Increase of the transmission and emittance acceptance through a cyclotron-based proton therapy gantry.

Purpose: In proton therapy, the gantry, as the final part of the beamline, has a major effect on beam intensity and beam size at the isocenter. Most of the conventional beam optics of cyclotron-based proton gantries have been designed with an imaging factor between 1 and 2 from the coupling point (CP) at the gantry entrance to the isocenter (patient location) meaning that to achieve a clinically desirable (small) beam size at isocenter, a small beam size is also required at the CP. Here we will show that such imaging factors are limiting the emittance which can be transported through the gantry.

A new emittance selection system to maximize beam transmission for low-energy beams in cyclotron-based proton therapy facilities with gantry.

Purpose: In proton therapy, the potential of using high-dose rates in the cancer treatment is being explored. High-dose rates could improve efficiency and throughput in standard clinical practice, allow efficient utilization of motion mitigation techniques for moving targets, and potentially enhance normal tissue sparing due to the so-called FLASH effect. However, high-dose rates are difficult to reach when lower energy beams are applied in cyclotron-based proton therapy facilities, because they result in large beam sizes and divergences downstream of the degrader, incurring large losses from the cyclotron to the patient position (isocenter).

Commissioning of a clinical pencil beam scanning proton therapy unit for ultra-high dose rates (FLASH).

Purpose: The purpose of this work was to provide a flexible platform for FLASH research with protons by adapting a former clinical pencil beam scanning gantry to irradiations with ultra-high dose rates.

Methods: PSI Gantry 1 treated patients until December 2018. We optimized the beamline parameters to transport the 250 MeV beam extracted from the PSI COMET accelerator to the treatment room, maximizing the transmission of beam intensity to the sample.

Beamline characterization of a dielectric-filled reentrant cavity resonator as beam current monitor for a medical cyclotron facility.

At PSI (Paul Scherrer Institute), Switzerland, a superconducting cyclotron called "COMET" delivers proton beam of 250 MeV pulsed at 72.85 MHz for proton radiation therapy. Measuring proton beam currents (0.

Towards FLASH proton therapy: the impact of treatment planning and machine characteristics on achievable dose rates.

This study aimed at evaluating spatially varying instantaneous dose rates for different intensity-modulated proton therapy (IMPT) planning strategies and delivery scenarios, and comparing these with FLASH dose rates (>40 Gy/s). In order to quantify dose rates in three-dimensions, we proposed the 'dose-averaged dose rate' (DADR) metric, defined for each voxel as the dose-weighted mean of the instantaneous dose rates of all spots (i.e.

Can Technological Improvements Reduce the Cost of Proton Radiation Therapy?

In recent years there has been increasing interest in the more extensive application of proton therapy in a clinical and preferably hospital-based environment. However, broader adoption of proton therapy has been hindered by the costs of treatment, which are still much higher than those in advanced photon therapy. This article presents an overview of on-going technical developments, which have a reduction of the capital investment or operational costs either as a major goal or as a potential outcome.

A novel beam optics concept in a particle therapy gantry utilizing the advantages of superconducting magnets.

Purpose: A first order design of the beam optics of a superconducting proton therapy gantry beam is presented. The possibilities of superconducting magnets with respect to the beam optics such as strong fields, large apertures and superposition of different multipole fields have been exploited for novel concepts in a gantry. Since various techniques used in existing gantries have been used in our first design steps, some examples of the existing superconducting gantry designs are described and the necessary requirements of such a gantry are explained.

Sparing the region of the salivary gland containing stem cells preserves saliva production after radiotherapy for head and neck cancer.

Each year, 500,000 patients are treated with radiotherapy for head and neck cancer, resulting in relatively high survival rates. However, in 40% of patients, quality of life is severely compromised because of radiation-induced impairment of salivary gland function and consequent xerostomia (dry mouth). New radiation treatment technologies enable sparing of parts of the salivary glands.

Emerging technologies in proton therapy.

An increasing number of proton therapy facilities are being planned and built at hospital based centers. Most facilities are employing traditional dose delivery methods. A second generation of dose application techniques, based on pencil beam scanning, is slowly being introduced into the commercially available proton therapy systems.

Volume-dependent expression of in-field and out-of-field effects in the proton-irradiated rat lung.

Purpose: To investigate whether occurrence of early radiation effects in lung tissue depends on local dose only.

Methods And Materials: Twenty-five percent, 50%, 66%, 88%, or 100% of the rat lung was irradiated using single fractions of 150-MeV protons. For all volumes, in-field and out-of-field dose-response curves were obtained 8 weeks after irradiation.

Quantifying local radiation-induced lung damage from computed tomography.

Purpose: Optimal implementation of new radiotherapy techniques requires accurate predictive models for normal tissue complications. Since clinically used dose distributions are nonuniform, local tissue damage needs to be measured and related to local tissue dose. In lung, radiation-induced damage results in density changes that have been measured by computed tomography (CT) imaging noninvasively, but not yet on a localized scale.

Bath and shower effects in the rat parotid gland explain increased relative risk of parotid gland dysfunction after intensity-modulated radiotherapy.

Purpose: To assess in a rat model whether adding a subtolerance dose in a region adjacent to a high-dose irradiated subvolume of the parotid gland influences its response (bath-and-shower effect).

Methods And Materials: Irradiation of the whole, cranial 50%, and/or the caudal 50% of the parotid glands of Wistar rats was performed using 150-MeV protons. To determine suitable (i.

The impact of heart irradiation on dose-volume effects in the rat lung.

Purpose: To test the hypothesis that heart irradiation increases the risk of a symptomatic radiation-induced loss of lung function (SRILF) and that this can be well-described as a modulation of the functional reserve of the lung.

Methods And Materials: Rats were irradiated with 150-MeV protons. Dose-response curves were obtained for a significant increase in breathing frequency after irradiation of 100%, 75%, 50%, or 25% of the total lung volume, either including or excluding the heart from the irradiation field.

Influence of adjacent low-dose fields on tolerance to high doses of protons in rat cervical spinal cord.

Purpose: The dose-response relationship for a relatively short length (4 mm) of rat spinal cord has been shown to be significantly modified by adjacent low-dose fields. In an additional series of experiments, we have now established the dose-volume dependence of this effect.

Methods And Materials: Wistar rats were irradiated on the cervical spinal cord with single doses of unmodulated protons (150 MeV) to obtain sharp lateral penumbras, by use of the shoot-through technique, which employs the plateau of the depth-dose profile rather than the Bragg peak.

Radiation damage to the heart enhances early radiation-induced lung function loss.

In many thoracic cancers, the radiation dose that can safely be delivered to the target volume is limited by the tolerance dose of the surrounding lung tissue. It has been hypothesized that irradiation of the heart may be an additional risk factor for the development of early radiation-induced lung morbidity. In the current study, the dependence of lung tolerance dose on heart irradiation is determined.

Data on dose-volume effects in the rat spinal cord do not support existing NTCP models.

Purpose: To evaluate several existing dose-volume effect models for their ability to describe the occurrence of white matter necrosis in rat spinal cord after irradiation with small proton beams.

Methods And Materials: A large number of dose-volume effect models has been fitted to data on the occurrence of white matter necrosis after irradiation with small proton beams. The fitting was done with the maximum likelihood method.

Regional differences in radiosensitivity across the rat cervical spinal cord.

Purpose: To study regional differences in radiosensitivity within the rat cervical spinal cord.

Methods And Materials: Three types of inhomogeneous dose distributions were applied to compare the radiosensitivity of the lateral and central parts of the rat cervical spinal cord. The left lateral half of the spinal cord was irradiated with two grazing proton beams, each with a different penumbra (20-80% isodoses): lateral wide (penumbra = 1.

Unexpected changes of rat cervical spinal cord tolerance caused by inhomogeneous dose distributions.

Purpose: The effects of dose distribution on dose-effect relationships have been evaluated and, from this, iso-effective doses (ED(50)) established.

Methods And Materials: Wistar rats were irradiated on the cervical spinal cord with single doses of unmodulated protons (150 MeV) to obtain sharp lateral penumbras, using the shoot-through technique, which employs the plateau of the depth-dose profile rather than the Bragg peak. Two types of inhomogeneous dose distributions have been administered: (1) 2 4-mm fields with 8- or 12-mm spacing between the center of the fields (referred to as split-field) were irradiated with variable single doses and (2) cervical spinal cord was irradiated with various combinations of relatively low doses to a large volume (20 mm) combined with high doses to a small volume (4 mm) (referred to as bath and shower).

Dose-volume effects in the rat cervical spinal cord after proton irradiation.

Purpose: To estimate dose-volume effects in the rat cervical spinal cord with protons.

Methods And Materials: Wistar rats were irradiated on the cervical spinal cord with a single fraction of unmodulated protons (150-190 MeV) using the shoot through method, which employs the plateau of the depth-dose profile rather than the Bragg peak. Four different lengths of the spinal cord (2, 4, 8, and 20 mm) were irradiated with variable doses.