U, Santiago A, Simeonov Y, Fritz P, Krämer M, Wittig A, Bassler N, Engenhart-Cabillic R, Zink K. Dosimetric comparisons of carbon ion treatment plans for 1D and 2D ripple filters with variable thicknesses. Phys Med Biol 2016; 61:4327-41. [DOI: 10.1088/0031-9155/61/11/4327] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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15
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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.
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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
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