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Tan HQ, Koh CWY, Lew KS, Yeap PL, Chua CGA, Lee JKH, Wibawa A, Master Z, Lee JCL, Park SY. Real-time gated proton therapy with a reduced source to imager distance: Commissioning and quality assurance. Phys Med 2024; 122:103380. [PMID: 38805761 DOI: 10.1016/j.ejmp.2024.103380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 04/12/2024] [Accepted: 05/20/2024] [Indexed: 05/30/2024] Open
Abstract
INTRODUCTION Real-time gated proton therapy (RGPT) is a motion management technique unique to the Hitachi particle therapy system. It uses pulsed fluoroscopy to track an implanted fiducial marker. There are currently no published guidelines on how to conduct the commissioning and quality assurance. In this work we reported on our centre's commissioning workflow and our daily and monthly QA procedures. METHODS Six commissioning measurements were designed for RGPT. The measurements include imaging qualities, fluoroscopic exposures, RGPT marker tracking accuracy, temporal gating latency, fiducial marker tracking fidelity and an end-to-end proton dosimetry measurement. Daily QA consists of one measurement on marker localization accuracy. Four months daily QA trends are presented. Monthly QA consists of three measurementson the gating latency, fluoroscopy imaging quality and dosimetry verification of gating operation with RGPT. RESULTS The RGPT was successfully commissioned in our centre. The air kerma rates were within 15 % from specifications and the marker tracking accuracies were within 0.245 mm. The gating latencies for turning the proton beam on and off were 119.5 and 50.0 ms respectively. The 0.4x10.0 mm2 Gold AnchorTM gave the best tracking results with visibility up to 30 g/cm2. Gamma analysis showed that dose distribution of a moving and static detectors had a passing rate of more than 95 % at 3 %/3mm. The daily marker localization QA results were all less than 0.2 mm. CONCLUSION This work could serve as a good reference for other upcoming Hitachi particle therapy centres who are interested to use RGPT as their motion management solution.
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Affiliation(s)
- Hong Qi Tan
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore; Oncology Academic Clinical Programme, Duke-NUS Medical School, Singapore.
| | | | - Kah Seng Lew
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | - Ping Lin Yeap
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | | | | | - Andrew Wibawa
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | - Zubin Master
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | | | - Sung Yong Park
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore; Oncology Academic Clinical Programme, Duke-NUS Medical School, Singapore
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2
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Zink K, Baumann KS, Theiss U, Subtil F, Lahrmann S, Eberle F, Adeberg S. Organization and operation of multi particle therapy facilities: the Marburg Ion-Beam Therapy Center, Germany (MIT). HEALTH AND TECHNOLOGY 2024; 14:929-938. [PMID: 39219555 PMCID: PMC11358185 DOI: 10.1007/s12553-024-00881-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 04/23/2024] [Indexed: 09/04/2024]
Abstract
Purpose The Marburg Ion-Beam Therapy Center (MIT) is one of two particle therapy centers in Germany that enables the treatment of patients with both protons and carbon ions. The facility was build by Siemens Healthineers and is one of only two centers worldwide built by Siemens (Marburg, Germany and Shanghai, China). The present report provides an overview of technical and clinical operations as well as research activities at MIT. Methods The MIT was completed in 2011 and uses a synchrotron for accelerating protons and carbon ions up to energies of 250 MeV/u and 430 MeV/u respectively. Three treatment rooms with a fixed horizontal beam-line and one room with a 45 degree beam angle are available. Results Since the start of clinical operations in 2015, around 2.500 patients have been treated at MIT, about 40% with carbon ions and 60% with protons. Currently around 400 patients are treated each year. The majority of the patients suffered from benign and malign CNS tumors (around 40%) followed by head and neck tumors (around 23%). MIT is actively involved in clinical studies with its patients. In addition to clinical operations, there is active research at MIT in the fields of radiation biology and medical physics. The focus is on translational research to improve the treatment of H & N carcinomas and lung cancer (NSCLC). Moreover, intensive work is being carried out on the technical implementation of FLASH irradiation for research purposes. Conclusion The MIT is one of two centers worldwide that were built by Siemens Healtineers and has been successfully in clinical operation since 2015. The service provided by Siemens is guaranteed until 2030, the future after 2030 is currently under discussion.
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Affiliation(s)
- Klemens Zink
- Marburg Ion-Beam Therapy Center (MIT), Department of Radiotherapy and Radiation Oncology, Marburg University Hospital, Albrecht-Kossel-Strasse, Marburg, 35043 Germany
- Department of Radiotherapy and Radiooncology, Marburg University Hospital, Baldingerstrasse, Marburg, 35043 Germany
- Institute for Medical Physics and Radiation Protection, University of Applied Sciences Giessen, Wiesenstr. 14, Giessen, 35390 Germany
| | - Kilian Simon Baumann
- Marburg Ion-Beam Therapy Center (MIT), Department of Radiotherapy and Radiation Oncology, Marburg University Hospital, Albrecht-Kossel-Strasse, Marburg, 35043 Germany
- Department of Radiotherapy and Radiooncology, Marburg University Hospital, Baldingerstrasse, Marburg, 35043 Germany
- Institute for Medical Physics and Radiation Protection, University of Applied Sciences Giessen, Wiesenstr. 14, Giessen, 35390 Germany
| | - Ulrike Theiss
- Marburg Ion-Beam Therapy Center (MIT), Department of Radiotherapy and Radiation Oncology, Marburg University Hospital, Albrecht-Kossel-Strasse, Marburg, 35043 Germany
- Department of Radiotherapy and Radiooncology, Marburg University Hospital, Baldingerstrasse, Marburg, 35043 Germany
| | - Florentine Subtil
- Department of Radiotherapy and Radiooncology, Marburg University Hospital, Baldingerstrasse, Marburg, 35043 Germany
| | - Sonja Lahrmann
- Marburg Ion-Beam Therapy Center (MIT), Department of Radiotherapy and Radiation Oncology, Marburg University Hospital, Albrecht-Kossel-Strasse, Marburg, 35043 Germany
| | - Fabian Eberle
- Marburg Ion-Beam Therapy Center (MIT), Department of Radiotherapy and Radiation Oncology, Marburg University Hospital, Albrecht-Kossel-Strasse, Marburg, 35043 Germany
- Department of Radiotherapy and Radiooncology, Marburg University Hospital, Baldingerstrasse, Marburg, 35043 Germany
| | - Sebastian Adeberg
- Marburg Ion-Beam Therapy Center (MIT), Department of Radiotherapy and Radiation Oncology, Marburg University Hospital, Albrecht-Kossel-Strasse, Marburg, 35043 Germany
- Department of Radiotherapy and Radiooncology, Marburg University Hospital, Baldingerstrasse, Marburg, 35043 Germany
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Giovannelli AC, Köthe A, Safai S, Meer D, Zhang Y, Weber DC, Lomax AJ, Fattori G. Exploring beamline momentum acceptance for tracking respiratory variability in lung cancer proton therapy: a simulation study. Phys Med Biol 2023; 68:195013. [PMID: 37652055 DOI: 10.1088/1361-6560/acf5c4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 08/31/2023] [Indexed: 09/02/2023]
Abstract
Objective. Investigating the aspects of proton beam delivery to track organ motion with pencil beam scanning therapy. Considering current systems as a reference, specify requirements for next-generation units aiming at real-time image-guided treatments.Approach. Proton treatments for six non-small cell lung cancer (NSCLC) patients were simulated using repeated 4DCTs to model respiratory motion variability. Energy corrections required for this treatment site were evaluated for different approaches to tumour tracking, focusing on the potential for energy adjustment within beamline momentum acceptance (dp/p). A respiration-synchronised tracking, taking into account realistic machine delivery limits, was compared to ideal tracking scenarios, in which unconstrained energy corrections are possible. Rescanning and the use of multiple fields to mitigate residual interplay effects and dose degradation have also been investigated.Main results. Energy correction requirements increased with motion amplitudes, for all patients and tracking scenarios. Higher dose degradation was found for larger motion amplitudes, rescanning has beneficial effects and helped to improve dosimetry metrics for the investigated limited dp/pof 1.2% (realistic) and 2.4%. The median differences between ideal and respiratory-synchronised tracking show minimal discrepancies, 1% and 5% respectively for dose coverage (CTV V95) and homogeneity (D5-D95). Multiple-field planning improves D5-D95 up to 50% in the most extreme cases while it does not show a significant effect on V95.Significance. This work shows the potential of implementing tumour tracking in current proton therapy units and outlines design requirements for future developments. Energy regulation within momentum acceptance was investigated to tracking tumour motion with respiratory-synchronisation, achieving results in line with the performance of ideal tracking scenarios. ±5% Δp/p would allow to compensate for all range offsets in our NSCLC patient cohort, including breathing variability. However, the realistic momentum of 1.2% dp/prepresentative of existing medical units limitations, has been shown to preserve plan quality.
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Affiliation(s)
- Anna Chiara Giovannelli
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen, Switzerland
- Department of Physics, ETH Zürich, 8092 Zürich, Switzerland
| | - Andreas Köthe
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen, Switzerland
- Department of Physics, ETH Zürich, 8092 Zürich, Switzerland
| | - Sairos Safai
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen, Switzerland
| | - David Meer
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen, Switzerland
| | - Ye Zhang
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen, Switzerland
| | - Damien Charles Weber
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen, Switzerland
- Department of Radiation Oncology, University Hospital of Zürich, 8091 Zürich, Switzerland
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Antony John Lomax
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen, Switzerland
- Department of Physics, ETH Zürich, 8092 Zürich, Switzerland
| | - Giovanni Fattori
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen, Switzerland
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Belikhin M, Pryanichnikov A, Balakin V, Shemyakov A, Zhogolev P, Chernyaev A. High-speed low-noise optical respiratory monitoring for spot scanning proton therapy. Phys Med 2023; 112:102612. [PMID: 37329740 DOI: 10.1016/j.ejmp.2023.102612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 04/24/2023] [Accepted: 05/30/2023] [Indexed: 06/19/2023] Open
Abstract
PURPOSE To investigate a novel optical markerless respiratory sensor for surface guided spot scanning proton therapy and to measure its main technical characteristics. METHODS The main characteristics of the respiratory sensor including sensitivity, linearity, noise, signal-to-noise, and time delay were measured using a dynamic phantom and electrical measuring equipment on a laboratory stand. The respiratory signals of free breathing and deep-inspiration breath-hold patterns were acquired for various distances with a volunteer. A comparative analysis of this sensor with existing commercially available and experimental respiratory monitoring systems was carried out based on several criteria including principle of operation, patient contact, application to proton therapy, distance range, accuracy (noise, signal-to-noise ratio), and time delay (sampling rate). RESULTS The sensor provides optical respiratory monitoring of the chest surface over a distance range of 0.4-1.2 m with the RMS noise of 0.03-0.60 mm, SNR of 40-15 dB (for motion with peak-to-peak of 10 mm), and time delay of 1.2 ± 0.2 ms. CONCLUSIONS The investigated optical respiratory sensor was found to be appropriate to use in surface guided spot scanning proton therapy. This sensor combined with a fast respiratory signal processing algorithm may provide accurate beam control and a fast response in patients' irregular breathing movements. A careful study of correlation between the respiratory signal and 4DCT data of tumor position will be required before clinical implementation.
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Affiliation(s)
- Mikhail Belikhin
- JSC Protom., Protvino 142281, Russian Federation; Lomonosov Moscow State University, Moscow 119992, Russian Federation.
| | - Alexander Pryanichnikov
- Division of Biomedical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg 69120, Germany.
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Inter- and intrafractional 4D dose accumulation for evaluating ΔNTCP robustness in lung cancer. Radiother Oncol 2023; 182:109488. [PMID: 36706960 DOI: 10.1016/j.radonc.2023.109488] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/12/2023] [Accepted: 01/18/2023] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND PURPOSE Model-based selection of proton therapy patients relies on a predefined reduction in normal tissue complication probability (NTCP) with respect to photon therapy. The decision is necessarily made based on the treatment plan, but NTCP can be affected when the delivered treatment deviates from the plan due to delivery inaccuracies. Especially for proton therapy of lung cancer, this can be important because of tissue density changes and, with pencil beam scanning, the interplay effect between the proton beam and breathing motion. MATERIALS AND METHODS In this work, we verified whether the expected benefit of proton therapy is retained despite delivery inaccuracies by reconstructing the delivered treatment using log-file based dose reconstruction and inter- and intrafractional accumulation. Additionally, the importance of two uncertain parameters for treatment reconstruction, namely deformable image registration (DIR) algorithm and α/β ratio, was assessed. RESULTS The expected benefit or proton therapy was confirmed in 97% of all studied cases, despite regular differences up to 2 percent point (p.p.) NTCP between the delivered and planned treatments. The choice of DIR algorithm affected NTCP up to 1.6 p.p., an order of magnitude higher than the effect of α/β ratio. CONCLUSION For the patient population and treatment technique employed, the predicted clinical benefit for patients selected for proton therapy was confirmed for 97.0% percent of all cases, although the NTCP based proton selection was subject to 2 p.p. variations due to delivery inaccuracies.
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Duetschler A, Prendi J, Safai S, Weber DC, Lomax AJ, Zhang Y. Limitations of phase-sorting based pencil beam scanned 4D proton dose calculations under irregular motion. Phys Med Biol 2022; 68. [PMID: 36571234 DOI: 10.1088/1361-6560/aca9b6] [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: 09/12/2022] [Accepted: 12/07/2022] [Indexed: 12/12/2022]
Abstract
Objective.4D dose calculation (4DDC) for pencil beam scanned (PBS) proton therapy is typically based on phase-sorting of individual pencil beams onto phases of a single breathing cycle 4DCT. Understanding the dosimetric limitations and uncertainties of this approach is essential, especially for the realistic treatment scenario with irregular free breathing motion.Approach.For three liver and three lung cancer patient CTs, the deformable multi-cycle motion from 4DMRIs was used to generate six synthetic 4DCT(MRI)s, providing irregular motion (11/15 cycles for liver/lung; tumor amplitudes ∼4-18 mm). 4DDCs for two-field plans were performed, with the temporal resolution of the pencil beam delivery (4-200 ms) or with 8 phases per breathing cycle (500-1000 ms). For the phase-sorting approach, the tumor center motion was used to determine the phase assignment of each spot. The dose was calculated either using the full free breathing motion or individually repeating each single cycle. Additionally, the use of an irregular surrogate signal prior to 4DDC on a repeated cycle was simulated. The CTV volume with absolute dose differences >5% (Vdosediff>5%) and differences in CTVV95%andD5%-D95%compared to the free breathing scenario were evaluated.Main results.Compared to 4DDC considering the full free breathing motion with finer spot-wise temporal resolution, 4DDC based on a repeated single 4DCT resulted inVdosediff>5%of on average 34%, which resulted in an overestimation ofV95%up to 24%. However, surrogate based phase-sorting prior to 4DDC on a single cycle 4DCT, reduced the averageVdosediff>5%to 16% (overestimationV95%up to 19%). The 4DDC results were greatly influenced by the choice of reference cycle (Vdosediff>5%up to 55%) and differences due to temporal resolution were much smaller (Vdosediff>5%up to 10%).Significance.It is important to properly consider motion irregularity in 4D dosimetric evaluations of PBS proton treatments, as 4DDC based on a single 4DCT can lead to an underestimation of motion effects.
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Affiliation(s)
- A Duetschler
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen PSI, CH, Switzerland.,Department of Physics, ETH Zürich, 8092 Zürich, CH, Switzerland
| | - J Prendi
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen PSI, CH, Switzerland.,Department of Physics, University of Basel, 4056 Basel, CH, Switzerland
| | - S Safai
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen PSI, CH, Switzerland
| | - D C Weber
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen PSI, CH, Switzerland.,Department of Radiation Oncology, University Hospital of Zürich, 8091 Zürich, CH, Switzerland.,Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, CH, Switzerland
| | - A J Lomax
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen PSI, CH, Switzerland.,Department of Physics, ETH Zürich, 8092 Zürich, CH, Switzerland
| | - Ye Zhang
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen PSI, CH, Switzerland
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Knopf AC, Czerska K, Fracchiolla F, Graeff C, Molinelli S, Rinaldi I, Rucincki A, Sterpin E, Stützer K, Trnkova P, Zhang Y, Chang JY, Giap H, Liu W, Schild SE, Simone CB, Lomax AJ, Meijers A. Clinical necessity of multi-image based (4DMIB) optimization for targets affected by respiratory motion and treated with scanned particle therapy – a comprehensive review. Radiother Oncol 2022; 169:77-85. [DOI: 10.1016/j.radonc.2022.02.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 01/31/2022] [Accepted: 02/14/2022] [Indexed: 12/28/2022]
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Hamatani N, Tsubouchi T, Takashina M, Yagi M, Kanai T. Commissioning of carbon-ion radiotherapy for moving targets at the Osaka Heavy-Ion Therapy Center. Med Phys 2021; 49:801-812. [PMID: 34894413 PMCID: PMC9306684 DOI: 10.1002/mp.15403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 10/04/2021] [Accepted: 11/24/2021] [Indexed: 11/09/2022] Open
Abstract
Purpose Herein, we report the methods and results of the Hitachi carbon‐ion therapy facility commissioning to determine the optimum values of the magnitude of movement and repaint number in respiratory‐gated irradiation. Methods A virtual‐cylinder target was created using the treatment‐planning system (VQA Plan), and measurements were performed to study the effects of respiratory movements using a two‐dimensional ionization‐chamber array detector and a phantom with movable wedge and stage. For simulations, we selected a 10 × 10 × 10 cm3 cubic irradiation pattern with a uniform physical dose and two actual cases of liver‐cancer treatments, whose prescribed doses were 60 Gy(RBE)/4 fraction (Case 1) and 60 Gy(RBE)/12 fraction (Case 2). We employed two types of repainting methods, one produced by the algorithm of VQA Plan (VQA algorithm) and the other by ideal repainting. The latter completely repeats all spots with set number of repaintings. We performed flatness calculations and gamma analysis to evaluate the effects of each condition. Results From the measurements, the gamma passing rates for which the criteria were 3%/3 mm exceeded 95% for displacements in the head‐to‐tail direction if the repaint number was greater than 3 and the magnitude of the residual motions was less than 5.0 mm. In simulations with the cubic irradiation pattern, the gamma passing rates (with criteria of 2%/2 mm) exceeded 95% when the magnitude of the residual motions was 3.0 mm and the repaint number was greater than 3. When the repaint number was set to 4 in the VQA with the actual liver cases, the flatness results for Case 2 was minimal. For ideal repainting, the flatness results for all ports fell within ∼3.0% even when the magnitude of the residual motions was 5.0 mm if the repaint number was 6. However, the flatness was less than 3.0% for almost all ports if the magnitude of the residual motions was less than 3.0 mm with a repaint number of 4 in case of both types of repaint methods. Conclusions At our facility, carbon‐ion radiotherapy can be provided safely to a moving target with residual motions of 3.0 mm magnitude and with a repaint number of 4.
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Affiliation(s)
| | | | | | - Masashi Yagi
- Department of Carbon Ion Radiotherapy, Osaka University Graduate School of Medicine, Osaka, Japan
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Emert F, Missimer J, Eichenberger PA, Walser M, Gmür C, Lomax AJ, Weber DC, Spengler CM. Enhanced Deep-Inspiration Breath Hold Superior to High-Frequency Percussive Ventilation for Respiratory Motion Mitigation: A Physiology-Driven, MRI-Guided Assessment Toward Optimized Lung Cancer Treatment With Proton Therapy. Front Oncol 2021; 11:621350. [PMID: 33996545 PMCID: PMC8116693 DOI: 10.3389/fonc.2021.621350] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 02/18/2021] [Indexed: 12/25/2022] Open
Abstract
Background: To safely treat lung tumors using particle radiation therapy (PRT), motion-mitigation strategies are of critical importance to ensure precise irradiation. Therefore, we compared applicability, effectiveness, reproducibility, and subjects' acceptance of enhanced deep-inspiration breath hold (eDIBH) with high-frequency percussive ventilation (HFPV) by MRI assessment within 1 month. Methods: Twenty-one healthy subjects (12 males/9 females; age: 49.5 ± 5.8 years; BMI: 24.7 ± 3.3 kg/m−2) performed two 1.5 T MRI scans in four visits at weekly intervals under eDIBH and HFPV conditions, accompanied by daily, home-based breath-hold training and spirometric assessments over a 3-week period. eDIBH consisted of 8-min 100% O2 breathing (3 min resting ventilation, 5 min controlled hyperventilation) prior to breath hold. HFPV was set at 200–250 pulses min−1 and 0.8–1.2 bar. Subjects' acceptance and preference were evaluated by questionnaire. To quantify inter- and intrafractional changes, a lung distance metric representing lung topography was computed for 10 reference points: a motion-invariant spinal cord and nine lung structure contours (LSCs: apex, carina, diaphragm, and six vessels as tumor surrogates distributed equally across the lung). To parameterize individual LSC localizability, measures of their spatial variabilities were introduced and lung volumes calculated by automated MRI analysis. Results: eDIBH increased breath-hold duration by > 100% up to 173 ± 73 s at visit 1, and to 217 ± 67 s after 3 weeks of home-based training at visit 4 (p < 0.001). Measures of vital capacity and lung volume remained constant over the 3-week period. Two vessels in the lower lung segment and the diaphragm yielded a two- to threefold improved positional stability with eDIBH, whereby absolute distance variability was significantly smaller for five LSCs; ≥70% of subjects showed significantly better intrafractional lung motion mitigation under reproducible conditions with eDIBH compared with HFPV with smaller ranges most apparent in the anterior-posterior and cranial-caudal directions. Approximately 80% of subjects preferred eDIBH over HFPV, with “less discomfort” named as most frequent reason. Conclusions: Both, eDIBH, and HFPV were well-tolerated. eDIBH duration was long enough to allow for potential PRT. Variability in lung volume was smaller and position of lung structures more precise with eDIBH. Subjects preferred eDIBH over HFPV. Thus, eDIBH is a very promising tool for lung tumor therapy with PRT, and further investigation of its applicability in patients is warranted.
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Affiliation(s)
- Frank Emert
- Center for Proton Therapy, Paul Scherrer Institute (PSI), Villigen, Switzerland
| | - John Missimer
- Center for Proton Therapy, Paul Scherrer Institute (PSI), Villigen, Switzerland
| | - Philipp A Eichenberger
- Exercise Physiology Lab, Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland
| | - Marc Walser
- Center for Proton Therapy, Paul Scherrer Institute (PSI), Villigen, Switzerland
| | - Celina Gmür
- Exercise Physiology Lab, Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland
| | - Antony J Lomax
- Center for Proton Therapy, Paul Scherrer Institute (PSI), Villigen, Switzerland.,Department of Physics, ETH Zurich, Zurich, Switzerland
| | - Damien C Weber
- Center for Proton Therapy, Paul Scherrer Institute (PSI), Villigen, Switzerland.,Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland.,Department of Radiation Oncology, University Hospital Bern, Bern, Switzerland
| | - Christina M Spengler
- Exercise Physiology Lab, Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland.,Zurich Center for Integrative Human Physiology (ZIHP), University of Zurich, Zurich, Switzerland
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Paganetti H, Grassberger C, Sharp GC. Physics of Particle Beam and Hypofractionated Beam Delivery in NSCLC. Semin Radiat Oncol 2021; 31:162-169. [PMID: 33610274 PMCID: PMC7905707 DOI: 10.1016/j.semradonc.2020.11.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The dosimetric advantages of particle therapy lead to significantly reduced integral dose to normal tissues, making it an attractive treatment option for body sites such as the thorax. With reduced normal tissue dose comes the potential for dose escalation, toxicity reduction, or hypofractionation. While proton and heavy ion therapy have been used extensively for NSCLC, there are challenges in planning and delivery compared with X-ray-based radiation therapy. Particularly, range uncertainties compounded by breathing motion have to be considered. This article summarizes the current state of particle therapy for NSCLC with a specific focus on the impact of dosimetric uncertainties in planning and delivery.
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Affiliation(s)
- Harald Paganetti
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
| | - Clemens Grassberger
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Gregory C Sharp
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
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Wong SL, Alshaikhi J, Grimes H, Amos RA, Poynter A, Rompokos V, Gulliford S, Royle G, Liao Z, Sharma RA, Mendes R. Retrospective Planning Study of Patients with Superior Sulcus Tumours Comparing Pencil Beam Scanning Protons to Volumetric-Modulated Arc Therapy. Clin Oncol (R Coll Radiol) 2021; 33:e118-e131. [PMID: 32798157 PMCID: PMC7883303 DOI: 10.1016/j.clon.2020.07.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 05/30/2020] [Accepted: 07/22/2020] [Indexed: 12/25/2022]
Abstract
AIMS Twenty per cent of patients with non-small cell lung cancer present with stage III locally advanced disease. Precision radiotherapy with pencil beam scanning (PBS) protons may improve outcomes. However, stage III is a heterogeneous group and accounting for complex tumour motion is challenging. As yet, it remains unclear as to whom will benefit. In our retrospective planning study, we explored if patients with superior sulcus tumours (SSTs) are a select cohort who might benefit from this treatment. MATERIALS AND METHODS Patients with SSTs treated with radical radiotherapy using four-dimensional planning computed tomography between 2010 and 2015 were identified. Tumour motion was assessed and excluded if greater than 5 mm. Photon volumetric-modulated arc therapy (VMAT) and PBS proton single-field optimisation plans, with and without inhomogeneity corrections, were generated retrospectively. Robustness analysis was assessed for VMAT and PBS plans involving: (i) 5 mm geometric uncertainty, with an additional 3.5% range uncertainty for proton plans; (ii) verification plans at maximal inhalation and exhalation. Comparative dosimetric and robustness analyses were carried out. RESULTS Ten patients were suitable. The mean clinical target volume D95 was 98.1% ± 0.4 (97.5-98.8) and 98.4% ± 0.2 (98.1-98.9) for PBS and VMAT plans, respectively. All normal tissue tolerances were achieved. The same four PBS and VMAT plans failed robustness assessment. Inhomogeneity corrections minimally impacted proton plan robustness and made it worse in one case. The most important factor affecting target coverage and robustness was the clinical target volume entering the spinal canal. Proton plans significantly reduced the mean lung dose (by 21.9%), lung V5, V10, V20 (by 47.9%, 36.4%, 12.1%, respectively), mean heart dose (by 21.4%) and thoracic vertebra dose (by 29.2%) (P < 0.05). CONCLUSIONS In this planning study, robust PBS plans were achievable in carefully selected patients. Considerable dose reductions to the lung, heart and thoracic vertebra were possible without compromising target coverage. Sparing these lymphopenia-related organs may be particularly important in this era of immunotherapy.
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Affiliation(s)
- S-L Wong
- University College London Cancer Institute, London, UK; Department of Clinical Oncology, University College London Hospitals NHS Foundation Trust, London, UK.
| | - J Alshaikhi
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK; Department of Radiotherapy Physics, University College London Hospitals NHS Foundation Trust, London, UK; Saudi Particle Therapy Centre, Riyadh, Saudi Arabia
| | - H Grimes
- Department of Radiotherapy Physics, University College London Hospitals NHS Foundation Trust, London, UK
| | - R A Amos
- Department of Clinical Oncology, University College London Hospitals NHS Foundation Trust, London, UK; Department of Radiotherapy Physics, University College London Hospitals NHS Foundation Trust, London, UK; Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - A Poynter
- Department of Radiotherapy Physics, University College London Hospitals NHS Foundation Trust, London, UK
| | - V Rompokos
- Department of Radiotherapy Physics, University College London Hospitals NHS Foundation Trust, London, UK
| | - S Gulliford
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK; Department of Radiotherapy Physics, University College London Hospitals NHS Foundation Trust, London, UK
| | - G Royle
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Z Liao
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - R A Sharma
- University College London Cancer Institute, London, UK; Department of Clinical Oncology, University College London Hospitals NHS Foundation Trust, London, UK; NIHR University College London Hospitals Biomedical Research Centre, London, UK
| | - R Mendes
- Department of Clinical Oncology, University College London Hospitals NHS Foundation Trust, London, UK
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12
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Alina G, Krieger M, Jud C, Duetschler A, Salomir R, Bieri O, Bauman G, Nguyen D, Weber DC, Lomax AJ, Zhang Y, Cattin PC. Liver-ultrasound based motion modelling to estimate 4D dose distributions for lung tumours in scanned proton therapy. ACTA ACUST UNITED AC 2020; 65:235050. [DOI: 10.1088/1361-6560/abaa26] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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13
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Fattori G, Zhang Y, Meer D, Weber DC, Lomax AJ, Safai S. The potential of Gantry beamline large momentum acceptance for real time tumour tracking in pencil beam scanning proton therapy. Sci Rep 2020; 10:15325. [PMID: 32948790 PMCID: PMC7501279 DOI: 10.1038/s41598-020-71821-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 08/18/2020] [Indexed: 02/01/2023] Open
Abstract
Tumour tracking is an advanced radiotherapy technique for precise treatment of tumours subject to organ motion. In this work, we addressed crucial aspects of dose delivery for its realisation in pencil beam scanning proton therapy, exploring the momentum acceptance and global achromaticity of a Gantry beamline to perform continuous energy regulation with a standard upstream degrader. This novel approach is validated on simulation data from three geometric phantoms of increasing complexity and one liver cancer patient using 4D dose calculations. Results from a standard high-to-low beamline ramping scheme were compared to alternative energy meandering schemes including combinations with rescanning. Target coverage and dose conformity were generally well recovered with tumour tracking even though for particularly small targets, large variations are reported for the different approaches. Meandering in energy while rescanning has a positive impact on target homogeneity and similarly, hot spots outside the targets are mitigated with a relatively fast convergence rate for most tracking scenarios, halving the volume of hot spots after as little as 3 rescans. This work investigates the yet unexplored potential of having a large momentum acceptance in medical beam line, and provides an alternative to take tumour tracking with particle therapy closer to clinical translation.
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Affiliation(s)
- Giovanni Fattori
- Center for Proton Therapy, WMSA/C14, Paul Scherrer Institute, 5232, Villigen, Switzerland.
| | - Ye Zhang
- Center for Proton Therapy, WMSA/C14, Paul Scherrer Institute, 5232, Villigen, Switzerland
| | - David Meer
- Center for Proton Therapy, WMSA/C14, Paul Scherrer Institute, 5232, Villigen, Switzerland
| | - Damien Charles Weber
- Center for Proton Therapy, WMSA/C14, Paul Scherrer Institute, 5232, Villigen, Switzerland.,Department of Radiation Oncology, University Hospital Zurich, 8091, Zurich, Switzerland.,Department of Radiation Oncology, University Hospital Bern, 3000, Bern, Switzerland
| | - Antony John Lomax
- Center for Proton Therapy, WMSA/C14, Paul Scherrer Institute, 5232, Villigen, Switzerland.,Department of Physics, ETH Zurich, 8092, Zurich, Switzerland
| | - Sairos Safai
- Center for Proton Therapy, WMSA/C14, Paul Scherrer Institute, 5232, Villigen, Switzerland
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14
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Meijers A, Knopf AC, Crijns AP, Ubbels JF, Niezink AG, Langendijk JA, Wijsman R, Both S. Evaluation of interplay and organ motion effects by means of 4D dose reconstruction and accumulation. Radiother Oncol 2020; 150:268-274. [DOI: 10.1016/j.radonc.2020.07.055] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 07/14/2020] [Accepted: 07/23/2020] [Indexed: 12/29/2022]
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15
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Meijers A, Seller OC, Free J, Bondesson D, Seller Oria C, Rabe M, Parodi K, Landry G, Langendijk JA, Both S, Kurz C, Knopf AC. Assessment of range uncertainty in lung-like tissue using a porcine lung phantom and proton radiography. ACTA ACUST UNITED AC 2020; 65:155014. [DOI: 10.1088/1361-6560/ab91db] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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16
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Kostiukhina N, Palmans H, Stock M, Knopf A, Georg D, Knäusl B. Time-resolved dosimetry for validation of 4D dose calculation in PBS proton therapy. Phys Med Biol 2020; 65:125015. [PMID: 32340002 DOI: 10.1088/1361-6560/ab8d79] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Four-dimensional dose calculation (4D-DC) is crucial for predicting the dosimetric outcome in the presence of intra-fractional organ motion. Time-resolved dosimetry can provide significant insights into 4D pencil beam scanning dose accumulation and is therefore irreplaceable for benchmarking 4D-DC. In this study a novel approach of time-resolved dosimetry using five PinPoint ionization chambers (ICs) embedded in an anthropomorphic dynamic phantom was employed and validated against beam delivery details. Beam intensity variations as well as the beam delivery time structure were well reflected with an accuracy comparable to the temporal resolution of the IC measurements. The 4D dosimetry approach was further applied for benchmarking the 4D-DC implemented in the RayStation 6.99 treatment planning system. Agreement between computed values and measurements was investigated for (i) partial doses based on individual breathing phases, and (ii) temporally distributed cumulative doses. For varied beam delivery and patient-related parameters the average unsigned dose difference for (i) was 0.04 ± 0.03 Gy over all considered IC measurement values, while the prescribed physical dose was 2 Gy. By implementing (ii), a strong effect of the dose gradient on measurement accuracy was observed. The gradient originated from scanned beam energy modulation and target motion transversal to the beam. Excluding measurements in the high gradient the relative dose difference between measurements and 4D-DCs for a given treatment plan at the end of delivery was 3.5% on average and 6.6% at maximum over measurement points inside the target. Overall, the agreement between 4D dose measurements in the moving phantom and retrospective 4D-DC was found to be comparable to the static dose differences for all delivery scenarios. The presented 4D-DC has been proven to be suitable for simulating treatment deliveries with various beam- as well as patient-specific parameters and can therefore be employed for dosimetric validation of different motion mitigation techniques.
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Affiliation(s)
- N Kostiukhina
- Division of Medical Radiation Physics, Department of Radiation Oncology, Medical University of Vienna/AKH Vienna, Vienna, Austria. Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Vienna, Austria
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17
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Wang P, Tang S, Leach K, Mangona V, Simone CB, Langen K, Chang C. Proton pencil beam scanning treatment with feedback based voluntary moderate breath hold. Med Dosim 2019; 45:e10-e15. [PMID: 31870600 DOI: 10.1016/j.meddos.2019.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 10/18/2019] [Accepted: 11/18/2019] [Indexed: 11/27/2022]
Abstract
Introduction The aim of this article is to introduce a novel protocol for proton pencil beam scanning treatment with moderate deep inspiration breath hold (mDIBH) and report on our clinical implementation results. Methods Three computed tomography (CT) scannings to build the patient's anatomy model were performed during the patient's voluntary mDIBH. All 3 CT scans were used in the optimization during the treatment planning process. Both orthogonal kV imaging and cone-beam computed tomography (CBCT) were implemented for patient alignment with BH prior to the treatment. The BH CBCT images were analyzed for BH reproducibility and the virtual total dose (VTD) retrospectively. To find the VTD, a series of deformable image registrations (DIR) were performed between CBCT and pCT. The effect of the variation of lung density on the dose distribution was also analyzed in the study. Results The values of the mean, standard deviation, maximum, and minimum of the tumor location difference between the CBCT and pCT were 1.9, 1.6, 4.7, and 0.0 mm, respectively. The percentage difference in D99% of CTVs between VTD and the nominal plan was within 1.5%. Conclusions The feedback-based voluntary moderate BH proton PBS treatment was successfully performed in our clinic. This study shows that there is a potential to implement the BH treatment widely in proton centers.
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Affiliation(s)
- Peng Wang
- Department of Radiation Oncology, Inova Health System, Falls Church, VA, USA.
| | - Shikui Tang
- Texas Center for Proton Therapy, Irving, TX, USA
| | - Karla Leach
- Texas Center for Proton Therapy, Irving, TX, USA
| | | | | | | | - Chang Chang
- California Protons Ca Therapy Center, San Diego, CA, USA
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18
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Potential for Improvements in Robustness and Optimality of Intensity-Modulated Proton Therapy for Lung Cancer with 4-Dimensional Robust Optimization. Cancers (Basel) 2019; 11:cancers11010035. [PMID: 30609652 PMCID: PMC6356681 DOI: 10.3390/cancers11010035] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 12/18/2018] [Accepted: 12/30/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Major challenges in the application of intensity-modulated proton therapy (IMPT) for lung cancer patients include the uncertainties associated with breathing motion, its mitigation and its consideration in IMPT optimization. The primary objective of this research was to evaluate the potential of four-dimensional robust optimization (4DRO) methodology to make IMPT dose distributions resilient to respiratory motion as well as to setup and range uncertainties; Methods: The effect of respiratory motion, characterized by different phases of 4D computed tomography (4DCT), was incorporated into an in-house 4DRO system. Dose distributions from multiple setup and range uncertainty scenarios were calculated for each of the ten phases of CT datasets. The 4DRO algorithm optimizes dose distributions to achieve target dose coverage and normal tissue sparing for multiple setup and range uncertainty scenarios as well as for all ten respiratory phases simultaneously. IMPT dose distributions of ten lung cancer patients with different tumor sizes and motion magnitudes were optimized to illustrate our approach and its potential; Results: Compared with treatment plans generated using the conventional planning target volume (PTV)-based optimization and 3D robust optimization (3DRO), plans generated by 4DRO were found to have superior clinical target volume coverage and dose robustness in the face of setup and range uncertainties as well as for respiratory motion. In most of the cases we studied, 4DRO also resulted in more homogeneous target dose distributions. Interestingly, such improvements were found even for cases in which moving diaphragms intruded into the proton beam paths; Conclusion: The incorporation of respiratory motion, along with setup and range uncertainties, into robust optimization, has the potential to improve the resilience of target and normal tissue dose distributions in IMPT plans in the face of the uncertainties considered. Moreover, it improves the optimality of plans compared to PTV-based optimization as well as 3DRO.
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19
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Farr JB, Flanz JB, Gerbershagen A, Moyers MF. New horizons in particle therapy systems. Med Phys 2018; 45:e953-e983. [DOI: 10.1002/mp.13193] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 05/28/2018] [Accepted: 07/14/2018] [Indexed: 11/06/2022] Open
Affiliation(s)
- Jonathan B. Farr
- Department of Medical Physics Applications of Detectors and Accelerators to Medicine SA 1217 Geneva Switzerland
| | - Jacob B. Flanz
- Department of Radiation Oncology Massachusetts General Hospital and Harvard Medical School Boston MAUSA
| | - Alexander Gerbershagen
- Department of Engineering European Organization for Nuclear Research (CERN) 1211 Geneva 23 Switzerland
| | - Michael F. Moyers
- Department of Medical Physics Shanghai Proton and Heavy Ion Center Shanghai 201315 China
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20
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Krieger M, Klimpki G, Fattori G, Hrbacek J, Oxley D, Safai S, Weber DC, Lomax AJ, Zhang Y. Experimental validation of a deforming grid 4D dose calculation for PBS proton therapy. ACTA ACUST UNITED AC 2018; 63:055005. [DOI: 10.1088/1361-6560/aaad1e] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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21
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A statistical comparison of motion mitigation performances and robustness of various pencil beam scanned proton systems for liver tumour treatments. Radiother Oncol 2018; 128:182-188. [PMID: 29459153 DOI: 10.1016/j.radonc.2018.01.019] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 01/30/2018] [Accepted: 01/31/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND PURPOSE Different scanned proton therapy systems provide different scanning scenarios, directly changing the temporal interference between sequential beam delivery and tumour motion. We aim here to quantify the interplay effects and compare motion mitigation performance among different PBS scanning systems. MATERIALS AND METHODS Using 6 4DCT(MRI) datasets of liver tumours with irregular motions greater than 10 mm, 4D treatments with single- and double-field plans, and assuming various doses and motion mitigation approaches, were simulated for 8 PBS scenarios including spot or raster scanning, layered or volumetric rescanning, gating, constant or varying beam current and cyclotron or synchrotron beam sources. The resulting 4D plans were compared using the homogeneity index (D5-D95 in CTV) and treatment time. RESULTS Independent of scanning scenario and field dose, neither gating nor rescanning alone could mitigate motion effects completely. Re-gating (rescanning with gating) however was found to be similarly effective for all scanning scenarios, most field doses and both rescan modes, with the difference being mainly in the treatment efficiency. The advantage of cyclotron-based systems together with layer-by-layer beam current variation was demonstrated by the nearly constant treatment time as a function of increased field dose. CONCLUSION Independently of PBS scanning dynamics, re-gating is sufficient to achieve acceptable 4D plan quality close to those of the static references.
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22
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Bert C, Herfarth K. Management of organ motion in scanned ion beam therapy. Radiat Oncol 2017; 12:170. [PMID: 29110693 PMCID: PMC5674859 DOI: 10.1186/s13014-017-0911-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 10/27/2017] [Indexed: 12/13/2022] Open
Abstract
Scanned ion beam therapy has special demands for treatment of intra-fractionally moving tumors such as lesions in lung or liver. Interplay effects between beam and organ motion can in those settings lead to under-dosage of the target volume. Dedicated treatment techniques such as gating or abdominal compression are required. In addition 4D treatment planning should be used to determine strategies for patient specific treatment planning such as an increased beam focus or the use of internal target volumes incorporating range changes.Several work packages of the Clinical Research Units 214 and 214/2 funded by the German Research Council investigated the management of organ motion in scanned ion beam therapy. A focus was laid on 4D treatment planning using TRiP4D and the development of motion mitigation strategies including their quality assurance. This review focuses on the activity in the second funding period covering adaptive treatment planning strategies, 4D treatment plan optimization, and the application of motion management in pre-clinical research on radiation therapy of cardiac arrhythmias.
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Affiliation(s)
- Christoph Bert
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsstraße 27, 91054, Erlangen, Germany.
| | - Klaus Herfarth
- Heidelberg Ion-Beam Therapy Center (HIT) and Department of Radiation Oncology, University Clinic Heidelberg, Heidelberg, Germany
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23
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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.
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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
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Batista V, Richter D, Combs SE, Jäkel O. Planning strategies for inter-fractional robustness in pancreatic patients treated with scanned carbon therapy. Radiat Oncol 2017; 12:94. [PMID: 28595643 PMCID: PMC5465513 DOI: 10.1186/s13014-017-0832-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 05/30/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Managing inter-fractional anatomy changes is a challenging task in radiotherapy of pancreatic tumors, especially in scanned carbon-ion delivery. This treatment planning study aims to focus on clinically feasible solutions, such as the beam angle selection and margin design to increase the robustness against inter-fractional uncertainties. METHODS This study included 10 patients with weekly 3D-CT imaging and physician-approved Clinical Target Volume (CTV). The study was directed to keep the CTV-coverage using six beam angle configurations in combination with different Internal Target Volume (ITV) concepts. These were: geometric-margin (symmetric 3 and 5 mm margin); range-equivalent margins with an isotropic HU replacement; and to evaluate the need of asymmetric margins the water-equivalent range path (WEPL) was determined per patient from the set of CTs. Plan optimization and forward dose calculation in each week-CT were performed with the research treatment planning system TRiP98 and the plan quality evaluated in terms of CTV coverage (V95CTV) and homogeneity dose (HCTV = D5-D95). RESULTS The beam geometry had a substantial impact on the target irradiation over the treatment course, with the single posterior or two beams showing the best average coverage of the CTV. The use of geometric margins for the more robust beam geometries showed acceptable results, with a V95CTV of (99.2 ± 1.2)% for the 5 mm-margin. For the non-robust configurations, due to substantial changes in the radiological depth, the use of this margin results in a V95CTV that might be below 80%, only showing improvement when the range changes are included. CONCLUSIONS Selection of adequate beam configurations and treatment margins in ion-beam therapy of pancreatic tumors is of great importance. For a single posterior beam or two beam configurations, application of geometrical margins compensate for dose degradation induced by inter-fractional anatomy changes for the majority of the analyzed treatment fractions.
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Affiliation(s)
- Vania Batista
- Hospital for Radiooncology and Radiation Therapy, Heidelberg University Hospital, Heidelberg, Germany
| | - Daniel Richter
- University Clinic of Erlangen, Erlangen, Germany
- GSI Helmholtz Centre for Heavy Ion Research, Darmstadt, Germany
| | - Stephanie E. Combs
- Hospital for Radiooncology and Radiation Therapy, Heidelberg University Hospital, Heidelberg, Germany
- Klinikum rechts der Isa, Technische Universität München, Muniche, Germany
| | - Oliver Jäkel
- Heidelberg Ion-Beam Therapy Center, Heidelberg, Germany
- Division Medical Physics in Radiation Oncology, German Cancer Research Center, Heidelberg, Germany
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Mori S, Karube M, Yasuda S, Yamamoto N, Tsuji H, Kamada T. Gating window dependency on scanned carbon-ion beam dose distribution and imaging dose for thoracoabdominal treatment. Br J Radiol 2017; 90:20160936. [PMID: 28466645 DOI: 10.1259/bjr.20160936] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To explore the trade-off between dose assessment and imaging dose in respiratory gating with radiographic fluoroscopic imaging, we evaluated the relationship between dose assessment and fluoroscopic imaging dose in various gating windows, retrospectively. METHODS Four-dimensional (4D) CT images acquired for 10 patients with lung and liver tumours were used for 4D treatment planning for scanned carbon ion beam. Imaging dose from two oblique directions was calculated by the number of images multiplied by the air kerma per image. Necessary beam-on time was calculated from the treatment log file. Accumulated dose distribution was calculated. The gating window was defined as tumour position not respiratory phase and changed from 0-100% duty cycle on 4DCT. These metrics were individually evaluated for every case. RESULTS For lung cases, sufficient dose conformation was achieved in respective gating windows [D95-clinical target volume (CTV) > 99%]. V20-lung values for 50%- and 30%-duty cycles were 2.5% and 6.0% of that for 100%-duty cycle. Maximum doses (cord/oesophagus) for 30%-duty cycle decreased 6.8%/7.4% to those for 100%-duty cycle. For liver cases, V10-liver values for 50%- and 30%-duty cycles were 9.4% and 12.8% of those for 100%-duty cycle, respectively. Maximum doses (cord/oesophagus) for 50%- and 30%-duty cycles also decreased 17.2%/19.3% and 24.6%/29.8% to those for 100%-duty cycle, respectively. Total imaging doses increased 43.5% and 115.8% for 50%- and 30%-duty cycles to that for the 100%-duty cycle. CONCLUSION When normal tissue doses are below the tolerance level, the gating window should be expanded to minimize imaging dose and treatment time. Advances in knowledge: The skin dose from imaging might not be counterbalanced to the OAR dose; however, imaging dose is a particularly important factor.
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Affiliation(s)
- Shinichiro Mori
- Research Center for Charged Particle Therapy, National Institute of Radiological Sciences, Chiba, Japan
| | - Masataka Karube
- Research Center for Charged Particle Therapy, National Institute of Radiological Sciences, Chiba, Japan
| | - Shigeo Yasuda
- Research Center for Charged Particle Therapy, National Institute of Radiological Sciences, Chiba, Japan
| | - Naoyoshi Yamamoto
- Research Center for Charged Particle Therapy, National Institute of Radiological Sciences, Chiba, Japan
| | - Hiroshi Tsuji
- Research Center for Charged Particle Therapy, National Institute of Radiological Sciences, Chiba, Japan
| | - Tadashi Kamada
- Research Center for Charged Particle Therapy, National Institute of Radiological Sciences, Chiba, Japan
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Zhang Y, Huth I, Wegner M, Weber DC, Lomax AJ. Surface as a motion surrogate for gated re-scanned pencil beam proton therapy. Phys Med Biol 2017; 62:4046-4061. [DOI: 10.1088/1361-6560/aa66c5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Kang M, Huang S, Solberg TD, Mayer R, Thomas A, Teo BKK, McDonough JE, Simone CB, Lin L. A study of the beam-specific interplay effect in proton pencil beam scanning delivery in lung cancer. Acta Oncol 2017; 56:531-540. [PMID: 28358666 DOI: 10.1080/0284186x.2017.1293287] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND For lung tumors with large motion amplitudes, the use of proton pencil beam scanning (PBS) can produce large dose errors. In this study, we assess under what circumstances PBS can be used to treat lung cancer patients who exhibit large tumor motion, based on the quantification of tumor motion and the dose interplay. MATERIAL AND METHODS PBS plans were optimized on average 4DCT datasets using a beam-specific PTV method for 10 consecutive patients with locally advanced non-small-cell-lung-cancer (NSCLC) treated with proton therapy to 6660/180 cGy. End inhalation (CT0) and end exhalation (CT50) were selected as the two extreme scenarios to acquire the relative stopping power ratio difference (Δrsp) for a respiration cycle. The water equivalent difference (ΔWET) per radiological path was calculated from the surface of patient to the iCTV by integrating the Δrsp of each voxel. The magnitude of motion of voxels within the target follows a quasi-Gaussian distribution. A motion index (MI (>5mm WET)), defined as the percentage of target voxels with an absolute integral ΔWET larger than 5 mm, was adopted as a metric to characterize interplay. To simulate the treatment process, 4D dose was calculated by accumulating the spot dose on the corresponding respiration phase to the reference phase CT50 by deformable image registration based on spot timing and patient breathing phase. RESULTS The study indicated that the magnitude of target underdose in a single fraction plan is proportional to the MI (p < .001), with larger motion equating to greater dose degradation and standard deviations. The target homogeneity, minimum, maximum and mean dose in the 4D dose accumulations of 37 fractions varied as a function of MI. CONCLUSIONS This study demonstrated that MI can predict the level of dose degradation, which potentially serves as a clinical decision tool to assess whether lung cancer patients are potentially suitable to receive PBS treatment.
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Affiliation(s)
- Minglei Kang
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Sheng Huang
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Timothy D. Solberg
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
- Department of Radiation Oncology, University of California, San Francisco, CA, USA
| | - Rulon Mayer
- Department of Radiation Oncology, Walter Reed Military Hospital, Bethesda, MD, USA
| | - Andy Thomas
- Department of Radiation Oncology, Walter Reed Military Hospital, Bethesda, MD, USA
| | - Boon-Keng Kevin Teo
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - James E. McDonough
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Charles B. Simone
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
- Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, MD, USA
| | - Liyong Lin
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
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Batista V, Chaudhri N, Richter D, Herfarth K, Jäkel O. Internal target volume margins for liver tumours treated with gated scanned carbon-ion radiotherapy. Biomed Phys Eng Express 2017. [DOI: 10.1088/2057-1976/aa5988] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Matney JE, Park PC, Li H, Court LE, Zhu XR, Dong L, Liu W, Mohan R. Perturbation of water-equivalent thickness as a surrogate for respiratory motion in proton therapy. J Appl Clin Med Phys 2016; 17:368-378. [PMID: 27074459 PMCID: PMC5546214 DOI: 10.1120/jacmp.v17i2.5795] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 12/02/2015] [Accepted: 11/18/2015] [Indexed: 12/25/2022] Open
Abstract
Respiratory motion is traditionally assessed using tumor motion magnitude. In proton therapy, respiratory motion causes density variations along the beam path that result in uncertainties of proton range. This work has investigated the use of water‐equivalent thickness (WET) to quantitatively assess the effects of respiratory motion on calculated dose in passively scattered proton therapy (PSPT). A cohort of 29 locally advanced non‐small cell lung cancer patients treated with 87 PSPT treatment fields were selected for analysis. The variation in WET (ΔWET) along each field was calculated between exhale and inhale phases of the simulation four‐dimensional computed tomography. The change in calculated dose (ΔDose) between full‐inhale and full‐exhale phase was quantified for each field using dose differences, 3D gamma analysis, and differential area under the curve (ΔAUC) analysis. Pearson correlation coefficients were calculated between ΔDose and ΔWET. Three PSPT plans were redesigned using field angles to minimize variations in ΔWET and compared to the original plans. The median ΔWET over 87 treatment fields ranged from 1‐9 mm, while the ΔWET 95th percentile value ranged up to 42 mm. The ΔWET was significantly correlated (p<0.001) to the ΔDose for all metrics analyzed. The patient plans that were redesigned using ΔWET analysis to select field angles were more robust to the effects of respiratory motion, as ΔAUC values were reduced by more than 60% in all three cases. The tumor motion magnitude alone does not capture the potential dosimetric error due to respiratory motion because the proton range is sensitive to the motion of all patient anatomy. The use of ΔWET has been demonstrated to identify situations where respiratory motion can impact the calculated dose. Angular analysis of ΔWET may be capable of designing radiotherapy plans that are more robust to the effects of respiratory motion. PACS number(s): 87.55.‐x
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Constantinescu A, Lehmann HI, Packer DL, Bert C, Durante M, Graeff C. Treatment Planning Studies in Patient Data With Scanned Carbon Ion Beams for Catheter-Free Ablation of Atrial Fibrillation. J Cardiovasc Electrophysiol 2016; 27:335-44. [PMID: 26638826 DOI: 10.1111/jce.12888] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 11/12/2015] [Accepted: 11/25/2015] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Catheter ablation with isolation of the pulmonary veins is a common treatment option for atrial fibrillation but still has insufficient success rates and carries several interventional risks. These treatment planning studies assessed if high-dose single fraction treatment with scanned carbon ions (12C) can be reliably delivered for AF ablation, while sparing risk structures and considering respiratory and contractile target motion. METHODS AND RESULTS Time resolved CT scans of complete respiratory and cardiac cycles of 9 and 5 patients, respectively, were obtained. Ablation lesions and organs at risk for beam delivery were contoured. Single fraction intensity-modulated particle therapy with target doses of 25 and 40 Gy were studied and motion influences on these deliveries mitigated. Respiration had a large influence on lesion displacement (≤ 2 cm). End expiration could be exploited as a stable gating window. Smaller, but less predictable, heartbeat displacements (< 6 mm) remained to be mitigated because cardiac contraction resulted in insufficient dose coverage (V95 < 90%) if uncompensated. Repeated irradiation (12C beam rescanning) during breath hold was used to accommodate contractile motion, resulting in good dose coverage. Dose depositions to all organs at risk were carefully examined and did not exceed values for X-ray cancer treatment. CONCLUSION Treatment planning of 12C with delivery of physical ionizing radiation doses that have been described to induce complete block is feasible for AF ablation, considering human anatomy, dose constraints, and encasing underlying motion patterns from respiration and cardiac contraction at the LA-PV junction into treatment planning.
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Affiliation(s)
- Anna Constantinescu
- Department of Biophysics, GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - H Immo Lehmann
- Mayo Clinic Translational Interventional Electrophysiology Laboratory, Rochester, Minnesota, USA
| | - Douglas L Packer
- Mayo Clinic Translational Interventional Electrophysiology Laboratory, Rochester, Minnesota, USA
| | - Christoph Bert
- Department of Biophysics, GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany.,Department of Radiation Oncology, Friedrich-Alexander University Erlangen-Nürnberg and University Hospital, Erlangen, Germany
| | - Marco Durante
- Department of Biophysics, GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - Christian Graeff
- Department of Biophysics, GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
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Brevet R, Richter D, Graeff C, Durante M, Bert C. Treatment Parameters Optimization to Compensate for Interfractional Anatomy Variability and Intrafractional Tumor Motion. Front Oncol 2015; 5:291. [PMID: 26734573 PMCID: PMC4689810 DOI: 10.3389/fonc.2015.00291] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 12/07/2015] [Indexed: 11/13/2022] Open
Abstract
Scanned ion beam therapy of lung tumors is severely limited in its clinical applicability by intrafractional organ motion, interference effects between beam and tumor motion (interplay), as well as interfractional anatomic changes. To compensate for dose deterioration caused by intrafractional motion, motion mitigation techniques, such as gating, have been developed. However, optimization of the treatment parameters is needed to further improve target dose coverage and normal tissue sparing. The aim of this study was to determine treatment-planning parameters that permit to recover good target coverage for each fraction of lung tumor treatments. For 9 lung tumor patients from MD Anderson Cancer Center (Houston, Texas), a total of 70 weekly time-resolved computed tomography (4DCT) datasets, which depict the evolution of the patient anatomy over the several fractions of the treatment, were available. Using the GSI in-house treatment planning system TRiP4D, 4D simulations were performed on each weekly 4DCT for each patient using gating and optimization of a single treatment plan based on a planning CT acquired prior to treatment. The impact on target dose coverage (V 95%,CTV) of variations in focus size and length of the gating window, as well as different additional margins and the number of fields was analyzed. It appeared that interfractional variability could potentially have a larger impact on V 95%,CTV than intrafractional motion. However, among the investigated parameters, the use of a large beam spot size, a short gating window, additional margins, and multiple fields permitted to obtain an average V 95%,CTV of 96.5%. In the presented study, it was shown that optimized treatment parameters have an important impact on target dose coverage in the treatment of moving tumors. Indeed, intrafractional motion occurring during the treatment of lung tumors and interfractional variability were best mitigated using a large focus, a short gating window, additional margins, and three fields.
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Affiliation(s)
- Romain Brevet
- GSI Helmholtzzentrum für Schwerionenforschung , Darmstadt , Germany
| | - Daniel Richter
- FAU Erlangen-Nürnberg and Universitätsklinikum Erlangen , Erlangen , Germany
| | - Christian Graeff
- GSI Helmholtzzentrum für Schwerionenforschung , Darmstadt , Germany
| | - Marco Durante
- GSI Helmholtzzentrum für Schwerionenforschung , Darmstadt , Germany
| | - Christoph Bert
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany; FAU Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
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Hild S, Graeff C, Rucinski A, Zink K, Habl G, Durante M, Herfarth K, Bert C. Scanned ion beam therapy for prostate carcinoma. Strahlenther Onkol 2015; 192:118-26. [DOI: 10.1007/s00066-015-0925-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 11/11/2015] [Indexed: 12/31/2022]
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Morel P, Flynn RT, Gelover E, Blin G, Vialette S, Wu X, Wang D. MSPT: an open-source motion simulator for proton therapy. Biomed Phys Eng Express 2015. [DOI: 10.1088/2057-1976/1/3/037001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Habermehl D, Naumann P, Bendl R, Oelfke U, Nill S, Debus J, Combs SE. Evaluation of inter- and intrafractional motion of liver tumors using interstitial markers and implantable electromagnetic radiotransmitters in the context of image-guided radiotherapy (IGRT) - the ESMERALDA trial. Radiat Oncol 2015; 10:143. [PMID: 26169281 PMCID: PMC4499938 DOI: 10.1186/s13014-015-0456-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 07/06/2015] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND With the development of more conformal and precise radiation techniques such as Intensity-Modulated Radiotherapy (IMRT), Stereotactic Body Radiotherapy (SBRT) and Image-Guided Radiotherapy (IGRT), patients with hepatic tumors could be treated with high local doses by sparing normal liver tissue. However, frequently occurring large HCC tumors are still a dosimetric challenge in spite of modern high sophisticated RT modalities. This interventional clinical study has been set up to evaluate the value of different fiducial markers, and to use the modern imaging methods for further treatment optimization using physical and informatics approaches. METHODS AND DESIGN Surgically implanted radioopaque or electromagnetic markers are used to detect tumor local-ization during radiotherapy. The required markers for targeting and observation during RT can be implanted in a previously defined optimal position during the oncologically indicated operation. If there is no indication for a surgical resection or open biopsy, markers may be inserted into the liver or tumor tissue by using ultrasound-guidance. Primary study aim is the detection of the patients' anatomy at the time of RT by observation of the marker position during the indicated irradiation (IGRT). Secondary study aims comprise detection and recording of 3D liver and tumor motion during RT. Furthermore, the study will help to develop technical strategies and mechanisms based on the recorded information on organ motion to avoid inaccurate dose application resulting from fast organ motion and deformation. DISCUSSION This is an open monocentric non-randomized, prospective study for the evaluation of organ motion using interstitial markers or implantable radiotransmitter. The trial will evaluate the full potential of different fiducial markers to further optimize treatment of moving targets, with a special focus on liver lesions.
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Affiliation(s)
- Daniel Habermehl
- Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Patrick Naumann
- Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
| | - Rolf Bendl
- Department of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
- Medical Informatics, Heilbronn University, Heilbronn, Germany.
| | - Uwe Oelfke
- Joint Department of Physics at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK.
| | - Simeon Nill
- Joint Department of Physics at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK.
| | - Jürgen Debus
- Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
| | - Stephanie E Combs
- Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
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Implementation of an analytical model for leakage neutron equivalent dose in a proton radiotherapy planning system. Cancers (Basel) 2015; 7:427-38. [PMID: 25768061 PMCID: PMC4381266 DOI: 10.3390/cancers7010427] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 02/12/2015] [Accepted: 03/02/2015] [Indexed: 01/05/2023] Open
Abstract
Equivalent dose from neutrons produced during proton radiotherapy increases the predicted risk of radiogenic late effects. However, out-of-field neutron dose is not taken into account by commercial proton radiotherapy treatment planning systems. The purpose of this study was to demonstrate the feasibility of implementing an analytical model to calculate leakage neutron equivalent dose in a treatment planning system. Passive scattering proton treatment plans were created for a water phantom and for a patient. For both the phantom and patient, the neutron equivalent doses were small but non-negligible and extended far beyond the therapeutic field. The time required for neutron equivalent dose calculation was 1.6 times longer than that required for proton dose calculation, with a total calculation time of less than 1 h on one processor for both treatment plans. Our results demonstrate that it is feasible to predict neutron equivalent dose distributions using an analytical dose algorithm for individual patients with irregular surfaces and internal tissue heterogeneities. Eventually, personalized estimates of neutron equivalent dose to organs far from the treatment field may guide clinicians to create treatment plans that reduce the risk of late effects.
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Eley JG, Newhauser WD, Richter D, Lüchtenborg R, Saito N, Bert C. Robustness of target dose coverage to motion uncertainties for scanned carbon ion beam tracking therapy of moving tumors. Phys Med Biol 2015; 60:1717-40. [PMID: 25650520 DOI: 10.1088/0031-9155/60/4/1717] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Beam tracking with scanned carbon ion radiotherapy achieves highly conformal target dose by steering carbon pencil beams to follow moving tumors using real-time magnetic deflection and range modulation. The purpose of this study was to evaluate the robustness of target dose coverage from beam tracking in light of positional uncertainties of moving targets and beams. To accomplish this, we simulated beam tracking for moving targets in both water phantoms and a sample of lung cancer patients using a research treatment planning system. We modeled various deviations from perfect tracking that could arise due to uncertainty in organ motion and limited precision of a scanned ion beam tracking system. We also investigated the effects of interfractional changes in organ motion on target dose coverage by simulating a complete course of treatment using serial (weekly) 4DCTs from six lung cancer patients. For perfect tracking of moving targets, we found that target dose coverage was high ([Formula: see text] was 94.8% for phantoms and 94.3% for lung cancer patients, respectively) but sensitive to changes in the phase of respiration at the start of treatment and to the respiratory period. Phase delays in tracking the moving targets led to large degradation of target dose coverage (up to 22% drop for a 15° delay). Sensitivity to technical uncertainties in beam tracking delivery was minimal for a lung cancer case. However, interfractional changes in anatomy and organ motion led to large decreases in target dose coverage (target coverage dropped approximately 8% due to anatomy and motion changes after 1 week). Our findings provide a better understand of the importance of each of these uncertainties for beam tracking with scanned carbon ion therapy and can be used to inform the design of future scanned ion beam tracking systems.
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Affiliation(s)
- John Gordon Eley
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA. The University of Texas Graduate School of Biomedical Sciences at Houston, 6767 Bertner Avenue, Houston, TX 77030, USA. Department of Radiation Oncology, University of Maryland School of Medicine, 22 South Green Street, Baltimore, MD 21201, USA
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Bert C, Graeff C, Riboldi M, Nill S, Baroni G, Knopf AC. Advances in 4D treatment planning for scanned particle beam therapy - report of dedicated workshops. Technol Cancer Res Treat 2014; 13:485-95. [PMID: 24354749 PMCID: PMC4527425 DOI: 10.7785/tcrtexpress.2013.600274] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Revised: 09/27/2013] [Accepted: 10/01/2013] [Indexed: 11/25/2022] Open
Abstract
We report on recent progress in the field of mobile tumor treatment with scanned particle beams, as discussed in the latest editions of the 4D treatment planning workshop. The workshop series started in 2009, with about 20 people from 4 research institutes involved, all actively working on particle therapy delivery and development. The first workshop resulted in a summary of recommendations for the treatment of mobile targets, along with a list of requirements to apply these guidelines clinically. The increased interest in the treatment of mobile tumors led to a continuously growing number of attendees: the 2012 edition counted more than 60 participants from 20 institutions and commercial vendors. The focus of research discussions among workshop participants progressively moved from 4D treatment planning to complete 4D treatments, aiming at effective and safe treatment delivery. Current research perspectives on 4D treatments include all critical aspects of time resolved delivery, such as in-room imaging, motion detection, beam application, and quality assurance techniques. This was motivated by the start of first clinical treatments of hepato cellular tumors with a scanned particle beam, relying on gating or abdominal compression for motion mitigation. Up to date research activities emphasize significant efforts in investigating advanced motion mitigation techniques, with a specific interest in the development of dedicated tools for experimental validation. Potential improvements will be made possible in the near future through 4D optimized treatment plans that require upgrades of the currently established therapy control systems for time resolved delivery. But since also these novel optimization techniques rely on the validity of the 4DCT, research focusing on alternative 4D imaging technique, such as MRI based 4DCT generation will continue.
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Affiliation(s)
- Christoph Bert
- University Clinic Erlangen, Radiation Oncology, Universitatsstrasse 27, 91054 Erlangen, Germany.
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Zhang Y, Knopf A, Tanner C, Lomax AJ. Online image guided tumour tracking with scanned proton beams: a comprehensive simulation study. Phys Med Biol 2014; 59:7793-817. [DOI: 10.1088/0031-9155/59/24/7793] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Residual motion mitigation in scanned carbon ion beam therapy of liver tumors using enlarged pencil beam overlap. Radiother Oncol 2014; 113:290-5. [DOI: 10.1016/j.radonc.2014.11.020] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Revised: 11/12/2014] [Accepted: 11/13/2014] [Indexed: 11/19/2022]
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Wink KCJ, Roelofs E, Solberg T, Lin L, Simone CB, Jakobi A, Richter C, Lambin P, Troost EGC. Particle therapy for non-small cell lung tumors: where do we stand? A systematic review of the literature. Front Oncol 2014; 4:292. [PMID: 25401087 PMCID: PMC4212620 DOI: 10.3389/fonc.2014.00292] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 10/07/2014] [Indexed: 12/25/2022] Open
Abstract
This review article provides a systematic overview of the currently available evidence on the clinical effectiveness of particle therapy for the treatment of non-small cell lung cancer and summarizes findings of in silico comparative planning studies. Furthermore, technical issues and dosimetric uncertainties with respect to thoracic particle therapy are discussed.
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Affiliation(s)
- Krista C J Wink
- Department of Radiation Oncology (MAASTRO Clinic), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre , Maastricht , Netherlands
| | - Erik Roelofs
- Department of Radiation Oncology (MAASTRO Clinic), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre , Maastricht , Netherlands
| | - Timothy Solberg
- Department of Radiation Oncology, Hospital of the University of Pennsylvania , Philadelphia, PA , USA
| | - Liyong Lin
- Department of Radiation Oncology, Hospital of the University of Pennsylvania , Philadelphia, PA , USA
| | - Charles B Simone
- Department of Radiation Oncology, Hospital of the University of Pennsylvania , Philadelphia, PA , USA
| | - Annika Jakobi
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden and Helmholtz-Zentrum Dresden-Rossendorf , Dresden , Germany
| | - Christian Richter
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden and Helmholtz-Zentrum Dresden-Rossendorf , Dresden , Germany ; German Cancer Consortium (DKTK) Dresden and German Cancer Research Center (DKFZ) , Heidelberg , Germany
| | - Philippe Lambin
- Department of Radiation Oncology (MAASTRO Clinic), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre , Maastricht , Netherlands
| | - Esther G C Troost
- Department of Radiation Oncology (MAASTRO Clinic), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre , Maastricht , Netherlands
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Mori S, Inaniwa T, Furukawa T, Takahashi W, Nakajima M, Shirai T, Noda K, Yasuda S, Yamamoto N. Amplitude-based gated phase-controlled rescanning in carbon-ion scanning beam treatment planning under irregular breathing conditions using lung and liver 4DCTs. JOURNAL OF RADIATION RESEARCH 2014; 55:948-958. [PMID: 24835238 PMCID: PMC4202290 DOI: 10.1093/jrr/rru032] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 02/26/2014] [Accepted: 04/01/2014] [Indexed: 05/29/2023]
Abstract
Amplitude-based gating aids treatment planning in scanned particle therapy because it gives better control of uncertainty with the gate window. We have installed an X-ray fluoroscopic imaging system in our treatment room for clinical use with an amplitude-based gating strategy. We evaluated the effects of this gating under realistic organ motion conditions using 4 DCT data of lung and liver tumors. 4 DCT imaging was done for 24 lung and liver patients using the area-detector CT. We calculated the field-specific target volume (FTV) for the gating window, which was defined for a single respiratory cycle. Prescribed doses of 48 Gy relative biological effectiveness (RBE)/fraction/four fields and 45 Gy RBE/two fractions/two fields were delivered to the FTVs for lung and liver treatments, respectively. Dose distributions were calculated for the repeated first respiratory cycle (= planning dose) and the whole respiratory data (= treatment dose). We applied eight phase-controlled rescannings with the amplitude-based gating. For the lung cases, D95 of the treatment dose (= 96.0 ± 1.0%) was almost the same as that of the planning dose (= 96.6 ± 0.9%). D(max)/D(min) of the treatment dose (= 104.5 ± 2.2%/89.4 ± 2.6%) was slightly increased over that of the planning dose (= 102.1 ± 1.0%/89.8 ± 2.5%) due to hot spots. For the liver cases, D95 of the treatment dose (= 97.6 ± 0.5%) was decreased by ∼ 1% when compared with the planning dose (= 98.5 ± 0.4%). D(max)/D(min) of the treatment dose was degraded by 3.0%/0.4% compared with the planning dose. Average treatment times were extended by 46.5 s and 65.9 s from those of the planning dose for lung and liver cases, respectively. As with regular respiratory patterns, amplitude-based gated multiple phase-controlled rescanning preserves target coverage to a moving target under irregular respiratory patterns.
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Affiliation(s)
- Shinichiro Mori
- Research Center for Charged Particle Therapy, National Institute of Radiological Sciences, Inage-ku, Chiba 263-8555, Japan
| | - Taku Inaniwa
- Research Center for Charged Particle Therapy, National Institute of Radiological Sciences, Inage-ku, Chiba 263-8555, Japan
| | - Takuji Furukawa
- Research Center for Charged Particle Therapy, National Institute of Radiological Sciences, Inage-ku, Chiba 263-8555, Japan
| | - Wataru Takahashi
- Research Center for Charged Particle Therapy, National Institute of Radiological Sciences, Inage-ku, Chiba 263-8555, Japan
| | - Mio Nakajima
- Research Center for Charged Particle Therapy, National Institute of Radiological Sciences, Inage-ku, Chiba 263-8555, Japan
| | - Toshiyuki Shirai
- Research Center for Charged Particle Therapy, National Institute of Radiological Sciences, Inage-ku, Chiba 263-8555, Japan
| | - Koji Noda
- Research Center for Charged Particle Therapy, National Institute of Radiological Sciences, Inage-ku, Chiba 263-8555, Japan
| | - Shigeo Yasuda
- Research Center for Charged Particle Therapy, National Institute of Radiological Sciences, Inage-ku, Chiba 263-8555, Japan
| | - Naoyoshi Yamamoto
- Research Center for Charged Particle Therapy, National Institute of Radiological Sciences, Inage-ku, Chiba 263-8555, Japan
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Whitaker TJ, Beltran C, Tryggestad E, Bues M, Kruse JJ, Remmes NB, Tasson A, Herman MG. Comparison of two methods for minimizing the effect of delayed charge on the dose delivered with a synchrotron based discrete spot scanning proton beam. Med Phys 2014; 41:081703. [PMID: 25086513 DOI: 10.1118/1.4885961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Delayed charge is a small amount of charge that is delivered to the patient after the planned irradiation is halted, which may degrade the quality of the treatment by delivering unwarranted dose to the patient. This study compares two methods for minimizing the effect of delayed charge on the dose delivered with a synchrotron based discrete spot scanning proton beam. METHODS The delivery of several treatment plans was simulated by applying a normally distributed value of delayed charge, with a mean of 0.001(SD 0.00025) MU, to each spot. Two correction methods were used to account for the delayed charge. Method one (CM1), which is in active clinical use, accounts for the delayed charge by adjusting the MU of the current spot based on the cumulative MU. Method two (CM2) in addition reduces the planned MU by a predicted value. Every fraction of a treatment was simulated using each method and then recomputed in the treatment planning system. The dose difference between the original plan and the sum of the simulated fractions was evaluated. Both methods were tested in a water phantom with a single beam and simple target geometry. Two separate phantom tests were performed. In one test the dose per fraction was varied from 0.5 to 2 Gy using 25 fractions per plan. In the other test the number fractions were varied from 1 to 25, using 2 Gy per fraction. Three patient plans were used to determine the effect of delayed charge on the delivered dose under realistic clinical conditions. The order of spot delivery using CM1 was investigated by randomly selecting the starting spot for each layer, and by alternating per layer the starting spot from first to last. Only discrete spot scanning was considered in this study. RESULTS Using the phantom setup and varying the dose per fraction, the maximum dose difference for each plan of 25 fractions was 0.37-0.39 Gy and 0.03-0.05 Gy for CM1 and CM2, respectively. While varying the total number of fractions, the maximum dose difference increased at a rate of 0.015 Gy and 0.0018 Gy per fraction for CM1 and CM2, respectively. For CM1, the largest dose difference was found at the location of the first spot in each energy layer, whereas for CM2 the difference in dose was small and showed no dependence on location. For CM1, all of the fields in the patient plans had an area where their excess dose overlapped. No such correlation was found when using CM2. Randomly selecting the starting spot reduces the maximum dose difference from 0.708 to 0.15 Gy. Alternating between first and last spot reduces the maximum dose difference from 0.708 to 0.37 Gy. In the patient plans the excess dose scaled linearly at 0.014 Gy per field per fraction for CM1 and standard delivery order. CONCLUSIONS The predictive model CM2 is superior to a cumulative irradiation model CM1 for minimizing the effects of delayed charge, particularly when considering maximal dose discrepancies and the potential for unplanned hot-spots. This study shows that the dose discrepancy potentially scales at 0.014 Gy per field per fraction for CM1.
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Affiliation(s)
| | - Chris Beltran
- Mayo Clinic, 200 First Street Southwest, Rochester, Minnesota 55905
| | - Erik Tryggestad
- Mayo Clinic, 200 First Street Southwest, Rochester, Minnesota 55905
| | - Martin Bues
- Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, Arizona 85054
| | - Jon J Kruse
- Mayo Clinic, 200 First Street Southwest, Rochester, Minnesota 55905
| | | | | | - Michael G Herman
- Mayo Clinic, 200 First Street Southwest, Rochester, Minnesota 55905
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Schätti A, Zakova M, Meer D, Lomax AJ. The effectiveness of combined gating and re-scanning for treating mobile targets with proton spot scanning. An experimental and simulation-based investigation. Phys Med Biol 2014; 59:3813-28. [PMID: 24955723 DOI: 10.1088/0031-9155/59/14/3813] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Organ motion is one of the major obstacles in radiotherapy and charged particle therapy. Even more so, the theoretical advantages of dose distributions in scanned ion beam therapy may be lost due to the interplay between organ motion and beam scanning. Several techniques for dealing with this problem have been devised. In re-scanning, the target volume is scanned several times to average out the motion effects. In gating and breath-hold, dose is only delivered if the tumour is in a narrow window of position. Experiments have been performed to verify if gating and re-scanning are effective means of motion mitigation. Dose distributions were acquired in a lateral plane of a homogeneous phantom. For a spherical target volume and regular motion gating was sufficient. However, for realistic, irregular motion or a patient target volume, gating did not reduce the interplay effect to an acceptable level. Combining gating with re-scanning recovered the dose distributions. The simplest re-scanning approach, where a treatment plan is duplicated several times and applied in sequence, was not efficient. Simulations of different combinations of gating window sizes and re-scanning schemes revealed that reducing the gating window is the most efficient approach. However, very small gating windows are not robust for irregular motion.
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Affiliation(s)
- A Schätti
- Centre for Proton Therapy, Paul Scherrer Institut, Villigen, Switzerland
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44
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Eley JG, Newhauser WD, Lüchtenborg R, Graeff C, Bert C. 4D optimization of scanned ion beam tracking therapy for moving tumors. Phys Med Biol 2014; 59:3431-52. [PMID: 24889215 DOI: 10.1088/0031-9155/59/13/3431] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Motion mitigation strategies are needed to fully realize the theoretical advantages of scanned ion beam therapy for patients with moving tumors. The purpose of this study was to determine whether a new four-dimensional (4D) optimization approach for scanned-ion-beam tracking could reduce dose to avoidance volumes near a moving target while maintaining target dose coverage, compared to an existing 3D-optimized beam tracking approach. We tested these approaches computationally using a simple 4D geometrical phantom and a complex anatomic phantom, that is, a 4D computed tomogram of the thorax of a lung cancer patient. We also validated our findings using measurements of carbon-ion beams with a motorized film phantom. Relative to 3D-optimized beam tracking, 4D-optimized beam tracking reduced the maximum predicted dose to avoidance volumes by 53% in the simple phantom and by 13% in the thorax phantom. 4D-optimized beam tracking provided similar target dose homogeneity in the simple phantom (standard deviation of target dose was 0.4% versus 0.3%) and dramatically superior homogeneity in the thorax phantom (D5-D95 was 1.9% versus 38.7%). Measurements demonstrated that delivery of 4D-optimized beam tracking was technically feasible and confirmed a 42% decrease in maximum film exposure in the avoidance region compared with 3D-optimized beam tracking. In conclusion, we found that 4D-optimized beam tracking can reduce the maximum dose to avoidance volumes near a moving target while maintaining target dose coverage, compared with 3D-optimized beam tracking.
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Affiliation(s)
- John Gordon Eley
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA. The University of Texas Graduate School of Biomedical Sciences at Houston, 6767 Bertner Avenue, Houston, TX, 77030, USA
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Mori S, Zenklusen S, Inaniwa T, Furukawa T, Imada H, Shirai T, Noda K, Yasuda S. Conformity and robustness of gated rescanned carbon ion pencil beam scanning of liver tumors at NIRS. Radiother Oncol 2014; 111:431-6. [DOI: 10.1016/j.radonc.2014.03.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 02/28/2014] [Accepted: 03/06/2014] [Indexed: 11/16/2022]
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46
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Richter D, Saito N, Chaudhri N, Härtig M, Ellerbrock M, Jäkel O, Combs SE, Habermehl D, Herfarth K, Durante M, Bert C. Four-Dimensional Patient Dose Reconstruction for Scanned Ion Beam Therapy of Moving Liver Tumors. Int J Radiat Oncol Biol Phys 2014; 89:175-81. [DOI: 10.1016/j.ijrobp.2014.01.043] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 01/22/2014] [Accepted: 01/27/2014] [Indexed: 10/25/2022]
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47
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Fattori G, Saito N, Seregni M, Kaderka R, Pella A, Constantinescu A, Riboldi M, Steidl P, Cerveri P, Bert C, Durante M, Baroni G. Commissioning of an integrated platform for time-resolved treatment delivery in scanned ion beam therapy by means of optical motion monitoring. Technol Cancer Res Treat 2013; 13:517-28. [PMID: 24354750 PMCID: PMC4527457 DOI: 10.7785/tcrtexpress.2013.600275] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The integrated use of optical technologies for patient monitoring is addressed in the framework of time-resolved treatment delivery for scanned ion beam therapy. A software application has been designed to provide the therapy control system (TCS) with a continuous geometrical feedback by processing the external surrogates tridimensional data, detected in real-time via optical tracking. Conventional procedures for phase-based respiratory phase detection were implemented, as well as the interface to patient specific correlation models, in order to estimate internal tumor motion from surface markers. In this paper, particular attention is dedicated to the quantification of time delays resulting from system integration and its compensation by means of polynomial interpolation in the time domain. Dedicated tests to assess the separate delay contributions due to optical signal processing, digital data transfer to the TCS and passive beam energy modulation actuation have been performed. We report the system technological commissioning activities reporting dose distribution errors in a phantom study, where the treatment of a lung lesion was simulated, with both lateral and range beam position compensation. The zero-delay systems integration with a specific active scanning delivery machine was achieved by tuning the amount of time prediction applied to lateral (14.61 ± 0.98 ms) and depth (34.1 ± 6.29 ms) beam position correction signals, featuring sub-millimeter accuracy in forward estimation. Direct optical target observation and motion phase (MPh) based tumor motion discretization strategies were tested, resulting in −0.3(2.3)% and −1.2(9.3)% median (IQR) percentual relative dose difference with respect to static irradiation, respectively. Results confirm the technical feasibility of the implemented strategy towards 4D treatment delivery, with negligible percentual dose deviations with respect to static irradiation.
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Affiliation(s)
- G Fattori
- Dipartimento di Elettronica Informazione e Bioingegneria, Politecnico di Milano, P.zza Leonardo da Vinci 32, 20133 Milano, Italy.
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48
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Richter D, Schwarzkopf A, Trautmann J, Krämer M, Durante M, Jäkel O, Bert C. Upgrade and benchmarking of a 4D treatment planning system for scanned ion beam therapy. Med Phys 2013; 40:051722. [PMID: 23635270 DOI: 10.1118/1.4800802] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Upgrade and benchmarking of a research 4D treatment planning system (4DTPS) suitable for realistic patient treatment planning and treatment simulations taking into account specific requirements for scanned ion beam therapy, i.e., modeling of dose heterogeneities due to interplay effects and range changes caused by patient motion and dynamic beam delivery. METHODS The 4DTPS integrates data interfaces to 4D computed tomography (4DCT), deformable image registration and clinically used motion monitoring devices. The authors implemented a novel data model for 4D image segmentation using Boolean mask volume datasets and developed an algorithm propagating a manually contoured reference contour dataset to all 4DCT phases. They further included detailed treatment simulation and dose reconstruction functionality, based on the irregular patient motion and the temporal structure of the beam delivery. The treatment simulation functionality was validated against experimental data from irradiation of moving radiographic films in air, 3D moving ionization chambers in a water phantom, and moving cells in a biological phantom with a scanned carbon ion beam. The performance of the program was compared to results obtained with predecessor programs. RESULTS The measured optical density distributions of the radiographic films were reproduced by the simulations to (-2 ± 12)%. Compared to earlier versions of the 4DTPS, the mean agreement improved by 2%, standard deviations were reduced by 7%. The simulated dose to the moving ionization chambers in water showed an agreement with the measured dose of (-1 ± 4)% for the typical beam configuration. The mean deviation of the simulated from the measured biologically effective dose determined via cell survival was (617 ± 538) mGy relative biological effectiveness corresponding to (10 ± 9)%. CONCLUSIONS The authors developed a research 4DTPS suitable for realistic treatment planning on patient data and capable of simulating dose delivery to a moving patient geometry for scanned ion beams. The accuracy and reliability of treatment simulations improved considerably with respect to earlier versions of the 4DTPS.
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Affiliation(s)
- D Richter
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, Abt. Biophysik, Planckstraße 1, 64291 Darmstadt, Germany
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Zhang Y, Knopf A, Tanner C, Boye D, Lomax AJ. Deformable motion reconstruction for scanned proton beam therapy using on-line x-ray imaging. Phys Med Biol 2013; 58:8621-45. [DOI: 10.1088/0031-9155/58/24/8621] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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50
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Schätti A, Zakova M, Meer D, Lomax AJ. Experimental verification of motion mitigation of discrete proton spot scanning by re-scanning. Phys Med Biol 2013; 58:8555-72. [DOI: 10.1088/0031-9155/58/23/8555] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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