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Shoot-through layers in upright proton arcs unlock advantages in plan quality and range verification.

作者信息

Engwall Erik, Mikhalev Victor, Sundström Johan, Marthin Otte, Wase Viktor

机构信息

Research and Development, RaySearch Laboratories, Stockholm, Sweden.

出版信息

Med Phys. 2025 Sep;52(9):e18051. doi: 10.1002/mp.18051.


DOI:10.1002/mp.18051
PMID:40830045
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12364776/
Abstract

BACKGROUND: Upright proton therapy with compact delivery systems has the potential to reduce costs for treatments but could also lead to broadening of the beam penumbra due to energy selection close to the patient. PURPOSE: This study aims at combining upright static proton arcs with additional layers of shoot-through (ST) protons to sharpen the beam penumbra and improve plan quality for such systems. An additional advantage of the method is that it provides a straightforward approach for range verification with a fixed range detector opposite the fixed proton nozzle. METHODS: We examined various treatment plans for a virtual phantom: 3-beam IMPT, static arc (Arc) with/without ST (Arc+ST), and with/without collimation (+Coll). In the virtual phantom three different targets were utilized to study the effect on conformity index (CI), homogeneity index (HI), robustness and mean dose to the phantom volume. The phantom study was complemented with a head-and-neck (H&N) patient case with a similar set of plans. The delivery time for all plans was estimated using a combined model of the upright patient positioner and the proton nozzle. A range verification concept that determines residual ranges of the ST protons was studied in simulated scenarios for the H&N case. RESULTS: In the phantom study, the Arc+ST plans show superior CI, HI and target robustness compared to the Arc+Coll plans. For the Arc plans without ST, the collimated plans perform better than the uncollimated plans. On the other hand, for Arc+ST, collimation has little impact on CI, HI and robustness. However, a small increase in the mean dose to the phantom volume is seen without collimation. For the H&N case, similar improvements for Arc+ST can be seen with only a marginal increase of the mean dose to the patient volume when no collimation is used. These results imply that no aperture is needed when combining arcs with ST, which in turn substantially reduces treatment times: for the H&N case the delivery time for Arc+ST is estimated to 5.4 min and for Arc+Coll to 6.5 min. The range verification simulation shows that the method is sensitive to detect systematic stopping power ratio errors, setup errors and changes in the patient anatomy. CONCLUSIONS: Combining proton arcs and ST layers can enhance compact upright proton solutions by improving plan quality at the same time as delivery time is reduced. The concept is also tailored for the inclusion of a fast and straightforward residual range verification method.

摘要
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/16be/12364776/6d3bea206a8c/MP-52-0-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/16be/12364776/121880558150/MP-52-0-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/16be/12364776/236393152447/MP-52-0-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/16be/12364776/ab113a6c44aa/MP-52-0-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/16be/12364776/bae8eeecc334/MP-52-0-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/16be/12364776/6d3bea206a8c/MP-52-0-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/16be/12364776/121880558150/MP-52-0-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/16be/12364776/236393152447/MP-52-0-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/16be/12364776/ab113a6c44aa/MP-52-0-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/16be/12364776/bae8eeecc334/MP-52-0-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/16be/12364776/6d3bea206a8c/MP-52-0-g002.jpg

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本文引用的文献

[1]
Early generation dynamic and static proton arc treatment planning algorithms assessment in oropharyngeal cancer patients.

Med Phys. 2025-7

[2]
Potential toxicity benefit and inter-fraction robustness of proton arc therapy compared to IMPT and VMAT for nasopharyngeal cancer patients.

Phys Med Biol. 2025-4-25

[3]
Static proton arc therapy: Comprehensive plan quality evaluation and first clinical treatments in patients with complex head and neck targets.

Med Phys. 2025-5

[4]
Commissioning of a novel gantry-less proton therapy system.

Front Oncol. 2024-11-7

[5]
Particle arc therapy: Status and potential.

Radiother Oncol. 2024-10

[6]
Reducing the lateral dose penumbra in IMPT by incorporating transmission pencil beams.

Radiother Oncol. 2024-9

[7]
Dosimetric evaluation of dose shaping by adaptive aperture and its impact on plan quality.

Med Dosim. 2024

[8]
Treatment planning of scanned proton beams in RayStation.

Med Dosim. 2024

[9]
Treatment planning comparison for head and neck cancer between photon, proton, and combined proton-photon therapy - From a fixed beam line to an arc.

Radiother Oncol. 2024-1

[10]
Partitioning of discrete proton arcs into interlaced subplans can bring proton arc advances to existing proton facilities.

Med Phys. 2023-9

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