Proton Therapy for Ocular Melanoma: A Dosimetric Comparison of Three Different Delivery Systems

PURPOSE/OBJECTIVE(S)

The purpose of this study is to compare the treatment plans for intraocular tumors with two types of Pencil Beam Scanning (PBS) machine configurations and compare them with the widely used uniform scanning (US)/scattering technique.

MATERIALS/METHODS

Two virtual PBS machines were constructed for ocular planning. The first machine (P1) consisted of a standard spot size and a 7.5cm WET range shifter (RS) positioned 50cm upstream from the aperture. The second machine (P2) had a smaller spot size and used a 4cm WET RS but had no aperture support. These PBS delivery systems resemble currently available models. Ten patients with different locations and sizes of intraocular tumors were planned with US using 2-3 conformal fields following our institution's intraocular criteria. PBS spot patterns for each machine were optimized using the same beam geometry as the US plan to achieve identical tumor coverage. PBS distribution was calculated using Monte Carlo. All air gaps were minimized as small as clinically achievable. PBS plans passed robustness criteria with all scenarios meeting CTV D95>95% with 2mm translational offsets and 3.5% range uncertainty.

RESULTS

The average conformity index (CI) of 95% reference isodose was better for both PBS techniques (P1: 1.43±0.22, P2:1.5±0.32) versus US (1.72±0.56) for all plans (p = 0.025, p = 0.034). The average CI of 50% reference isodose was worse for the P2 plans (10.4±3.3) compared to US (9.34±2.93). However, CI 50% for P1 plans was better than US (5.21±1.24, p<0.003). There were no significant improvements to OARs using P2. However, the mean dose to anterior structures ciliary body, lacrimal gland, and D0.03cc lens were significantly lower in the P1 plans than in the US plans (p<0.016).

CONCLUSION

Small spot size PBS systems without apertures can achieve similar coverage to US plans but have higher OAR dose. PBS systems with a standard spot size and reconfigured RS and apertures are better for anterior OAR sparing and is non-inferior to US planning of intraocular targets.

Comparative accuracy and resolution assessment of two prototype proton computed tomography scanners

BACKGROUND

Improving the accuracy of relative stopping power (RSP) in proton therapy may allow reducing range margins. Proton computed tomography (pCT) has been shown to provide state-of-the-art RSP accuracy estimation, and various scanner prototypes have recently been built. The different approaches used in scanner design are expected to impact spatial resolution and RSP accuracy.

PURPOSE

The goal of this study was to perform the first direct comparison, in terms of spatial resolution and RSP accuracy, of two pCT prototype scanners installed at the same facility and by using the same image reconstruction algorithm.

METHODS

A phantom containing cylindrical inserts of known RSP was scanned at the phase-II pCT prototype of the U.S. pCT collaboration and at the commercially oriented ProtonVDA scanner. Following distance-driven binning filtered backprojection reconstruction, the radial edge spread function of high-density inserts was used to estimate the spatial resolution. RSP accuracy was evaluated by the mean absolute percent error (MAPE) over the inserts. No direct imaging dose estimation was possible, which prevented a comparison of the two scanners in terms of RSP noise.

RESULTS

In terms of RSP accuracy, both scanners achieved the same MAPE of 0.72% when excluding the porous sinus insert from the evaluation. The ProtonVDA scanner reached a better overall MAPE when all inserts and the body of the phantom were accounted for (0.81%), compared to the phase-II scanner (1.14%). The spatial resolution with the phase-II scanner was found to be 0.61 lp/mm, while for the ProtonVDA scanner somewhat lower at 0.46 lp/mm.

CONCLUSIONS

The comparison between two prototype pCT scanners operated in the same clinical facility showed that they both fulfill the requirement of an RSP accuracy of about 1%. Their spatial resolution performance reflects the different design choices of either a scanner with full tracking capabilities (phase-II) or of a more compact tracker system which only provides the positions of protons but not their directions (ProtonVDA). This article is protected by copyright. All rights reserved.

Spatially fractionated (GRID) radiation therapy using proton pencil beam scanning (PBS): Feasibility study and clinical implementation

PURPOSE

GRID therapy is an effective treatment for bulky tumors. Linear accelerator (Linac)-produced photon beams collimated through blocks or multileaf collimators (MLCs) are the most common methods used to deliver this therapy. Utilizing the newest proton delivery method of pencil beam scanning (PBS) can further improve the efficacy of GRID therapy. In this study, we developed a method of delivering GRID therapy using proton PBS, evaluated the dosimetry of this novel technique and applied this method in two clinical cases.

MATERIALS/METHODS

In the feasibility study phase, a single PBS proton beam was optimized to heterogeneously irradiate a shallow 20 × 20 × 12 cm³ target volume centered at a 6 cm depth in a water phantom. The beam was constrained to have an identical spot pattern in all layers, creating a "beamlet" at each spot position. Another GRID treatment using PBS was also performed on a deep 15 × 15 × 8 cm³ target volume centered at a 14 cm depth in a water phantom. Dosimetric parameters of both PBS dose distributions were compared with typical photon GRID dose distributions. In the next phase, four patients have been treated at our center with this proton GRID technique. The planning, dosimetry, and measurements for two representative patients are reported.

RESULTS

For the shallow phantom target, the depth-dose curve of the PBS plan was uniform within the target (variation < 5%) and dropped quickly beyond the target (50% at 12.9 cm and 0.5% at 14 cm). The lateral profiles of the PBS plan were comparable to those of photon GRID in terms of valley-to-peak ratios. For the deep phantom target, the PBS plan provided smaller valley-to-peak ratios than the photon GRID technique. Pretreatment dose verification QA showed close agreement between the measurements and the plan (pass rate > 95% with a gamma index criterion of 3%/3 mm). Patients tolerated the treatment well without significant skin toxicity (radiation dermatitis grade ≤ 1).

CONCLUSIONS

Proton GRID therapy using a PBS delivery method was successfully developed and implemented clinically. Proton GRID therapy offers many advantages over photon GRID techniques. The use of protons provides a more uniform beamlet dose within the tumor and spares normal tissues located beyond the tumor. This new PBS method will also reduce the dose to proximal organs when treating a deep-seated tumor.

A gas scintillator detector for 2D dose profile monitoring in pencil beam scanning and pulsed beam proton radiotherapy treatments

In order to address dosimetry demands during proton therapy treatments utilizing pencil beam scanning and/or pulsed beam accelerators, we have developed a xenon-filled gas scintillation detector (GSD) that can monitor delivered dose and 2D beam centroid position pulse-by-pulse in real time, with high response linearity up to high instantaneous dose rates. We present design considerations for the GSD and results of beam tests carried out at operating proton therapy clinics. In addition to demonstrating spatial resolution with σ of a few hundred microns in each transverse dimension and relative dose precision better than 1% over large treatment areas, the test beam results also reveal the dependence of the GSD dose normalization on dose rate, beam energy, and gas impurities. The results demonstrate the promise of the GSD technology to provide an important addition to dosimetry approaches for next-generation ion beam therapy.

Determination of penumbral widths from ion chamber measurements

We have investigated methods of reconstructing beam profiles in the penumbral region using a set of axially symmetric chambers, differing only in the detector radius. In principal, the transfer functions, or kernels, of such chambers should be functions of radius only. Three chambers of radii 0.297, 0.556, and 0.714 cm have been used. The transfer functions of the chambers can be determined by deconvolving the profiles measured with each detector with the PPMC profile. The results indicate that the transfer functions can be parametrized accurately as a Gaussian cutoff at 1.75(r), with (r) the average radius of the chamber. Deconvolution of the measured profiles with the transfer functions yields a profile that agrees with the PPMC profile to +/- 0.5 mm over the 20-80% penumbra.