Building a precise machine-specific time structure of the spot and energy delivery model for a cyclotron-based proton therapy system

Objective: We proposed an experimental approach to build a precise machine-specific beam delivery time (BDT) prediction and delivery sequence model for standard, volumetric, and layer repainting delivery based on a cyclotron accelerator system. Approach Test fields and clinical treatment plans’ log files were used to experimentally derive three main beam delivery parameters that impacted BDT: energy layer switching time (ELST), spot switching time (SSWT), and spot drill time (SDT). This derived machine-specific model includes standard, volumetric, and layer repainting delivery sequences. A total of 103 clinical treatment fields were used to validate the model. Main results: The study found that ELST is not stochastic in this specific machine. Instead, it is actually the data transmission time or energy selection time, whichever takes longer. The validation showed that the accuracy of each component of the BDT matches well between machine log files and the model’s prediction. The average total BDT was about (-0.74±3.33)% difference compared to the actual treatment log files, which is improved from the current commercial proton therapy system’s prediction (67.22%±26.19%). Significance: An accurate BDT prediction and delivery sequence model was established for an cyclotron-based proton therapy system IBA ProteusPLUS®. Most institutions could adopt this method to build a machine-specific model for their own proton system.

Future Developments in Charged Particle Therapy: Improving Beam Delivery for Efficiency and Efficacy

The physical and clinical benefits of charged particle therapy (CPT) are well recognized. However, the availability of CPT and complete exploitation of dosimetric advantages are still limited by high facility costs and technological challenges. There are extensive ongoing efforts to improve upon these, which will lead to greater accessibility, superior delivery, and therefore better treatment outcomes. Yet, the issue of cost remains a primary hurdle as utility of CPT is largely driven by the affordability, complexity and performance of current technology. Modern delivery techniques are necessary but limited by extended treatment times. Several of these aspects can be addressed by developments in the beam delivery system (BDS) which determines the overall shaping and timing capabilities enabling high quality treatments. The energy layer switching time (ELST) is a limiting constraint of the BDS and a determinant of the beam delivery time (BDT), along with the accelerator and other factors. This review evaluates the delivery process in detail, presenting the limitations and developments for the BDS and related accelerator technology, toward decreasing the BDT. As extended BDT impacts motion and has dosimetric implications for treatment, we discuss avenues to minimize the ELST and overview the clinical benefits and feasibility of a large energy acceptance BDS. These developments support the possibility of advanced modalities and faster delivery for a greater range of treatment indications which could also further reduce costs. Further work to realize methodologies such as volumetric rescanning, FLASH, arc, multi-ion and online image guided therapies are discussed. In this review we examine how increased treatment efficiency and efficacy could be achieved with improvements in beam delivery and how this could lead to faster and higher quality treatments for the future of CPT.

Redesigning the Jefferson Lab Hall A beam line for high precision parity experiments

The Continuous Electron Beam Accelerator Facility (CEBAF) was built with a thermionic electron source and the three original experimental hall lines reflected this. A few years after beam delivery began a parity violation experiment was approved and two polarimeters were installed in the Hall A beam line. The beam raster system was placed after the new Compton polarimeter, before one accelerator quadrupole and four quadrupoles in the new Moller polarimeter. It was very difficult to meet experimental requirements on envelope functions and raster shape with this arrangement so a sixth quadrupole was installed downstream of the Moller polarimeter to provide an additional degree of freedome. All of the parity experiments in Hall A have been run with this still-unsatisfactory configuration. The MOLLER experiment is predicated on achieving a 2% error on a 32 ppb asymmetry. Beam line changes are required to meet the systematic error budget. This paper documents the existing beam line, an interim change which can be accomplished during a annual maintenance down, and the final configuration for MOLLER and subsequent experiments.

Proton therapy facilities: an overview of the development in recent years

Since its discovery in 1946, Proton therapy has continued to overgrow from the number of units installed in various countries and the technology used. This paper aims to provide an overview of the development of proton therapy facilities to date based on a literature review. The results are discussed in several aspects, including its distribution across the globe, beam delivery techniques, dose verification, room layout, and shielding design considerations.

Verification of an optimizer algorithm by the beam delivery evaluation of intensity-modulated arc therapy plans

Background In the case of dynamic radiotherapy plans, the fractionation schemes can have dosimetric effects. Our goal was to define the effect of the fraction dose on the plan quality and the beam delivery. Materials and methods Treatment plans were created for 5 early-stage lung cancer patients with different dose schedules. The planned total dose was 60 Gy, fraction dose was 2 Gy, 3 Gy, 5 Gy, 12 Gy and 20 Gy. Additionally renormalized plans were created by changing the prescribed fraction dose after optimization. The dosimetric parameters and the beam delivery parameters were collected to define the plan quality and the complexity of the treatment plans. The accuracy of dose delivery was verified with dose measurements using electronic portal imaging device (EPID). Results The plan quality was independent from the used fractionation scheme. The fraction dose could be changed safely after the optimization, the delivery accuracy of the treatment plans with changed prescribed dose was not lower. According to EPID based measurements, the high fraction dose and dose rate caused the saturation of the detector, which lowered the gamma passing rate. The aperture complexity score, the gantry speed and the dose rate changes were not predicting factors for the gamma passing rate values. Conclusions The plan quality and the delivery accuracy are independent from the fraction dose, moreover the fraction dose can be changed safely after the dose optimization. The saturation effect of the EPID has to be considered when the action limits of the quality assurance system are defined.

A new DOSXYZnrc method for Monte Carlo simulations of 4D dose distributions

The purpose of this study is to present a novel method for generating Monte Carlo 4D dose distributions in a single DOSXYZnrc simulation. During a standard simulation, individual energy deposition events are summed up to generate a 3D dose distribution and their associated temporal information is discarded. This means that in order to determine dose distributions as a function of time, separate simulations would have to be run for each interval of interest. Consequently, it has not been clinically feasible until now to routinely perform Monte Carlo simulations of dose rate, time-resolved dose accumulation, or EPID cine-mode images for VMAT plans. To overcome this limitation, we modified DOSXYZnrc and defined new input and output variables that allow a time-like parameter associated with each particle history to be binned in a user-defined manner. Under the new code version, computation times are the same as for a standard simulation, and the time-integrated 4D dose is identical to the standard 3D dose. We present a comparison of scintillator measurements and Monte Carlo simulations for dose rate during a VMAT beam delivery, a study of dose rate in a VMAT Total Body Irradiation plan, and simulations of transit (through-patient) EPID cine-mode images.

A 3D RANGE MODULATOR FOR ULTRA-SHORT PROTON FLASH IRRADIATION

Background and aims In the pursuit of optimal parameters for FLASH irradiation, all components involved in the beam delivery should be compatible with requirements spread in an extreme and wide unexplored regime. Aiming for minimal total irradiation times with modulated proton beams, which deliver a flat depth-dose distribution along tumors, a static range modulator has been developed to accommodate ultra-short beam durations regardless of their time structure. The design goals were set to match the functionality of the rotating wheel used for in-vivo and in-vitro FLASH investigations at HZB. Methods Having the form of a ridge filter extended to an additional dimension, a hexagonal-pyramid pattern was configured to an incoming beam of 23 MeV energy with > 1 mm radius, in order to create a 6 mm uniform field with a flat dose range of 5 mm at the target. The manufacturing was done with a 3D printer using VeroWhite, a material similar to PMMA. The lateral and distal dose distribution of both modulators were measured using a Markus Chamber (PTW-Freiburg, Germany) in a water phantom and a radioluminescent screen mounted in front of CCD camera, respectively. Results The developed modulator created very flat dose distributions as designed, with negligible differences to the reference rotating wheel. The positioning tolerances were evaluated as relatively relaxed, with offsets of 2 cm and an angle of 5 degrees not compromising the desired performance. Conclusions The developed static modulator allows systematic proton FLASH studies on small organs using a broad range of timing schemes, disentangled from temporal and spatial incoherencies.

Kilometre-scale, kilowatt average power, single-mode laser delivery through hollow core fibre: overcoming nonlinear limits of glass fibre

High power laser delivery with near-diffraction-limited beam quality, widely used in industry for precision manufacturing, is typically limited to tens of metres distances by nonlinearity-induced spectral broadening inside the glass-core delivery fibres. Anti-resonant hollow-core fibres offer not only orders-of-magnitude lower non-linearity, but also loss and modal purity comparable to conventional beam-delivery fibres. Using a single-mode hollow-core nested anti-resonant nodeless fibre (NANF) with 0.74-dB/km loss, we demonstrate delivery of 1 kW of near-diffraction-limited continuous wave laser light over an unprecedented 1-km distance, with a total throughput efficiency of ~80%. From simulations, more than one order of magnitude further improvement in transmitted power or length should be possible in such air-filled fibres, and considerably more if the core is evacuated. This paves the way to multi-kilometre, kW-scale power delivery – not only for future manufacturing and subsurface drilling, but also for new scientific possibilities in sensing, particle acceleration and gravitational wave detection.