Beam Delivery System Research Articles

Assessment of pencil beam scanning proton therapy beam delivery accuracy through machine learning and log file analysis

PurposeComprehensive Quality Assurance (QA) protocols are necessary for complex beam delivery systems like Pencil Beam Scanning (PBS) proton therapy. This study focuses on automating the evaluation of beam delivery accuracy using irradiation log files and machine learning (ML) models. MethodsIrradiation log files of 935 clinical treatment fields and routine QA beams were analysed to evaluate spot parameters and Monitor Unit (MU) accuracy. ML models predicted spot size along the X, Y, major, and minor axes. In-house scripts automated log file analysis and spot size predictions. Predicted spot sizes were compared with expected baselines, and the accuracy of spot position, symmetry, and MU for each spot in the beam was evaluated. ResultsMore than 99.5 % of spot positions were accurate within a 1 mm. The mean and Standard Deviation (SD) of X positional error were −0.021 mm (SD: 0.181 mm), and for Y positional error, they were −0.002 mm (SD: 0.132 mm). ML models accurately predicted spot sizes, with over 95 % of spots demonstrating size variations within 10 % of the baseline. The Root Mean Squared Error (RMSE) of X and Y spot size differences were 0.15 mm and 0.16 mm, respectively. Spot symmetry was within 10 %, and MU accuracy showed 95 % of spots with MU per spot variation less than 2 %. ConclusionThis method can validate the vendor’s beam delivery safety interlock system and serve as a quick alternative to patient-specific QA in adaptive treatment, where time is limited, as well as for routine QA spot parameter evaluations.

Microscope integrated MHz optical coherence tomography system for neurosurgery: development and clinical in-vivo imaging.

Neurosurgical interventions on the brain are impeded by the requirement to keep damages to healthy tissue at a minimum. A new contrast channel enhancing the visual separation of malign tissue should be created. A commercially available surgical microscope was modified with adaptation optics adapting the MHz speed optical coherence tomography (OCT) imaging system developed in our group. This required the design of a scanner optics and beam delivery system overcoming constraints posed by the mechanical and optical parameters of the microscope. High quality volumetric OCT C-scans with dense sample spacing can be acquired in-vivo as part of surgical procedures within seconds and are immediately available for post-processing.

Design of a large energy acceptance beamline using fixed field accelerator optics

Large energy acceptance arcs have been proposed for applications such as cancer therapy, muon accelerators, and recirculating linacs. The efficacy of hadron therapy can be improved by reducing the energy layer switching time, however this is currently limited by the small momentum acceptance of the beam delivery system (<±1%). A “closed-dispersion arc” with a large momentum acceptance has the potential to remove this bottleneck, however such a beamline has not yet been constructed. We have developed a design methodology for large momentum acceptance arcs with Fixed Field Accelerator optics, applying it to a demonstrator beam delivery system for protons at 0.5–3.0 MeV (±42% momentum acceptance) as part of the Technology for Ultra-Rapid Beam Operation project at the University of Melbourne. Using realistic magnetic fields, a beamline has been designed with zero dispersion at either end. An algorithm has been devised for the construction of permanent magnet Halbach arrays for this beamline with multipole error below one part in 104, using commercially available magnets. The sensitivity to errors has been investigated, finding that the delivered beam is robust in realistic conditions. This study demonstrates that a closed-dispersion arc with fixed fields can achieve a large momentum acceptance, and we outline future work required to develop these ideas into a complete proof-of-principle beam delivery system that can be scaled up for a medical facility. Published by the American Physical Society 2024

Investigation of dosimetric effect of beam current fluctuations in synchrotron-based proton PBS continuous scanning

Objective. In proton pencil beam scanning (PBS) continuous delivery, the beam is continuously delivered without interruptions between spots. For synchrotron-based systems, the extracted beam current exhibits a spill structure, and recent publications on beam current measurements have demonstrated significant fluctuations around the nominal values. These fluctuations potentially lead to dose deviations from those calculated assuming a stable beam current. This study investigated the dosimetric implications of such beam current fluctuations during proton PBS continuous scanning. Approach. Using representative clinical proton PBS plans, we performed simulations to mimic a worst-case clinical delivery environment with beam current varies from 50% to 250% of the nominal values. The simulations used the beam delivery parameters optimized for the best beam delivery efficiency of the upcoming particle therapy system at Mayo Clinic Florida. We reconstructed the simulated delivered dose distributions and evaluated the dosimetric impact of beam current fluctuations. Main results. Despite significant beam current fluctuations resulting in deviations at each spot level, the overall dose distributions were nearly identical to those assuming a stable beam current. The 1 mm/1% Gamma passing rate was 100% for all plans. Less than 0.2% root mean square error was observed in the planning target volume dose-volume histogram. Minimal differences were observed in all dosimetric evaluation metrics. Significance. Our findings demonstrate that with our beam delivery system and clinical planning practice, while significant beam current fluctuations may result in large local move monitor unit deviations at each spot level, the overall impact on the dose distribution is minimal.

The potential of mixed carbon–helium beams for online treatment verification: a simulation and treatment planning study

Objective. Recently, a new and promising approach for range verification was proposed. This method requires the use of two different ion species. Due to their equal magnetic rigidity, fully ionized carbon and helium ions can be simultaneously accelerated in accelerators like synchrotrons. At sufficiently high treatment energies, helium ions can exit the patient distally, reaching approximately three times the range of carbon ions at an equal energy per nucleon. Therefore, the proposal involves adding a small helium fluence to the carbon ion beam and utilizing helium as an online range probe during radiation therapy. This work aims to develop a software framework for treatment planning and motion verification in range-guided radiation therapy using mixed carbon–helium beams. Approach. The developed framework is based on the open-source treatment planning toolkit matRad. Dose distributions and helium radiographs were simulated using the open-source Monte Carlo package TOPAS. Beam delivery system parameters were obtained from the Heidelberg Ion Therapy Center, and imaging detectors along with reconstruction were facilitated by ProtonVDA. Methods for reconstructing the most likely patient positioning error scenarios and the motion phase of 4DCT are presented for prostate and lung cancer sites. Main results. The developed framework provides the capability to calculate and optimize treatment plans for mixed carbon–helium ion therapy. It can simulate the treatment process and generate helium radiographs for simulated patient geometry, including small beam views. Furthermore, motion reconstruction based on these radiographs seems possible with preliminary validation. Significance. The developed framework can be applied for further experimental work with the promising mixed carbon–helium ion implementation of range-guided radiotherapy. It offers opportunities for adaptation in particle therapy, improving dose accumulation, and enabling patient anatomy reconstruction during radiotherapy.

Luminosity and beam-induced background studies for the Cool Copper Collider

A high-energy electron-positron collider has been widely recognized by the particle physics community to be the next crucial step for detailed studies of the Higgs boson and other fundamental particles and processes. Several proposals for such colliders, either linear or circular, are currently under evaluation. Any such collider will be required to reach high lumimosities, in order to collect enough data at a reasonable time scale, while at the same time coping with high rates of background particles produced from beam-beam interactions during the collisions. In this paper, we analyze the luminosity and beam-beam interaction characteristics of the Cool Copper Collider (C3) and perform a comparison with other linear collider proposals. We conclude that C3 can reach the same or higher collision rates as the other proposals, without having to cope with higher beam-induced background fluxes. Thus, C3 emerges as an attractive option for a future electron-positron collider, benefiting from the collective advancements in beam delivery and final focus system technologies developed by other linear collider initiatives. Published by the American Physical Society 2024

CERN-based experiments and Monte-Carlo studies on focused dose delivery with very high energy electron (VHEE) beams for radiotherapy applications

Very High Energy Electron (VHEE) beams are a promising alternative to conventional radiotherapy due to their highly penetrating nature and their applicability as a modality for FLASH (ultra-high dose-rate) radiotherapy. The dose distributions due to VHEE need to be optimised; one option is through the use of quadrupole magnets to focus the beam, reducing the dose to healthy tissue and allowing for targeted dose delivery at conventional or FLASH dose-rates. This paper presents an in depth exploration of the focusing achievable at the current CLEAR (CERN Linear Electron Accelerator for Research) facility, for beam energies >200 MeV. A shorter, more optimal quadrupole setup was also investigated using the TOPAS code in Monte Carlo simulations, with dimensions and beam parameters more appropriate to a clinical situation. This work provides insight into how a focused VHEE radiotherapy beam delivery system might be achieved.

Clinical Viability of an Active Spot Scanning Beam Delivery System With a Newly Developed Carbon-Ion Treatment Planning System

PurposeAlthough active spot scanning irradiation technique is theoretically superior to passive-scattered broad beam irradiation with respect to normal tissue sparing, corroborations of the clinical benefit of carbon-ion spot scanning have remained scarce. This study aims to investigate the feasibility and clinical implementation of an active spot scanning beam calculation algorithm in a homemade carbon-ion treatment planning system (TPS) by comparing it with a conventional passive uniform scanning technique. Materials and methodsCarbon-ion plans were initially formulated using spot/uniform scanning methods in 22 participants enrolled in a prospective observational clinical trial. Subsequently, two additional plans were designed, resulting in three carbon-ion plans for each participant: uniform and spot scanning with mini-ridge filters (MRFs) of 2mm and 4mm, respectively. ResultsThe findings revealed no significant differences in dose homogeneity; however, significant differences in dose conformity were found between the active and passive scanning plans. For dose drop-off outside the target volume, the average gradient index (GI) values were 1.94 (95% confidence interval (CI): 1.79%-2.09%), 1.87 (95% CI: 1.73%-2.01%), and 3.20 (95% CI: 2.80%-3.61%) for the MRF4, MRF2, and uniform scanning plans, respectively. The pre-treatment tumor volume was 124.7 cm3 (range, 54.2-234 cm3), and the average shrinkage observed was 38.4% (95% CI: 17.6%-59.4%). Seven participants experienced grade 1 acute toxicity, and four experienced grade 2 acute toxicity. However, none of the patients developed grade 3 acute toxicity. ConclusionsIncreasing evidence suggests that potential clinical advantages of spot scanning delivery underlie its technical characteristics. As one among the few institutions currently utilizing carbon-ion radiotherapy, the investigation also provides promising safety and efficacy outcomes from the initial groups of treated participants, thereby contributing to the established clinical evidence supporting the effectiveness and superiority of carbon-ion therapy.

Progress in heavy ion cancer therapy at IMP and future development

AbstractBasic research on heavy ion cancer therapy such as radiobiology, medical physics, and therapeutic technique has been conducted at the Institute of Modern Physics (IMP), Chinese Academy of Sciences since 1995. Based on the achievements acquired in the basic research and the requirements for a heavy ion accelerator for radiotherapy purposes, a dedicated heavy ion therapy facility named Heavy Ion Medical Machine (HIMM) was designed at IMP and constructed in Wuwei, China. The HIMM facility consists of two electron cyclotron resonance ion sources, one cyclotron as the injector and one synchrotron as the main accelerator, and four different treatment rooms equipped with passive or active beam delivery systems, and accelerates carbon ions up to 400 MeV/u. After the performance inspection of HIMM organized by the National Medical Device Inspection Center, preclinical tests like cell and animal radiobiological experiments and dosimetric verification using anthropomorphic phantoms for elucidating the biophysical properties of the carbon ion beams provided by HIMM were carried out. According to the Chinese medical device regulations, a clinical trial in which 46 tumor patients were recruited and two hospitals participated was conducted in the HIMM facility, aiming at evaluating the treatment safety and short‐term efficacy of the medical device. The success of the clinical trial helped the HIMM facility be authorized by the Chinese government as a class III medical device. In this paper, all the aspects mentioned above are introduced and discussed, and implications for future improvements are also given.

Precision-controlled ultrafast electron microscope platforms. A case study: Multiple-order coherent phonon dynamics in 1T-TaSe2 probed at 50 fs-10 fm scales.

We report on the first detailed beam tests attesting the fundamental principle behind the development of high-current-efficiency ultrafast electron microscope systems where a radio frequency (RF) cavity is incorporated as a condenser lens in the beam delivery system. To allow for the experiment to be carried out with a sufficient resolution to probe the performance at the emittance floor, a new cascade loop RF controller system is developed to reduce the RF noise floor. Temporal resolution at 50 fs in full-width-at-half-maximum and detection sensitivity better than 1% are demonstrated on exfoliated 1T-TaSe2 system under a moderate repetition rate. To benchmark the performance, multi-terahertz edge-mode coherent phonon excitation is employed as the standard candle. The high temporal resolution and the significant visibility to very low dynamical contrast in diffraction signals via high-precision phase-space manipulation give strong support to the working principle for the new high-brightness femtosecond electron microscope systems.

FLASH radiotherapy sparing effect on the circulating lymphocytes in pencil beam scanning proton therapy: impact of hypofractionation and dose rate

Purpose. The sparing effect of ultra-high dose rate (FLASH) radiotherapy has been reported, but its potential to mitigate depletion of circulating blood and lymphocytes (CL) has not been investigated in pencil-beam scanning-based (PBS) proton therapy, which could potentially reduce the risk of radiation-induced lymphopenia. Material and methods. A time-dependent framework was used to score the dose to the CL during the course of radiotherapy. For brain patients, cerebral vasculatures were semi-automatic segmented from 3T MR-angiography data. A dynamic beam delivery system was developed capable of simulating spatially varying instantaneous dose rates of PBS treatment plans, and which is based on realistic beam delivery parameters that are available clinically. We simulated single and different hypofractionated PBS intensity modulated proton therapy (IMPT) FLASH schemes using 600 nA beam current along with conventionally fractionated IMPT treatment plan at 2 nA beam current. The dosimetric impact of treatment schemes on CL was quantified, and we also evaluated the depletion in subsets of CL based on their radiosensitivity. Results. The proton FLASH sparing effect on CL was observed. In single-fraction PBS FLASH, just 1.5% of peripheral blood was irradiated, whereas hypofractionated FLASH irradiated 7.3% of peripheral blood. In contrast, conventional fractionated IMPT exposed 42.4% of peripheral blood to radiation. PBS FLASH reduced the depletion rate of CL by 69.2% when compared to conventional fractionated IMPT. Conclusion. Our dosimetric blood flow model provides quantitative measures of the PBS FLASH sparing effect on the CL in radiotherapy for brain cancer. FLASH Single treatment fraction offers superior CL sparing when compared to hypofractionated FLASH and conventional IMPT, supporting assumptions about reducing risks of lymphopenia compared to proton therapy at conventional dose rates. The results also indicate that faster conformal FLASH delivery, such as passive patient-specific energy modulation, may further enhance the sparing of the immune system.

Progress Toward TURBO: A Novel Beam Delivery System for Charged Particle Therapy

TURBO – Technology for Ultra Rapid Beam Operation – is a novel beam delivery system (BDS) in development at the University of Melbourne. The BDS determines several aspects of treatment delivery where a key bottleneck is the deadtime associated with beam energy variation. Beamlines at treatment facilities have a ±1% momentum acceptance range, requiring all the magnetic fields to adjust to deliver different energy beams at multiple depths in the tumour volume. A BDS using Fixed Field Alternating Gradient (FFA) optics could reduce the energy layer switching time (ELST) by enabling the transport of a large range of beam energies within the same fixed fields. We present recent progress and ongoing developments with TURBO, a proof-of-concept demonstrator adapted for low energy protons. Characterisation measurements were performed to determine realistic parameters for beam transport and particle tracking modelling. Simulation and experimental studies are shown for an energy degrader. We mention considerations of canted-cosine-theta magnets and further work to explore the clinical feasibility of a scaled-up BDS for charged particle therapy.

Femtotesla 87Rb magnetometer based on a coaxial pump-probe beam delivery system

Advancements in highly sensitive and miniaturized spin-exchange relaxation-free atomic magnetometers have attracted significant attention. Although dual-beam magnetometers with high sensitivity have been developed, miniaturization while maintaining sensitivity remains challenging. In this study, we present a novel magnetometer configuration featuring a coaxial pump-probe beam delivery system facilitated by a single polarization-maintaining optical fiber. Utilizing polarized atoms to probe the diffuse central region of a ring pump beam, we achieved optimized performance through parameter adjustments, including the power of the pump and probe beams, modulation index, and other key factors. The magnetometer exhibited a remarkable sensitivity of 15 fT/Hz1/2. In addition, we introduced a novel method for evaluating the polarizability of alkali metals. The proposed magnetometer configuration shows considerable potential for advancing the field of highly sensitive miniaturized atomic magnetometers that are well suited for magnetocardiography (MCG) and magnetoencephalography (MEG) applications.

SAPT: a synchrotron-based proton therapy facility in Shanghai

Because of its excellent dose distribution, proton therapy is becoming increasingly popular in the medical application of cancer treatment. A synchrotron-based proton therapy facility was designed and constructed in Shanghai. The synchrotron, beam delivery system, and other technical systems were commissioned and reached their expected performances. After a clinical trial of 47 patients was finished, the proton therapy facility obtained a registration certificate from the National Medical Products Administration. The characteristics of the accelerator and treatment systems are described in this article.

Beam Delivery and Patient Alignment: Perspective of the Innovative Cycloton 400MEV/u Multi-Ion System

The C400IONS system is the first multi-ion particle therapy system based on a cyclotron world-wide. The first treatment delivery is foreseen in Caen, France in 2026. This work provides major beam delivery and patient alignment specifications and design evaluations that will be integrated in the first installation. The C400IONS is an innovative system developed on a 400 MeV/u isochronous cyclotron, it can generate carbon ions, protons and helium ions. The beam delivery and treatment room design of this multi-ion treatment system is based on the IBA Proteus®PLUS equipment. The C400IONS fixed horizontal beamlines use pencil beam scanning technology and provide, e.g., planar imaging, a 6D robotic patient positioning system coupled with either a couch or a chair, and options to use patient or treatment specific accessories like a ripple filter. Nozzle and chair have been designed for optimal clinical perspectives for adult and pediatric treatments. The Beam Delivery System will provide scan fields from 20 × 20cm2 for carbon ions up to 30 × 30cm2 for protons. Beams will be available for treatment with ranges between 4 and 32 g/cm2 for protons and helium ions and between 4 and 27 g/cm2 for carbon ions. The nozzle shape and bottom clearance have been optimized for a chair designed for brain and head and neck treatment with several backrest heights and rotation settings enabling a large treatment volume. This work describes design investigations by Nha and its partners on nozzle and patient positioning components, supporting a reliable, comprehensive, optimized and evolutive multi-ion therapy system.

Development of the Independent Dose Verification Method for the Ring Gantry PET/CT Linac

The RefleXion Xi is a new external beam radiotherapy delivery modality combining kilovoltage fan-beam CT and on-board PET for Biology-guided Radiotherapy. Although the machine shares similar components with the Tomotherapy machine, it has unique hardware features such as stationary beam delivery system with couch increments. The goal of this study is to develop an in-house independent secondary dose calculation method for this ring gantry PET/CT Linac. The method aggregates the beam intensities at each discrete firing gantry angle and couch moving position. The non-uniform intensity map is decomposed into a series of segments of uniform beam intensities, and then coordinates of beam segments were modified based on the relative distance from the dose calculation point to keep the calculation point in the same spot along the gantry rotation. The dose to the calculation point of each segment is determined by using measured tissue-maximum-ratio, output factors, and off-axis ratio by independent binary collimators. Two-dimensional convolution method is applied to integrate all dose contribution components in segment areas for efficient calculation. The final dose is obtained by summing all dose to the calculation point of segments for all firing gantry angle and couch position. Twenty patients with different treatment sites including head and neck, prostate, and lung regions were analyzed. Comparison of the point dose calculated by the independent program to that calculated by the planning system has shown reasonable agreement within ±5%. The independent dose verification program has been developed as an initial patient specific QA for improving patient safety. Further study will be performed to enhance the accuracy and reliability by including additional leakage and scatter models.

2.2 kW single-mode narrow-linewidth laser delivery through a hollow-core fiber

Antiresonant hollow-core fibers (AR-HCFs) have opened up exciting possibilities for high-energy and high-power laser delivery because of their exceptionally low nonlinearities and high damage thresholds. While these fiber designs offer great potential for handling kilowatt-class powers, it is crucial to investigate their performance at multi-kW power levels. Until now, transmission of narrow-linewidth single-mode lasers at multi-kW power levels through a HCF has not been demonstrated, to our knowledge. Here, we present the delivery of a record 2.2 kW laser power with an input spectral linewidth of 86 GHz, centered at 1080 nm, while maintaining 95% transmission efficiency and beam quality (M2) of 1.03. This was achieved via a 104.5 m single-mode five-tube nested AR-HCF with 0.79 dB/km loss. Furthermore, we show power delivery of 1.7 kW with a spectral linewidth as narrow as 38 GHz through the same fiber. Our results could lead to a new generation of fiber-based laser beam delivery systems with applications in precision machining, nonlinear science, directed energy, and power beaming over fiber.

Beam delivery and beamstrahlung considerations for ultra-high energy linear colliders

As part of the Snowmass'21 community planning excercise, the Advanced Accelerator Concepts (AAC) community proposed future linear colliders with center-of-mass energies up to 15 TeV and luminosities up to 50 × 1034 cm-2 s-1 in a compact footprint. In addition to being compact, these machines must also be energy efficient. We identify two challenges that must be addressed in the design of these machines. First, the Beam Delivery System (BDS) must not add significant length to the accelerator complex. Second, beam parameters must be chosen to mitigate beamstrahlung effects and maximize the luminosity-per-power of the machine. In this paper, we review advances in plasma lens technology that will help to reduce the length of the BDS system and we detail new Particle-in-Cell simulation studies that will provide insight into beamstrahlung mitigation techniques. We apply our analysis to both e + e - and γγ colliders. The challenges and solutions described in this paper are considered independently. A unified, self-consistent concept for a BDS system for a 15 TeV linear collider will be the subject of future work.

Secondary radiation dose modeling in passive scattering and pencil beam scanning very high energy electron (VHEE) radiation therapy.

Electrons with kinetic energy up to a few hundred MeV, also called very high energy electrons (VHEE), are currently considered a promising technique for the future of radiation therapy (RT) and in particular ultra-high dose rate (UHDR) therapy. However, the feasibility of a clinical application is still being debated and VHEE therapy remains an active area of research for which the optimal conformal technique is also yet to be determined. In this work, we will apply two existing formalisms based on analytical Gaussian multiple-Coulomb scattering theory and Monte Carlo (MC) simulations to study and compare the electron and bremsstrahlung photon dose distributions arising from two beam delivery systems (passive scattering with or without a collimator or active scanning). We therefore tested the application of analytical and MC models to VHEE beams and assessed their performance and parameterization in the energy range of 6-200MeV. The optimized electron beam fluence, the bremsstrahlung, an estimation of central-axis and off-axis x-ray dose at the practical range and neutron contributions to the total dose, along with an extended parameterization for the photon dose model were developed, together with a comparison between double scattering (DS) and pencil beam scanning (PBS) techniques. MC simulations were performed with the TOPAS/Geant4 toolkit to verify the dose distributions predicted by the analytical calculations. The results for the clinical energy range (between 6 and 20MeV) as well as for higher energies (VHEE range between 20 and 200MeV) and for two treatment field sizes (5×5 and 10×10 cm2 ) are reported, showing a reasonable agreement with MC simulations with mean differences below 2.1%. The relative contributions of photons generated in the medium or by the scattering system along the central-axis (up to 50% of the total dose) are also illustrated, along with their relative variations with electron energy. The fast analytical models parametrized in this study allow an estimation of the amount of photons produced behind the practical range by a DS system with an accuracy lower than 3%, providing important information for the eventual design of a VHEE system. The results of this work could support future research on VHEE radiotherapy.

Formation of spread-out Bragg peak for helium-ion beam using microdosimetric kinetic model

PurposeTo evaluate the applicability of microdosimetric kinetic model (MKM) to helium-ion therapy by forming a spread-out Bragg peak (SOBP) of a helium-ion beam using the MKM developed for carbon-ion radiotherapy and confirming the predictions in biological experiments. MethodsUsing a ridge filter, a 90-mm wide SOBP for a 210 MeV/u helium-ion beam was created in a broad beam delivery system. The ridge filter was designed such that a uniform biological response was achieved with a cell survival rate of 7% over the SOBP region. Biological experiments were then performed using the SOBP beam in a human salivary gland (HSG) cell line to measure the cell survival rates. ResultsThe biological responses were uniform in the SOBP region, as expected by the MKM; however, the mean of the measured cell survival rates was (11.2 ± 0.6) % in the SOBP region, which was 60% higher than the designed rate. When investigating the biological parameters of the HSG cell line used in the experiments, we found that they were altered slightly from the MKM parameters used for carbon-ion radiotherapy. The new β parameter reproduced the measured survival rates within 6.5% in the SOBP region. ConclusionWe produced biologically uniform SOBP using MKM for carbon-ion radiotherapy. The measured survival rates in the SOBP region were higher than expected, and the survival rates were reproduced by modifying the MKM parameter. This study was limited to one SOBP, and further investigations are required to prove that MKM is generally applicable to helium-ion radiotherapy.