Defining the role of intensity modulation in electron conformal therapy for the treatment of head and neck cancer.

Bolus electron conformal therapy (BECT) in the treatment of cancers of the head and neck is often limited by an inability to reduce dosimetric hot spots resulting from surface irregularity or tissue heterogeneity. We examined the potential benefits of using intensity modulation for electron therapy (IM-BECT) to reduce hotspots in patients undergoing electron beam therapy for superficial cancers of the head and neck (HN). Twenty patients with HN cancer previously treated with BECT were identified.

Advancing the Role of Proton Therapy for Spine Metastases Through Diagnostic Scan-Based Planning.

Purpose: Many patients with metastatic cancer live years beyond diagnosis, and there remains a need to improve the therapeutic ratio of metastasis-directed radiation for these patients. This study aimed to assess a process for delivering cost-effective palliative proton therapy to the spine using diagnostic scan-based planning (DSBP) and prefabricated treatment delivery devices.

Materials And Methods: We designed and characterized a reusable proton aperture system that adjusts to multiple lengths for spine treatment.

Evaluating Carbon Footprint of Proton Therapy Based on Power Consumption and Possible Mitigation Strategies.

Purpose: There is increasing concern about rising carbon dioxide (CO) emissions and their hazardous effect on human health. This study quantifies the energy utilization of proton therapy, assesses the corresponding carbon footprint, and discusses possible offsetting strategies toward carbon-neutral health care operations.

Methods And Materials: Patients treated between July 2020 and June 2021 using the Mevion proton system were evaluated.

Operational Performance of a Compact Proton Therapy System: A 5-Year Experience.

Purpose: We present an analysis of various operational metrics for a novel compact proton therapy system, including clinical case mix, subsystems utilization, and quality assurance trends in beam delivery parameters over a period of 5 years.

Materials And Methods: Patient-specific data from a total of 850 patients (25,567 fractions) have been collected and analyzed. The patient mix include a variety of simple, intermediate, and complex cases.

Dosimetric Comparison of Various Spot Placement Techniques in Proton Pencil Beam Scanning.

Purpose: To present quantitative dosimetric evaluations of five proton pencil beam spot placement techniques.

Materials And Methods: The spot placement techniques that were investigated include two grid-based (rectilinear grid and hexagonal grid, both commonly available in commercial planning systems) and three boundary-contoured (concentric contours, hybrid, and optimized) techniques. Treatment plans were created for two different target volumes, one spherical and one conical.

Evaluation of cine imaging during multileaf collimator and gantry motion for real-time magnetic resonance guided radiation therapy.

Purpose: Real-time magnetic resonance guided radiation therapy (MRgRT) uses 2D cine imaging for target tracking. This work evaluates the percent image uniformity (PIU) and spatial integrity of cine images in the presence of multileaf collimator (MLC) and gantry motion in order to simulate sliding window and volumetric modulated arc therapy (VMAT) conditions.

Methods: Percent image uniformity and spatial integrity of cine images were measured (1) during MLC motion, (2) as a function of static gantry position, and (3) during gantry rotation.

Effect of Proposed Episode-Based Payment Models on Advanced Radiotherapy Procedures.

Purpose: An episode-based payment model, the Radiation Oncology Alternative Payment Model (RO-APM), has been proposed for Medicare reimbursement of radiation services provided to oncology patients. RO-APM may have significant impact on reimbursement for specific patient populations.

Methods: This investigation compares historical fee-for-service technical reimbursement estimates at a large hospital-based system to the RO-APM for advanced radiotherapy treatment of specific cancer types.

An optimized approach for robust spot placement in proton pencil beam scanning.

Maintaining a sharp lateral dose falloff in pencil beam scanning (PBS) proton therapy is crucial for sparing organs at risk (OARs), especially when they are in close proximity to the target volume. The most common approach to improve lateral dose falloff is through the use of physical beam shaping devices, such as brass apertures or collimator based systems. A recently proposed approach focuses on proton beam spot placements, moving away from traditional grid-based placements to concentric-contours based schemes.

Commissioning an in-room mobile CT for adaptive proton therapy with a compact proton system.

Purpose: To describe the commissioning of AIRO mobile CT system (AIRO) for adaptive proton therapy on a compact double scattering proton therapy system.

Methods: A Gammex phantom was scanned with varying plug patterns, table heights, and mAs on a CT simulator (CT Sim) and on the AIRO. AIRO-specific CT-stopping power ratio (SPR) curves were created with a commonly used stoichiometric method using the Gammex phantom.

Effectiveness of base-of-skull immobilization system in a compact proton therapy setting.

Purpose: The purpose of this study was to investigate daily repositioning accuracy by analyzing inter- and intra-fractional uncertainties associated with patients treated for intracranial or base of skull tumors in a compact proton therapy system with 6 degrees of freedom (DOF) robotic couch and a thermoplastic head mask indexed to a base of skull (BoS) frame.

Materials And Methods: Daily orthogonal kV alignment images at setup position before and after daily treatments were analyzed for 33 patients. The system was composed of a new type of thermoplastic mask, a bite block, and carbon-fiber BoS couch-top insert specifically designed for proton therapy treatments.

The Mobius AIRO mobile CT for image-guided proton therapy: Characterization & commissioning.

Purpose: The purpose of this study was to characterize the Mobius AIRO Mobile CT System for localization and image-guided proton therapy. This is the first known application of the AIRO for proton therapy.

Methods: Five CT images of a Catphan 504 phantom were acquired on the AIRO Mobile CT System, Varian EDGE radiosurgery system cone beam CT (CBCT), Philips Brilliance Big Bore 16 slice CT simulator, and Siemens SOMATOM Definition AS 20 slice CT simulator.

An end-to-end assessment of range uncertainty in proton therapy using animal tissues.

Accurate assessment of range uncertainty is critical in proton therapy. However, there is a lack of data and consensus on how to evaluate the appropriate amount of uncertainty. The purpose of this study is to quantify the range uncertainty in various treatment conditions in proton therapy, using transmission measurements through various animal tissues.

Utilization of optical tracking to assess efficacy of intracranial immobilization techniques in proton therapy.

We present a quantitative methodology to measure head interfraction movements within intracranial masks of commercial immobilization devices used for proton radiotherapy. A three-points tracking (3PtTrack) method was developed to measure the mask location for each treatment field over an average of 10 fractions for seven patients. Five patients were treated in supine with the Qfix Base-of-Skull (BoS) headframe, and two patients were treated in prone with the CIVCO Uni-frame baseplate.

Utilization of optical tracking to validate a software-driven isocentric approach to robotic couch movements for proton radiotherapy.

Purpose: An optical tracking and positioning system (OTPS) was developed to validate the software-driven isocentric (SDI) approach to control the six-degrees-of-freedom movement of a robotic couch.

Methods: The SDI approach to movements rotating around a predefined isocenter, referred to as a GeoIso, instead of a mechanical pivot point was developed by the robot automation industry. With robotic couch-sag corrections for weight load in a traditional SDI approach, movements could be accurately executed for a GeoIso located within a 500 mm cubic volume on the couch for treatments.

Dosimetric study of uniform scanning proton therapy planning for prostate cancer patients with a metal hip prosthesis, and comparison with volumetric-modulated arc therapy.

The main purposes of this study were to 1) investigate the dosimetric quality of uniform scanning proton therapy planning (USPT) for prostate cancer patients with a metal hip prosthesis, and 2) compare the dosimetric results of USPT with that of volumetric-modulated arc therapy (VMAT). Proton plans for prostate cancer (four cases) were generated in XiO treatment planning system (TPS). The beam arrangement in each proton plan consisted of three fields (two oblique fields and one lateral or slightly angled field), and the proton beams passing through a metal hip prosthesis was avoided.

Measurements of lateral penumbra for uniform scanning proton beams under various beam delivery conditions and comparison to the XiO treatment planning system.

Purpose: The main purposes of this study were to (1) investigate the dependency of lateral penumbra (80%-20% distance) of uniform scanning proton beams on various factors such as air gap, proton range, modulation width, compensator thickness, and depth, and (2) compare the lateral penumbra calculated by a treatment planning system (TPS) with measurements.

Methods: First, lateral penumbra was measured using solid-water phantom and radiographic films for (a) air gap, ranged from 0 to 35 cm, (b) proton range, ranged from 8 to 30 cm, (c) modulation, ranged from 2 to 10 cm, (d) compensator thickness, ranged from 0 to 20 cm, and (e) depth, ranged from 7 to 15 cm. Second, dose calculations were computed in a virtual water phantom using the XiO TPS with pencil beam algorithm for identical beam conditions and geometrical configurations that were used for the measurements.

Image-guided method for TLD-based in vivo rectal dose verification with endorectal balloon in proton therapy for prostate cancer.

Purpose: To present a practical image-guided method to position an endorectal balloon that improves in vivo thermoluminiscent dosimeter (TLD) measurements of rectal doses in proton therapy for prostate cancer.

Methods: TLDs were combined with endorectal balloons to measure dose at the anterior rectal wall during daily proton treatment delivery. Radiopaque metallic markers were employed as surrogates for balloon position reproducibility in rotation and translation.

A novel daily QA system for proton therapy.

We describe the design and use of a daily quality assurance (QA) system for proton therapy. The QA system is designed to check the overall readiness of proton therapy system consistently within certain reference tolerances by a home-made QA device (the QA device). The QA device is comprised of a commercially available QA device, rf-Daily QA 3, a home-made acrylic phantom, a set of acrylic compensators with various thicknesses, and a mechanical indexing jig.

Measurements of neutron dose equivalent for a proton therapy center using uniform scanning proton beams.

Purpose: Neutron exposure is of concern in proton therapy, and varies with beam delivery technique, nozzle design, and treatment conditions. Uniform scanning is an emerging treatment technique in proton therapy, but neutron exposure for this technique has not been fully studied. The purpose of this study is to investigate the neutron dose equivalent per therapeutic dose, H/D, under various treatment conditions for uniform scanning beams employed at our proton therapy center.

An experimental investigation into the effect of periodic motion on proton dosimetry using polymer gel dosimeters and a programmable motion platform.

Organ motion in proton therapy affects treatment dose distribution during both double-scattering (DS) and uniform-scanning (US) deliveries. We investigated the dosimetric impact of target motion using three-dimensional polymer gel dosimeters and a programmable motion platform. A simple one-beam treatment plan with 16 cm range and 6 cm modulation was generated from the treatment planning system (TPS) in both the DS and US modes.

Spatial correlation of proton irradiation-induced activity and dose in polymer gel phantoms for PET/CT delivery verification studies.

Purpose: This work demonstrates a novel application of BANG3-Pro2 polymer gel dosimeter as a dosimetric phantom able to accurately capture both dose and induced activity.

Methods: BANG3-Pro2 dosimeters were irradiated with a clinical proton beam using an unmodulated beam and a spread-out Bragg peak (SOBP) modulation, the latter with a Lucite compensator to introduce a range offset in one quadrant of the circular field. The dosimeters were imaged in a nearby positron emission tomography/computed tomography (PET/CT) unit starting within 5 min of beam-off.

Commissioning of output factors for uniform scanning proton beams.

Purpose: Current commercial treatment planning systems are not able to accurately predict output factors and calculate monitor units for proton fields. Patient-specific field output factors are thus determined by either measurements or empirical modeling based on commissioning data. The objective of this study is to commission output factors for uniform scanning beams utilized at the ProCure proton therapy centers.

Image-guided bolus electron conformal therapy - a case study.

We report on our initial experience with daily image guidance for the treatment of a patient with a basal cell carcinoma of the nasal dorsum using bolus electron conformal therapy. We describe our approach to daily alignment using treatment machine-integrated megavoltage (MV) planar imaging in conjunction with cone beam CT (CBCT) volumetric imaging to ensure the best possible setup reproducibility. Based on MV imaging, beam aperture misalignment with the intended treatment region was as large as 0.

A comparison of soft-tissue implanted markers and bony anatomy alignments for image-guided treatments of head-and-neck cancers.

Purpose: To compare the geometric alignments of soft-tissue implanted markers to the traditional bony-based alignments in head-and-neck cancers, on the basis of daily image guidance. Dosimetric impact of the two alignment techniques on target coverage is presented.

Methods And Materials: A total of 330 retrospective alignments (5 patients) were performed on daily megavoltage computed tomography (MVCT) image sets using both alignment techniques.

Megavoltage computed tomography image-based low-dose rate intracavitary brachytherapy planning for cervical carcinoma.

Initial results of megavoltage computed tomography (MVCT) brachytherapy treatment planning are presented, using a commercially available helical tomotherapy treatment unit and standard low dose rate (LDR) brachytherapy applicators used for treatment of cervical carcinoma. The accuracy of MVCT imaging techniques, and dosimetric accuracy of the CT based plans were tested with in-house and commercially-available phantoms. Three dimensional (3D) dose distributions were computed and compared to the two dimensional (2D) dosimetry results.