Prompt-Gamma Based Range Verification in Particle Therapy: New prospects (also) for 4D?
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1 Prompt-Gamma Based Range Verification in Particle Therapy: New prospects (also) for 4D? Guntram Pausch OncoRay National Center for Radiation Research in Oncology, Dresden 2 Technische Universität Dresden, Department of Radiation Oncology, University Hospital Carl Gustav Carus, Dresden 3 Helmholtz-Zentrum Dresden Rossendorf, Dresden G. Pausch 4D Treatment Planning Workshop, Dresden, November 27, 2015
2 Outline 1. Origin and properties of prompt gamma rays 2. Prompt-gamma based methods of range assessment 3. Recent results obtained at OncoRay 4. Prospects for 4D treatment verification PBS 5. Summary and conclusions (Motivation covered by other talks.) G. Pausch 4D Treatment Planning Workshop, Dresden, November 27,
3 Origin and properties of prompt gamma rays Prompt gammas Resulting from nuclear interactions of beam particles with tissue Verburg et al., PMB 58 (2013) L37 Emission spectrum extends up to 7 8 MeV with prominent lines at 4.45 and 6.13 MeV Emission spectrum depends on the proton energy (penetration depth) G. Pausch 4D Treatment Planning Workshop, Dresden, November 27,
4 Origin and properties of prompt gamma rays Prompt gammas Resulting from nuclear interactions of beam particles with tissue Verburg et al., PMB 58 (2013) L37 Emission spectrum extends up to 7 8 MeV with prominent lines at 4.45 and 6.13 MeV Emission spectrum depends on the proton energy (penetration depth) Strong spatial correlation of gamma emissions with dose deposition (for 3-6 MeV gammas) G. Pausch 4D Treatment Planning Workshop, Dresden, November 27,
5 Origin and properties of prompt gamma rays Prompt gammas Resulting from nuclear interactions of beam particles with tissue Verburg et al., PMB 58 (2013) L37 Emission spectrum extends up to 7 8 MeV with prominent lines at 4.45 and 6.13 MeV Emission spectrum depends on the proton energy (penetration depth) Strong spatial correlation of gamma emissions with dose deposition (for 3-6 MeV gammas) Emission is time-correlated with the proton passage through matter (tissue) Hueso González et al., PMB60 (2015) 6247 G. Pausch 4D Treatment Planning Workshop, Dresden, November 27,
6 Origin and properties of prompt gamma rays Prompt gammas Resulting from nuclear interactions of beam particles with tissue Options for range verification Emission spectrum extends up to 7 8 MeV with prominent lines at 4.45 and 6.13 MeV Emission spectrum depends on the proton energy (penetration depth) Strong spatial correlation of gamma emissions with dose deposition (for 3-6 MeV gammas) Emission is time-correlated with the proton passage through matter (tissue) Prompt gamma spectroscopy Prompt gamma imaging (PGS) (PGI) G. Pausch 4D Treatment Planning Workshop, Dresden, November 27,
7 Origin and properties of prompt gamma rays Prompt gammas Resulting from nuclear interactions of beam particles with tissue Options for range verification Emission spectrum extends up to 7 8 MeV with prominent lines at 4.45 and 6.13 MeV Emission spectrum depends on the proton energy (penetration depth) Strong spatial correlation of gamma emissions with dose deposition (for 3-6 MeV gammas) Emission is time-correlated with the proton passage through matter (tissue) Prompt gamma spectroscopy Prompt gamma imaging (PGS) (PGI) G. Pausch 4D Treatment Planning Workshop, Dresden, November 27,
8 Origin and properties of prompt gamma rays Prompt gammas Resulting from nuclear interactions of beam particles with tissue Options for range verification Emission spectrum extends up to 7 8 MeV with prominent lines at 4.45 and 6.13 MeV Emission spectrum depends on the proton energy (penetration depth) Strong spatial correlation of gamma emissions with dose deposition (for 3-6 MeV gammas) Emission is time-correlated with the proton passage through matter (tissue) Prompt gamma spectroscopy Prompt gamma imaging Prompt gamma timing (PGS) (PGI) (PGT) G. Pausch 4D Treatment Planning Workshop, Dresden, November 27,
9 Prompt gamma imaging (PGI) Idea Stichelbaut and Jongen, PTCOG 2003 Emission pattern of prompt gamma rays is correlated with dose deposition Imaging the prompt gamma emissions means imaging the dose deposition Prompt gamma-ray timing (PGT) Spatial information from timing Gamma emission Dose deposition Fiedler and Mueller et al., 2011 IEEE NSS/MIC G. Pausch 4D Treatment Planning Workshop, Dresden, November 27,
10 Prompt gamma imaging (PGI) Idea Stichelbaut and Jongen, PTCOG 2003 Emission pattern of prompt gamma rays is correlated with dose deposition Imaging the prompt gamma emissions means imaging the dose deposition Gamma emission Gamma camera G. Pausch 4D Treatment Planning Workshop, Dresden, November 27,
11 Prompt gamma imaging (PGI) Idea Stichelbaut and Jongen, PTCOG 2003 Emission pattern of prompt gamma rays is correlated with dose deposition Imaging the prompt gamma emissions means imaging the dose deposition Can we deploy common gamma cameras as used in nuclear medicine? Gamma emission Gamma camera G. Pausch 4D Treatment Planning Workshop, Dresden, November 27,
12 Prompt gamma imaging (PGI) Idea Stichelbaut and Jongen, PTCOG 2003 Emission pattern of prompt gamma rays is correlated with dose deposition Imaging the prompt gamma emissions means imaging the dose deposition Can we deploy common gamma cameras as used in nuclear medicine?? G. Pausch 4D Treatment Planning Workshop, Dresden, November 27,
13 Prompt gamma imaging (PGI) Idea Stichelbaut and Jongen, PTCOG 2003 Emission pattern of prompt gamma rays is correlated with dose deposition Imaging the prompt gamma emissions means imaging the dose deposition Can we deploy common gamma cameras as used in nuclear medicine? No.? G. Pausch 4D Treatment Planning Workshop, Dresden, November 27,
14 Prompt gamma imaging (PGI) Idea Options Stichelbaut and Jongen, PTCOG 2003 Emission pattern of prompt gamma rays is correlated with dose deposition Imaging the prompt gamma emissions means imaging the dose deposition Passively collimated systems with thick collimators Knife-edge collimator Multi-slat collimator Electronically collimated systems Compton camera Compton electron tracking G. Pausch 4D Treatment Planning Workshop, Dresden, November 27,
15 PGI with passive collimation Pinhole concept Knife-edge collimator (IBA, ) 2D 1D imaging but improved efficiency After hundreds of simulations, satisfying parameter values yielding a correlated detection profile were found and are given in table 2. Before commenting these values, we will first describe the detection profile characteristics. The detection profile is the reversed 1D projection on the scintillator of the proton track through the slit. The collimator and the detector are not perfect, but the detection profile is clearly decreasing around the Bragg peak depth. In figure 8, one can see that this beam evidence is solely due to the photon contribution, while neutrons detected just add a flat background. In figure 9, one can also distinguish the contribution of particles that passed through the collimator wall, through the slit collimator edge (where the collimator is thinner and less particles are absorbed) and through the slit opening. Unless otherwise stated, the reference pencil beam of 10 9 protons is simulated with 10 9 histories (or 10 8 with cylindrical symmetry) so that statistics ofthe simulated profiles are meaningful. Counts onthe left axis ofthe detection profiles are always indicated with respect to this number of incident protons and for 5 mm position bins. On the right axis, the same number of counts is normalized for one incident proton and divided by the 10 cm 2 area of the crystal segments associated with the position Knife-edge slit collimator + imaging detector Prototype available, clinical tests performed G. Pausch 4D Treatment Planning Workshop, Dresden, November 27, 2015 Figure7. Decomposition in energy groups of the photon-simulated detection profile with a perfect scintillator and a perfect collimator (infinite density). Smeets et al., PMB 57 (2012) 3371 Perali et al., PMB 59 (2014)
16 PGI with passive collimation Multi-hole concept 2D 1D imaging but improved efficiency Multi-slat collimator (Coimbra, Delft, ) Multi-slat collimator + imaging detector Modeling Cambraia Lopes et al., IEEE NSS/MIC 2012 G. Pausch 4D Treatment Planning Workshop, Dresden, November 27,
17 PGI with passive collimation Multi-hole concept 2D 1D imaging but improved efficiency Multi-slat collimator (Lyon, ) Multi-slat collimator + imaging detector Modeling + measurements with single detector elements Pinto et al., PMB 59 (2014) 7653 G. Pausch 4D Treatment Planning Workshop, Dresden, November 27,
18 PGI with electronic collimation Compton camera concept Everett et al., Proc. IEE 124 (1977) 995 E E E e = E E G. Pausch 4D Treatment Planning Workshop, Dresden, November 27,
19 PGI with electronic collimation Compton camera concept Scatter plane(s) + absorber plane Measure deposited energies and interaction positions Each valid event defines a cone Courtesy of C. Golnik and S. Schoene, 2013 G. Pausch 4D Treatment Planning Workshop, Dresden, November 27,
20 PGI with electronic collimation Compton camera concept Scatter plane(s) + absorber plane Measure deposited energies and interaction positions Each valid event defines a cone Superposition of many cones Courtesy of C. Golnik and S. Schoene, 2013 G. Pausch 4D Treatment Planning Workshop, Dresden, November 27,
21 PGI with electronic collimation Compton camera concept Scatter plane(s) + absorber plane Measure deposited energies and interaction positions Each valid event defines a cone Superposition of many cones Courtesy of C. Golnik and S. Schoene, 2013 G. Pausch 4D Treatment Planning Workshop, Dresden, November 27,
22 PGI with electronic collimation Compton camera concept Scatter plane(s) + absorber plane Measure deposited energies and interaction positions Each valid event defines a cone Superposition of many cones + image reconstruction (MLEM) 3D Image of the source Courtesy of C. Golnik and S. Schoene, 2013 G. Pausch 4D Treatment Planning Workshop, Dresden, November 27,
23 PGI with electronic collimation Compton camera concepts for prompt gamma imaging: Various approaches differing in the detectors design Dresden: CZT + segmented LSO/BGO Kormoll et al., NIM A (2011) 113 Kormoll et al., IEEE NSS/MIC Na point source G. Pausch 4D Treatment Planning Workshop, Dresden, November 27,
24 PGI with electronic collimation Compton camera concepts for prompt gamma imaging: Various approaches differing in the detectors design Dresden: CZT + segmented LSO/BGO Kormoll et al., NIM A (2011) MeV Kormoll gamma et al., point IEEE NSS/MIC source MeV gamma point source G. Pausch 4D Treatment Planning Workshop, Dresden, November 27,
25 PGI with electronic collimation Compton camera concepts for prompt gamma imaging: Various approaches differing in the detectors design Dresden: CZT + segmented LSO/BGO Munich: double-sided Si strip detectors + monolithic LaBr 3 Thirolf et al., NN 2015 G. Pausch 4D Treatment Planning Workshop, Dresden, November 27,
26 PGI with electronic collimation Compton camera concepts for prompt gamma imaging: Various approaches differing in the detectors design Dresden: CZT + segmented LSO/BGO Munich: double-sided Si strip detectors + monolithic LaBr 3 Lyon: double-sided Si strip detectors + segmented BGO Krimmer et al., NIM A787 (2015) 98 G. Pausch 4D Treatment Planning Workshop, Dresden, November 27,
27 PGI with electronic collimation Compton camera concepts for prompt gamma imaging: Various approaches differing in the detectors design Dresden: CZT + segmented LSO/BGO Munich: double-sided Si strip detectors + monolithic LaBr 3 Lyon: double-sided Si strip detectors + segmented BGO Valencia: monolithic LaBr 3 + monolithic LaBr 3 22 Na point source Llosa et al., NIM A718 (2013) 130 G. Pausch 4D Treatment Planning Workshop, Dresden, November 27,
28 PGI with electronic collimation Compton camera concepts for prompt gamma imaging: Various approaches differing in the detectors design Dresden: CZT + segmented LSO/BGO Munich: double-sided Si strip detectors + monolithic LaBr 3 Lyon: double-sided Si strip detectors + segmented BGO Valencia: monolithic LaBr 3 + monolithic LaBr 3 Baltimore: multistage CZT based on POLARIS McCleskey et al., NIM A785 (2015) 163 Polf et al., PMB 60 (2015) 7085 G. Pausch 4D Treatment Planning Workshop, Dresden, November 27,
29 PGI with electronic collimation Compton camera concepts for prompt gamma imaging: Various approaches differing in the detectors design Results Imaging of radioactive sources ( 22 Na) Imaging of monoenergetic 4.45 MeV gamma rays ~ Imaging of proton-induced prompt gamma rays at long exposures and very low beam currents PGI with clinical beam currents and exposure times Estimate Protons per PBS spot up to 10 8 Scatter detector size and distance from isocenter 55 cm 2 25 cm Camera efficiency *) Usable events per PBS spot 50 Scatter detector trigger rate **) *) measured / scaled for a CZT-BGO setup; Golnik, PhD thesis, 2015 (unpublished) **) conservative estimate considering the minimum interaction probability of gammas in 5mm CZT G. Pausch 4D Treatment Planning Workshop, Dresden, November 27,
30 PGI with electronic collimation Compton camera concepts for prompt gamma imaging: Various approaches differing in the detectors design Results Imaging of radioactive sources ( 22 Na) Imaging of monoenergetic 4.45 MeV gamma rays ~ Imaging of proton-induced prompt gamma rays at long exposures and very low beam currents PGI with clinical beam currents and exposure times Applicability basically biased by Event statistics (few usable events per target volume element) Detector load (limits size of detectors and camera) Load asymmetry (thin scatter detectors, thick absorber detectors) Are there simpler/cheaper solutions? G. Pausch 4D Treatment Planning Workshop, Dresden, November 27,
31 Prompt gamma spectroscopy (PGS) Idea Verburg and Seco, PMB 59 (2014) 7089 Emission spectrum of prompt gamma rays is correlated with the residual particle energy (range) Spectroscopy of prompt gamma rays from a given depth discloses the residual range G. Pausch 4D Treatment Planning Workshop, Dresden, November 27,
32 Prompt gamma spectroscopy (PGS) Idea Verburg and Seco, PMB 59 (2014) 7089 Emission spectrum of prompt gamma rays is correlated with the residual particle energy (range) Spectroscopy of prompt gamma rays from a given depth discloses the residual range G. Pausch 4D Treatment Planning Workshop, Dresden, November 27,
33 Prompt gamma spectroscopy (PGS) Idea Verburg and Seco, PMB 59 (2014) 7089 Emission spectrum of prompt gamma rays is correlated with the residual particle energy (range) Spectroscopy of prompt gamma rays from a given depth discloses the residual range G. Pausch 4D Treatment Planning Workshop, Dresden, November 27,
34 Prompt gamma spectroscopy (PGS) Idea Procedure Challenge Verburg and Seco, PMB 59 (2014) 7089 Emission spectrum of prompt gamma rays is correlated with the residual particle energy (range) Spectroscopy of prompt gamma rays from a given depth discloses the residual range Focus a collimated spectroscopic detector on the last few millimeters of beam range Measure distinct line intensity ratios Achievable statistics to be combined with multi-slat concept? G. Pausch 4D Treatment Planning Workshop, Dresden, November 27,
35 Prompt gamma timing (PGT) Idea Golnik et al., PMB 59 (2014) 5399 Emission time of prompt gamma rays is correlated with the stopping time of particles in tissue and thus with the stopping distance (range) Timing spectroscopy of prompt gamma rays discloses the particle range Pausch et al., SCINT 2015 G. Pausch 4D Treatment Planning Workshop, Dresden, November 27,
36 Prompt gamma timing (PGT) Idea Golnik et al., PMB 59 (2014) 5399 Emission time of prompt gamma rays is correlated with the stopping time of particles in tissue and thus with the stopping distance (range) Timing spectroscopy of prompt gamma rays discloses the particle range 230 MeV protons PMMA + air gaps Hueso González et al., PMB 60 (2015) 6247 G. Pausch 4D Treatment Planning Workshop, Dresden, November 27,
37 Prompt gamma timing (PGT) Idea Procedure Emission time of prompt gamma rays is correlated with the stopping time of particles in tissue and thus with the stopping distance (range) Timing spectroscopy of prompt gamma rays discloses the particle range Put timing detectors close to the target Measure timing spectra Advantage and challenge Golnik et al., PMB 59 (2014) 5399 Uncollimated detector Statistics only limited by tolerable detector load and DACQ throughput Fast energy and timing spectroscopy at about 1 Mcps throughput rates and up to 10 Mcps detector load Pausch et al., paper accepted for publication in IEEE TNS, 2015 G. Pausch 4D Treatment Planning Workshop, Dresden, November 27,
38 State of the art in PGT PGT hardware Pausch et al., paper accepted for publication in IEEE TNS, 2015 Detection of 5 mm range deviations in single pencil beam spots Maximum throughput to collect the statistics needed with few (2-4) detectors Target U100 - Parameters and Features Features Timing resolution Dynamic range Throughput Fast timing and energy spectrometer List mode and spectrum (1D, 2D) output 14-pin plug-on PMT connector Ethernet featuring POE < 200 ps (FWHM) with CeBr 3 detector > 1:1.000 (10 kev 10 MeV) up to ~1 Mcps (spectroscopy, list mode) G. Pausch 4D Treatment Planning Workshop, Dresden, November 27,
39 State of the art in PGT PGT hardware Pausch et al., paper accepted for publication in IEEE TNS, 2015 Detection of 5 mm range deviations in single pencil beam spots Maximum throughput to collect the statistics needed with few (2-4) detectors Test at OncoRay, dose cube PBS plan (1 Gy) Petzoldt et al., unpublished data G. Pausch 4D Treatment Planning Workshop, Dresden, November 27,
40 State of the art in PGT PGT hardware Pausch et al., paper accepted for publication in IEEE TNS, 2015 Detection of 5 mm range deviations in single pencil beam spots Maximum throughput to collect the statistics needed with few (2-4) detectors Test at OncoRay, dose cube PBS plan (1 Gy) Petzoldt et al., unpublished data G. Pausch 4D Treatment Planning Workshop, Dresden, November 27,
41 State of the art in PGT PGT hardware Pausch et al., paper accepted for publication in IEEE TNS, 2015 Detection of 5 mm range deviations in single pencil beam spots Maximum throughput to collect the statistics needed with few (2-4) detectors Test at OncoRay, dose cube PBS plan (1 Gy) Petzoldt et al., unpublished data G. Pausch 4D Treatment Planning Workshop, Dresden, November 27,
42 State of the art in PGT PGT hardware Pausch et al., paper accepted for publication in IEEE TNS, 2015 Detection of 5 mm range deviations in single pencil beam spots Maximum throughput to collect the statistics needed with few (2-4) detectors Test at OncoRay, dose cube PBS plan (1 Gy) Petzoldt et al., unpublished data G. Pausch 4D Treatment Planning Workshop, Dresden, November 27,
43 State of the art in PGT PGT hardware Pausch et al., paper accepted for publication in IEEE TNS, 2015 Detection of 5 mm range deviations in single pencil beam spots Maximum throughput to collect the statistics needed with few (2-4) detectors Test at OncoRay, dose cube PBS plan (1 Gy) Petzoldt et al., unpublished data G. Pausch 4D Treatment Planning Workshop, Dresden, November 27,
44 State of the art in PGT PGT hardware Pausch et al., paper accepted for publication in IEEE TNS, 2015 Detection of 5 mm range deviations in single pencil beam spots Maximum throughput to collect the statistics needed with few (2-4) detectors Test at OncoRay, dose cube PBS plan (1 Gy) Petzoldt et al., unpublished data G. Pausch 4D Treatment Planning Workshop, Dresden, November 27,
45 State of the art in PGT PGT hardware Pausch et al., paper accepted for publication in IEEE TNS, 2015 Detection of 5 mm range deviations in single pencil beam spots Maximum throughput to collect the statistics needed with few (2-4) detectors Test at OncoRay, dose cube PBS plan (1 Gy) Petzoldt et al., unpublished data entries 1 PBS spot 1 detector This is in accordance with our estimates and design goals. G. Pausch 4D Treatment Planning Workshop, Dresden, November 27,
46 State of the art in PGT Prompt gamma timaging Petzoldt et al., submitted to PMB, 2015 Proton beam scanning of a structured PMMA target at OncoRay to explore imaging capabilities of PGT PGT spectra measured and corrected for RF-bunch phase shifts, target absorption, and solid angle variation 19mm (large) cavity 9mm (small) cavity 13mm filled cavity ( marrowbone ) G. Pausch 4D Treatment Planning Workshop, Dresden, November 27,
47 State of the art in PGT Prompt gamma timaging Proton beam scanning of a structured PMMA target at OncoRay to explore imaging capabilities of PGT PGT spectra measured and corrected for RF-bunch phase shifts, target absorption, and solid angle variation Difference of the measured to a reference distribution is calculated Petzoldt et al., submitted to PMB, mm (large) cavity 9mm (small) cavity 13mm filled cavity ( marrowbone ) G. Pausch 4D Treatment Planning Workshop, Dresden, November 27,
48 State of the art in PGT Prompt gamma timaging Proton beam scanning of a structured PMMA target at OncoRay to explore imaging capabilities of PGT PGT spectra measured and corrected for RF-bunch phase shifts, target absorption, and solid angle variation Difference of the measured to a reference distribution is calculated and visualized Petzoldt et al., submitted to PMB, mm (large) cavity 9mm (small) cavity 13mm filled cavity ( marrowbone ) G. Pausch 4D Treatment Planning Workshop, Dresden, November 27,
49 State of the art in PGT Prompt gamma timaging Proton beam scanning of a structured PMMA target at OncoRay to explore imaging capabilities of PGT PGT spectra measured and corrected for RF-bunch phase shifts, target absorption, and solid angle variation Difference of the measured to a reference distribution is calculated and visualized Petzoldt et al., submitted to PMB, 2015 First prompt-gamma based image of target inhomogeneities and resulting proton beam overranges ever made! Not a clinical scenario: High dose, maximum beam energy, long exposure (minutes per spot ) G. Pausch 4D Treatment Planning Workshop, Dresden, November 27,
50 First clinical application of PGI OncoRay has operated / tested the IBA slit camera prototype since Sept 2014 First clinical application in Aug 2015 H&N patient, DS, 3 fields, proton boost Inter-fractional treatment verification Barczyk, Priegnitz et al., submitted to PMB, 2015 Richter et al., submitted to Radiother Oncol, 2015 G. Pausch 4D Treatment Planning Workshop, Dresden, November 27,
51 First clinical application of PGI OncoRay has operated / tested the IBA slit camera prototype since Sept 2014 First clinical application in Aug 2015 H&N patient, DS, 3 fields, proton boost Inter-fractional treatment verification Barczyk, Priegnitz et al., submitted to PMB, 2015 Richter et al., submitted to Radiother Oncol, 2015 ΔR= [-2.0 mm,1.3 mm] consistent with control-ct based dose-recalculation G. Pausch 4D Treatment Planning Workshop, Dresden, November 27,
52 Prospects for 4D treatment verification 1. All PG methods could provide accurate beam timing information Petzoldt et al., unpublished data Each PBS spot can be exactly allocated in time If synchronized with motion monitoring, this provides the exact motion phase of spot delivery If 4D CT and motion model are available, this allows calculating the 3D dose deposition for each individual PBS spot after the treatment (supposed that the lateral spot positions of the full sequence are known) G. Pausch 4D Treatment Planning Workshop, Dresden, November 27,
53 Prospects for 4D treatment verification 1. All PG methods could provide accurate beam timing information Post-treatment 3D dose evaluation 2. Some methods could provide range verification per PBS spot IBA slit camera (sensitivity study to setup errors in a realistic PBS plan): Janssens et al., accepted for publication in Radiother Oncol, 2015 PGT (estimates supposing 4 of the existing hardware units): R 5 mm for PBS spots with 10 8 protons This allows verifying the 3D dose deposition for each individual PBS spot G. Pausch 4D Treatment Planning Workshop, Dresden, November 27,
54 Prospects for 4D treatment verification 1. All PG methods could provide accurate beam timing information Post-treatment 3D dose evaluation 2. Some methods could provide range verification per PBS spot Post-treatment 3D dose verification 3. PGT could provide beam position information per PBS spot PGT spectrum comprises Proton stopping time Prompt gamma TOF G. Pausch 4D Treatment Planning Workshop, Dresden, November 27,
55 Prospects for 4D treatment verification 1. All PG methods could provide accurate beam timing information Post-treatment 3D dose evaluation 2. Some methods could provide range verification per PBS spot Post-treatment 3D dose verification 3. PGT could provide beam position information per PBS spot PGT spectrum comprises Proton stopping time Prompt gamma TOF G. Pausch 4D Treatment Planning Workshop, Dresden, November 27,
56 Prospects for 4D treatment verification 1. All PG methods could provide accurate beam timing information Post-treatment 3D dose evaluation 2. Some methods could provide range verification per PBS spot Post-treatment 3D dose verification 3. PGT could provide beam position information per PBS spot PGT spectrum comprises Proton stopping time Prompt gamma TOF G. Pausch 4D Treatment Planning Workshop, Dresden, November 27,
57 Prospects for 4D treatment verification 1. All PG methods could provide accurate beam timing information Post-treatment 3D dose evaluation 2. Some methods could provide range verification per PBS spot Post-treatment 3D dose verification 3. PGT could provide beam position information per PBS spot PGT spectrum comprises Proton stopping time Prompt gamma TOF Use of multiple (at least 4) PGT detection units Improved statistics per spot TOF component discloses beam position G. Pausch 4D Treatment Planning Workshop, Dresden, November 27,
58 Prospects for 4D treatment verification 1. All PG methods could provide accurate beam timing information Post-treatment 3D dose evaluation 2. Some methods could provide range verification per PBS spot Post-treatment 3D dose verification 3. PGT could provide beam position information per PBS spot Post-treatment 3D dose verification G. Pausch 4D Treatment Planning Workshop, Dresden, November 27,
59 59 Summary and conclusions Prompt gamma rays (PG) are appropriate probes for range assessment in PT. So far, none of the electronically collimated PG imaging (PGI) systems under development could demonstrate imaging under treatment conditions. Simpler approaches seem more promising. So far, the passively collimated IBA knife-edge slit camera is the only PGI system with proven clinical applicability. PG timing (PGT) and spectroscopy (PGS) are promising, inexpensive alternatives to PGI. Clinical tests are in sight. PG measurements, combined with 4D CT and motion monitoring, could provide data for 3D dose re-calculation after treatments. PGI and PGT could even provide range verification for (strong) PBS spots. OncoRay is on the way to translating PGI and PGT into clinical practice. Thank you for your attention.
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