Real-time proton beam range monitoring by means of prompt-gamma detection with a collimated camera

Influence of the background in Compton camera images for proton therapy treatment monitoring

Objective. Background events are one of the most relevant contributions to image degradation in Compton camera imaging for hadron therapy treatment monitoring. A study of the background and its contribution to image degradation is important to define future strategies to reduce the background in the system.Approach. In this simulation study, the percentage of different kinds of events and their contribution to the reconstructed image in a two-layer Compton camera have been evaluated. To this end, GATE v8.2 simulations of a proton beam impinging on a PMMA phantom have been carried out, for different proton beam energies and at different beam intensities.Main results. For a simulated Compton camera made of Lanthanum (III) Bromide monolithic crystals, coincidences caused by neutrons arriving from the phantom are the most common type of background produced by secondary radiations in the Compton camera, causing between 13% and 33% of the detected coincidences, depending on the beam energy. Results also show that random coincidences are a significant cause of image degradation at high beam intensities, and their influence in the reconstructed images is studied for values of the time coincidence windows from 500 ps to 100 ns.Significance. Results indicate the timing capabilities required to retrieve the fall-off position with good precision. Still, the noise observed in the image when no randoms are considered make us consider further background rejection methods.

Prompt-gamma fall-off estimation with C-ion irradiation at clinical energies, using a knife-edge slit camera: A Monte Carlo study

PURPOSE

In-vivo range verification has been a hot topic in particle therapy since two decades. Many efforts have been done for proton therapy, while fewer studies were conducted considering a beam of carbon ions. In the present work, a simulation study was performed to show whether it is possible to measure the prompt-gamma fall-off inside the high neutron background typical of carbon-ion irradiation, using a knife-edge slit camera. In addition to this, we wanted to estimate the uncertainty in retrieving the particle range in the case of a pencil beam of C-ions at clinically relevant energy of 150 MeVu.

METHODS

For these purposes, the Monte Carlo code FLUKA was adopted for simulations and three different analytical methods were implemented to get the accuracy in the range retrieval of the simulated set-up.

RESULTS

The analysis of simulation data has brought to the promising and desired precision of about 4 mm in the determination of the dose profile fall-off in case of a spill irradiation, for which all the three cited methods were coherent in their predictions.

CONCLUSIONS

The Prompt Gamma Imaging technique should be further studied as a tool to reduce range uncertainties affecting carbon ion radiation therapy.

Dual- and multi-energy CT for particle stopping-power estimation: current state, challenges and potential

Range uncertainty has been a key factor preventing particle radiotherapy from reaching its full physical potential. One of the main contributing sources is the uncertainty in estimating particle stopping power (ρ_s) within patients. Currently, theρ_sdistribution in a patient is derived from a single-energy CT (SECT) scan acquired for treatment planning by converting CT number expressed in Hounsfield units (HU) of each voxel toρ_susing a Hounsfield look-up table (HLUT), also known as the CT calibration curve. HU andρ_sshare a linear relationship with electron density but differ in their additional dependence on elemental composition through different physical properties, i.e. effective atomic number and mean excitation energy, respectively. Because of that, the HLUT approach is particularly sensitive to differences in elemental composition between real human tissues and tissue surrogates as well as tissue variations within and among individual patients. The use of dual-energy CT (DECT) forρ_sprediction has been shown to be effective in reducing the uncertainty inρ_sestimation compared to SECT. The acquisition of CT data over different x-ray spectra yields additional information on the material elemental composition. Recently, multi-energy CT (MECT) has been explored to deduct material-specific information with higher dimensionality, which has the potential to further improve the accuracy ofρ_sestimation. Even though various DECT and MECT methods have been proposed and evaluated over the years, these approaches are still only scarcely implemented in routine clinical practice. In this topical review, we aim at accelerating this translation process by providing: (1) a comprehensive review of the existing DECT/MECT methods forρ_sestimation with their respective strengths and weaknesses; (2) a general review of uncertainties associated with DECT/MECT methods; (3) a general review of different aspects related to clinical implementation of DECT/MECT methods; (4) other potential advanced DECT/MECT applications beyondρ_sestimation.

Design and performance evaluation of a slit-slat camera for 2D prompt gamma imaging in proton therapy monitoring: A Monte Carlo simulation study

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 gap_real 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.

Proton range monitoring based on picosecond detection using a Cherenkov radiation detector: A Monte Carlo study

In this study, we analyzed the performance of a PbF₂ crystal-based detector at proton range monitoring with Monte Carlo simulations. The correlations between the depth-dose and Cherenkov profiles showed that the changes in the peak position in the Cherenkov profiles corresponded to the changes in the corresponding depth-dose profiles. Moreover, the deviations between the changes in the peak positions in the two curves were generally less than 2 mm. The results also showed that the actual proton range could be obtained using flight time information. When the proton energy was 160 MeV, the peak position detected in the Cherenkov profile detected was 14.83 cm with a flight time of 5.3-5.4 ns (starting from the time when protons were emitted), and the actual proton range in polymethyl-methacrylate was 15 cm. Therefore, the accuracy of the proton range measurements could be improved and the absolute range obtained by using the fast and time-sensitive characteristics of the proposed Cherenkov radiator.

Influence of sub-nanosecond time of flight resolution for online range verification in proton therapy using the line-cone reconstruction in Compton imaging

Online ion range monitoring in hadron therapy can be performed via detection of secondary radiation, such as promptγ-rays, emitted during treatment. The promptγemission profile is correlated with the ion depth-dose profile and can be reconstructed via Compton imaging. The line-cone reconstruction, using the intersection between the primary beam trajectory and the cone reconstructed via a Compton camera, requires negligible computation time compared to iterative algorithms. A recent report hypothesised that time of flight (TOF) based discrimination could improve the precision of theγfall-off position (FOP) measured via line-cone reconstruction, where TOF comprises both the proton transit time from the phantom entrance untilγemission, and the flight time of theγ-ray to the detector. The aim of this study was to implement such a method and investigate the influence of temporal resolution on the precision of the FOP. Monte Carlo simulations of a 160 MeV proton beam incident on a homogeneous PMMA phantom were performed using GATE. The Compton camera consisted of a silicon-based scatterer and CeBr₃scintillator absorber. The temporal resolution of the detection system (absorber + beam trigger) was varied between 0.1 and 1.3 ns rms and a TOF-based discrimination method applied to eliminate unlikely solution(s) from the line-cone reconstruction. The FOP was obtained for varying temporal resolutions and its precision obtained from its shift across 100 independentγemission profiles compared to a high statistics reference profile. The optimal temporal resolution for the given camera geometry and 10⁸primary protons was 0.2 ns where a precision of 2.30 ± 0.15 mm (1σ) on the FOP was found. This precision is comparable to current state-of-the-art Compton imaging using iterative reconstruction methods or 1D imaging with mechanically collimated devices, and satisfies the requirement of being smaller than the clinical safety margins.

Distal edge determination precision for a multi-slat prompt-gamma camera: A comprehensive simulation and optimization of the detection system

Multi-slat prompt-gamma camera is a promising tool for range monitoring during proton therapy. We report the results of a comprehensive simulation study analyzing the precision which is possible to reach with this camera in determination of the position of the distal edge of the Bragg peak. For the first time we include simulation of optical photons. The proton beam (single pencil beam, 130 MeV, 10 ns bunch period, total of 1·10⁸ protons) is interacting with a polymethyl methacrylate (PMMA) phantom, which is a cylinder of 200 mm in diameter and length. The prompt gamma rays generated in the phantom are collimated with a multi-slat collimator and detected using a combination of yttrium aluminum perovskite (YAP) scintillators, installed in the collimator apertures, and light sensors. Two scintillator packing schemes, with one and with two scintillator plates per aperture, are considered. The collimator configuration (the septal thickness, aperture and height), resulting in the best precision, is determined using two methods of detector optimization. Precision of 2.1 mm (full width at half maximum) in the edge position determination is demonstrated.

Full 3D position reconstruction of a radioactive source based on a novel hyperbolic geometrical algorithm

A new method to locate, with millimetre uncertainty, in 3D, a γ -ray source emitting multiple γ -rays in a cascade, employing conventional LaBr₃(Ce) scintillation detectors, has been developed. Using 16 detectors in a symmetrical configuration the detector energy and time signals, resulting from the γ -ray interactions, are fed into a new source position reconstruction algorithm. The Monte-Carlo based Geant4 framework has been used to simulate the detector array and a ⁶⁰Co source located at two positions within the spectrometer central volume. For a source located at (0,0,0) the algorithm reports X, Y, Z values of -0.3 ± 2.5, -0.4 ± 2.4, and -0.6 ± 2.5 mm, respectively. For a source located at (20,20,20) mm, with respect to the array centre, the algorithm reports X, Y, Z values of 20.2 ± 1.0, 20.2 ± 0.9, and 20.1 ± 1.2 mm. The resulting precision of the reconstruction means that this technique could find application in a number of areas including nuclear medicine, national security, radioactive waste assay and proton beam therapy.

A filtering approach for PET and PG predictions in a proton treatment planning system

Positron emission tomography (PET) and prompt gamma (PG) detection are promising proton therapy monitoring modalities. Fast calculation of the expected distributions is desirable for comparison to measurements and to develop/train algorithms for automatic treatment error detection. A filtering formalism was used for positron-emitter predictions and adapted to allow for its use for the beamline of any proton therapy centre. A novel approach based on a filtering formalism was developed for the prediction of energy-resolved PG distributions for arbitrary tissues. The method estimates PG yields and their energy spectra in the entire treatment field. Both approaches were implemented in a research version of the RayStation treatment planning system. The method was validated against PET monitoring data and Monte Carlo simulations for four patients treated with scanned proton beams. Longitudinal shifts between profiles from analytical and Monte Carlo calculations were within -1.7 and 0.9 mm, with maximum standard deviation of 0.9 mm and 1.1 mm, for positron-emitters and PG shifts, respectively. Normalized mean absolute errors were within 1.2 and 5.3%. When comparing measured and predicted PET data, the same more complex case yielded an average shift of 3 mm, while all other cases were below absolute average shifts of 1.1 mm. Normalized mean absolute errors were below 7.2% for all cases. A novel solution to predict positron-emitter and PG distributions in a treatment planning system is proposed, enabling calculation times of only a few seconds to minutes for entire patient cases, which is suitable for integration in daily clinical routine.

In vivo range verification in particle therapy

Exploitation of the full potential offered by ion beams in clinical practice is still hampered by several sources of treatment uncertainties, particularly related to the limitations of our ability to locate the position of the Bragg peak in the tumor. To this end, several efforts are ongoing to improve the characterization of patient position, anatomy, and tissue stopping power properties prior to treatment as well as to enable in vivo verification of the actual dose delivery, or at least beam range, during or shortly after treatment. This contribution critically reviews methods under development or clinical testing for verification of ion therapy, based on pretreatment range and tissue probing as well as the detection of secondary emissions or physiological changes during and after treatment, trying to disentangle approaches of general applicability from those more specific to certain anatomical locations. Moreover, it discusses future directions, which could benefit from an integration of multiple modalities or address novel exploitation of the measurable signals for biologically adapted therapy.

Accuracy of using high-energy prompt gamma to verify proton beam range with a Compton camera: A Monte Carlo simulation study

Prompt gamma (PG) rays emitted during proton therapy has been used for proton range verification. Because high-energy PG emission is well correlated to the Bragg peak (BP), high-energy PG rays are well-suited for proton range verification. However, the low production and detection of high-energy PG rays often lead to inaccurate BP position estimates. The aim of this study is to improve the BP position estimates obtained from high-energy PG rays. We propose a BP position estimation method based on the local maximum closest to the distal fall-off region. We present the results of Monte Carlo simulations in which a water phantom was irradiated with a proton beam. Our results show that the BP position estimated from the 6.13 MeV PG rays can be improved using the proposed position estimation method. Moreover, the 6.92 and 7.12 MeV PG rays can be used for predicting the BP position. However, the accuracy of the BP position estimation decreases with decreasing tissue oxygen levels. We also found that the subtraction of the PG images of 6.13 MeV from those of 6.92 and 7.12 MeV can be used to predict the BP position with a mean accuracy of < 2 mm. The accurate estimation of the BP position can be achieved using different high-energy PG rays, but factors including position estimation, irradiated tissue and event selection should be carefully taken into account.

A low-count reconstruction algorithm for Compton-based prompt gamma imaging

The Compton camera is an imaging device which has been proposed to detect prompt gammas (PGs) produced by proton-nuclear interactions within tissue during proton beam irradiation. Compton-based PG imaging has been developed to verify proton ranges because PG rays, particularly characteristic ones, have strong correlations with the distribution of the proton dose. However, accurate image reconstruction from characteristic PGs is challenging because the detector efficiency and resolution are generally low. Our previous study showed that point spread functions can be incorporated into the reconstruction process to improve image resolution. In this study, we proposed a low-count reconstruction algorithm to improve the image quality of a characteristic PG emission by pooling information from other characteristic PG emissions. PGs were simulated from a proton beam irradiated on a water phantom, and a two-stage Compton camera was used for PG detection. The results show that the image quality of the reconstructed characteristic PG emission is improved with our proposed method in contrast to the standard reconstruction method using events from only one characteristic PG emission. For the 4.44 MeV PG rays, both methods can be used to predict the positions of the peak and the distal falloff with a mean accuracy of 2 mm. Moreover, only the proposed method can improve the estimated positions of the peak and the distal falloff of 5.25 MeV PG rays, and a mean accuracy of 2 mm can be reached.

Imaging of monochromatic beams by measuring secondary electron bremsstrahlung for carbon-ion therapy using a pinhole x-ray camera

A feasibility study on the imaging of monochromatic carbon-ion beams for carbon-ion therapy was performed. The evaluation was based on Monte Carlo simulations and beam-irradiation experiments, using a pinhole x-ray camera, which measured secondary electron bremsstrahlung (SEB). The simulation results indicated that the trajectories of the carbon-ion beams with injection energies of 278, 249 and 218 MeV/u in a water phantom, were clearly imaged by measuring the SEB with energies from 30 to 60 keV, using a pinhole camera. The Bragg-peak positions for these three injection energies were located at the positions where the ratios of the counts of SEB acquisitions to the maximum counts were approximately 0.23, 0.26 and 0.29, respectively. Moreover, we experimentally demonstrated that it was possible to identify the Bragg-peak positons, at the positions where the ratios coincided with the simulation results. However, the estimated Bragg-peak positions for the injection energies of 278 and 249 MeV/u were slightly deeper than the expected positions. In conclusion, for both the simulations and experiments, we found that the 25 mm shifts in the Bragg-peak positions can be observed by this method.

3D prompt gamma imaging for proton beam range verification

We tested the ability of a single Compton camera (CC) to produce 3-dimensional (3D) images of prompt gammas (PGs) emitted during the irradiation of a tissue-equivalent plastic phantom with proton pencil beams for clinical doses delivered at clinical dose rates. PG measurements were made with a small prototype CC placed at three different locations along the proton beam path. We evaluated the ability of the CC to produce images at each location for two clinical scenarios: (1) the delivery of a single 2 Gy pencil beam from a hypo-fractionated treatment (~9  ×  10⁸ protons), and (2) a single pencil beam from a standard treatment (~1  ×  10⁸ protons). Additionally, the data measured at each location were combined to simulate measurements with a larger scale, clinical CC and its ability to image shifts in the Bragg peak (BP) range for both clinical scenarios. With our prototype CC, the location of the distal end of the BP could be seen with the CC placed up to 4 cm proximal or distal to the BP distal falloff. Using the data from the simulated full scale clinical CC, 3D images of the PG emission were produced with the delivery of as few as 1  ×  10⁸ protons, and shifts in the proton beam range as small as 2 mm could be detected for delivery of a 2 Gy spot. From these results we conclude that 3D PG imaging for proton range verification under clinical beam delivery conditions is possible with a single CC.

Experimental Comparison of Knife-Edge and Multi-Parallel Slit Collimators for Prompt Gamma Imaging of Proton Pencil Beams

More and more camera concepts are being investigated to try and seize the opportunity of instantaneous range verification of proton therapy treatments offered by prompt gammas emitted along the proton tracks. Focusing on one-dimensional imaging with a passive collimator, the present study experimentally compared in combination with the first, clinically compatible, dedicated camera device the performances of instances of the two main options: a knife-edge slit (KES) and a multi-parallel slit (MPS) design. These two options were experimentally assessed in this specific context as they were previously demonstrated through analytical and numerical studies to allow similar performances in terms of Bragg peak retrieval precision and spatial resolution in a general context. Both collimators were prototyped according to the conclusions of Monte Carlo optimization studies under constraints of equal weight (40 mm tungsten alloy equivalent thickness) and of the specificities of the camera device under consideration (in particular 4 mm segmentation along beam axis and no time-of-flight discrimination, both of which less favorable to the MPS performance than to the KES one). Acquisitions of proton pencil beams of 100, 160, and 230 MeV in a PMMA target revealed that, in order to reach a given level of statistical precision on Bragg peak depth retrieval, the KES collimator requires only half the dose the present MPS collimator needs, making the KES collimator a preferred option for a compact camera device aimed at imaging only the Bragg peak position. On the other hand, the present MPS collimator proves more effective at retrieving the entrance of the beam in the target in the context of an extended camera device aimed at imaging the whole proton track within the patient.

A simulation study investigating a Cherenkov material for use with the prompt gamma range verification in proton therapy

In vivo range verification methods will reveal information about the penetration depth into a patient for an incident proton beam. The prompt gamma (PG) method is a promising in vivo technique that has been shown to yield this range information by measuring the escaping MeV photons given a suitable detector system. The majority of current simulations investigating PG detectors utilize common scintillating materials ideal for photons within a low neutron background radiation field using complex geometries or novel designs. In this work we simulate a minimal detector system using a material ideal for MeV photon detection in the presence of a significant neutron field based on the Cherenkov phenomenon. The response of this selected material was quantified for the escaping particles commonly found in proton therapy applications and the feasibility of using the PG technique for this detector material was studied. Our simulations found that the majority of the range information can be determined by detecting photons emitted with a timing window less than ∼50 ns after the interaction of the proton beam with the water phantom and with an energy threshold focusing on the energy range of the de-excitation of 16O photons (∼6 MeV). The Cherenkov material investigated is able to collect these photons and estimate the range with timescales on the order of tens of nanoseconds as well as greatly suppress the signal due to neutron.

First Images of a Three-Layer Compton Telescope Prototype for Treatment Monitoring in Hadron Therapy

A Compton telescope for dose monitoring in hadron therapy is under development at IFIC. The system consists of three layers of LaBr3 crystals coupled to silicon photomultiplier arrays. (22)Na sources have been successfully imaged reconstructing the data with an ML-EM code. Calibration and temperature stabilization are necessary for the prototype operation at low coincidence rates. A spatial resolution of 7.8 mm FWHM has been obtained in the first imaging tests.

Assessment of Geant4 Prompt-Gamma Emission Yields in the Context of Proton Therapy Monitoring

Monte Carlo tools have been long used to assist the research and development of solutions for proton therapy monitoring. The present work focuses on the prompt-gamma emission yields by comparing experimental data with the outcomes of the current version of Geant4 using all applicable proton inelastic models. For the case in study and using the binary cascade model, it was found that Geant4 overestimates the prompt-gamma emission yields by 40.2 ± 0.3%, even though it predicts the prompt-gamma profile length of the experimental profile accurately. In addition, the default implementations of all proton inelastic models show an overestimation in the number of prompt gammas emitted. Finally, a set of built-in options and physically sound Geant4 source code changes have been tested in order to try to improve the discrepancy observed. A satisfactory agreement was found when using the QMD model with a wave packet width equal to 1.3 fm².

Sensitivity study of prompt gamma imaging of scanned beam proton therapy in heterogeneous anatomies

BACKGROUND AND PURPOSE

To investigate the use of a fast analytical prediction algorithm in the evaluation of the accuracy in Bragg peak position estimation using prompt gamma imaging in realistic anatomies.

MATERIAL AND METHODS

Brain, nasal cavity and lung spot scanning treatments were planned on an anthropomorphic phantom. Plan delivery in a clinical proton therapy facility was monitored using a prompt gamma camera. A pencil-beam algorithm was developed to simulate prompt gamma acquisition. For each spot, the sensitivity to setup and CT conversion errors was evaluated based on error scenarios.

RESULTS

Good agreement was found between simulations and measurements (average shift of 0.4mm on whole-layer profiles). The spots with greatest sensitivity to setup or CT conversion errors could be identified. The comparison between expected and estimated shifts showed that the errors in shift estimation due to heterogeneities were in average lower than 1mm in all cases except the lung. In the lung case, only 40% of the spots showed accuracy better than 2mm.

CONCLUSIONS

The analytical prediction algorithm was successfully used to simulate prompt gamma acquisitions of scanned treatment plans. The accuracy in Bragg peak position estimation was generally sub-millimeter in heterogeneous anatomies, except in lung tissues.

Monte Carlo simulation of prompt γ-ray emission in proton therapy using a specific track length estimator

A Monte Carlo (MC) variance reduction technique is developed for prompt-γ emitters calculations in proton therapy. Prompt-γ emitted through nuclear fragmentation reactions and exiting the patient during proton therapy could play an important role to help monitoring the treatment. However, the estimation of the number and the energy of emitted prompt-γ per primary proton with MC simulations is a slow process. In order to estimate the local distribution of prompt-γ emission in a volume of interest for a given proton beam of the treatment plan, a MC variance reduction technique based on a specific track length estimator (TLE) has been developed. First an elemental database of prompt-γ emission spectra is established in the clinical energy range of incident protons for all elements in the composition of human tissues. This database of the prompt-γ spectra is built offline with high statistics. Regarding the implementation of the prompt-γ TLE MC tally, each proton deposits along its track the expectation of the prompt-γ spectra from the database according to the proton kinetic energy and the local material composition. A detailed statistical study shows that the relative efficiency mainly depends on the geometrical distribution of the track length. Benchmarking of the proposed prompt-γ TLE MC technique with respect to an analogous MC technique is carried out. A large relative efficiency gain is reported, ca. 10(5).

Time-resolved imaging of prompt-gamma rays for proton range verification using a knife-edge slit camera based on digital photon counters

Proton range monitoring may facilitate online adaptive proton therapy and improve treatment outcomes. Imaging of proton-induced prompt gamma (PG) rays using a knife-edge slit collimator is currently under investigation as a potential tool for real-time proton range monitoring. A major challenge in collimated PG imaging is the suppression of neutron-induced background counts. In this work, we present an initial performance test of two knife-edge slit camera prototypes based on arrays of digital photon counters (DPCs). PG profiles emitted from a PMMA target upon irradiation with a 160 MeV proton pencil beams (about 6.5 × 10(9) protons delivered in total) were measured using detector modules equipped with four DPC arrays coupled to BGO or LYSO : Ce crystal matrices. The knife-edge slit collimator and detector module were placed at 15 cm and 30 cm from the beam axis, respectively, in all cases. The use of LYSO : Ce enabled time-of-flight (TOF) rejection of background events, by synchronizing the DPC readout electronics with the 106 MHz radiofrequency signal of the cyclotron. The signal-to-background (S/B) ratio of 1.6 obtained with a 1.5 ns TOF window and a 3 MeV-7 MeV energy window was about 3 times higher than that obtained with the same detector module without TOF discrimination and 2 times higher than the S/B ratio obtained with the BGO module. Even 1 mm shifts of the Bragg peak position translated into clear and consistent shifts of the PG profile if TOF discrimination was applied, for a total number of protons as low as about 6.5 × 10(8) and a detector surface of 6.6 cm × 6.6 cm.

Range Verification Methods in Particle Therapy: Underlying Physics and Monte Carlo Modeling

Hadron therapy allows for highly conformal dose distributions and better sparing of organs-at-risk, thanks to the characteristic dose deposition as function of depth. However, the quality of hadron therapy treatments is closely connected with the ability to predict and achieve a given beam range in the patient. Currently, uncertainties in particle range lead to the employment of safety margins, at the expense of treatment quality. Much research in particle therapy is therefore aimed at developing methods to verify the particle range in patients. Non-invasive in vivo monitoring of the particle range can be performed by detecting secondary radiation, emitted from the patient as a result of nuclear interactions of charged hadrons with tissue, including β (+) emitters, prompt photons, and charged fragments. The correctness of the dose delivery can be verified by comparing measured and pre-calculated distributions of the secondary particles. The reliability of Monte Carlo (MC) predictions is a key issue. Correctly modeling the production of secondaries is a non-trivial task, because it involves nuclear physics interactions at energies, where no rigorous theories exist to describe them. The goal of this review is to provide a comprehensive overview of various aspects in modeling the physics processes for range verification with secondary particles produced in proton, carbon, and heavier ion irradiation. We discuss electromagnetic and nuclear interactions of charged hadrons in matter, which is followed by a summary of some widely used MC codes in hadron therapy. Then, we describe selected examples of how these codes have been validated and used in three range verification techniques: PET, prompt gamma, and charged particle detection. We include research studies and clinically applied methods. For each of the techniques, we point out advantages and disadvantages, as well as clinical challenges still to be addressed, focusing on MC simulation aspects.

Automation and uncertainty analysis of a method for in-vivo range verification in particle therapy

We introduce the automation of the range difference calculation deduced from particle-irradiation induced β(+)-activity distributions with the so-called most-likely-shift approach, and evaluate its reliability via the monitoring of algorithm- and patient-specific uncertainty factors. The calculation of the range deviation is based on the minimization of the absolute profile differences in the distal part of two activity depth profiles shifted against each other. Depending on the workflow of positron emission tomography (PET)-based range verification, the two profiles under evaluation can correspond to measured and simulated distributions, or only measured data from different treatment sessions. In comparison to previous work, the proposed approach includes an automated identification of the distal region of interest for each pair of PET depth profiles and under consideration of the planned dose distribution, resulting in the optimal shift distance. Moreover, it introduces an estimate of uncertainty associated to the identified shift, which is then used as weighting factor to 'red flag' problematic large range differences. Furthermore, additional patient-specific uncertainty factors are calculated using available computed tomography (CT) data to support the range analysis. The performance of the new method for in-vivo treatment verification in the clinical routine is investigated with in-room PET images for proton therapy as well as with offline PET images for proton and carbon ion therapy. The comparison between measured PET activity distributions and predictions obtained by Monte Carlo simulations or measurements from previous treatment fractions is performed. For this purpose, a total of 15 patient datasets were analyzed, which were acquired at Massachusetts General Hospital and Heidelberg Ion-Beam Therapy Center with in-room PET and offline PET/CT scanners, respectively. Calculated range differences between the compared activity distributions are reported in a 2D map in beam-eye-view. In comparison to previously proposed approaches, the new most-likely-shift method shows more robust results for assessing in-vivo the range from strongly varying PET distributions caused by differing patient geometry, ion beam species, beam delivery techniques, PET imaging concepts and counting statistics. The additional visualization of the uncertainties and the dedicated weighting strategy contribute to the understanding of the reliability of observed range differences and the complexity in the prediction of activity distributions. The proposed method promises to offer a feasible technique for clinical routine of PET-based range verification.