Range Shifter Research Articles

The practical radius of a pencil beam in proton therapy

The central Gaussian shaped high dose region of a pencil beam (PB) in light ion beam therapy (LIBT) is enveloped by a low dose region causing non-negligible field size effects and impairs the dose calculation accuracy considerably if the low dose envelope is not well modeled. The purpose of this study was to calculate the practical radius, Rc, at which a PB does not influence a field more than a certain accuracy level.Lateral dose profiles of proton beams in water were simulated using GATE/Geant4. Those lateral dose profiles were integrated numerically and used to calculate field size factors (FSFs). The Rc was then determined such, that the lateral dose at radii exceeding Rc can be neglected without compromising the FSF of a 20cm×20cm field more than a desired accuracy level c. The practical radius Rc yielding c=0.5% was compared to the frequently applied concept of full width at a ratio x of the maximum (FWxM). The sensitivity to variations of the beam width was tested by increasing the initial beam width σC of the clinical beam model by 0.5 and 1mm, respectively.Neglecting the dose at radii exceeding Rc resulted in the desired FSF accuracy, whereas using the FW0.01%M cut resulted in varying accuracy. In order to yield a constant FSF accuracy, the ratio x in FWxM ranged from 0.003% to 0.065% of the maximum. In contrast to Rc, FWxM was sensitive to variations of the initial beam width. The maximum Rc over all depths was less than 7cm for the low(62.4MeV) and medium(148.2MeV) proton energy beam, which suggests that a plane parallel ionization chamber exceeding that radius is sufficient to acquire laterally integrated depth dose distributions for those energies. However, this holds not true for the highest energy (252.7MeV) or when including a range shifter (RaShi). The values of Rc are specific to our beam line configuration as the maximum Rc was depending on both, the scattering material in the Nozzle as well as the distance of the air-gap between Nozzle and phantom.

Commissioning and beam characterization of the first gantry-mounted accelerator pencil beam scanning proton system.

To present and discuss beam characteristics and commissioning process of the first gantry-mounted accelerator single room pencil beam scanning (PBS) proton system. The Mevion HYPERSCAN employs a design configuration with a synchrocyclotron mounted on the gantry to eliminate the traditional beamline and a nozzle that contains the dosimetry monitoring chambers, the energy modulator (Energy Selector (ES)), and an Adaptive Aperture (AA). To characterize the beam, we measured the integrated depth dose (IDDs) for 12 energies, from highest energy of 227MeV down to 28MeV with a range difference~2cm between the adjacent energies, using a large radius Bragg peak chamber; single-spot profiles in air at five locations along the beam central axis using radiochromic EBT3 film and cross compared with a scintillation detector; and determined the output using a densely packed spot map. To access the performance of AA, we measured interleaf leakage and the penumbra reduction effect. Monte Carlo simulation using TOPAS was performed to study spot size variation along the beam path, beam divergence, and energy spectrum. This proton system is calibrated to deliver 1Gy dose at 5cm depth in water using the highest beam energy by delivering 1 MU/spot to a 10×10 cm2 map with a 2.5mm spot spacing. The spot size in air varies from 4mm to 26mm from 227MeV to 28MeV at the isocenter planewith the nozzle retracted 23.6 cm from isocenter. The beam divergence of 28MeV beam is~52.7 mrad, which is nearly 22 times that of 227MeV proton beam. The binary design of the ES has resulted in shifts of the effective SSD toward the isocenter as the energy is modulated lower. The peaks of IDD curves have a constant 80%-80% width of 8.4mm at all energies. The interleaf leakage of the AA is less than 1.5% at the highest energy; and the AA can reduce the penumbra by 2mm to 13mm for the 227 and 28MeV energies at isocenter plane in air. The unique design of the HYPERSCAN proton system has yielded beam characteristics significantly different from that of other proton systems in terms of the Bragg peak shapes, spot sizes, and the penumbra sharpening effect of the AA. The combination of the ES and AA has made PBS implementation possible without using beam transport line and range shifter devices. Different considerations may be required in treatment planning optimization to account for different design and beam characteristics.

Design and Optimization Based on Monte Carlo Method of a Range Shifter for Proton Therapy

A proton therapy facility based on an isochronous superconducting cyclotron is under constructed at the Proton Therapy Facility of the Huazhong University of Science and Technology. Due to the limitation of minimum energy extracted by the energy selection system in the upstream beamline, a range shifter is installed at the end of the nozzle to further decrease the proton beam energy so that the shallow-seated tumors can be treated. In this paper, the physical structure, energy degradation scheme, and material optimization selection of the range shifter are discussed and analyzed by Monte Carlo simulation software Geant4 and FLUKA. At the same time, the treatment outcome on the energy degradation process and its influence on the synthesis of spread-out Bragg peak (SOBP) in the treatment plan system after the application of the range shifter are analyzed. The results show that by using a high-density polyethylene energy-degrading plate with a thickness of 42.35 mm, combined with two 30-mm copper collimators, the range shifter can achieve a good energy-degradation effect while significantly reducing the beam horizontal penumbra at the edge of the radiation field. At the same time, the addition of the range shifter can reduce the number of the energy level required to form the SOBP and shorten the treatment time, but it will inevitably lead to a slight increase in the longitudinal penumbra.

Adjusting the lens of invasion biology to focus on the impacts of climate-driven range shifts

As Earth’s climate rapidly changes, species range shifts are considered key to species persistence. However, some range-shifting species will alter community structure and ecosystem processes. By adapting existing invasion risk assessment frameworks, we can identify characteristics shared with high-impact introductions and thus predict potential impacts. There are fundamental differences between introduced and range-shifting species, primarily shared evolutionary histories between range shifters and their new community. Nevertheless, impacts can occur via analogous mechanisms, such as wide dispersal, community disturbance and low biotic resistance. As ranges shift in response to climate change, we have an opportunity to develop plans to facilitate advantageous movements and limit those that are problematic. Climate change will cause species to shift their ranges to persist. This Review uses invasion ecology theory to consider the impacts of shifting species and how to manage these shifts to protect the recipient communities as well as the survival of the shifters.

Design of a focused collimator for proton therapy spot scanning using Monte Carlo methods.

When designing a collimation system for pencil beam spot scanning proton therapy, a decision must be made whether or not to rotate, or focus, the collimator to match beamlet deflection as a function of off-axis distance. If the collimator is not focused, the beamlet shape and fluence will vary as a function of off-axis distance due to partial transmission through the collimator. In this work, we quantify the magnitude of these effects and propose a focused dynamic collimation system (DCS) for use in proton therapy spot scanning. This study was done in silico using a model of the Miami Cancer Institute's (MCI) IBA Proteus Plus system created in Geant4-based TOPAS. The DCS utilizes rectangular nickel trimmers mounted on rotating sliders that move in synchrony with the pencil beam to provide focused collimation at the edge of the target. Using a simplified setup of the DCS, simulations were performed at various off-axis locations corresponding to beam deflection angles ranging from 0° to 2.5°. At each off-axis location, focused (trimmer rotated) and unfocused (trimmer not rotated) simulations were performed. In all simulations, a 4cm water equivalent thickness range shifter was placed upstream of the collimator, and a voxelized water phantom that scored dose was placed downstream, each with 4cm airgaps. Increasing the beam deflection angle for an unfocused trimmer caused the collimated edge of the beamlet profile to shift 0.08-0.61mm from the baseline 0° simulation. There was also an increase in low-dose regions on the collimated edge ranging from 14.6% to 192.4%. Lastly, the maximum dose, , was 0-5% higher for the unfocused simulations. With a focused trimmer design, the profile shift and dose increases were all eliminated. We have shown that focusing a collimator in spot scanning proton therapy reduces dose at the collimated edge compared to conventional, unfocused collimation devices and presented a simple, mechanical design for achieving focusing for a range of source-to-collimator distances.

Measurement-based study on characterizing symmetric and asymmetric respiratory motion interplay effect on target dose distribution in the proton pencil beam scanning.

Pencil beam scanning proton therapy makes possible intensity modulation, resulting in improved target dose conformity and organ‐at‐risk (OAR) dose sparing. This benefit, however, results in increased sensitivity to certain clinical and beam delivery parameters, such as respiratory motion. These effects can cause plan degeneration, which could lead to decreased tumor dose or increased OAR dose. This study evaluated the measurements of proton pencil beam scanning delivery made with a 2D ion chamber array in solid water on a 1D motion platform, where respiratory motion was simulated using sine and cosine4 waves representing sinusoidal symmetric and realistic asymmetric breathing motions, respectively. Motion amplitudes were 0.5 cm and 1 cm corresponding to 1 cm and 2 cm of maximum respiratory excursions, respectively, with 5 sec fixed breathing cycle. The treatment plans were created to mimic spherical targets of 3 cm or 10 cm diameter located at 5 cm or 1 cm depth in solid water phantom. A reference RBE dose of 200 cGy per fraction was delivered in 1, 5, 10, and 15 fractions for each dataset. We evaluated dose conformity and uniformity at the center plane of targets by using the Conformation Number and the Homogeneity Index, respectively. Results indicated that dose conformity as well as homogeneity was more affected by motion for smaller targets. Dose conformity was better achieved for symmetric breathing patterns than asymmetric breathing patterns regardless of the number of fractions. The presence of a range shifter with shallow targets reduced the motion effect by improving dose homogeneity. While motion effects are known to be averaged out over the course of multifractional treatments, this might not be true for proton pencil beam scanning under asymmetrical breathing pattern.

Commissioning of pencil beam and Monte Carlo dose engines for non-isocentric treatments in scanned proton beam therapy

This work describes the dosimetric commissioning of the treatment planning system (TPS) RayStation v6.1 from RaySearch Laboratories (Stockholm, Sweden) for a synchrotron-based scanned proton beam delivery with isocentric and non-isocentric setups at MedAustron. Focus was on the comparison of the pencil beam (PBv4.1) and Monte Carlo (MCv4.0) calculation algorithms.Commissioning of dose calculations was done first for 1D/2D dose delivery where the performance of the beam model in reproducing dosimetric properties for the delivery of single static pencil beams and mono-energetic layers with multiple spots was evaluated. The commissioning for 3D beam delivery employed test cases with increasing complexity: from box-shaped fields in homogeneous phantoms to the introduction of oblique incidences and inhomogeneities. Dose calculations were compared to the measured data for different air gaps and using beams with and without range shifter (RaShi).Depth-dose curves and spot shape comparisons showed good agreement of the results obtained with PBv4.1 and MCv4.0 algorithms at isocentric setup for open beam configurations (without RaShi). Comparison of transverse dose profiles for lateral heterogeneities at different depths showed better performance of the MCv4.0 algorithm in comparison to the PBv4.1 algorithm. In the case of 3D delivery comparisons of measured and TPS-calculated dose with MCv4.0 algorithm in box-shaped fields in water showed an average agreement within 2%. The results for dose calculations with the PBv4.1 algorithm showed larger deviations for beams with RaShi at all evaluated air gaps (from 64.8 cm to 14.8 cm).Our results suggest that the MCv4.0 algorithm shall be used in clinics for final dose calculation when beams with RaShi are used especially in the presence of large air gaps, inclined patient surface and lateral inhomogeneities. The detailed stepwise methodology implemented for the RayStation commissioning in this work could serve as further guidance for other facilities introducing a new TPS for proton beam therapy.

Stereotactical fields applied in proton spot scanning mode with range shifter and collimating aperture

Some clinical indications require small fields with sharp lateral dose gradients, which is technically challenging in proton beam therapy. This holds especially true for low-range fields applied with the spot scanning technique, where large beam profiles entering from the beam-line or the insertion of range shifting blocks lead to large lateral gradients. We regard the latter case and solve it by shifting the range shifting block far upstream in conjunction with a collimating aperture close to the patient. The experiments of the current work are based on a commercial proton therapy treatment head designed for several delivery modes. In a research environment of the spot-scanning delivery mode a range shifter is inserted downstream of the scanning magnets in a slot which is usually employed only in a scattering delivery mode. This configuration is motivated by equations assuming a simple model of proton transport. In the experiments lateral dose planes are acquired with a scintillation screen and radiochromic films. Dose distributions are calculated with the Monte Carlo dose engine of the RayStation treatment planning system. We demonstrate that proton fields with 80%–20% lateral dose fall-off values between 1.4 mm and 4.0 mm can be achieved for water equivalent depths between 0 cm and 10 cm. The simulated lateral dose profiles agree with the experimental dose profiles. The sharpening of the field edges is set off by a broadening of the proton spots towards the center of the fields. This limits the clinical application mainly to small fields for which the distal and proximal conformality is of minor importance.

Radiobiological and dosimetric impact of RayStation pencil beam and Monte Carlo algorithms on intensity-modulated proton therapy breast cancer plans.

PurposeRayStation treatment planning system employs pencil beam (PB) and Monte Carlo (MC) algorithms for proton dose calculations. The purpose of this study is to evaluate the radiobiological and dosimetric impact of RayStation PB and MC algorithms on the intensity‐modulated proton therapy (IMPT) breast plans.MethodsThe current study included ten breast cancer patients, and each patient was treated with 1–2 proton beams to the whole breast/chestwall (CW) and regional lymph nodes in 28 fractions for a total dose of 50.4 Gy relative biological effectiveness (RBE). A total clinical target volume (CTV_Total) was generated by combining individual CTVs: AxI, AxII, AxIII, CW, IMN, and SCVN. All beams in the study were treated with a range shifter (7.5 cm water equivalent thickness). For each patient, three sets of plans were generated: (a) PB optimization followed by PB dose calculation (PB‐PB), (b) PB optimization followed by MC dose calculation (PB‐MC), and (c) MC optimization followed by MC dose calculation (MC‐MC). For a given patient, each plan was robustly optimized on the CTVs with same parameters and objectives. Treatment plans were evaluated using dosimetric and radiobiological indices (equivalent uniform dose (EUD), tumor control probability (TCP), and normal tissue complication probability (NTCP)).ResultsThe results are averaged over ten breast cancer patients. In comparison to PB‐PB plans, PB‐MC plans showed a reduction in CTV target dose by 5.3% for D99% and 4.1% for D95%, as well as a reduction in TCP by 1.5–2.1%. Similarly, PB overestimated the EUD of target volumes by 1.8─3.2 Gy(RBE). In contrast, MC‐MC plans achieved similar dosimetric and radiobiological (EUD and TCP) results as the ones in PB‐PB plans. A selection of one dose calculation algorithm over another did not produce any noticeable differences in the NTCP of the heart, lung, and skin.ConclusionIf MC is more accurate than PB as reported in the literature, dosimetric and radiobiological results from the current study suggest that PB overestimates the target dose, EUD, and TCP for IMPT breast cancer treatment. The overestimation of dosimetric and radiobiological results of the target volume by PB needs to be further interpreted in terms of clinical outcome.

Evaluation of electromagnetic and nuclear scattering models in GATE/Geant4 for proton therapy.

PurposeThe dose core of a proton pencil beam (PB) is enveloped by a low dose area reaching several centimeters off the central axis and containing a considerable amount of the dose. Adequate modeling of the different components of the PB profile is, therefore, required for accurate dose calculation. In this study, we experimentally validated one electromagnetic and two nuclear scattering models in GATE/Geant4 for dose calculation of proton beams in the therapeutic energy window (62–252 MeV) with and without range shifter (RaShi).MethodsThe multiple Coulomb scattering (MCS) model was validated by lateral dose core profiles measured for five energies at up to four depths from beam plateau to Bragg peak region. Nuclear halo profiles of single PBs were evaluated for three (62.4, 148.2, and 252.7 MeV) and two (97.4 and 124.7 MeV) energies, without and with RaShi, respectively. The influence of the dose core and nuclear halo on field sizes varying from 2–20 cm was evaluated by means of output factors (OFs), namely frame factors (FFs) and field size factors (FSFs), to quantify the relative increase of dose when increasing the field size.ResultsThe relative increase in the dose core width in the simulations deviated negligibly from measurements for depths until 80% of the beam range, but was overestimated by up to 0.2 mm in σ toward the end of range for all energies. The dose halo region of the lateral dose profile agreed well with measurements in the open beam configuration, but was notably overestimated in the deepest measurement plane of the highest energy or when the beam passed through the RaShi. The root‐mean‐square deviations (RMSDs) between the simulated and the measured FSFs were less than 1% at all depths, but were higher in the second half of the beam range as compared to the first half or when traversing the RaShi. The deviations in one of the two tested hadron physics lists originated mostly in elastic scattering. The RMSDs could be reduced by approximately a factor of two by exchanging the default elastic scattering cross sections for protons.ConclusionsGATE/Geant4 agreed satisfyingly with most measured quantities. MCS was systematically overestimated toward the end of the beam range. Contributions from nuclear scattering were overestimated when the beam traversed the RaShi or at the depths close to the end of the beam range without RaShi. Both, field size effects and calculation uncertainties, increased when the beam traversed the RaShi. Measured field size effects were almost negligible for beams up to medium energy and were highest for the highest energy beam without RaShi, but vice versa when traversing the RaShi.

Impact of TPS calculation algorithms on dose delivered to the patient in proton therapy treatments

To estimate the impact of dose calculation approaches adopted in different treatment planning systems (TPSs) on proton therapy dose delivered with pencil beam scanning (PBS).Treatment plans for six regular volumes in water and 15 clinical cases were optimized with Syngo-VC13 and exported for forward recalculation with Raystation-V7.0 pencil beam (RS-PBA) and Monte Carlo (RS-MC) algorithms and with the independent Fluka-MC engine. To verify clinical consistency between the two TPS dosimetric outcomes, the average percentage variations of clinical target volume (CTV) D98%, D50% and D2%, adopted for plan prescription and evaluation, were considered. Ionization chamber measurements served as a further reference for comparison in homogeneous conditions. CTV dose volume histogram (DVH) analysis and gamma evaluation with 3 mm—3% agreement criteria quantified the dose deviation of TPS calculation algorithms, in heterogeneous conditions, against the Fluka-MC code.CTV D50%, representing the plan dose prescription goal, was higher on average over H&N cases of (3.9 ± 0.9)% and (2.3 ± 0.6)% as calculated with RS-PBA and RS-MC, respectively, compared to Syngo. For tumors located in the pelvis district, average D50% variations of (1.6 ± 0.7)% and (1.2 ± 0.7)% were found. Syngo underestimated target near maximum doses with respect to all computation systems. Calculation accuracy in heterogeneous conditions of RS-PBA H&N plans resulted poor when a range shifter was required. Target DVH and γ-analysis showed excellent agreement between RS-MC and Fluka-MC, with γ-pass rates >98% for all patient groups.Different TPS dose calculation approaches mainly affected dose delivered in H&N proton treatments, while minor deviations were found for pelvic tumors. RS-MC proved to be the most accurate TPS dose calculation algorithm when compared to an independent MC simulation code.

Parametric characterization of penumbra reduction for aperture-collimated pencil beam scanning (PBS) proton therapy

Recently, a commercial treatment planning system (TPS) has implemented aperture collimators for PBS dose calculations which can serve to reduce lateral penumbra. This study characterized the variation in magnitude of lateral penumbra for collimated and un-collimated PBS fields versus the parameters of air gap, depth, and range shifter thickness. Comparisons were performed in a homogenous geometry between measured data and calculations made by a commercial TPS. Beam-specific target volumes were generated for collimated and un-collimated PBS fields and optimized for various range shifter thicknesses and air gaps. Lateral penumbra (80%-20% distance) was measured across each target volume to characterize penumbra variation with depth and air gap. An analytic equation was introduced to predict the reduction in lateral penumbra between un-collimated and collimated PBS treatments. Calculated penumbra values increased with depth across all combinations of range shifters for a constant air gap. At 2 cm depth, the reductions in penumbra due to the aperture were 2.7 mm, 3.7 mm and 4.2 mm when using range shifter thicknesses of 0 cm, 4.0 cm and 7.5 cm, respectively. At a depth of approximately 20 cm and air gap of 5 cm, differences between penumbras of collimated and un-collimated beams were less than 1 mm. Penumbra reductions for the collimated beams were largest at small air gaps. All TPS-calculated penumbra values derived in this study were within 1 mm of film measurement values. Finally, the analytic equation was tested using a clinical CT scan, and we found good dosimetric agreement between the model predictions and the result calculated by the TPS. In conclusion, application of collimators to PBS fields can sharpen penumbra by several mm and are most beneficial for shallow targets. Furthermore, measurements indicate that the dose calculation accuracy in the penumbra region of PBS-collimated fields is adequate for clinical use.

Annihilation gamma imaging for carbon ion beam range monitoring using Si/CdTe Compton camera

In this study, we performed on-beam monitoring of 511 keV annihilation gamma emissions using a Compton camera. Beam monitoring experiments were conducted using carbon ion beams of 290 MeV/u irradiated on a polymethyl methacrylate (PMMA) phantom. The intensity of the beams was 3 × 109 particles per pulse, with 20 pulses per minute. A Compton camera based on a silicon/cadmium telluride (Si/CdTe) detector was used to monitor the annihilation gamma rays emitted from the phantom. We successfully reconstructed the energy events of 511 keV annihilation gamma rays and developed Compton images using a simple back-projection method. The distribution of the annihilation gamma ray generation traced the beam trajectory and the peak intensity position was a few millimeters shorter than the Bragg peak position. Moreover, the effect of the beam range shifter with 30, 60, and 90 mm water equivalent thickness (WET) was clearly visualized in the reconstructed Compton images. The experimentally measured values of the corresponding range shifts in the PMMA phantom (28.70 mm, 52.49 mm, and 76.77 mm, respectively) were consistent with the shifts of the Bragg peak position (25.50 mm, 51.30 mm and 76.70 mm, respectively) evaluated by Monte Carlo simulation. The results show that the Si/CdTe Compton camera has strong potential for on-beam monitoring of annihilation gamma rays in particle therapy in clinical situations.

Design and commissioning of the non-dedicated scanning proton beamline for ocular treatment at the synchrotron-based CNAO facility.

Only few centers worldwide treat intraocular tumors with proton therapy, all of them with a dedicated beamline, except in one case in the USA. The Italian National Center for Oncological Hadrontherapy (CNAO) is a synchrotron-based hadrontherapy facility equipped with fixed beamlines and pencil beam scanning modality. Recently, a general-purpose horizontal proton beamline was adapted to treat also ocular diseases. In this work, the conceptual design and main dosimetric properties of this new proton eyeline are presented. A 28 mm thick water-equivalent range shifter (RS) was placed along the proton beamline to shift the minimum beam penetration at shallower depths. FLUKA Monte Carlo (MC) simulations were performed to optimize the position of the RS and patient-specific collimator, in order to achieve sharp lateral dose gradients. Lateral dose profiles were then measured with radiochromic EBT3 films to evaluate the dose uniformity and lateral penumbra width at several depths. Different beam scanning patterns were tested. Discrete energy levels with 1 mm water-equivalent step within the whole ocular energy range (62.7-89.8 MeV) were used, while fine adjustment of beam range was achieved using thin polymethylmethacrylate additional sheets. Depth-dose distributions (DDDs) were measured with the Peakfinder system. Monoenergetic beam weights to achieve flat spread-out Bragg Peaks (SOBPs) were numerically determined. Absorbed dose to water under reference conditions was measured with an Advanced Markus chamber, following International Atomic Energy Agency (IAEA) Technical Report Series (TRS)-398 Code of Practice. Neutron dose at the contralateral eye was evaluated with passive bubble dosimeters. Monte Carlo simulations and experimental results confirmed that maximizing the air gap between RS and aperture reduces the lateral dose penumbra width of the collimated beam and increases the field transversal dose homogeneity. Therefore, RS and brass collimator were placed at about 98 cm (upstream of the beam monitors) and 7 cm from the isocenter, respectively. The lateral 80%-20% penumbra at middle-SOBP ranged between 1.4 and 1.7 mm depending on field size, while 90%-10% distal fall-off of the DDDs ranged between 1.0 and 1.5 mm, as a function of range. Such values are comparable to those reported for most existing eye-dedicated facilities. Measured SOBP doses were in very good agreement with MC simulations. Mean neutron dose at the contralateral eye was 68 μSv/Gy. Beam delivery time, for 60 Gy relative biological effectiveness (RBE) prescription dose in four fractions, was around 3 min per session. Our adapted scanning proton beamline satisfied the requirements for intraocular tumor treatment. The first ocular treatment was delivered in August 2016 and more than 100 patients successfully completed their treatment in these 2 yr.

Development of proton beam irradiation system for small animals using FFAG accelerator

To evaluate the biological effect of boron compounds on normal tissues in boron neutron capture therapy, it is necessary to compare the radiation effects of neutron irradiation and gamma ray irradiation on small animals in nonclinical studies. Neutron beams and gamma rays are difficult to collimate; thus, it is impossible to administer a dose on each part of the normal tissues of small animals. Therefore, we have developed a method to compare biological effects by irradiating neutrons and gamma rays after irradiating a proton beam to the point just before the threshold dose at which the biological effects occur. We aim to develop an irradiation field that irradiates proton beams locally using a fixed-field alternating-gradient (FFAG) accelerator and a small ridge filter.An aluminum scatterer, transmission dose monitor, ridge filter, range shifter, collimator, and a proton beam from the FFAG accelerator were used to form an irradiation field with a spread out Bragg peak (SOBP) with a length of 10 mm and a size of 10 mm2.Dose measurement was performed using a Gafchromic film and an ionization chamber. The irradiation system was simulated using the PHITS Monte Carlo simulation code, and simulation results were compared with experimental results.We succeeded in forming an irradiation field with a dose rate of 14.3 ± 0.24 Gy/min, an SOBP length of 10 mm, and a size of 10 mm2.

A pre-absorber optimization technique for pencil beam scanning proton therapy treatments

PurposeTo implement a new proton therapy planning method for the treatment of shallow lesions with PBS and to compare it to the standard method. Methods and materialsIn order to treat shallow lesions, a pre-absorber, usually called range-shifter (RS), is needed: it is used to degrade the beam energy and treat tumors shallower than the minimum range available. Its use is associated to dose calculation uncertainties and plan quality degradation which should be minimized. We studied five tumor localizations requiring RS and created three plans for each case: a) standard method with the RS close to the patient surface, b) with the RS used only for the shallow part of the tumor (when strictly needed) and completely retracted and c) as the b) approach but with the RS close to the patient. We called these two approaches ‘Range Shifter Optimization’ (RSO) techniques. We compared those plans in terms of dose distribution quality, delivery time and patient-specific-QA results. ResultsIn most cases a good dose reduction to OARs with no significant loss in terms of target coverage was obtained when the RSO techniques were used. Patient-specific-QA gave very good results in terms of γ-Passing-Rate (PR) (3%, 3 mm) for both RSO techniques (mean 98.09%), while the standard had some very low PR (minimum 81.09%). The delivery time increased (5.0 min on average per treatment) but was still acceptable in terms of patient compliance. ConclusionWe developed a new planning technique for shallow lesions and we demonstrated its superiority in terms of both plan quality and patient-specific-QA results with respect to the standard method. This technique is routinely used to treat patients in our center.

Online adaption approaches for intensity modulated proton therapy for head and neck patients based on cone beam CTs and Monte Carlo simulations

To develop an online plan adaptation algorithm for intensity modulated proton therapy (IMPT) based on fast Monte Carlo dose calculation and cone beam CT (CBCT) imaging.A cohort of ten head and neck cancer patients with an average of six CBCT scans were studied. To adapt the treatment plan to the new patient geometry, contours were propagated to the CBCTs with a vector field (VF) calculated with deformable image registration between the CT and the CBCTs. Within the adaptive planning algorithm, beamlets were shifted following the VF at their distal falloff and raytraced in the CBCT to adjust their energies, creating a geometrically adapted plan. Four geometric adaptation modes were studied: unconstrained geometric shifts (Free), isocenter shift (Iso), a range shifter (RS), or isocenter shift and range shifter (Iso-RS). After evaluation of the geometrical adaptation, the weights of a selected subset of beamlets were automatically tuned using MC-generated influence matrices to fulfill the original plan requirements. All beamlet calculations were done with a fast Monte Carlo running on a GPU (graphics processing unit).Geometrical adaptation alone only worked with small anatomy changes. The weight-tuned adaptation worked for every fraction, with the Free and Iso modes performing similarly and being superior than the two range shifters modes. The mean V95 and V107 were 99.4 ± 0.9 and 6.4% ± 4.7% in the Free mode with weight tuning. The calculation time per fraction was ~5 min, but further task parallelization could reduce it to ~1–2 min for delivery adaptation right after patient setup.An online adaptation algorithm was developed that significantly improved the treatment quality for inter-fractional geometry changes. Clinical implementation of the algorithm would allow delivery adaptation right before treatment and thus allow planning margin reductions for IMPT.

221. A pre-absorber optimization technique for pencil beam scanning (PBS) proton therapy treatments

Purpose To design and implement a new protontherapy planning method for the treatment of shallow lesions with PBS and to compare it to the standard method. Methods In order to treat tumors located at depths lower than our minimum range available (4.1 cm), a pre-absorber is needed (Range Shifter – RS). The RS also causes scatter, so it is associated to some dose degradation, which should be minimized. We studied three tumor localizations (pelvic, H&N and Cranio-Spinal-Irradiation) requiring RS and we created three plans for each case: one is the standard method with the RS always used as close as possible to the patient, one with the RS used only for the shallow part of the tumor but completely retracted (Figure a) and the third as the second but with the RS as close as possible to the patient (Figure b). We called these last two Range Shifter Optimization (RSO) techniques. We compared those plans in terms of dose distribution quality, delivery time and patient QA results. Results In tables dosimetric results and delivery time are reported. A very good sparing of OARs are obtained when the RSO technique is used with the RS extended toward the patient with no significative loss in terms of target coverage. Patient QA gave very good results in terms of γ Passing Rate (PR) (3%,3 mm) for both RSO techniques (mean 98.09%, minimum 93.75%) while the standard had some very low PR (minimum 81.09%) while the average was still good (97.73%). The delivery time increased but was still acceptable in terms of patient compliance. Conclusions Graphical Abstract View Large Image Figure Viewer Download Hi-res image Graphical Abstract View Large Image Figure Viewer Download Hi-res image To design and implement a new protontherapy planning method for the treatment of shallow lesions with PBS and to compare it to the standard method. In order to treat tumors located at depths lower than our minimum range available (4.1 cm), a pre-absorber is needed (Range Shifter – RS). The RS also causes scatter, so it is associated to some dose degradation, which should be minimized. We studied three tumor localizations (pelvic, H&N and Cranio-Spinal-Irradiation) requiring RS and we created three plans for each case: one is the standard method with the RS always used as close as possible to the patient, one with the RS used only for the shallow part of the tumor but completely retracted (Figure a) and the third as the second but with the RS as close as possible to the patient (Figure b). We called these last two Range Shifter Optimization (RSO) techniques. We compared those plans in terms of dose distribution quality, delivery time and patient QA results. In tables dosimetric results and delivery time are reported. A very good sparing of OARs are obtained when the RSO technique is used with the RS extended toward the patient with no significative loss in terms of target coverage. Patient QA gave very good results in terms of γ Passing Rate (PR) (3%,3 mm) for both RSO techniques (mean 98.09%, minimum 93.75%) while the standard had some very low PR (minimum 81.09%) while the average was still good (97.73%). The delivery time increased but was still acceptable in terms of patient compliance.

9. Commissioning of the first synchrotron-based scanning proton beamline for ocular melanoma treatments

Purpose Around 10 centers worldwide treat ocular tumors with proton therapy, all with dedicated eyelines. Our synchrotron-based facility is equipped with general-purpose fixed beamlines; proton and carbon ion treatments are delivered with pencil beam scanning modality (range in water 3 ÷ 32 cm). Recently, our proton beamline was adapted to treat also ocular diseases. The main dosimetric properties of this new eyeline are described in this work. Methods A 3 cm water-equivalent range shifter (RS) was placed along the beamline to reach shallower penetration depths. In order to achieve steep lateral dose gradients, the position of the RS and patient-specific collimator were simulated using MonteCarlo (MC) FLUKA code. Lateral dose profiles were measured with gafchromic EBT3 films to evaluate lateral penumbra width and dose homogeneity. Several beam scanning patterns were tested. Depth-dose distributions (DDDs) were measured with the Peakfinder system. To obtain uniform dose distributions (Spread-Out Bragg Peaks, SOBPs), the weights of each DDD were optimized simulating different targets. Absorbed doses were then measured in water with an advanced Markus chamber. Neutron dose at the contralateral eye was also evaluated with passive bubble dosimeters. Results MC simulations and experimental results showed that maximizing the distance between RS and collimator reduces the lateral dose penumbra of the collimated beam and increases field transversal dose homogeneity. Therefore, RS and patient-specific collimator were placed at about 98 cm (behind beam monitors) and 6 cm from the isocenter, respectively. The lateral penumbra (distal fall-off) ranged between 1.0 and 1.8 mm (1.0 and 1.6 mm). The measured SOBP doses were in very good agreement with MC simulations, as shown in Fig. 1. The mean neutron dose at the contralateral eye was 68.8 ± 10.2 μSv/Gy. Conclusions Our eyeline satisfied the requirements to treat ocular tumors. The first ocular patient was treated in August 2016. Around 60 patients have been treated so far.

113. Eligibility and feasibility of adjuvant breast cancer treatments with pencil beam scanning (PBS) proton therapy. An inter-institutional study

Purpose Proton therapy reduces lung dose and mean heart dose in breast cancer irradiation in adjuvant breast cancer, in particular with nodal involvement [1] . In this work we compare 10 selected intensity modulated photon therapy (IMXT) treatment cases selected from the sending institution with PBS proton therapy. Methods and materials The eligibly criteria of the sending institution were: poor coverage of the target volumes, unfavourable dose volume histograms (DVH) to the organs at risk (OAR) lung and heart or wide irradiated volume (IV) with static IMXT. The type of case were heterogeneous as shown in Table 1. All plans were performed on the CT and volumes send applying a class solution of 3 proton field with range shifter with treatment planning system (TPS) Raystation. All plans were performed in robust Single Field Optimization technique (rSFO) optimizing the target and the OAR heart and the ipsilateral lung. The optimization was done with clinical pencil beam algorithm and 5 mm geometrical robust optimization tool provided by the TPS. No robust optimization of the range was applied. Results Comparing the proton and photon plans there was a significant improvement in at least one of the following parameter: IV, DVH of lung, DVH of heart for each case (e.g. Fig. 1). Conclusion The results of this study are promising. The heuristic eligibility method provide positive answer in 100% of the cases. Further work are necessary to assess role of range errors of proton peak.