Ion Therapy Research Articles

Latent profiles of resilience and associations with quality of life in head and neck cancer patients undergoing proton and heavy ion therapy.

Psychological resilience is the most important psychological protection factor for cancer patients in the face of tumors and treatment. However, few studies have performed meaningful latent profile analyses of resilience to identify unobserved subgroups of head and neck cancer patients. The purpose of this study was to investigate the characteristics of resilience in head and neck cancer patients using latent profile analysis (LPA) to determine the sociodemographic and disease characteristics of each profile. In particular, we examined the association of different resilience profiles with the quality of life of head and neck cancer patients. A total of 254 head and neck cancer patients completed a demographic questionnaire, the Resilience Scale Specific to Cancer and the EOTRC QLQ-C3O, used to assess their resilience and quality of life. LPA identified three distinct profiles based on varying levels of resilience: "low resilience" group (n = 45; 17.72%), "moderate resilience" group (n = 113; 44.49%), and "high resilience" group (n = 96; 37.80%). Gender (χ2 = 6.20; p < 0.01), education level (χ2 = 1,812.59; p < 0.01), treatment regimen (χ2 = 6.32; p < 0.01), tumor stage (χ2 = 3.92; p ≤ 0.05), and initial recurrence (χ2 = 5.13; p < 0.05) were important predictors. High resilience was significantly related to higher quality of life (χ2 = 15.694; p < 0.001). Head and neck cancer patients' psychological resilience can be categorized as three resilience profiles; those who are female and have a low education level tend to have lower psychological resilience. Low resilience in patients is linked to poor role function and social function, low quality of life, and more severe pain symptoms, highlighting the need to address resilience in patient care for improved wellbeing.

Preliminary study of low-pressure ionization chamber for online dose monitoring in FLASH carbon ion radiotherapy

The FLASH effect of carbon ion therapy has recently attracted significant attention from the scientific community. However, the radiobiological mechanism of the effect and the exact therapeutic conditions are still under investigation. Therefore, the dosimetry accuracy is critical for testing hypotheses about the effect and quantifying FLASH Radiotherapy. In this paper, the FLASH ionization chamber at low-pressure was designed, and its dose rate dependence was verified with the Faraday cup. In addition, the dose response was tested under the air pressure of the ionization chamber of 10 mbar, 80 mbar and 845 mbar, respectively. The results showed that when the pressure was 10 mbar, the dose linearity was verified and calibrated at the dose rate of ∼50 Gy s−1, and the residuals were less than 2%. In conclusion, the FLASH ionization chamber is a promising instrument for online dose monitoring.

Using the photon isoeffective dose formalism to compare and combine BNCT and CIRT in a head and neck tumour

Boron Neutron Capture Therapy (BNCT) is a radiotherapy technique based on the enrichment of tumour cells with suitable 10-boron concentration and on subsequent neutron irradiation. Low-energy neutron irradiation produces a localized deposition of radiation dose caused by boron neutron capture reactions. Boron is vehiculated into tumour cells via proper borated formulations, able to accumulate in the malignancy more than in normal tissues. The neutron capture releases two high-LET charged particles (i.e., an alpha particle and a lithium ion), losing their energy in a distance comparable to the average dimension of one cell. Thus BNCT is selective at the cell level and characterized by high biological effectiveness. As the radiation field is due to the interaction of neutrons with the components of biological tissues and with boron, the dosimetry requires a formalism to express the absorbed dose into photon-equivalent units. This work analyzes a clinical case of an adenoid cystic carcinoma treated with carbon-ion radiotherapy (CIRT), located close to optic nerve and deep-seated as a practical example of how to apply the formalism of BNCT photon isoeffective dose and how to evaluate the BNCT dose distribution against CIRT. The example allows presenting different dosimetrical and radiobiological quantities and drawing conclusions on the potential of BNCT stemming on the clinical result of the CIRT. The patient received CIRT with a dose constraint on the optic nerve, affecting the peripheral part of the Planning Target Volume (PTV). After the treatment, the tumour recurred in this low-dose region. BNCT was simulated for the primary tumour, with the goal to calculate the dose distribution in isoeffective units and a Tumour Control Probability (TCP) to be compared with the one of the original treatment. BNCT was then evaluated for the recurrence in the underdosed region which was not optimally covered by charged particles due to the proximity of the optic nerve. Finally, a combined treatment consisting in BNCT and carbon ion therapy was considered to show the consistency and the potential of the model. For the primary tumour, the photon isoeffective dose distribution due to BNCT was evaluated and the resulted TCP was higher than that obtained for the CIRT. The formalism produced values that are consistent with those of carbon-ion. For the recurrence, BNCT dosimetry produces a similar TCP than that of primary tumour. A combined treatment was finally simulated, showing a TCP comparable to the BNCT-alone with overall dosimetric advantage in the most peripheral parts of the treatment volume. Isoeffective dose formalism is a robust tool to analyze BNCT dosimetry and to compare it with the photon-equivalent dose calculated for carbon-ion treatment. This study introduces for the first time the possibility to combine the dosimetry obtained by two different treatment modalities, showing the potential of exploiting the cellular targeting of BNCT combined with the precision of charged particles in delivering an homogeneous dose distribution in deep-seated tumours.

Comparison of 352 MHz linac structures for injection into an ion therapy accelerator

In the frame of ongoing initiatives for the design of a new generation of synchrotron-based accelerators for cancer therapy with ion beams, an analysis of linac designs has been started, to address a critical element with a strong impact on the performance and cost of the accelerator. The goal is to identify alternatives at lower cost and a similar or possibly smaller footprint than the standard 217 MHz injector presently used in all carbon therapy facilities in Europe. As an additional feature, a new linac design can be tailored to produce radioisotopes for treatment and diagnostics in parallel with operation as a synchrotron injector. In this paper, the attractive option of moving to 352 MHz frequency is analyzed, to a profit of reliable mechanical designs already developed for protons and of the cost savings that can be obtained using Radiofrequency (RF) power sources klystrons with a much lower cost per Watt than tubes or solid-state units. The paper is presenting a Quasi-Alvarez Drift Tube Linac (QA-DTL) version of an injector linac for carbon ions at q/A=1/3 and compare it with Inter-Digital H-Mode DTL (IH-DTL) designs. The option of a Separated-tank IH-DTL structure (S-IH-DTL) is also discussed, along with a standard IH-DTL, both at 352 MHz. Finally, a DTL design at 352 MHz for the injection of fully stripped helium ions into the synchrotron is presented.

GATE Monte Carlo simulation toolkit for medical physics

The GATE toolkit (GEANT4 Application for Tomographic Emission) is a GEANT4-based (GEometry ANd Tracking) platform for Monte Carlo simulations in medical physics. GATE applications can be divided into two main axes: radiation-based medical imaging and radiotherapy/dosimetry. The accurate modeling of the first one is crucial for system design and optimization as well as for development and refinement of image analysis algorithms. The importance of the precise simulation of the second is essential for characterisation of external beam radiotherapy (proton therapy and carbon ion therapy) and absorbed dose assessment. Within this paper, we discuss the main features of GATE and give a general view on applications, followed by insights into future development perspectives.

High-Power Modular GaN Based Power Supply for MedAustron Scanning Magnets

MedAustron is a synchrotron-based ion therapy center in Wiener Neustadt, Austria, constantly working towards the performance improvement of cancer treatment. A major improvement opportunity comes from the scanning magnets system – a crucial element of dose delivery system at MedAustron - that is influenced by the bandwidth and power density of the magnet power supplies. Therefore, a novel highly modular power converter, based on the latest gallium nitride technology is being developed to tackle the aforementioned requirements. One sub-module of this power supply is based on two H-bridges that are operated in hard parallel and are integrated into a standardized euro-crate form factor with target output power specifications of 720 kW. This design also includes a 4th-order output Bessel filter to meet the ripple requirements for clinical operation. Furthermore, those sub-modules offer the possibility of being connected, cascaded or interleaved, in order to meet different output power requirements, providing a high modularity aspect. The status of this development in terms of requirements, global topology, and control structure is presented.

Enhanced MRI Radiomics Based Model for Predicting Recurrence or Metastasis of Nasopharyngeal Cancer (NC) Undergoing Concurrent Chemoradiotherapy: A Retrospective Study.

Nasopharyngeal Carcinoma (NC) refers to the malignant tumor that occurs at the top and side walls of the nasopharyngeal cavity. The NC incidence rate always dominates the first among the malignant tumors of the ear, nose and throat, and mainly occurs in Asia. NC cases are mainly concentrated in southern provinces in China, with about 4 million existing NC. With the pollution of environment and pickled diet, and the increase of life pressure, the domestic NC incidence rate has reached 4.5-6.5/100000 and is increasing year by year. It was reported that the known main causes of NC include hereditary factor, genetic mutations, and EB virus infection, common clinical symptoms of NC include nasal congestion, bloody mucus, etc. About 90% of NC is highly sensitive to radiotherapy which is regard as the preferred treatment method; However, for NC with lower differentiation, larger volume, and recurrence after treatment, surgical resection and local protons and heavy ions therapy are also indispensable means. According to reports, the subtle heterogeneity and diversity exists in some NC, with about 80% of NC undergone radiotherapy and about 25% experienced recurrence and death within five years after radiotherapy in China. Therefore, screening the NC population with suspected recurrence after concurrent chemoradiotherapy may improve survival rates in current clinical decision-making.

Quantum-mechanical four-body versus semi-classical three-body theories for double charge exchange in collisions of fast alpha particles with helium targets

AbstractWithin the two-channel distorted wave second-order perturbative theoretical formalism, we study capture of both electrons from helium-like targets by heavy nuclei as projectiles at intermediate and high impact energies. The emphasis is on the four-body single-double scattering (SDS-4B) method and the three-body continuum distorted wave impact parameter method (CDW-3B-IPM). The SDS-4B method deals with the full quantum-mechanical correlative dynamics of all the four interactively participating particles (two electrons, two nuclei). The CDW-3B-IPM is a semi-classical three-body independent particle model (one electron, two nuclei), using a combinatorial calculus to describe double capture by a product of two uncorrelated probabilities, integrated over impact parameters. Both theories share a common feature in having altogether two electronic full Coulomb continuum wave functions. One such function is centered on the projectile nucleus in the entrance channel, whereas the other is centered on the target nucleus in the exit channel. These two methods satisfy the correct initial and final Coulomb boundary conditions in the asymptotic region of scattering, at infinitely large inter-particle separations. Yet, it is presently demonstrated that most of the available experimental data on total cross sections for the double capture from helium by alpha particles distinctly favor the SDS-4B method. This is especially true at intermediate energies. Such energies are critically important in versatile applications under the general umbrella of ion transport in matter, including thermonuclear fusion (plasma physics) and ion therapy (medicine).

Dual Nucleosomal Double-Strand Breaks Are the Key Effectors of Curative Radiation Therapy

Most ionizing radiation produces δ-rays of ≈1 keV that can impart MGy doses to 100 nm3 volumes of DNA. These events can produce severe dual double-strand breaks (DDSBs) on nucleosomes, particularly in dense heterochromatic DNA. This is the most common multiply damaged site, and their probabilities determine the biological effectiveness of different types of radiation. We discuss their frequency, effect on cell survival, DNA repair, and imaging by gold nanoparticle tracers and electron microscopy. This new and valuable nanometer resolution information can be used for determining the optimal tumor cure by maximizing therapeutic effects on tumors and minimizing therapeutic effects on normal tissues. The production of DDSBs makes it important to deliver a rather high dose and LET to the tumor (&gt;2.5 Gy/Fr) and at the same time reach approximately 1.8–2.3 Gy of the lowest possible LET per fraction in TP53 intact normal tissues at risk. Therefore, their intrinsic low-dose hyper-sensitivity (LDHS)-related optimal daily fractionation window is utilized. Before full p53 activation of NHEJ and HR repair at ≈½ Gy, the low-dose apoptosis (LDA) and LDHS minimize normal tissue mutation probabilities. Ion therapy should thus ideally produce the lowest possible LET in normal tissues to avoid elevated DDSBs. Helium to boron ions can achieve this with higher-LET Bragg peaks, producing increased tumor DDSB densities. Interestingly, the highest probability of complication-free cure with boron or heavier ions requires a low LET round-up for the last 10–15 GyE, thereby steepening the dose response and further minimizing normal tissue damage. In conclusion, the new high-resolution DSB and DDSB diagnostic methods, and the new more accurate DNA-repair-based radiation biology, have been combined to increase our understanding of what is clinically important in curative radiation therapy. In fact, we must understand that we already passed the region of optimal LET and need to go back one step rather than forward, with oxygen being contemplated. As seen by the high overkill and severely high LET in the distal tumor and the increased LET to normal tissues (reminding of neutrons or neon ions), it is therefore preferable to use lithium–boron ions or combine carbon with an optimal 10–15 GyE photon, electron, or perhaps even a proton round-up, thus allowing optimized, fractionated, curative, almost complication-free treatments with photons, electrons, and light ions, introducing a real paradigm shift in curative radiation therapy with a potential 5 GyE tumor boost, 25% increase in complication-free cure and apoptotic–senescent Bragg Peak molecular light ion radiation therapy.

A phantom to simulate organ motion and its effect on dose distribution in carbon ion therapy for pancreatic cancer

Objective. Carbon ion radiotherapy is a promising radiation technique for malignancies like pancreatic cancer. However, organs’ motion imposes challenges for achieving homogeneous dose delivery. In this study, an anthropomorphic Pancreas Phantom for Ion-beam Therapy (PPIeT) was developed to simulate breathing and gastrointestinal motion during radiotherapy. Approach. The developed phantom contains a pancreas, two kidneys, a duodenum, a spine and a spinal cord. The shell of the organs was 3D printed and filled with agarose-based mixtures. Hounsfield Units (HU) of PPIeTs’ organs were measured by CT. The pancreas motion amplitude in cranial-caudal (CC) direction was evaluated from patients’ 4D CT data. Motions within the obtained range were simulated and analyzed in PPIeT using MRI. Additionally, GI motion was mimicked by changing the volume of the duodenum and quantified by MRI. A patient-like treatment plan was calculated for carbon ions, and the phantom was irradiated in a static and moving condition. Dose measurements in the organs were performed using an ionization chamber and dosimetric films. Main results. PPIeT presented tissue equivalent HU and reproducible breathing-induced CC displacements of the pancreas between (3.98 ± 0.36) mm and a maximum of (18.19 ± 0.44) mm. The observed maximum change in distance of (14.28 ± 0.12) mm between pancreas and duodenum was consistent with findings in patients. Carbon ion irradiation revealed homogenous coverage of the virtual tumor at the pancreas in static condition with a 1% deviation from the treatment plan. Instead, the dose delivery during motion with the maximum amplitude yielded an underdosage of 21% at the target and an increased uncertainty by two orders of magnitude. Significance. A dedicated phantom was designed and developed for breathing motion assessment of dose deposition during carbon ion radiotherapy. PPIeT is a unique tool for dose verification in the pancreas and its organs at risk during end-to-end tests.

High-Dose Ionizing Radiation Impairs Healthy Dendrite Growth in C. elegans

PurposeThe nervous system is vulnerable to radiation damage, and further optimization is required to increase the efficacy of radiotherapy while reducing harm to neurons. Given recent developments in heavy ion therapy, experimental models would be valuable to improve these therapies. Here, we utilized the nematode Caenorhabditis elegans (C. elegans) to evaluate the effects of high-dose radiation on neuron development. Methods and MaterialsIn this study, we used confocal microscopy to assess dendritic growth of the PVD nociceptor following high-dose gamma-irradiation from a Cs-137 source. ResultsIrradiation during an early larval stage (L2) delayed overall development but also independently impaired dendrite outgrowth in the PVD nociceptive neuron. Irradiation at L4 larval stage did not result in significant alterations in dendrite morphology. ConclusionsThe nematode C. elegans can serve as a high-throughput model to study the effects of high-dose radiation on dendrite growth. We propose that C. elegans can be useful for studies of experimental radiation therapy modalities and dose rates for translational research.

Simulation of Particle Interactions with Matter Using PHITS Monte Carlo Code: Physical Aspects of Bragg Curve for Carbon Ion Therapy

Simulation of Particle Interactions with Matter Using PHITS Monte Carlo Code: Physical Aspects of Bragg Curve for Carbon Ion Therapy

A Smart Bacteria-Capture-Killing Vector for Effectively Treating Osteomyelitis Through Synergy Under Microwave Therapy.

Osteomyelitis caused by deep tissue infections is difficult to cure through phototherapy due to the poor penetration depth of the light. Herein, Cu/C/Fe3O4-COOH nanorod composites (Cu/C/Fe3O4-COOH) with nanoscale tip convex structures are successfully fabricated as a microwave-responsive smart bacteria-capture-killing vector. Cu/C/Fe3O4-COOH exhibited excellent magnetic targeting and bacteria-capturing ability due to its magnetism and high selectivity affinity to the amino groups on the surface of Staphylococcus aureus (S. aureus). Under microwave irradiation, Cu/C/Fe3O4-COOH efficiently treated S. aureus-infected osteomyelitis through the synergistic effects of microwave thermal therapy, microwave dynamic therapy, and copper ion therapy. It is calculated the electric field intensity in various regions of Cu/C/Fe3O4-COOH under microwave irradiation, demonstrating that it obtained the highest electric field intensity on the surface of copper nanoparticles of Cu/C/Fe3O4-COOH due to its high-curvature tips and metallic properties. This led to copper nanoparticles attracted more charged particles compared with other areas in Cu/C/Fe3O4-COOH. These charges are easier to escape from the high curvature surface of Cu/C/Fe3O4-COOH, and captured by adsorbed oxygen, resulting in the generation of reactive oxygen species. The Cu/C/Fe3O4-COOH designed in this study is expected to provide insight into the treatment of deep tissue infections under the irradiation of microwave.

Enhancing Tissue Equivalence in 7Li Heavy Ion Therapy with MC Algorithm Optimized Polymer-Based Bioinks.

The unique physical properties of heavy ion beams, particularly their distinctive depth-dose distribution and sharp lateral dose reduction profiles, have led to their widespread adoption in tumor therapy worldwide. However, the physical properties of heavy ion beams must be investigated to deliver a sufficient dose to tumors without damaging organs at risk. These studies should be performed on phantoms made of biomaterials that closely mimic human tissue. Polymers can serve as soft tissue substitutes and are suitable materials for building radiological phantoms due to their physical, mechanical, biological, and chemical properties. Extensive research, development, and applications of polymeric biomaterials have been encouraged due to these properties. In this study, we investigated the ionization, recoils, phonon release, collision events, and lateral straggle properties of polymeric biomaterials that closely resemble soft tissue using lithium-ion beams and Monte Carlo Transport of Ions in Matter simulation. The results indicated that the Bragg peak position closest to soft tissue was achieved with a 7.3% difference in polymethylmethacrylate, with an average recoils value of 10.5%. Additionally, average values of 33% were observed in collision events and 22.6% in lateral straggle. A significant contribution of this study to the existing literature lies in the exploration of secondary interactions alongside the assessment of linear energy transfer induced by the 7Li beam used for treatment. Furthermore, we analyzed the tissue-equivalent properties of polymer biomaterials using heavy ion beams, taking into account phonon release resulting from ionization, recoils, lateral straggle, and all other interactions. This approach allows for the evaluation of the most suitable polymeric biomaterials for heavy ion therapy while considering the full range of interactions involved.

A new Chinese standard for testing of quality control in medical proton/heavy ion beam radiotherapy equipment

With the development of social economy and radiotherapy technique, proton/heavy ion radiotherapy has been applied widely to clinical practices. At present, there are at least 29 hospitals in China at various stages of planning, construction, commissioning or clinical operation of medical proton/heavy ion beam radiotherapy equipment. Compared with common radiotherapy accelerators used in conventional external beam radiotherapy, the proton/heavy ion therapy system has more stringent requirements for quality control so as to achieve an optimum therapeutic effect. In order to protect the health rights of patients undergoing radiotherapy, to facilitate the relevant administrative supervision departments to carry out standard-based approval and routine supervision and to promote the development of related medical undertakings, the standard for testing of quality control for medical proton/heavy ion beam radiotherapy equipment is drafted to fill the gap in this regard in China and even worldwide. The standard contains five indicators and corresponding testing methods for radiological protection and safety and 16 indicators for quality control of equipment performance. The standard is a mandatory standard and is based on the relevant Chinese legal requirements for the testing of radiotherapy equipment, so all the indicators listed in the standard shall be tested. During the drafting of the standard, the opinions from hospitals that are currently using proton/heavy ion medical accelerators for radiotherapy purpose and from the related equipment manufacturers were taken into account. The draft standard was revised with reference to these opinions and the feasibility of the related quality control requirements. The official version of the standard was released on March 7, 2023, and implementation is scheduled to begin on March 1, 2024.

Neutron radiation induced effects in 4H-SiC PiN diodes

Silicon carbide (SiC) is a wide band gap semiconductor and an attractive candidate for applications in harsh environments such as space, fusion, or future high luminosity colliders. Due to the large band gap, the leakage currents in SiC devices are extremely small, even after irradiation to very high fluences, enabling operation without cooling and at high temperatures. This study investigates the effect of neutron irradiation on 50 μm p-n 4H-SiC diodes using current-voltage, capacitance-voltage, and charge collection efficiency (CCE) measurements up to neutron fluences of 1 × 1016 n eq/cm2. The leakage currents of the investigated devices remained extremely small, below 10 pA at 1.1 kV reverse bias. In the forward bias, a remarkable drop of the current was observed, which was attributed to an increased epi resistivity due to compensation of the epi layer doping by deep-level defects. The CCE was evaluated for alpha particles from a radioactive source, a 62.4 MeV proton beam at the MedAustron ion therapy center and using UV-TCT. The charge collection efficiency in reverse bias was shown to scale directly with the 1 MeV equivalent fluence Φeq as CCE∝Φeq -0.63±0.01. A CCE better than 50% was able to be obtained for fluences up to 1 × 1015 n eq/cm2. Because of the low currents in the forward direction, particle detection was also possible in forward bias, where the CCE was found to be increased relative to reverse bias. Furthermore, a significant dependency on the amount of injected charge was observed, with the CCE surpassing 100% in alpha and UV-TCT measurements, requiring further systematic investigation.

A TOPAS model for lens-based proton radiography

Objective. Proton Radiography can be used in conjunction with proton therapy for patient positioning, real-time estimates of stopping power, and adaptive therapy in regions with motion. The modeling capability shown here can be used to evaluate lens-based radiography as an instantaneous proton-based radiographic technique. The utilization of user-friendly Monte Carlo program TOPAS enables collaborators and other users to easily conduct medical- and therapy- based simulations of the Los Alamos Neutron Science Center (LANSCE). The resulting transport model is an open-source Monte Carlo package for simulations of proton and heavy ion therapy treatments and concurrent particle imaging. Approach. The four-quadrupole, magnetic lens system of the 800-MeV proton beamline at LANSCE is modeled in TOPAS. Several imaging and contrast objects were modelled to assess transmission at energies from 230–930 MeV and different levels of particle collimation. At different proton energies, the strength of the magnetic field was scaled according to βγ, the inverse product of particle relativistic velocity and particle momentum. Main results. Materials with high atomic number, Z, (gold, gallium, bone-equivalent) generated more contrast than materials with low-Z (water, lung-equivalent, adipose-equivalent). A 5-mrad collimator was beneficial for tissue-to-contrast agent contrast, while a 10-mrad collimator was best to distinguish between different high-Z materials. Assessment with a step-wedge phantom showed water-equivalent path length did not scale directly according to predicted values but could be mapped more accurately with calibration. Poor image quality was observed at low energies (230 MeV), but improved as proton energy increased, with sub-mm resolution at 630 MeV. Significance. Proton radiography becomes viable for shallow bone structures at 330 MeV, and for deeper structures at 630 MeV. Visibility improves with use of high-Z contrast agents. This modality may be particularly viable at carbon therapy centers with accelerators capable of delivering high energy protons and could be performed with carbon therapy.

Carbon ion radiography with a composite ionization chamber detector

Range uncertainty in carbon ion therapy can diminish treatment efficacy because it may cause deviation from the planned dose distribution. The precise and accurate determination of relative stopping power (RSP) maps of carbon ions in the patient is a direct solution to this problem. To obtain RSP maps in patients undergoing carbon ion radiography, our team developed a preliminary prototype of a composite ionization chamber detection (CICD) system. The CICD prototype employs synchronously gated integral electronics with the ability to measure the depth-to-dose curve and the beam profile simultaneously. Carbon ion radiography experiments were performed on hemispherical, sloped, and stepped phantoms using the Heavy Ion Medical Machine (HIMM) beam. The beam energy was 190.19 MeV/μ and the beam spot full width at half maximum (FWHM) was 7.42 mm. The radiographic image of the sloped phantom, the thickness prediction accuracy of each pixel (2 mm) is 88.25%, its absolute mean error (AME) is 1.07 mm, and the maximum absolute deviation (MAD) is 2.64 mm. The prediction accuracy of the CICD prototype is mainly affected by electronic noise, with a noise-to-signal ratio (NSR) of about 14.36 dB. Carbon ion radiography simulations were performed in this study using Geant4 software to eliminate the effect of the electronic noise. The thickness prediction accuracy is 98.54%, 98.62%, and 99.07% per pixel for hemispherical, sloped and stepped phantoms, respectively, with AME of 0.09 mm, 0.27 mm, and 0.48 mm. Carbon ion radiography utilizing the CICD prototype scheme has the ability to refine the accuracy and resolution of radiographic images, consequently establishing a scientific foundation for diminishing the effects of range uncertainty and fully exploiting the advantages of precision particle therapy.

The Role of Carbon Ion Therapy in the Changing Oncology Landscape-A Narrative Review of the Literature and the Decade of Carbon Ion Experience at the Italian National Center for Oncological Hadrontherapy.

Currently, 13 Asian and European facilities deliver carbon ion radiotherapy (CIRT) for preclinical and clinical activity, and, to date, 55 clinical studies including CIRT for adult and paediatric solid neoplasms have been registered. The National Center for Oncological Hadrontherapy (CNAO) is the only Italian facility able to accelerate both protons and carbon ions for oncological treatment and research. To summarise and critically evaluate state-of-the-art knowledge on the application of carbon ion radiotherapy in oncological settings, the authors conducted a literature search till December 2022 in the following electronic databases: PubMed, Web of Science, MEDLINE, Google Scholar, and Cochrane. The results of 68 studies are reported using a narrative approach, highlighting CNAO's clinical activity over the last 10 years of CIRT. The ballistic and radiobiological hallmarks of CIRT make it an effective option in several rare, radioresistant, and difficult-to-treat tumours. CNAO has made a significant contribution to the advancement of knowledge on CIRT delivery in selected tumour types. After an initial ramp-up period, CNAO has progressively honed its clinical, technical, and dosimetric skills. Growing engagement with national and international networks and research groups for complex cancers has led to increasingly targeted patient selection for CIRT and lowered barriers to facility access.

Trajectories of fear of progression in nasopharyngeal carcinoma patients receiving proton and heavy ion therapy.

The study examined the growth trajectory of fear of progression(FOP) in nasopharyngeal carcinoma (NPC) patients. In addition, sociodemographic and clinical variables of each trajectory class were analyzed. Two hundred sixteen NPC patients undergoing proton and heavy ion therapy were measured beginning (T0) and end of a 4-week proton and heavy ion therapy (T1), 3months (T2) and 6months (T3) after discharge. And data from the final 197 NPC patients were analyzed. NPC patients' FOP was investigated by the Fear of Progression Questionnaire-Short Form (FOP-Q-SF) form T0 to T3. SPSS and Mplus were used for statistical analysis. The LGMM was used to analyze the trajectory of FOP followed up over 6months after proton and heavy ion therapy. The logistic regression was utilized to compare the differences in sociodemographic and clinical characteristics of patients in different trajectory groups of FOP. One hundred ninety-seven NPC patients were analyzed. LGMM analysis showed that three-group trajectory solution was the best fitting (low-fear decline FOP (14.21%), the moderate-fear stable FOP(43.15%), and high-fear rising FOP (42.64%). Significant positive associations were found between age < 30years (β = 3.399, p = 0.023), with or without children (β = 3.1, p = 0.002), primary/recurrence (β = -6.196, p < 0.001), diagnosis < 3months (β = 4.435, p = 0.031), high school education (β = 2.98, p = 0.048), and high fear rising FOP. Patients who had moderate financial stress (β = 2.51, p = 0.041), with or without children (β = 1.564, p = 0.003), primary/recurrence (β = -2.578, p = 0.005), less than 30 radiotherapy times (β = 0.979, p = 0.046) tended to report significant moderate-fear stable FOP over time. 42.64% of the NPC patients showed high-fear rising FOP over the 6months after treatment. Age 18-30years, with or without children, relapsed, diagnosis < 3months, and high school education and reporting being a pessimist predicts higher FOP scores. Early identification of age 18-30years, with or without children, relapsed, diagnosis < 3months, and high school education might help to identify populations experiencing long-term FOP. Clinical teams responsible to develop the target interventions for management of FCR in clinical practice.