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Tarp IS, Taasti VT, Jensen MF, Vestergaard A, Jensen K. Benefit of range uncertainty reduction in robust optimisation for proton therapy of brain, head-and-neck and breast cancer patients. Phys Imaging Radiat Oncol 2024; 31:100632. [PMID: 39257572 PMCID: PMC11386293 DOI: 10.1016/j.phro.2024.100632] [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: 04/16/2024] [Revised: 08/14/2024] [Accepted: 08/18/2024] [Indexed: 09/12/2024] Open
Abstract
Background and Purpose The primary cause of range uncertainty in proton therapy is inaccuracy in estimating the stopping-power ratio from computed tomography. This study examined the impact on dose-volume metrics by reducing range uncertainty in robust optimisation for a diverse patient cohort and determined the level of range uncertainty that resulted in a relevant reduction in doses to organs-at-risk (OARs). Materials and Methods The effect of reducing range uncertainty on OAR doses was evaluated by robustly optimising six proton plans with varying range uncertainty levels (ranging from 3.5% in the original plan to 1.0%), keeping setup uncertainty fixed. All plans used the initial clinical treatment plan's beam directions and optimisation objectives and were optimised until a clinically acceptable plan was achieved across all setup and range scenarios. The effect of reduced range uncertainty on dose-volume metrics for OARs near the target was evaluated. This study included 30 brain cancer patients, as well as five head-and-neck and five breast cancer patients, investigating the relevance of reducing range uncertainty when different setup uncertainties were used. Results Lowering range uncertainty slightly reduced the nominal dose to surrounding tissue. For body volume receiving 80% of the prescribed dose, reducing range uncertainty from 3.5% to 2.0% resulted in a median decrease of 4 cm3 for the brain, 17 cm3 for head-and-neck, and 27 cm3 for breast cancer patients. Conclusions Reducing range uncertainty in robust optimisation showed a reduction in dose to OARs. The clinical relevance depends on the affected organs and the clinical dose constraints.
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Affiliation(s)
- Ivanka Sojat Tarp
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Vicki Trier Taasti
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | | | - Anne Vestergaard
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Kenneth Jensen
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
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Koh CWY, Lew KS, Wibawa A, Master Z, Yeap PL, Chua CGA, Lee JCL, Tan HQ, Park SY. First clinical experience following the consensus guide for calibrating a proton stopping power ratio curve in a new proton centre. Phys Med 2024; 120:103341. [PMID: 38554639 DOI: 10.1016/j.ejmp.2024.103341] [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: 08/22/2023] [Revised: 03/07/2024] [Accepted: 03/25/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND AND PURPOSE This work introduces the first assessment of CT calibration following the ESTRO's consensus guidelines and validating the HLUT through the irradiation of biological material. METHODS Two electron density phantoms were scanned with two CT scanners using two CT scan energies. The stopping power ratio (SPR) and mass density (MD) HLUTs for different CT scan energies were derived using Schneider's and ESTRO's methods. The comparison metric in this work is based on the Water-Equivalent Thickness (WET) difference between the treatment planning system and biological irradiation measurement. The SPR HLUTs were compared between the two calibration methods. To assess the accuracy of using MD HLUT for dose calculation in the treatment planning system, MD vs SPR HLUT was compared. Lastly, the feasibility of using a single SPR HLUT to replace two different energy CT scans was explored. RESULTS The results show a WET difference of less than 3.5% except for the result in the Bone region between Schneider's and ESTRO's methods. Comparing MD and SPR HLUT, the results from MD HLUT show less than a 3.5% difference except for the Bone region. However, the SPR HLUT shows a lower mean absolute percentage difference as compared to MD HLUT between the measured and calculated WET difference. Lastly, it is possible to use a single SPR HLUT for two different CT scan energies since both WET differences are within 3.5%. CONCLUSION This is the first report on calibrating an HLUT following the ESTRO's guidelines. While our result shows incremental improvement in range uncertainty using the ESTRO's guideline, the prescriptional approach of the guideline does promote harmonization of CT calibration protocols between different centres.
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Affiliation(s)
| | - Kah Seng Lew
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore; Nanyang Technological University Singapore, Singapore
| | - Andrew Wibawa
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | - Zubin Master
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | - Ping Lin Yeap
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore; Department of Oncology, University of Cambridge, United Kingdom
| | | | - James Cheow Lei Lee
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore; Nanyang Technological University Singapore, Singapore
| | - Hong Qi Tan
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore; Oncology Academic Clinical Programme, Duke-NUS Medical School, 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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Tattenberg S, Liu P, Mulhem A, Cong X, Thome C, Ding X. Impact of and interplay between proton arc therapy and range uncertainties in proton therapy for head-and-neck cancer. Phys Med Biol 2024; 69:055015. [PMID: 38324904 DOI: 10.1088/1361-6560/ad2718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 02/07/2024] [Indexed: 02/09/2024]
Abstract
Objective. Proton therapy reduces the integral dose to the patient compared to conventional photon treatments. However,in vivoproton range uncertainties remain a considerable hurdle. Range uncertainty reduction benefits depend on clinical practices. During intensity-modulated proton therapy (IMPT), the target is irradiated from only a few directions, but proton arc therapy (PAT), for which the target is irradiated from dozens of angles, may see clinical implementation by the time considerable range uncertainty reductions are achieved. It is therefore crucial to determine the impact of PAT on range uncertainty reduction benefits.Approach. For twenty head-and-neck cancer patients, four different treatment plans were created: an IMPT and a PAT treatment plan assuming current clinical range uncertainties of 3.5% (IMPT3.5%and PAT3.5%), and an IMPT and a PAT treatment plan assuming that range uncertainties can be reduced to 1% (IMPT1%and PAT1%). Plans were evaluated with respect to target coverage and organ-at-risk doses as well as normal tissue complication probabilities (NTCPs) for parotid glands (endpoint: parotid gland flow <25%) and larynx (endpoint: larynx edema).Main results. Implementation of PAT (IMPT3.5%-PAT3.5%) reduced mean NTCPs in the nominal and worst-case scenario by 3.2 percentage points (pp) and 4.2 pp, respectively. Reducing range uncertainties from 3.5% to 1% during use of IMPT (IMPT3.5%-IMPT1%) reduced evaluated NTCPs by 0.9 pp and 2.0 pp. Benefits of range uncertainty reductions subsequently to PAT implementation (PAT3.5%-PAT1%) were 0.2 pp and 1.0 pp, with considerably higher benefits in bilateral compared to unilateral cases.Significance. The mean clinical benefit of implementing PAT was more than twice as high as the benefit of a 3.5%-1% range uncertainty reduction. Range uncertainty reductions are expected to remain beneficial even after PAT implementation, especially in cases with target positions allowing for full leveraging of the higher number of gantry angles during PAT.
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Affiliation(s)
- Sebastian Tattenberg
- Laurentian University, Sudbury P3E 2C6, Ontario, Canada
- Northern Ontario School of Medicine University, Sudbury P3E 2C6, Ontario, Canada
- TRIUMF, 4004 Wesbrook Mall, Vancouver V6T 2A3, British Columbia, Canada
| | - Peilin Liu
- Department of Radiation Oncology, William Beaumont University Hospital, Corewell Health, 3601 W 13 Mile Road, MI, United States of America
| | - Anthony Mulhem
- Department of Radiation Oncology, William Beaumont University Hospital, Corewell Health, 3601 W 13 Mile Road, MI, United States of America
- Department of Human Biology, Michigan State University, Natural Science Building, 288 Farm Ln, East Lansing, MI 48824, United States of America
| | - Xiaoda Cong
- Department of Radiation Oncology, William Beaumont University Hospital, Corewell Health, 3601 W 13 Mile Road, MI, United States of America
| | - Christopher Thome
- Laurentian University, Sudbury P3E 2C6, Ontario, Canada
- Northern Ontario School of Medicine University, Sudbury P3E 2C6, Ontario, Canada
| | - Xuanfeng Ding
- Department of Radiation Oncology, William Beaumont University Hospital, Corewell Health, 3601 W 13 Mile Road, MI, United States of America
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Taasti VT, Decabooter E, Eekers D, Compter I, Rinaldi I, Bogowicz M, van der Maas T, Kneepkens E, Schiffelers J, Stultiens C, Hendrix N, Pijls M, Emmah R, Fonseca GP, Unipan M, van Elmpt W. Clinical benefit of range uncertainty reduction in proton treatment planning based on dual-energy CT for neuro-oncological patients. Br J Radiol 2023; 96:20230110. [PMID: 37493227 PMCID: PMC10461272 DOI: 10.1259/bjr.20230110] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 06/01/2023] [Accepted: 06/14/2023] [Indexed: 07/27/2023] Open
Abstract
OBJECTIVE Several studies have shown that dual-energy CT (DECT) can lead to improved accuracy for proton range estimation. This study investigated the clinical benefit of reduced range uncertainty, enabled by DECT, in robust optimisation for neuro-oncological patients. METHODS DECT scans for 27 neuro-oncological patients were included. Commercial software was applied to create stopping-power ratio (SPR) maps based on the DECT scan. Two plans were robustly optimised on the SPR map, keeping the beam and plan settings identical to the clinical plan. One plan was robustly optimised and evaluated with a range uncertainty of 3% (as used clinically; denoted 3%-plan); the second plan applied a range uncertainty of 2% (2%-plan). Both plans were clinical acceptable and optimal. The dose-volume histogram parameters were compared between the two plans. Two experienced neuro-radiation oncologists determined the relevant dose difference for each organ-at-risk (OAR). Moreover, the OAR toxicity levels were assessed. RESULTS For 24 patients, a dose reduction >0.5/1 Gy (relevant dose difference depending on the OAR) was seen in one or more OARs for the 2%-plan; e.g. for brainstem D0.03cc in 10 patients, and hippocampus D40% in 6 patients. Furthermore, 12 patients had a reduction in toxicity level for one or two OARs, showing a clear benefit for the patient. CONCLUSION Robust optimisation with reduced range uncertainty allows for reduction of OAR toxicity, providing a rationale for clinical implementation. Based on these results, we have clinically introduced DECT-based proton treatment planning for neuro-oncological patients, accompanied with a reduced range uncertainty of 2%. ADVANCES IN KNOWLEDGE This study shows the clinical benefit of range uncertainty reduction from 3% to 2% in robustly optimised proton plans. A dose reduction to one or more OARs was seen for 89% of the patients, and 44% of the patients had an expected toxicity level decrease.
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Affiliation(s)
- Vicki Trier Taasti
- Department of Radiation Oncology (MAASTRO), GROW – School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Esther Decabooter
- Department of Radiation Oncology (MAASTRO), GROW – School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Daniëlle Eekers
- Department of Radiation Oncology (MAASTRO), GROW – School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Inge Compter
- Department of Radiation Oncology (MAASTRO), GROW – School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Ilaria Rinaldi
- Department of Radiation Oncology (MAASTRO), GROW – School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Marta Bogowicz
- Department of Radiation Oncology (MAASTRO), GROW – School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Tim van der Maas
- Department of Radiation Oncology (MAASTRO), GROW – School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Esther Kneepkens
- Department of Radiation Oncology (MAASTRO), GROW – School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Jacqueline Schiffelers
- Department of Radiation Oncology (MAASTRO), GROW – School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Cissy Stultiens
- Department of Radiation Oncology (MAASTRO), GROW – School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Nicole Hendrix
- Department of Radiation Oncology (MAASTRO), GROW – School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Mirthe Pijls
- Department of Radiation Oncology (MAASTRO), GROW – School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Rik Emmah
- Department of Radiation Oncology (MAASTRO), GROW – School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Gabriel Paiva Fonseca
- Department of Radiation Oncology (MAASTRO), GROW – School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Mirko Unipan
- Department of Radiation Oncology (MAASTRO), GROW – School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Wouter van Elmpt
- Department of Radiation Oncology (MAASTRO), GROW – School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
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Marants R, Tattenberg S, Scholey J, Kaza E, Miao X, Benkert T, Magneson O, Fischer J, Vinas L, Niepel K, Bortfeld T, Landry G, Parodi K, Verburg J, Sudhyadhom A. Validation of an MR-based multimodal method for molecular composition and proton stopping power ratio determination using ex vivo animal tissues and tissue-mimicking phantoms. Phys Med Biol 2023; 68:10.1088/1361-6560/ace876. [PMID: 37463589 PMCID: PMC10645122 DOI: 10.1088/1361-6560/ace876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 07/18/2023] [Indexed: 07/20/2023]
Abstract
Objective. Range uncertainty in proton therapy is an important factor limiting clinical effectiveness. Magnetic resonance imaging (MRI) can measure voxel-wise molecular composition and, when combined with kilovoltage CT (kVCT), accurately determine mean ionization potential (Im), electron density, and stopping power ratio (SPR). We aimed to develop a novel MR-based multimodal method to accurately determine SPR and molecular compositions. This method was evaluated in tissue-mimicking andex vivoporcine phantoms, and in a brain radiotherapy patient.Approach. Four tissue-mimicking phantoms with known compositions, two porcine tissue phantoms, and a brain cancer patient were imaged with kVCT and MRI. Three imaging-based values were determined: SPRCM(CT-based Multimodal), SPRMM(MR-based Multimodal), and SPRstoich(stoichiometric calibration). MRI was used to determine two tissue-specific quantities of the Bethe Bloch equation (Im, electron density) to compute SPRCMand SPRMM. Imaging-based SPRs were compared to measurements for phantoms in a proton beam using a multilayer ionization chamber (SPRMLIC).Main results. Root mean square errors relative to SPRMLICwere 0.0104(0.86%), 0.0046(0.45%), and 0.0142(1.31%) for SPRCM, SPRMM, and SPRstoich, respectively. The largest errors were in bony phantoms, while soft tissue and porcine tissue phantoms had <1% errors across all SPR values. Relative to known physical molecular compositions, imaging-determined compositions differed by approximately ≤10%. In the brain case, the largest differences between SPRstoichand SPRMMwere in bone and high lipids/fat tissue. The magnitudes and trends of these differences matched phantom results.Significance. Our MR-based multimodal method determined molecular compositions and SPR in various tissue-mimicking phantoms with high accuracy, as confirmed with proton beam measurements. This method also revealed significant SPR differences compared to stoichiometric kVCT-only calculation in a clinical case, with the largest differences in bone. These findings support that including MRI in proton therapy treatment planning can improve the accuracy of calculated SPR values and reduce range uncertainties.
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Affiliation(s)
- Raanan Marants
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women’s Hospital, and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Sebastian Tattenberg
- Department of Medical Physics, Faculty of Physics, Ludwig-Maximilians-Universität München, Garching, Germany
- Division of Radiation Biophysics, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Jessica Scholey
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, California, United States of America
| | - Evangelia Kaza
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women’s Hospital, and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Xin Miao
- Siemens Medical Solutions USA Inc., Boston, Massachusetts, United States of America
| | | | - Olivia Magneson
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women’s Hospital, and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Jade Fischer
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women’s Hospital, and Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Medical Physics, University of Calgary, Calgary, Alberta, Canada
| | - Luciano Vinas
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women’s Hospital, and Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Statistics, University of California, Los Angeles, Los Angeles, California, United States of America
| | - Katharina Niepel
- Department of Medical Physics, Faculty of Physics, Ludwig-Maximilians-Universität München, Garching, Germany
| | - Thomas Bortfeld
- Division of Radiation Biophysics, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Guillaume Landry
- Department of Radiation Oncology, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Katia Parodi
- Department of Medical Physics, Faculty of Physics, Ludwig-Maximilians-Universität München, Garching, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Joost Verburg
- Division of Radiation Biophysics, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Atchar Sudhyadhom
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women’s Hospital, and Harvard Medical School, Boston, Massachusetts, United States of America
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Peters N, Trier Taasti V, Ackermann B, Bolsi A, Vallhagen Dahlgren C, Ellerbrock M, Fracchiolla F, Gomà C, Góra J, Cambraia Lopes P, Rinaldi I, Salvo K, Sojat Tarp I, Vai A, Bortfeld T, Lomax A, Richter C, Wohlfahrt P. Consensus guide on CT-based prediction of stopping-power ratio using a Hounsfield look-up table for proton therapy. Radiother Oncol 2023; 184:109675. [PMID: 37084884 PMCID: PMC10351362 DOI: 10.1016/j.radonc.2023.109675] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 03/08/2023] [Accepted: 04/10/2023] [Indexed: 04/23/2023]
Abstract
BACKGROUND AND PURPOSE Studies have shown large variations in stopping-power ratio (SPR) prediction from computed tomography (CT) across European proton centres. To standardise this process, a step-by-step guide on specifying a Hounsfield look-up table (HLUT) is presented here. MATERIALS AND METHODS The HLUT specification process is divided into six steps: Phantom setup, CT acquisition, CT number extraction, SPR determination, HLUT specification, and HLUT validation. Appropriate CT phantoms have a head- and body-sized part, with tissue-equivalent inserts in regard to X-ray and proton interactions. CT numbers are extracted from a region-of-interest covering the inner 70% of each insert in-plane and several axial CT slices in scan direction. For optimal HLUT specification, the SPR of phantom inserts is measured in a proton beam and the SPR of tabulated human tissues is computed stoichiometrically at 100 MeV. Including both phantom inserts and tabulated human tissues increases HLUT stability. Piecewise linear regressions are performed between CT numbers and SPRs for four tissue groups (lung, adipose, soft tissue, and bone) and then connected with straight lines. Finally, a thorough but simple validation is performed. RESULTS The best practices and individual challenges are explained comprehensively for each step. A well-defined strategy for specifying the connection points between the individual line segments of the HLUT is presented. The guide was tested exemplarily on three CT scanners from different vendors, proving its feasibility. CONCLUSION The presented step-by-step guide for CT-based HLUT specification with recommendations and examples can contribute to reduce inter-centre variations in SPR prediction.
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Affiliation(s)
- Nils Peters
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Germany; Massachusetts General Hospital and Harvard Medical School, Department of Radiation Oncology, Boston, MA, USA.
| | - Vicki Trier Taasti
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands.
| | - Benjamin Ackermann
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Alessandra Bolsi
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
| | | | - Malte Ellerbrock
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Francesco Fracchiolla
- Azienda Provinciale per i Servizi Sanitari (APSS) Protontherapy Department, Trento, Italy
| | - Carles Gomà
- Department of Radiation Oncology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Joanna Góra
- MedAustron Ion Therapy Center, Wiener Neustadt, Austria
| | | | - Ilaria Rinaldi
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Koen Salvo
- AZ Sint-Maarten, Department of Radiotherapy, Mechelen, Belgium
| | - Ivanka Sojat Tarp
- Aarhus University Hospital, Danish Center for Particle Therapy, Aarhus, Denmark
| | - Alessandro Vai
- Radiotherapy Department, Center for National Oncological Hadrontherapy (CNAO), 27100 Pavia, Italy
| | - Thomas Bortfeld
- Massachusetts General Hospital and Harvard Medical School, Department of Radiation Oncology, Boston, MA, USA
| | - Antony Lomax
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
| | - Christian Richter
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Germany; Helmholtz-Zentrum Dresden - Rossendorf, Institute of Radiooncology - OncoRay, Dresden, Germany; Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; German Cancer Consortium (DKTK), partner site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Patrick Wohlfahrt
- Massachusetts General Hospital and Harvard Medical School, Department of Radiation Oncology, Boston, MA, USA
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Meric I, Alagoz E, Hysing LB, Kögler T, Lathouwers D, Lionheart WRB, Mattingly J, Obhodas J, Pausch G, Pettersen HES, Ratliff HN, Rovituso M, Schellhammer SM, Setterdahl LM, Skjerdal K, Sterpin E, Sudac D, Turko JA, Ytre-Hauge KS. A hybrid multi-particle approach to range assessment-based treatment verification in particle therapy. Sci Rep 2023; 13:6709. [PMID: 37185591 PMCID: PMC10130067 DOI: 10.1038/s41598-023-33777-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 04/18/2023] [Indexed: 05/17/2023] Open
Abstract
Particle therapy (PT) used for cancer treatment can spare healthy tissue and reduce treatment toxicity. However, full exploitation of the dosimetric advantages of PT is not yet possible due to range uncertainties, warranting development of range-monitoring techniques. This study proposes a novel range-monitoring technique introducing the yet unexplored concept of simultaneous detection and imaging of fast neutrons and prompt-gamma rays produced in beam-tissue interactions. A quasi-monolithic organic detector array is proposed, and its feasibility for detecting range shifts in the context of proton therapy is explored through Monte Carlo simulations of realistic patient models and detector resolution effects. The results indicate that range shifts of [Formula: see text] can be detected at relatively low proton intensities ([Formula: see text] protons/spot) when spatial information obtained through imaging of both particle species are used simultaneously. This study lays the foundation for multi-particle detection and imaging systems in the context of range verification in PT.
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Affiliation(s)
- Ilker Meric
- Department of Computer Science, Electrical Engineering and Mathematical Sciences, Western Norway University of Applied Sciences, P.O. Box 7030, 5020, Bergen, Norway.
| | - Enver Alagoz
- Department of Computer Science, Electrical Engineering and Mathematical Sciences, Western Norway University of Applied Sciences, P.O. Box 7030, 5020, Bergen, Norway
| | - Liv B Hysing
- Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway
- Department of Physics and Technology, University of Bergen, P.O. Box 7803, 5020, Bergen, Norway
| | - Toni Kögler
- OncoRay-National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany.
- Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiooncology-OncoRay, Dresden, Germany.
| | | | | | - John Mattingly
- Department of Nuclear Engineering, North Carolina State University, Raleigh, NC, USA
| | | | - Guntram Pausch
- Target Systemelektronik GmbH & Co. KG, Wuppertal, Germany
| | - Helge E S Pettersen
- Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway
| | - Hunter N Ratliff
- Department of Computer Science, Electrical Engineering and Mathematical Sciences, Western Norway University of Applied Sciences, P.O. Box 7030, 5020, Bergen, Norway
| | | | - Sonja M Schellhammer
- OncoRay-National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
- Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiooncology-OncoRay, Dresden, Germany
| | - Lena M Setterdahl
- Department of Computer Science, Electrical Engineering and Mathematical Sciences, Western Norway University of Applied Sciences, P.O. Box 7030, 5020, Bergen, Norway
| | - Kyrre Skjerdal
- Department of Computer Science, Electrical Engineering and Mathematical Sciences, Western Norway University of Applied Sciences, P.O. Box 7030, 5020, Bergen, Norway
| | - Edmond Sterpin
- Department of Oncology, Laboratory of Experimental Radiotherapy, KU Leuven, Leuven, Belgium
| | | | - Joseph A Turko
- OncoRay-National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
- Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiooncology-OncoRay, Dresden, Germany
| | - Kristian S Ytre-Hauge
- Department of Physics and Technology, University of Bergen, P.O. Box 7803, 5020, Bergen, Norway
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Malekzadeh E, Rajabi H, Tajik-Mansoury MA, Sabouri P, Fiorina E, Kalantari F. Design and performance evaluation of a slit-slat camera for 2D prompt gamma imaging in proton therapy monitoring: A Monte Carlo simulation study. Med Phys 2023. [PMID: 36718592 DOI: 10.1002/mp.16259] [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: 11/01/2021] [Revised: 12/21/2022] [Accepted: 12/26/2022] [Indexed: 02/01/2023] Open
Abstract
PURPOSE We investigated the design of a prompt gamma camera for real-time dose delivery verification and the partial mitigation of range uncertainties. METHODS A slit slat (SS) camera was optimized using the trade-off between the signal-to-noise ratio and spatial resolution. Then, using the GATE Monte Carlo package, the camera performances were estimated by means of target shifts, beam position quantification, changing the camera distance from the beam, and air cavity inserting. A homogeneous PMMA phantom and the air gaps induced PMMA phantom were used. The air gaps ranged from 5 mm to 30 mm by 5 mm increments were positioned in the middle of the beam range. To reduce the simulation time, phase space scoring was used. The batch method with five realizations was used for stochastic error calculations. RESULTS The system's detection efficiency was 1.1 × 10 - 4 PGs Emitted PGs ( 1.8 × 10 - 5 $1.1 \times {10}^{-4}\frac{{\rm PGs}}{{\rm Emitted}\ {\rm PGs}}\ (1.8 \times {10}^{-5}$ PGs/proton) for a 10 × 20 cm2 detector (source-to-collimator distance = 15.0 cm). Axial and transaxial resolutions were 23 mm and 18 mm, respectively. The SS camera estimated the range as 69.0 ± 3.4 (relative stochastic error 1-sigma is 5%) and 67.6 ± 1.8 mm (2.6%) for the real range of 67.0 mm for 107 and 108 protons of 100 MeV, respectively. Considering 160 MeV, these values are 155.5 ± 3.1 (2%) and 152.2 ± 2.0 mm (1.3%) for the real range of 152.0 mm for 107 and 108 protons, respectively. Considering phantom shift, for a 100 MeV beam, the precision of the quantification (1-sigma) in the axial and lateral phantom shift estimation is 2.6 mm and 1 mm, respectively. Accordingly, the axial and lateral quantification precisions were 1.3 mm and 1 mm for a 160 MeV beam, respectively. Furthermore, the quantification of an air gap formulated as gap d e t = 0.98 × gap real ${{\rm gap}}_{det}=0.98 \times {{\rm gap}}_{{\rm real}}$ , where gap d e t ${{\rm gap}}_{det}$ and gapreal are the estimated and real air gap, respectively. The precision of the air gap quantification is 1.6 mm (1 sigma). Moreover, 2D PG images show the trajectory of the proton beam through the phantom. CONCLUSION The proposed slit-slat imaging systems can potentially provide a real-time, in-vivo, and non-invasive treatment monitoring method for proton therapy.
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Affiliation(s)
- Etesam Malekzadeh
- Department of Medical Physics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Hossein Rajabi
- Department of Medical Physics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Mohammad Ali Tajik-Mansoury
- Biomedical Engineering and Medical Physics Department, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Pouya Sabouri
- Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Elisa Fiorina
- National Institute of Nuclear Physics INFN, Section of Torino, Torino, Italy.,Clinical Department, Fondazione CNAO, Pavia, Italy
| | - Faraz Kalantari
- Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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9
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Potential benefits of using radioactive ion beams for range margin reduction in carbon ion therapy. Sci Rep 2022; 12:21792. [PMID: 36526710 PMCID: PMC9758201 DOI: 10.1038/s41598-022-26290-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
Sharp dose gradients and high biological effectiveness make ions such as 12C an ideal tool to treat deep-seated tumors, however, at the same time, sensitive to errors in the range prediction. Tumor safety margins mitigate these uncertainties, but during the irradiation they lead to unavoidable damage to the surrounding healthy tissue. To fully exploit the Bragg peak benefits, a large effort is put into establishing precise range verification methods. Despite positron emission tomography being widely in use for this purpose in 12C therapy, the low count rates, biological washout, and broad activity distribution still limit its precision. Instead, radioactive beams used directly for treatment would yield an improved signal and a closer match with the dose fall-off, potentially enabling precise in vivo beam range monitoring. We have performed a treatment planning study to estimate the possible impact of the reduced range uncertainties, enabled by radioactive 11C ions treatments, on sparing critical organs in tumor proximity. Compared to 12C treatments, (i) annihilation maps for 11C ions can reflect sub- millimeter shifts in dose distributions in the patient, (ii) outcomes of treatment planning with 11C significantly improve and (iii) less severe toxicities for serial and parallel critical organs can be expected.
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10
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Tattenberg S, Madden TM, Bortfeld T, Parodi K, Verburg J. Range uncertainty reductions in proton therapy may lead to the feasibility of novel beam arrangements which improve organ-at-risk sparing. Med Phys 2022; 49:4693-4704. [PMID: 35362163 DOI: 10.1002/mp.15644] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/09/2022] [Accepted: 03/24/2022] [Indexed: 01/11/2023] Open
Abstract
PURPOSE In proton therapy, dose distributions are currently often conformed to organs at risk (OARs) using the less sharp dose fall-off at the lateral beam edge to reduce the effects of uncertainties in the in vivo proton range. However, range uncertainty reductions may make greater use of the sharper dose fall-off at the distal beam edge feasible, potentially improving OAR sparing. We quantified the benefits of such novel beam arrangements. METHODS For each of 10 brain or skull base cases, five treatment plans robust to 2 mm setup and 0%-4% range uncertainty were created for the traditional clinical beam arrangement and a novel beam arrangement making greater use of the distal beam edge to conform the dose distribution to the brainstem. Metrics including the brainstem normal tissue complication probability (NTCP) with the endpoint of necrosis were determined for all plans and all setup and range uncertainty scenarios. RESULTS For the traditional beam arrangement, reducing the range uncertainty from the current level of approximately 4% to a potentially achievable level of 1% reduced the brainstem NTCP by up to 0.9 percentage points in the nominal and up to 1.5 percentage points in the worst-case scenario. Switching to the novel beam arrangement at 1% range uncertainty improved these values by a factor of 2, that is, to 1.8 percentage points and 3.2 percentage points, respectively. The novel beam arrangement achieved a lower brainstem NTCP in all cases starting at a range uncertainty of 2%. CONCLUSION The benefits of novel beam arrangements may be of the same magnitude or even exceed the direct benefits of range uncertainty reductions. Indirect effects may therefore contribute markedly to the benefits of reducing proton range uncertainties.
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Affiliation(s)
- Sebastian Tattenberg
- Department of Medical Physics, Faculty of Physics, Ludwig-Maximilians-Universität München, Garching, Germany
- Division of Radiation Biophysics, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Thomas M Madden
- Division of Radiation Biophysics, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Thomas Bortfeld
- Division of Radiation Biophysics, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Katia Parodi
- Department of Medical Physics, Faculty of Physics, Ludwig-Maximilians-Universität München, Garching, Germany
| | - Joost Verburg
- Division of Radiation Biophysics, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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11
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Longarino FK, Kowalewski A, Tessonnier T, Mein S, Ackermann B, Debus J, Mairani A, Stiller W. Potential of a Second-Generation Dual-Layer Spectral CT for Dose Calculation in Particle Therapy Treatment Planning. Front Oncol 2022; 12:853495. [PMID: 35530308 PMCID: PMC9069208 DOI: 10.3389/fonc.2022.853495] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 03/14/2022] [Indexed: 11/20/2022] Open
Abstract
In particle therapy treatment planning, dose calculation is conducted using patient-specific maps of tissue ion stopping power ratio (SPR) to predict beam ranges. Improving patient-specific SPR prediction is therefore essential for accurate dose calculation. In this study, we investigated the use of the Spectral CT 7500, a second-generation dual-layer spectral computed tomography (DLCT) system, as an alternative to conventional single-energy CT (SECT) for patient-specific SPR prediction. This dual-energy CT (DECT)-based method allows for the direct prediction of SPR from quantitative measurements of relative electron density and effective atomic number using the Bethe equation, whereas the conventional SECT-based method consists of indirect image data-based prediction through the conversion of calibrated CT numbers to SPR. The performance of the Spectral CT 7500 in particle therapy treatment planning was characterized by conducting a thorough analysis of its SPR prediction accuracy for both tissue-equivalent materials and common non-tissue implant materials. In both instances, DLCT was found to reduce uncertainty in SPR predictions compared to SECT. Mean deviations of 0.7% and 1.6% from measured SPR values were found for DLCT- and SECT-based predictions, respectively, in tissue-equivalent materials. Furthermore, end-to-end analyses of DLCT-based treatment planning were performed for proton, helium, and carbon ion therapies with anthropomorphic head and pelvic phantoms. 3D gamma analysis was performed with ionization chamber array measurements as the reference. DLCT-predicted dose distributions revealed higher passing rates compared to SECT-predicted dose distributions. In the DLCT-based treatment plans, measured distal-edge evaluation layers were within 1 mm of their predicted positions, demonstrating the accuracy of DLCT-based particle range prediction. This study demonstrated that the use of the Spectral CT 7500 in particle therapy treatment planning may lead to better agreement between planned and delivered dose compared to current clinical SECT systems.
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Affiliation(s)
- Friderike K Longarino
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Department of Physics and Astronomy, Heidelberg University, Heidelberg, Germany
| | - Antonia Kowalewski
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Translational Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Physics, Simon Fraser University, Burnaby, BC, Canada
| | | | - Stewart Mein
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Translational Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Heidelberg Ion Beam Therapy Center (HIT), Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany.,National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | | | - Jürgen Debus
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Ion Beam Therapy Center (HIT), Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany.,National Center for Tumor Diseases (NCT), Heidelberg, Germany.,German Cancer Consortium (DKTK), Core Center Heidelberg, Heidelberg, Germany
| | - Andrea Mairani
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Ion Beam Therapy Center (HIT), Heidelberg, Germany.,National Center for Tumor Diseases (NCT), Heidelberg, Germany.,Medical Physics, National Center of Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Wolfram Stiller
- Diagnostic and Interventional Radiology (DIR), Heidelberg University Hospital, Heidelberg, Germany
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12
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Ku Y, Jung J, Kim CH. New Algorithm to Estimate Proton Beam Range for Multi-slit Prompt-gamma Camera. NUCLEAR ENGINEERING AND TECHNOLOGY 2022. [DOI: 10.1016/j.net.2022.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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13
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Poon DMC, Wu S, Ho L, Cheung KY, Yu B. Proton Therapy for Prostate Cancer: Challenges and Opportunities. Cancers (Basel) 2022; 14:cancers14040925. [PMID: 35205673 PMCID: PMC8870339 DOI: 10.3390/cancers14040925] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/10/2022] [Accepted: 02/11/2022] [Indexed: 01/02/2023] Open
Abstract
Simple Summary Reported clinical outcomes of proton therapy (PT) for localized prostate cancer are similar to photon-based external beam radiotherapy. Apparently, the dosimetric advantages of PT have yet to be translated to clinical benefits. The suboptimal clinical outcomes of PT might be attributable to inadequate dose prescription, as indicated by the ASCENDE-RT trial. Moreover, uncertainties involved in the treatment planning and delivery processes, as well as technological limitations in PT treatment systems, may lead to discrepancies between planned doses and actual doses delivered to patients. In this article, we reviewed the current status of PT for prostate cancer and discussed different clinical implementations that could potentially improve the clinical outcome of PT for prostate cancer. Various technological advancements under which uncertainties in dose calculations can be minimized, including MRI-guided PT, dual-energy photon-counting CT and high-resolution Monte Carlo-based treatment planning systems, are highlighted. Abstract The dosimetric advantages of proton therapy (PT) treatment plans are demonstrably superior to photon-based external beam radiotherapy (EBRT) for localized prostate cancer, but the reported clinical outcomes are similar. This may be due to inadequate dose prescription, especially in high-risk disease, as indicated by the ASCENDE-RT trial. Alternatively, the lack of clinical benefits with PT may be attributable to improper dose delivery, mainly due to geometric and dosimetric uncertainties during treatment planning, as well as delivery procedures that compromise the dose conformity of treatments. Advanced high-precision PT technologies, and treatment planning and beam delivery techniques are being developed to address these uncertainties. For instance, external magnetic resonance imaging (MRI)-guided patient setup rooms are being developed to improve the accuracy of patient positioning for treatment. In-room MRI-guided patient positioning systems are also being investigated to improve the geometric accuracy of PT. Soon, high-dose rate beam delivery systems will shorten beam delivery time to within one breath hold, minimizing the effects of organ motion and patient movements. Dual-energy photon-counting computed tomography and high-resolution Monte Carlo-based treatment planning systems are available to minimize uncertainties in dose planning calculations. Advanced in-room treatment verification tools such as prompt gamma detector systems will be used to verify the depth of PT. Clinical implementation of these new technologies is expected to improve the accuracy and dose conformity of PT in the treatment of localized prostate cancers, and lead to better clinical outcomes. Improvement in dose conformity may also facilitate dose escalation, improving local control and implementation of hypofractionation treatment schemes to improve patient throughput and make PT more cost effective.
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Affiliation(s)
- Darren M. C. Poon
- Comprehensive Oncology Centre, Hong Kong Sanatorium & Hospital, Hong Kong 999077, China;
| | - Stephen Wu
- Medical Physics Department, Hong Kong Sanatorium & Hospital, Hong Kong 999077, China; (L.H.); (K.Y.C.); (B.Y.)
- Correspondence: ; Tel.: +852-29171413
| | - Leon Ho
- Medical Physics Department, Hong Kong Sanatorium & Hospital, Hong Kong 999077, China; (L.H.); (K.Y.C.); (B.Y.)
| | - Kin Yin Cheung
- Medical Physics Department, Hong Kong Sanatorium & Hospital, Hong Kong 999077, China; (L.H.); (K.Y.C.); (B.Y.)
| | - Ben Yu
- Medical Physics Department, Hong Kong Sanatorium & Hospital, Hong Kong 999077, China; (L.H.); (K.Y.C.); (B.Y.)
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14
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Longarino FK, Tessonnier T, Mein S, Harrabi SB, Debus J, Stiller W, Mairani A. Dual-layer spectral CT for proton, helium, and carbon ion beam therapy planning of brain tumors. J Appl Clin Med Phys 2022; 23:e13465. [PMID: 34724327 PMCID: PMC8803296 DOI: 10.1002/acm2.13465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 08/23/2021] [Accepted: 10/14/2021] [Indexed: 01/21/2023] Open
Abstract
Pretreatment computed tomography (CT) imaging is an essential component of the particle therapy treatment planning chain. Treatment planning and optimization with charged particles require accurate and precise estimations of ion beam range in tissues, characterized by the stopping power ratio (SPR). Reduction of range uncertainties arising from conventional CT-number-to-SPR conversion based on single-energy CT (SECT) imaging is of importance for improving clinical practice. Here, the application of a novel imaging and computational methodology using dual-layer spectral CT (DLCT) was performed toward refining patient-specific SPR estimates. A workflow for DLCT-based treatment planning was devised to evaluate SPR prediction for proton, helium, and carbon ion beam therapy planning in the brain. DLCT- and SECT-based SPR predictions were compared in homogeneous and heterogeneous anatomical regions. This study included eight patients scanned for diagnostic purposes with a DLCT scanner. For each patient, four different treatment plans were created, simulating tumors in different parts of the brain. For homogeneous anatomical regions, mean SPR differences of about 1% between the DLCT- and SECT-based approaches were found. In plans of heterogeneous anatomies, relative (absolute) proton range shifts of 0.6% (0.4 mm) in the mean and up to 4.4% (2.1 mm) at the distal fall-off were observed. In the investigated cohort, 12% of the evaluated organs-at-risk (OARs) presented differences in mean or maximum dose of more than 0.5 Gy (RBE) and up to 6.8 Gy (RBE) over the entire treatment. Range shifts and dose differences in OARs between DLCT and SECT in helium and carbon ion treatment plans were similar to protons. In the majority of investigated cases (75th percentile), SECT- and DLCT-based range estimations were within 0.6 mm. Nonetheless, the magnitude of patient-specific range deviations between SECT and DLCT was clinically relevant in heterogeneous anatomical sites, suggesting further study in larger, more diverse cohorts. Results indicate that patients with brain tumors may benefit from DLCT-based treatment planning.
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Affiliation(s)
- Friderike K. Longarino
- German Cancer Research Center (DKFZ)Clinical Cooperation Unit Radiation OncologyHeidelbergGermany
- Department of Radiation OncologyHeidelberg University HospitalHeidelbergGermany
- Department of Physics and AstronomyHeidelberg UniversityHeidelbergGermany
| | | | - Stewart Mein
- Department of Radiation OncologyHeidelberg University HospitalHeidelbergGermany
- Heidelberg Ion Beam Therapy Center (HIT)HeidelbergGermany
- German Cancer Research Center (DKFZ)Translational Radiation OncologyHeidelbergGermany
- National Center for Radiation Research in Oncology (NCRO)Heidelberg Institute of Radiation Oncology (HIRO)HeidelbergGermany
- National Center for Tumor Diseases (NCT)HeidelbergGermany
| | - Semi B. Harrabi
- Department of Radiation OncologyHeidelberg University HospitalHeidelbergGermany
- Heidelberg Ion Beam Therapy Center (HIT)HeidelbergGermany
- National Center for Radiation Research in Oncology (NCRO)Heidelberg Institute of Radiation Oncology (HIRO)HeidelbergGermany
- National Center for Tumor Diseases (NCT)HeidelbergGermany
| | - Jürgen Debus
- German Cancer Research Center (DKFZ)Clinical Cooperation Unit Radiation OncologyHeidelbergGermany
- Department of Radiation OncologyHeidelberg University HospitalHeidelbergGermany
- Heidelberg Ion Beam Therapy Center (HIT)HeidelbergGermany
- National Center for Radiation Research in Oncology (NCRO)Heidelberg Institute of Radiation Oncology (HIRO)HeidelbergGermany
- National Center for Tumor Diseases (NCT)HeidelbergGermany
- Partner Site HeidelbergGerman Cancer Consortium (DKTK)HeidelbergGermany
| | - Wolfram Stiller
- Diagnostic and Interventional Radiology (DIR)Heidelberg University HospitalHeidelbergGermany
| | - Andrea Mairani
- Department of Radiation OncologyHeidelberg University HospitalHeidelbergGermany
- Heidelberg Ion Beam Therapy Center (HIT)HeidelbergGermany
- National Center for Tumor Diseases (NCT)HeidelbergGermany
- Medical PhysicsNational Centre of Oncological Hadrontherapy (CNAO)PaviaItaly
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15
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Hofmaier J, Walter F, Hadi I, Rottler M, von Bestenbostel R, Dedes G, Parodi K, Niyazi M, Belka C, Kamp F. Combining inter-observer variability, range and setup uncertainty in a variance-based sensitivity analysis for proton therapy. Phys Imaging Radiat Oncol 2021; 20:117-120. [PMID: 34917780 PMCID: PMC8645917 DOI: 10.1016/j.phro.2021.11.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/16/2021] [Accepted: 11/16/2021] [Indexed: 12/13/2022] Open
Abstract
Margin concepts in proton therapy aim to ensure full dose coverage of the clinical target volume (CTV) in presence of setup and range uncertainty. Due to inter-observer variability (IOV), the CTV itself is uncertain. We present a framework to evaluate the combined impact of IOV, setup and range uncertainty in a variance-based sensitivity analysis (SA). For ten patients with skull base meningioma, the mean calculation time to perform the SA including 1.6 × 104 dose recalculations was 59 min. For two patients in this dataset, IOV had a relevant impact on the estimated CTV D95% uncertainty.
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Affiliation(s)
- Jan Hofmaier
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Franziska Walter
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Indrawati Hadi
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Maya Rottler
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | | | - George Dedes
- Department of Medical Physics, Faculty of Physics, LMU Munich, Munich, Germany
| | - Katia Parodi
- Department of Medical Physics, Faculty of Physics, LMU Munich, Munich, Germany
| | - Maximilian Niyazi
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Claus Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany.,German Cancer Consortium (DKTK), Munich, Germany
| | - Florian Kamp
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany.,Department of Radiation Oncology and CyberKnife Center, Faculty of Medicine, University Hospital Cologne, Cologne, Germany
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16
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Boscolo D, Kostyleva D, Safari MJ, Anagnostatou V, Äystö J, Bagchi S, Binder T, Dedes G, Dendooven P, Dickel T, Drozd V, Franczack B, Geissel H, Gianoli C, Graeff C, Grahn T, Greiner F, Haettner E, Haghani R, Harakeh MN, Horst F, Hornung C, Hucka JP, Kalantar-Nayestanaki N, Kazantseva E, Kindler B, Knöbel R, Kuzminchuk-Feuerstein N, Lommel B, Mukha I, Nociforo C, Ishikawa S, Lovatti G, Nitta M, Ozoemelam I, Pietri S, Plaß WR, Prochazka A, Purushothaman S, Reidel CA, Roesch H, Schirru F, Schuy C, Sokol O, Steinsberger T, Tanaka YK, Tanihata I, Thirolf P, Tinganelli W, Voss B, Weber U, Weick H, Winfield JS, Winkler M, Zhao J, Scheidenberger C, Parodi K, Durante M. Radioactive Beams for Image-Guided Particle Therapy: The BARB Experiment at GSI. Front Oncol 2021; 11:737050. [PMID: 34504803 PMCID: PMC8422860 DOI: 10.3389/fonc.2021.737050] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 08/04/2021] [Indexed: 12/11/2022] Open
Abstract
Several techniques are under development for image-guidance in particle therapy. Positron (β+) emission tomography (PET) is in use since many years, because accelerated ions generate positron-emitting isotopes by nuclear fragmentation in the human body. In heavy ion therapy, a major part of the PET signals is produced by β+-emitters generated via projectile fragmentation. A much higher intensity for the PET signal can be obtained using β+-radioactive beams directly for treatment. This idea has always been hampered by the low intensity of the secondary beams, produced by fragmentation of the primary, stable beams. With the intensity upgrade of the SIS-18 synchrotron and the isotopic separation with the fragment separator FRS in the FAIR-phase-0 in Darmstadt, it is now possible to reach radioactive ion beams with sufficient intensity to treat a tumor in small animals. This was the motivation of the BARB (Biomedical Applications of Radioactive ion Beams) experiment that is ongoing at GSI in Darmstadt. This paper will present the plans and instruments developed by the BARB collaboration for testing the use of radioactive beams in cancer therapy.
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Affiliation(s)
- Daria Boscolo
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - Daria Kostyleva
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | | | | | - Juha Äystö
- University of Jyväskylä, Jyväskylä, Finland.,Helsinki Institute of Physics, Helsinki, Finland
| | | | - Tim Binder
- Ludwig-Maximilians-Universität München, Munich, Germany
| | | | | | - Timo Dickel
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany.,Justus-Liebig-Universität Gießen, Gießen, Germany
| | - Vasyl Drozd
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany.,University of Groningen, Groningen, Netherlands
| | | | - Hans Geissel
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany.,Justus-Liebig-Universität Gießen, Gießen, Germany
| | | | - Christian Graeff
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - Tuomas Grahn
- University of Jyväskylä, Jyväskylä, Finland.,Helsinki Institute of Physics, Helsinki, Finland
| | - Florian Greiner
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - Emma Haettner
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | | | | | - Felix Horst
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - Christine Hornung
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany.,Technische Universität Darmstadt, Darmstadt, Germany
| | - Jan-Paul Hucka
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany.,Technische Universität Darmstadt, Darmstadt, Germany
| | | | - Erika Kazantseva
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - Birgit Kindler
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - Ronja Knöbel
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | | | - Bettina Lommel
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - Ivan Mukha
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - Chiara Nociforo
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | | | | | | | | | - Stephane Pietri
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - Wolfgang R Plaß
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany.,Justus-Liebig-Universität Gießen, Gießen, Germany
| | | | | | | | - Heidi Roesch
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany.,Technische Universität Darmstadt, Darmstadt, Germany
| | - Fabio Schirru
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - Christoph Schuy
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - Olga Sokol
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - Timo Steinsberger
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany.,Technische Universität Darmstadt, Darmstadt, Germany
| | | | - Isao Tanihata
- Research Center for Nuclear Physics, Osaka University, Osaka, Japan.,Peking University, Beijing, China.,Institute of Modern Physics, Lanzhou, China
| | - Peter Thirolf
- Ludwig-Maximilians-Universität München, Munich, Germany
| | | | - Bernd Voss
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - Uli Weber
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - Helmut Weick
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - John S Winfield
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - Martin Winkler
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - Jianwei Zhao
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany.,Peking University, Beijing, China
| | - Christoph Scheidenberger
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany.,Justus-Liebig-Universität Gießen, Gießen, Germany
| | - Katia Parodi
- Ludwig-Maximilians-Universität München, Munich, Germany
| | - Marco Durante
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany.,Technische Universität Darmstadt, Darmstadt, Germany
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