| Autor: |
Khamfongkhruea, C., Nenoff, L., Priegnitz, M., Barczyk, S., Berthold, J., Vander Stappen, F., Petzoldt, J., Smeets, J., Enghardt, W., Pausch, G., Richter, C. |
| Jazyk: |
angličtina |
| Rok vydání: |
2019 |
| Zdroj: |
1. German Cancer Research Congress-GCRC, 04.-05.02.2019, Heidelberg, Deutschland |
| Popis: |
Introduction Proton therapy is the most advanced radiotherapeutic technique. For the same dose in the tumor, the dose in the surrounding normal tissue is substantially lower than in classical radiation therapy using photon beams. Protons stop in the patient and no dose is deposited behind that position. However, the resulting dose deposition is more sensitive to anatomical changes during treatment and to uncertainties in the CT-based range calculation. Therefore, monitoring of the proton range during treatment would substantially improve proton therapy. Prompt gamma radiation, which is emitted in nuclear reactions of the proton beam with the patient’s tissue, can be used to conclude on the proton range. The most translational advanced approach is prompt-gamma imaging (PGI) using a so-called slit camera [1]. A one-dimensional projection of the prompt-gamma distribution is acquired through a slit collimator onto a spatially resolved detector (Fig.1). The system, developed by IBA, is evaluated concerning its clinical benefit. Materials and Methods The PGI slit-camera was first enabled for routine clinical use by developing dedicated calibration and QA procedures as well as a clinical workflow and setting up a clinical study. In 2015, we were able to perform the first in-man PGI-based range verification [2], 13 years after the idea was initially proposed. In addition, the sensitivity and accuracy of the PGI slit-camera to detect different types of treatment deviations were evaluated for pencil-beam-scanning (PBS) proton therapy in an anthropomorphic phantom [3]. Following, a 2nd generation system was developed to improve positioning accuracy and reproducibility. Clinical application of this system in PBS proton therapy started in 2018. Results In the first in-man applications, detected inter-fractional global range variations were below ±2 mm, and thereby within the overall measurement uncertainties. This was verified with independent control CTs acquired directly before treatment. The phantom study revealed, that global and local range shifts can be detected with high sensitivity. Shift detection accuracy was better than 2 mm under clinical conditions. With the 2nd generation system, positioning uncertainty could be reduced to about 1 mm, potentially allowing a first in-man validation of the absolute range prediction as the measurement uncertainty is below the range prediction uncertainty. Conclusion With the translation from basic physics experiments into clinical operation, we were able to demonstrate the applicability of PGI-based range verification for improving the accuracy of proton therapy. Currently, we systematically evaluate the clinical benefit of the approach aiming for an automated detection of clinical relevant treatment deviation and classification of the underlying error source. |
| Databáze: |
OpenAIRE |
| Externí odkaz: |
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