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Title: TU-FG-BRB-12: Real-Time Visualization of Discrete Spot Scanning Proton Therapy Beam for Quality Assurance

Abstract

Purpose: With the growing adoption of proton beam therapy there is an increasing need for effective and user-friendly tools for performing quality assurance (QA) measurements. The speed and versatility of spot-scanning proton beam (PB) therapy systems present unique challenges for traditional QA tools. To address these challenges a proof-of-concept system was developed to visualize, in real-time, the delivery of individual spots from a spot-scanning PB in order to perform QA measurements. Methods: The PB is directed toward a custom phantom with planar faces coated with a radioluminescent phosphor (Gd2O2s:Tb). As the proton beam passes through the phantom visible light is emitted from the coating and collected by a nearby CMOS camera. The images are processed to determine the locations at which the beam impinges on each face of the phantom. By so doing, the location of each beam can be determined relative to the phantom. The cameras are also used to capture images of the laser alignment system. The phantom contains x-ray fiducials so that it can be easily located with kV imagers. Using this data several quality assurance parameters can be evaluated. Results: The proof-of-concept system was able to visualize discrete PB spots with energies ranging from 70 MeVmore » to 220 MeV. Images were obtained with integration times ranging from 20 to 0.019 milliseconds. If not limited by data transmission, this would correspond to a frame rate of 52,000 fps. Such frame rates enabled visualization of individual spots in real time. Spot locations were found to be highly correlated (R{sup 2}=0.99) with the nozzle-mounted spot position monitor indicating excellent spot positioning accuracy Conclusion: The system was shown to be capable of imaging individual spots for all clinical beam energies. Future development will focus on extending the image processing software to provide automated results for a variety of QA tests.« less

Authors:
 [1]; ; ;  [2]; ;  [3];  [4]
  1. Proton Beam Therapy Center, Hokkaido University Hospital, Sapporo, Hokkaido (Japan)
  2. Stanford University, Stanford, California (United States)
  3. Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido (Japan)
  4. Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University, Sapporo, Hokkaido (Japan)
Publication Date:
OSTI Identifier:
22654005
Resource Type:
Journal Article
Resource Relation:
Journal Name: Medical Physics; Journal Volume: 43; Journal Issue: 6; Other Information: (c) 2016 American Association of Physicists in Medicine; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
60 APPLIED LIFE SCIENCES; 61 RADIATION PROTECTION AND DOSIMETRY; BIOMEDICAL RADIOGRAPHY; COMPUTER CODES; IMAGE PROCESSING; MEV RANGE 100-1000; MEV RANGE 10-100; PHANTOMS; PROTON BEAMS; QUALITY ASSURANCE; RADIOTHERAPY; VISIBLE RADIATION; X RADIATION

Citation Formats

Matsuzaki, Y, Jenkins, C, Yang, Y, Xing, L, Yoshimura, T, Fujii, Y, and Umegaki, K. TU-FG-BRB-12: Real-Time Visualization of Discrete Spot Scanning Proton Therapy Beam for Quality Assurance. United States: N. p., 2016. Web. doi:10.1118/1.4957552.
Matsuzaki, Y, Jenkins, C, Yang, Y, Xing, L, Yoshimura, T, Fujii, Y, & Umegaki, K. TU-FG-BRB-12: Real-Time Visualization of Discrete Spot Scanning Proton Therapy Beam for Quality Assurance. United States. doi:10.1118/1.4957552.
Matsuzaki, Y, Jenkins, C, Yang, Y, Xing, L, Yoshimura, T, Fujii, Y, and Umegaki, K. 2016. "TU-FG-BRB-12: Real-Time Visualization of Discrete Spot Scanning Proton Therapy Beam for Quality Assurance". United States. doi:10.1118/1.4957552.
@article{osti_22654005,
title = {TU-FG-BRB-12: Real-Time Visualization of Discrete Spot Scanning Proton Therapy Beam for Quality Assurance},
author = {Matsuzaki, Y and Jenkins, C and Yang, Y and Xing, L and Yoshimura, T and Fujii, Y and Umegaki, K},
abstractNote = {Purpose: With the growing adoption of proton beam therapy there is an increasing need for effective and user-friendly tools for performing quality assurance (QA) measurements. The speed and versatility of spot-scanning proton beam (PB) therapy systems present unique challenges for traditional QA tools. To address these challenges a proof-of-concept system was developed to visualize, in real-time, the delivery of individual spots from a spot-scanning PB in order to perform QA measurements. Methods: The PB is directed toward a custom phantom with planar faces coated with a radioluminescent phosphor (Gd2O2s:Tb). As the proton beam passes through the phantom visible light is emitted from the coating and collected by a nearby CMOS camera. The images are processed to determine the locations at which the beam impinges on each face of the phantom. By so doing, the location of each beam can be determined relative to the phantom. The cameras are also used to capture images of the laser alignment system. The phantom contains x-ray fiducials so that it can be easily located with kV imagers. Using this data several quality assurance parameters can be evaluated. Results: The proof-of-concept system was able to visualize discrete PB spots with energies ranging from 70 MeV to 220 MeV. Images were obtained with integration times ranging from 20 to 0.019 milliseconds. If not limited by data transmission, this would correspond to a frame rate of 52,000 fps. Such frame rates enabled visualization of individual spots in real time. Spot locations were found to be highly correlated (R{sup 2}=0.99) with the nozzle-mounted spot position monitor indicating excellent spot positioning accuracy Conclusion: The system was shown to be capable of imaging individual spots for all clinical beam energies. Future development will focus on extending the image processing software to provide automated results for a variety of QA tests.},
doi = {10.1118/1.4957552},
journal = {Medical Physics},
number = 6,
volume = 43,
place = {United States},
year = 2016,
month = 6
}
  • Hokkaido University and Hitachi Ltd. have started joint development of the Gated Spot Scanning Proton Therapy with Real-Time Tumor-Tracking System by integrating real-time tumor tracking technology (RTRT) and the proton therapy system dedicated to discrete spot scanning techniques under the {sup F}unding Program for World-Leading Innovative R and D on Science and Technology (FIRST Program){sup .} In this development, we have designed the synchrotron-based accelerator system by using the advantages of the spot scanning technique in order to realize a more compact and lower cost proton therapy system than the conventional system. In the gated irradiation, we have focused onmore » the issues to maximize irradiation efficiency and minimize the dose errors caused by organ motion. In order to understand the interplay effect between scanning beam delivery and target motion, we conducted a simulation study. The newly designed system consists of the synchrotron, beam transport system, one compact rotating gantry treatment room with robotic couch, and one experimental room for future research. To improve the irradiation efficiency, the new control function which enables multiple gated irradiations per synchrotron cycle has been applied and its efficacy was confirmed by the irradiation time estimation. As for the interplay effect, we confirmed that the selection of a strict gating width and scan direction enables formation of the uniform dose distribution.« less
  • Purpose: In spot-scanning proton therapy, the interplay effect between tumor motion and beam delivery leads to deterioration of the dose distribution. To mitigate the impact of tumor motion, gating in combination with repainting is one of the most promising methods that have been proposed. This study focused on a synchrotron-based spot-scanning proton therapy system integrated with real-time tumor monitoring. The authors investigated the effectiveness of gating in terms of both the delivered dose distribution and irradiation time by conducting simulations with patients' motion data. The clinically acceptable range of adjustable irradiation control parameters was explored. Also, the relation between themore » dose error and the characteristics of tumor motion was investigated.Methods: A simulation study was performed using a water phantom. A gated proton beam was irradiated to a clinical target volume (CTV) of 5 Multiplication-Sign 5 Multiplication-Sign 5 cm{sup 3}, in synchronization with lung cancer patients' tumor trajectory data. With varying parameters of gate width, spot spacing, and delivered dose per spot at one time, both dose uniformity and irradiation time were calculated for 397 tumor trajectory data from 78 patients. In addition, the authors placed an energy absorber upstream of the phantom and varied the thickness to examine the effect of changing the size of the Bragg peak and the number of required energy layers. The parameters with which 95% of the tumor trajectory data fulfill our defined criteria were accepted. Next, correlation coefficients were calculated between the maximum dose error and the tumor motion characteristics that were extracted from the tumor trajectory data.Results: With the assumed CTV, the largest percentage of the data fulfilled the criteria when the gate width was {+-}2 mm. Larger spot spacing was preferred because it increased the number of paintings. With a prescribed dose of 2 Gy, it was difficult to fulfill the criteria for the target with a very small effective depth (the sum of an assumed energy absorber's thickness and the target depth in the phantom) because of the sharpness of the Bragg peak. However, even shallow targets could be successfully irradiated by employing an adequate number of paintings and by placing an energy absorber of sufficient thickness to make the effective target depth more than 12 cm. The authors also observed that motion in the beam direction was the main cause of dose distortion, followed by motion in the lateral plane perpendicular to the scan direction.Conclusions: The results suggested that by properly adjusting irradiation control parameters, gated proton spot-scanning beam therapy can be robust to target motion. This is an important first step toward establishing treatment plans in real patient geometry.« less
  • Purpose: A novel Proton Beam Therapy system has been developed by integrating Real-Time Tumor-Tracking (RTRT) and discrete spot scanning techniques. The system dedicated for spot scanning delivers significant advantages for both clinical and economical points of view. The system has the ability to control dose distribution with spot scanning beams and to gate the beams from the synchrotron to irradiate moving tumors only when the actual positions of them are within the planned position. Methods: The newly designed system consists of a synchrotron, beam transport systems, a compact and rotating gantry system with robotic couch and two orthogonal sets ofmore » X-ray fluoroscopes. The fully compact design of the system has been realized by reducing the maximum energy of the beam to 220MeV, corresponding to 30g/cm2 range and the number of circulating protons per synchrotron operation cycle, due to higher beam utilization efficiency in spot scanning. To improve the irradiation efficiency in the integration of RTRT and spot scanning, a new control system has been developed to enable multiple gated irradiation per operation cycle according to the gating signals. After the completion of the equipment installation, beam tests and commissioning has been successfully performed. Results: The basic performances and beam characteristics through the synchrotron accelerator to iso-center have been confirmed and the performance test of the irradiation nozzle and whole system has been appropriately completed. CBCT image has been checked and sufficient quality was obtained. RTRT system has been demonstrated and realized accurate dose distributions for moving targets. Conclusion: The gated spot scanning Proton Beam Therapy system with Real-Time Tumor-Tracking has been developed, successfully installed and tested. The new system enables us to deliver higher dose to the moving target tumors while sparing surrounding normal tissues and to realize the compact design of the system and facility by maximizing the efficiency of proton beam utilization. This research is granted by the Japan Society for the Promotion of Science(JSPS) through the “Funding Program for World-Leading Innovative R and D on Science and Technology(FIRST Program)”, initiated by the Council for Science and Technology Policy(CSTP)« less
  • Purpose: At Hokkaido University, we have developed a gated spot scanning proton beam therapy system with real-time tumor-tracking under collaborative work with Hitachi Ltd. This system has the ability to gate proton beams from the synchrotron, turning the beam on only when the actual positions of inserted fiducial markers monitored by two fluoroscopic X-ray systems are within the planned positions [Shirato, 2012]. In this research, we validated the accuracy of the proton beams while utilizing external gating signals. Methods: The accuracy of spot positions, spot dose, absolute dose at the center of the SOBP, and range were measured while utilizingmore » external gating signals. The following external gating signals were generated by an arbitrary waveform generator: (1) ON at all times (without gating), (2) an OFF period of 4 s followed by an ON period of 1 s, (3) two ON periods of 0.5 s with a 0.15 s OFF interval, (4) signals recorded during the treatment of real-time tumor-tracking X-ray therapy in Hokkaido University. The spot positions and spot dose were measured by beam monitors in the nozzle. The ranges were measured with a multi-layer ion chamber made by Hitachi Ltd. The absolute dose was measured with a Farmer ionization chamber and a RFA300 water phantom system. Results: The maximum error of the beam position in the isocenter plane was 0.8 mm without the gating signal and 1.0 mm with the gating signal. The maximum error of the spot dose was 0.0029 MU, below the criterion of 0.0032 MU. The maximum error of the absolute dose was 0.4% and the maximum variation of the range was 0.1 mm. Conclusion: It was confirmed with measurements of the beam that the accuracy of the proton beam met the criteria with external gating signals. This research was supported by the Cabinet Office, Government of Japan and the Japan Society for the Promotion of Science (JSPS) through the Funding Program for World-Leading Innovative R and D on Science and Technology (FIRST Program), initiated by the Council for Science and Technology Policy (CSTP)« less
  • Purpose: To realize real-time-image gated proton beam therapy (RGPT) for treating mobile tumors. Methods: The rotating gantry of spot scanning proton beam therapy has been designed to equip two x-ray fluoroscopy devices that enable real-time imaging of the internal fiducial markers during respiration. Three-dimensional position of the fiducial marker located near the tumor can be calculated from the fluoroscopic images obtained from orthogonal directions and therapeutic beam is gated only when the fiducial marker is within the predefined gating window. Image acquisition rate can be selected from discrete value ranging from 0.1 Hz to 30 Hz. In order to confirmmore » the effectiveness of RGPT and apply it clinically, clinical commissioning was conducted. Commissioning tests were categorized to main three parts including geometric accuracy, temporal accuracy and dosimetric evaluation. Results: Developed real-time imaging function has been installed and its basic performances have been confirmed. In the evaluation of geometric accuracy, coincidence of three-dimensional treatment room coordinate system and imaging coordinate system was confirmed to be less than 1 mm. Fiducial markers (gold sphere and coil) were able to be tracked in simulated clinical condition using an anthropomorphic chest phantom. In the evaluation of temporal accuracy, latency from image acquisition to gate on/off signal was about 60 msec in typical case. In dosimetric evaluation, treatment beam characteristics including beam irradiation position and dose output were stable in gated irradiation. Homogeneity indices to the mobile target were 0.99 (static), 0.89 (w/o gating, motion is parallel to direction of scan), 0.75 (w/o gating, perpendicular), 0.98 (w/ gating, parallel) and 0.93 (w/ gating, perpendicular). Dose homogeneity to the mobile target can be maintained in RGPT. Conclusion: Real-time imaging function utilizing x-ray fluoroscopy has been developed and commissioned successfully in order to realize RGPT. Funding Support: This research was partially supported by Japan Society for the Promotion of Science (JSPS) through the FIRST Program. Conflict of Interest: Prof. Shirato has research fund from Hitachi Ltd, Mitsubishi Heavy Industries Ltd and Shimadzu Corporation.« less