AAPM Task Group Report 290: Respiratory motion management for particle therapy.

Dose uncertainty induced by respiratory motion remains a major concern for treating thoracic and abdominal lesions using particle beams. This Task Group report reviews the impact of tumor motion and dosimetric considerations in particle radiotherapy, current motion-management techniques, and limitations for different particle-beam delivery modes (i.e.

One-Year Efficacy and Safety of Proton-Beam Irradiation Combined with Intravitreal Conbercept for Refractory or Recurrent Polypoidal Choroidal Vasculopathy: A Pilot Study.

Introduction: To investigate the efficacy and safety of proton-beam irradiation (PBI) combined with intravitreal conbercept (IVC) injection for refractory or recurrent polypoidal choroidal vasculopathy (PCV).

Methods: A prospective interventional clinical trial included 12 patients with refractory PCV (defined as persistent exudation or fluid after six consecutive injections at monthly intervals and/or photodynamic therapy) or recurrent PCV (defined as new exudative signs after six monthly injections and/or photodynamic therapy) treated between January 2019 and September 2020. Every patient underwent single PBI (14 GyE) with concomitant IVC (0.

Technical Note: A simple and fast daily quality assurance solution for modulated scanning proton and carbon ion beams.

Purpose: A typical ion beam treatment facility has multiple treatment rooms and may treat with more than one ion species, thus requiring a significant quality assurance (QA) effort. The goal of this work was to perform daily QA using a single irradiation per ion species to obtain the beam dosimetry parameters of dose per monitor unit (D/MU), range, and spot position. The X-ray alignment system should also be checked and the entire procedure performed by therapists.

Automatic phase space generation for Monte Carlo calculations of intensity modulated particle therapy.

Monte Carlo (MC) is generally considered as the most accurate dose calculation tool for particle therapy. However, a proper description of the beam particle kinematics is a necessary input for a realistic simulation. Such a description can be stored in phase space (PS) files for different beam energies.

Clinical commissioning of intensity-modulated proton therapy systems: Report of AAPM Task Group 185.

Proton therapy is an expanding radiotherapy modality in the United States and worldwide. With the number of proton therapy centers treating patients increasing, so does the need for consistent, high-quality clinical commissioning practices. Clinical commissioning encompasses the entire proton therapy system's multiple components, including the treatment delivery system, the patient positioning system, and the image-guided radiotherapy components.

Scanned Proton Beam Performance and Calibration of the Shanghai Advanced Proton Therapy Facility.

The Shanghai Advanced Proton Therapy facility (SAPT) is a hospital-based facility that began construction in December of 2014 with commissioning of the first scanned proton beam line starting in October of 2017. Proton beams are extracted from a synchrotron accelerator with energies between 70 and 235 MeV. Beam delivery uses the modulated scanning and energy stacking techniques to produce a maximal scanning area of 40 × 30 cm at the iso-center.

A track repeating algorithm for intensity modulated carbon ion therapy.

The fast dose calculator (FDC), a track repeating Monte Carlo (MC) algorithm was initially developed for proton therapy. The validation for proton therapy has been demonstrated in a previous work. In this work we presented the extension of FDC to the calculation of dose distributions for ions, particularly for carbon.

New horizons in particle therapy systems.

Particle therapy is rapidly expanding and claiming its position as the treatment modality of choice in teletherapy. However, the rate of expansion continues to be restricted by the size and cost of the associated particle therapy systems and their operation. Additional technical limitations such as dose delivery rate, treatment process efficiency, and achievement of superior dose conformity potentially hinder the complete fulfillment of the promise of particle therapy.

Analysis of ion beam teletherapy patient-specific quality assurance.

The objective of this study was to evaluate the procedures for patient-specific quality assurance measurements using modulated scanned and energy stacked beams for proton and carbon ion teletherapy. Delivery records from 1734 portal measurements were analyzed using a 3-point pass criteria: more than 22 of 24 chambers in a water phantom (WP) had to have a measured dose difference from the planned portal doses less than or equal to 3%, or the distance from the measurement point location to a point location in the plan having the same dose had to be less than or equal to 3 mm (distance to agreement [DTA]), and the mean dose deviation of all chambers had to be less than 3%. Stratification of results showed some associations between measurement parameters and pass rates.

Technical Note: Spot characteristic stability for proton pencil beam scanning.

Purpose: The spot characteristics for proton pencil beam scanning (PBS) were measured and analyzed over a 16 month period, which included one major site configuration update and six cyclotron interventions. The results provide a reference to establish the quality assurance (QA) frequency and tolerance for proton pencil beam scanning.

Methods: A simple treatment plan was generated to produce an asymmetric 9-spot pattern distributed throughout a field of 16 × 18 cm for each of 18 proton energies (100.

Comparison of x ray computed tomography number to proton relative linear stopping power conversion functions using a standard phantom.

Purpose: Adequate evaluation of the results from multi-institutional trials involving light ion beam treatments requires consideration of the planning margins applied to both targets and organs at risk. A major uncertainty that affects the size of these margins is the conversion of x ray computed tomography numbers (XCTNs) to relative linear stopping powers (RLSPs). Various facilities engaged in multi-institutional clinical trials involving proton beams have been applying significantly different margins in their patient planning.

Use of proton beams with breast prostheses and tissue expanders.

Since the early 2000s, a small but rapidly increasing number of patients with breast cancer have been treated with proton beams. Some of these patients have had breast prostheses or tissue expanders in place during their courses of treatment. Procedures must be implemented to plan the treatments of these patients.

Independent dose per monitor unit review of eight U.S.A. proton treatment facilities.

Purpose: Compare the dose per monitor unit at different proton treatment facilities using three different dosimetry methods.

Methods: Measurements of dose per monitor unit were performed by a single group at eight facilities using 11 test beams and up to six different clinical portal treatment sites. These measurements were compared to the facility reported dose per monitor unit values.

MO-D-BRB-03: Comparison of Proton Therapy Institutional Data Collected by the RPC.

Purpose: To detail and compare data collected during RPC onsite dosimetry review visits at proton therapy centers.

Methods: The RPC has established a complete review process for proton therapy institutions wishing to participate in NCI-funded clinical trials that includes an on-site dosimetry review visit performed by the RPC. During the visit, the RPC takes measurements that include CT# vs.

MO-D-BRB-04: The Approval Process for the Use of Proton Therapy in NCI-Sponsored Clinical Trials.

Purpose: To describe the approval process for the use of proton therapy in NCI- sponsored clinical trials.

Methods: The RPC has developed a comprehensive system for the approval of proton therapy centers for participation in clinical trials. The approval process includes: 1) completion of the proton facility questionnaire, 2) participation in the RPC's annual TLD remote audit program, 3) electronic submission of treatment planning data to the Image-Guided Therapy Center (ITC), and 4) successful completion of an on-site dosimetry review visit, including the irradiation of two of the RPC's anthropomorphic proton phantoms (prostate and spine).

Factors for converting dose measured in polystyrene phantoms to dose reported in water phantoms for incident proton beams.

Purpose: Previous dosimetry protocols allowed calibrations of proton beamline dose monitors to be performed in plastic phantoms. Nevertheless, dose determinations were referenced to absorbed dose-to-muscle or absorbed dose-to-water. The IAEA Code of Practice TRS 398 recommended that dose calibrations be performed with ionization chambers only in water phantoms because plastic-to-water dose conversion factors were not available with sufficient accuracy at the time of its writing.

Ion stopping powers and CT numbers.

One of the advantages of ion beam therapy is the steep dose gradient produced near the ion's range. Use of this advantage makes knowledge of the stopping powers for all materials through which the beam passes critical. Most treatment planning systems calculate dose distributions using depth dose data measured in water and an algorithm that converts the kilovoltage X-ray computed tomography (CT) number of a given material to its linear stopping power relative to water.

Dose response of CaF2:Tm to charged particles of different LET.

Thermoluminescent dosimeters are well established for performing calibrations in radiotherapy and for monitoring dose to personnel exposed to low linear energy transfer (LET) ionizing radiation. Patients undergoing light ion therapy and astronauts engaged in space flight are, however, exposed to radiation fields consisting of a mix of low- and high-LET charged particles. In this study, glow curves from CaF2:Tm chips were examined after exposure to various electron and ion beams.

Energy spectrum control for modulated proton beams.

In proton therapy delivered with range modulated beams, the energy spectrum of protons entering the delivery nozzle can affect the dose uniformity within the target region and the dose gradient around its periphery. For a cyclotron with a fixed extraction energy, a rangeshifter is used to change the energy but this produces increasing energy spreads for decreasing energies. This study investigated the magnitude of the effects of different energy spreads on dose uniformity and distal edge dose gradient and determined the limits for controlling the incident spectrum.

Range and modulation dependencies for proton beam dose per monitor unit calculations.

Calculations of dose per monitor unit (D/MU) are required in addition to measurements to increase patient safety in the clinical practice of proton radiotherapy. As in conventional photon and electron therapy, the D/MU depends on several factors. This study focused on obtaining range and modulation dependence factors used in D/MU calculations for the double scattered proton beam line at the Midwest Proton Radiotherapy Institute.

Spill-to-spill and daily proton energy consistency with a new accelerator control system.

The Loma Linda University proton accelerator has had several upgrades installed including synchrotron dipole power supplies and a system for monitoring the beam energy. The consistency of the energy from spill-to-spill has been tested by measuring the depth ionization at the distal edge as a function of time. These measurements were made with a minimally equipped beamline to reduce interference from confounding factors.

EDR-2 film response to charged particles.

A useful tool for verifying segmental or dynamic treatments with multiple multi-leaf collimator positions, spinning range modulator propellors or magnetically scanned beams would be a film with a linear dose response up to several hundred centiGray, as typical for delivered treatments. Kodak has released an extended range film (EDR-2) that may satisfy this desire. In this study, dose response curves were obtained for several electron, proton, carbon ion and iron ion beams of different energies to determine the utility of this film.

Leakage and scatter radiation from a double scattering based proton beamline.

Proton beams offer several advantages over conventional radiation techniques for treating cancer and other diseases. These advantages might be negated if the leakage and scatter radiation from the beamline and patient are too large. Although the leakage and scatter radiation for the double scattering proton beamlines at the Loma Linda University Proton Treatment Facility were measured during the acceptance testing that occurred in the early 1990s, recent discussions in the radiotherapy community have prompted a reinvestigation of this contribution to the dose equivalent a patient receives.

Calibration of a proton beam energy monitor.

Delivery of therapeutic proton beams requires an absolute energy accuracy of +/-0.64 to 0.27 MeV for patch fields and a relative energy accuracy of +/-0.

Generation and characterization of a proton microbeam for experimental radiosurgery.

A proton microbeam has been developed to support various research endeavors. Test subjects may be irradiated from any angle with respect to the vertical because the beamline is contained within a rotating gantry used for human patients. Converting from the treatment to experimental arrangement is quick and straightforward as is the reverse.