Number Of Energy Layers Research Articles

First direct machine-specific parameters incorporated in Spot-scanning Proton Arc (SPArc) optimization algorithm.

Spot-scanning Proton Arc (SPArc) has been of significant interest in recent years because of its superior plan quality. Currently, the primary focus of research and development is on deliverability and treatment efficiency. To address the challenges in generating a deliverable and efficient SPArc plan for a proton therapy system with a massive gantry, we developed a novel SPArc optimization algorithm (SPArcDMPO) by directly incorporating the machine-specific parameters such as gantry mechanical constraints and proton delivery sequence. SPArc delivery sequence model (DSMarc) was built based on the machine-specific parameters of the prototype arc delivery system, IBA ProteusONE®, including mechanical constraint (maximum gantry speed, acceleration, and deceleration) and proton delivery sequence (energy and spot delivery sequence, and irradiation time). SPArcDMPO resamples and adjusts each control point's delivery speed based on the DSMarc calculation through the iterative approach. In SPArcDMPO, users could set a reasonable arc delivery time during the plan optimization, which aims to minimize the gantry momentum changes and improve the delivery efficiency. Ten cases were selected to test SPArcDMPO. Two kinds of SPArc plans were generated using the same planning objective functions: (1) original SPArc plan (SPArcoriginal); (2) SPArcDMPO plan with a user-pre-defined delivery time. Additionally, arc delivery sequence was simulated based on the DSMarc and was compared. Treatment delivery time was compared between SPArcoriginal and SPArcDMPO. Dynamic arc delivery time, the static irradiation time, and its corresponding time differential (time differential=dynamic arc delivery time-static irradiation time) were analyzed, respectively. The total gantry velocity change was accumulated throughout the treatment delivery. With a similar plan quality, objective value, number of energy layers, and spots, both SPArcoriginal and SPArcDMPO plans could be delivered continuously within the±1 degree tolerance window. However, compared to the SPArcoriginal, the strategy of SPArcDMPO is able to reduce the time differential from 30.55±11.42%(90±32 s) to 14.67±6.97%(42±20 s), p<0.01. Furthermore, the corresponding total variations of gantry velocity during dynamic arc delivery are mitigated (SPArcoriginal vs. SPArcDMPO) from 14.73±9.14 degree/s to 4.28±2.42 degree/s, p<0.01. Consequently, the SPArcDMPO plans could minimize the gantry momentum change based on the clinical user's input compared to the SPArcoriginal plans, which could help relieve the mechanical challenge of accelerating or decelerating the massive proton gantry. For the first time, clinical users not only could generate a SPArc plan meeting the mechanical constraint of their proton system but also directly control the arc treatment speed and momentum changes of the gantry during the plan optimization process. This work paved the way for the routine clinical implementation of proton arc therapy in the treatment planning system.

Improving delivery efficiency using spots and energy layers reduction algorithms based on a large momentum acceptance beamline.

Intensity-modulated proton therapy (IMPT) is a well-known delivery method of proton therapy. Besides higher plan quality, reducing the delivery time is also essential to IMPT plans. It can enhance patient comfort, reduce treatment costs, and improve delivery efficiency. From the perspective of treatment efficacy, it contributes to mitigating the intra-fractional motions and improving the accuracy of radiotherapy, especially for moving tumors. However, there is a tradeoff problem between the plan quality and delivery time. We consider the potential of a large momentum acceptance (LMA) beamline and apply the spots and energy layers reduction method to reduce the delivery time. The delivery time for each field consists of the energy layer switching time, spot traveling time, and dose delivery time. The larger momentum spread and higher intensity beam offered by the LMA beamline contribute to reducing the total delivery time compared to the conventional beamline. In addition to the dose fidelity term, an L1 and logarithm items were added to the objective function to increase the sparsity of the low-weighted spots and energy layers. After that, the low-weighted spots and layers were iteratively excluded in the reduced plan, which reduced the energy layer switching time and spot traveling time. We used the standard, reduced, and LMA-reduced plans to validate the proposed method and tested it on prostate and nasopharyngeal cases. Then, we compared and evaluated the plan quality, treatment time, and plan robustness against delivery uncertainty. Compared with the standard plans, the number of spots in the LMA-reduced plans was on average reduced by 13 400 (95.6%) for prostate cases and by 48 300 (80.7%) for nasopharyngeal cases and the number of energy layers was on average reduced by 49 (61.3%) for prostate cases and by 97 (50.5%) for nasopharyngeal cases. And, the delivery time of the LMA-reduced plans was shortened from 34.5 to 8.6 s for prostate cases and from 163.8 to 53.6 s for nasopharyngeal cases. The LMA-reduced plans had comparable robustness to the spot monitor unit (MU) error compared with the standard plans, but the LMA-reduced plans became more sensitive to spot position uncertainty. The delivery efficiency can be significantly improved using the LMA beamline and spots and energy layers reduction strategies. The method is promising to improve the efficiency of motion mitigation strategies for treating moving tumors.

Spot scanning proton arc therapy reduces toxicity in oropharyngeal cancer patients.

Proton arc technology has recently shown dosimetric gains for various treatment indications. The increased number of beams and energy layers (ELs) in proton arc plans, increases the degrees of freedom in plan optimization and thereby flexibility to spare dose in organs at risk (OARs). A relationship exists between dosimetric plan quality, delivery efficiency, the number of ELs -and beams in a proton arcplan. This work aims to investigate the effect of the number of beams and ELs in a proton arc plan, on toxicity and delivery time for oropharyngeal cancer patients (OPC) selected for intensity modulated proton therapy (IMPT) based on the Dutch model-basedapproach. The EL reduction algorithm iteratively selects ELs from beams equidistantly spaced over a 360° arc. The beams in the final plan may contain multiple ELs, making them suited for static delivery on the studied treatment machine. The produced plans can therefore be called "step and shoot" proton arc plans. The number of beams and ELs were varied to determine the relationship with the planning cost function value, normal tissue complication probability (NTCP) and delivery time. Proton arc plans with robust target coverage and optimal energy layer reduction (ELR) settings to reduce NTCP, were generated for 10 OPC patients. Proton arc plans were compared to clinical volumetric modulated arc therapy (VMAT) and IMPT plans in terms of integral dose, OAR dose, NTCP for xerostomia and dysphagia and delivery time. Furthermore, dose-weighted average linear energy transfer (LETd ) distributions were compared between the IMPT and proton arc plans. A dry run delivery of a plan containing 20 beams and 360 ELs was performed to evaluate delivery time andaccuracy. We found 360 ELs distributed over 30 beams generated proton arc plans with near minimal expected plan toxicity. Relative to corresponding IMPT and VMAT plans, an average reduction of 21 ± 3% and 58 ± 10% in integral dose was observed. D was reduced most in the pharyngeal constrictor muscle (PCM) medius structure, with on average 9.0 ± 4.2 Gy(RBE) (p = 0.0002) compared to the clinical IMPT plans. The average NTCP for grade≥2 and grade≥3 xerostomia at 6 months after treatment significantly decreased with 4.7 ± 1.8% (p = 0.002) and 1.7 ± 0.8% (p = 0.002), respectively, while the average NTCP for grade≥2 and grade≥3 dysphagia decreased with 4.4 ± 2.9% (p = 0.002) and 0.9 ± 0.4% (p = 0.002), respectively, increasing the benefit of protons relative to VMAT. For a "step and shoot" proton arc delivery with auto beam sequencing the estimated delivery time is 11 min, similar to the delivery time of a 6-field IMPT treatment. Gamma analysis between the planned and delivered dose distribution resulted in a 99.99% pass rate using 1mm/1% dose difference/distance to agreement criteria. "Step and shoot" proton arc demonstrates potential to further reduce toxicity compared to IMPT and VMAT in OPC treatment. By employing 360 ELs and 30 beams in the proposed ELR method, delivery time can reach clinically acceptable levels without compromising plan toxicity when automatic beam sequencing isavailable.

Evaluation of Patient-Specific Quality Assurance for Carbon Ion Radiotherapy Using Full Energy Scanning Method at QST Hospital

Purpose: Patient-specific QA (PSQA) measurements for carbon ion radiotherapy (CIRT) are critical components of processes designed to identify discrepancies between calculated and delivered doses. We report the results of PSQA conducted at the QST Hospital during the period from September 2017 to March 2018. Methods: We analyzed PSQA results for 1448 fields for 10 disease sites with various target volumes, target depths and number of energy layers. For the PSQA, all the planned beams were recalculated on a water phantom with treatment planning software. The recalculated dose distributions were compared with the measured distributions using a 2D ionization chamber array at three depths, including 95% of the area of the prescription dose. These recalculated dose distributions were evaluated using the 3%/3mm gamma index with a passing threshold of 90%. Results: The passing rates for prostate, head and neck, and bone and soft tissue were 96.8%, 99.3%, and 91.7%, respectively. Additionally, 94.7% of lung plans with low energy beams passed. Overall, the CIRT in the QST Hospital reached a high passing rate of more than 95%. Although the remaining 5% failed to pass, there was no dependence between measurement depth and disease sites in these failures. Conclusion: Using PSQA measurements, we confirmed consistency between the planned and delivered doses for CIRT using the full energy scanning method.

A Direct Machine-Specific Parameters Incorporated Spot-Scanning Proton Arc (SPArc) Algorithm

To address the challenges of generating a deliverable and efficient spot-scanning proton arc (SPArc) plan for a proton therapy system. We developed a novel SPArc optimization algorithm (SPArcDMSP) by directly incorporating the machine-specific parameters such as mechanical constraints and delivery sequence.A SPArc delivery sequence model (DSMarc) was built based on the machine-specific parameters of the prototype arc delivery system. The SPArcDMSP resamples and adjusts each control point's delivery speed based on the DSMarc calculation through the iterative approach. Users could set the expected arc delivery time and gantry max acceleration as a mechanical constraint during the SPArcDMSP optimization. Four cases (brain, liver, head neck, liver, and lung cancer) were selected to test SPArcDMSP. Two kinds of SPArc plans were generated using the same planning objective functions: (1) SPArcDMSP plan meeting the maximum allowable gantry acceleration speed (0.6deg/s2); (2) SPArcDMSP-user-speed plan with a user pre-defined delivery time and acceleration speed < 0.1 deg/s2. Arc delivery sequence such as gantry speed, delivery time was simulated based on the DSMarc and was compared.With a similar objective value, number of energy layers and spots, both SPArcDMSP and SPArcDMSP-user-speed plans could be delivered continuously within the ± 1 degree tolerance window (Table 1). The SPArcDMSP-user-speed plan could minimize the gantry momentum change based on clinical users input compared to the SPArcDMSP, which could help relieve mechanical challenge to accelerate or decelerate the hundreds of tons of gantry.For the first time, clinical users not only could generate a SPArc plan meeting the mechanical constraint of their proton system but also directly controlled the arc treatment speed and momentum changes of the gantry during the plan optimization. This work paved the roadmap for the clinical implementation of proton arc therapy in the treatment planning system.

Energy layer optimization strategies for intensity-modulated proton therapy of lung cancer patients.

When treating lung cancer patients with intensity-modulated proton therapy (IMPT), target coverage can only be guaranteed when utilizing motion mitigation. The three motion mitigation techniques, gating, breath-hold, and dose repainting, all benefit from a more rapid application of the treatment plan. A lower limit for the ungated treatment time is defined by the number of energy layers in the IMPT plan. By limiting this number during treatment planning, IMPT could become more viable for lung cancer patients. We investigate to what extend the number of layers can be reduced in single-field optimization (SFO) and multifield optimization (MFO) plans and which implications it has on the plan quality and robustness. We have implemented three distinct layer-reducing strategies in the treatment planning system Hyperion; constant energy steps, exponential energy steps, and an adaptive strategy, where the spot weights are exposed to a group sparsity penalty in combination with layer exclusion during optimization. Four levels of increasing layer removal are planned for each strategy. SFO and MFO plans with three treatment fields are created for eleven locally advanced NSCLC patients on the midventilation 4DCT phase to simulate a breath-hold. A minimum dose to the target is ensured for each degree of layer reduction, reflecting the plan quality in the homogeneity index (HI). Plan quality was also assessed by a robustness evaluation, where the patient setup was shifted 2 mm or 4 mm in six directions. The three strategies result in very similar target coverages and robustness levels as a function of removed layers. The HI increases unacceptably for all the SFO plans after 50% layer removal as compared to the reference plan, while all the MFO plans are clinically acceptable with up to a highest removed percentage of 75%. The robustness level is constant as a function of removed layers. The SFO plans are significantly more robust than the MFO plans with all P-values below 0.001 (Wilcoxon signed-rank). The overall mean D98% CTV dose difference is at 2-mm setup error amplitude: 0.7 Gy (SFO) and 1.9 Gy (MFO), and at 4 mm: 3.2 Gy (SFO) and 5.4 Gy (MFO), respectively. The number of layers in MFO plans can be reduced substantially more than in SFO plans without compromising plan quality. Furthermore, as the robustness is independent of the number of layers, it follows that if the level of robustness is acceptable or enforced via robust optimization, MFO plans could be candidates for treatment time reductions via energy layer reductions.

SU‐E‐T‐110: An Investigation On Monitor Unit Threshold and Effects On IMPT Delivery in Proton Pencil Beam Planning System

Purpose:An approved proton pencil beam scanning (PBS) treatment plan might not be able to deliver because of existed extremely low monitor unit per beam spot. A dual hybrid plan with higher efficiency of higher spot monitor unit and the efficacy of less number of energy layers were searched and optimized. The range of monitor unit threshold setting was investigated and the plan quality was evaluated by target dose conformity.Methods:Certain limitations and requirements need to be checks and tested before a nominal proton PBS treatment plan can be delivered. The plan needs to be met the machine characterization, specification in record and verification to deliver the beams. Minimal threshold of monitor unit, e.g. 0.02, per spot was set to filter the low counts and plan was re‐computed. Further MU threshold increment was tested in sequence without sacrificing the plan quality. The number of energy layer was also alternated due to elimination of low count layer(s).Results:Minimal MU/spot threshold, spot spacing in each energy layer and total number of energy layer and the MU weighting of beam spots of each beam were evaluated. Plan optimization between increases of the spot MU (efficiency) and less energy layers of delivery (efficacy) was adjusted. 5% weighting limit of total monitor unit per beam was feasible. Scarce spreading of beam spots was not discouraging as long as target dose conformity within 3% criteria.Conclusion:Each spot size is equivalent to the relative dose in the beam delivery system. The energy layer is associated with the depth of the targeting tumor. Our work is crucial to maintain the best possible quality plan. To keep integrity of all intrinsic elements such as spot size, spot number, layer number and the carried weighting of spots in each layer is important in this study.

SU-D-304-01: Development of An Applicator for Treating Shallow and Moving Tumors with Respiratory-Gated Spot-Scanning Proton Therapy Using Real-Time Image Guidance

Purpose: To develop a method for treating shallow and moving tumors (e.g., lung tumors) with respiratory-gated spot-scanning proton therapy using real-time image guidance (RTPT). Methods: An applicator was developed which can be installed by hand on the treatment nozzle. The mechanical design was considered such that the Bragg peaks are placed at the patient surface while a sufficient field of view (FOV) of fluoroscopic X-rays was maintained during the proton beam delivery. To reduce the treatment time maintaining the robustness of the dose distribution with respect to motion, a mini-ridge filter (MRF) was sandwiched between two energy absorbers. The measurements were performed to obtain a data for beam modeling and to verify the spot position-invariance of a pencil beam dose distribution. For three lung cancer patients, treatment plans were made with and without the MRF and the effects of the MRF were evaluated. Next, the effect of respiratory motion on the dose distribution was investigated. Results: To scan the proton beam over a 14 × 14 cm area while maintaining the φ16 cm of fluoroscopic FOV, the lower face of the applicator was set 22 cm upstream of the isocenter. With an additional range variance of 2.2 mm and peak-to-peak distance of 4 mm of the MRF, the pencil beam dose distribution was unchanged with the displacement of the spot position. The quality of the treatment plans was not worsened by the MRF. With the MRF, the number of energy layers was reduced to less than half and the treatment time by 26–37%. The simulation study showed that the interplay effect was successfully suppressed by respiratory-gating both with and without MRF. Conclusions: The spot-scanning proton beam was successfully delivered to shallow and moving tumors within a sufficiently short time by installing the developed applicator at the RTPT nozzle.