Clinical Implementation of Proton Therapy Using Pencil-Beam Scanning Delivery Combined With Static Apertures
Proton therapy makes use of the favorable depth-dose distribution with its characteristic Bragg peak to spare normal tissue distal of the target volume. A steep dose gradient would be desired in lateral dimensions, too. The widespread spot scanning delivery technique is based, however, on pencil-bea...
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2021-05-01
|
| Series: | Frontiers in Oncology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2021.599018/full |
| _version_ | 1831687691117264896 |
|---|---|
| author | Christian Bäumer Christian Bäumer Christian Bäumer Christian Bäumer Sandija Plaude Sandija Plaude Dalia Ahmad Khalil Dalia Ahmad Khalil Dalia Ahmad Khalil Dirk Geismar Dirk Geismar Dirk Geismar Dirk Geismar Paul-Heinz Kramer Paul-Heinz Kramer Kevin Kröninger Christian Nitsch Jörg Wulff Jörg Wulff Beate Timmermann Beate Timmermann Beate Timmermann Beate Timmermann |
| author_facet | Christian Bäumer Christian Bäumer Christian Bäumer Christian Bäumer Sandija Plaude Sandija Plaude Dalia Ahmad Khalil Dalia Ahmad Khalil Dalia Ahmad Khalil Dirk Geismar Dirk Geismar Dirk Geismar Dirk Geismar Paul-Heinz Kramer Paul-Heinz Kramer Kevin Kröninger Christian Nitsch Jörg Wulff Jörg Wulff Beate Timmermann Beate Timmermann Beate Timmermann Beate Timmermann |
| author_sort | Christian Bäumer |
| collection | DOAJ |
| description | Proton therapy makes use of the favorable depth-dose distribution with its characteristic Bragg peak to spare normal tissue distal of the target volume. A steep dose gradient would be desired in lateral dimensions, too. The widespread spot scanning delivery technique is based, however, on pencil-beams with in-air spot full-widths-at-half-maximum of typically 1 cm or more. This hampers the sparing of organs-at-risk if small-scale structures adjacent to the target volume are concerned. The trimming of spot scanning fields with collimating apertures constitutes a simple measure to increase the transversal dose gradient. The current study describes the clinical implementation of brass apertures in conjunction with the pencil-beam scanning delivery mode at a horizontal, clinical treatment head based on commercial hardware and software components. Furthermore, clinical cases, which comprised craniopharyngiomas, re-irradiations and ocular tumors, were evaluated. The dosimetric benefits of 31 treatment plans using apertures were compared to the corresponding plans without aperture. Furthermore, an overview of the radiation protection aspects is given. Regarding the results, robust optimization considering range and setup uncertainties was combined with apertures. The treatment plan optimizations followed a single-field uniform dose or a restricted multi-field optimization approach. Robustness evaluation was expanded to account for possible deviations of the center of the pencil-beam delivery and the mechanical center of the aperture holder. Supplementary apertures improved the conformity index on average by 15.3%. The volume of the dose gradient surrounding the PTV (evaluated between 80 and 20% dose levels) was decreased on average by 17.6%. The mean dose of the hippocampi could be reduced on average by 2.9 GyRBE. In particular cases the apertures facilitated a sparing of an organ-at-risk, e.g. the eye lens or the brainstem. For six craniopharyngioma cases the inclusion of apertures led to a reduction of the mean dose of 1.5 GyRBE (13%) for the brain and 3.1 GyRBE (16%) for the hippocampi. |
| first_indexed | 2024-12-20T09:01:41Z |
| format | Article |
| id | doaj.art-9dce2fdfd8df47d2b8fbb4e7454f234a |
| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-12-20T09:01:41Z |
| publishDate | 2021-05-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj.art-9dce2fdfd8df47d2b8fbb4e7454f234a2022-12-21T19:45:50ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2021-05-011110.3389/fonc.2021.599018599018Clinical Implementation of Proton Therapy Using Pencil-Beam Scanning Delivery Combined With Static AperturesChristian Bäumer0Christian Bäumer1Christian Bäumer2Christian Bäumer3Sandija Plaude4Sandija Plaude5Dalia Ahmad Khalil6Dalia Ahmad Khalil7Dalia Ahmad Khalil8Dirk Geismar9Dirk Geismar10Dirk Geismar11Dirk Geismar12Paul-Heinz Kramer13Paul-Heinz Kramer14Kevin Kröninger15Christian Nitsch16Jörg Wulff17Jörg Wulff18Beate Timmermann19Beate Timmermann20Beate Timmermann21Beate Timmermann22West German Proton Therapy Centre Essen, Essen, GermanyWest German Cancer Center (WTZ), University Hospital Essen, Essen, GermanyGerman Cancer Consortium (DKTK), Heidelberg, GermanyFaculty of Physics, TU Dortmund University, Dortmund, GermanyWest German Proton Therapy Centre Essen, Essen, GermanyWest German Cancer Center (WTZ), University Hospital Essen, Essen, GermanyWest German Proton Therapy Centre Essen, Essen, GermanyWest German Cancer Center (WTZ), University Hospital Essen, Essen, GermanyDepartment of Particle Therapy, University Hospital Essen, Essen, GermanyWest German Proton Therapy Centre Essen, Essen, GermanyWest German Cancer Center (WTZ), University Hospital Essen, Essen, GermanyGerman Cancer Consortium (DKTK), Heidelberg, GermanyDepartment of Particle Therapy, University Hospital Essen, Essen, GermanyWest German Proton Therapy Centre Essen, Essen, GermanyWest German Cancer Center (WTZ), University Hospital Essen, Essen, GermanyFaculty of Physics, TU Dortmund University, Dortmund, GermanyFaculty of Physics, TU Dortmund University, Dortmund, GermanyWest German Proton Therapy Centre Essen, Essen, GermanyWest German Cancer Center (WTZ), University Hospital Essen, Essen, GermanyWest German Proton Therapy Centre Essen, Essen, GermanyWest German Cancer Center (WTZ), University Hospital Essen, Essen, GermanyGerman Cancer Consortium (DKTK), Heidelberg, GermanyDepartment of Particle Therapy, University Hospital Essen, Essen, GermanyProton therapy makes use of the favorable depth-dose distribution with its characteristic Bragg peak to spare normal tissue distal of the target volume. A steep dose gradient would be desired in lateral dimensions, too. The widespread spot scanning delivery technique is based, however, on pencil-beams with in-air spot full-widths-at-half-maximum of typically 1 cm or more. This hampers the sparing of organs-at-risk if small-scale structures adjacent to the target volume are concerned. The trimming of spot scanning fields with collimating apertures constitutes a simple measure to increase the transversal dose gradient. The current study describes the clinical implementation of brass apertures in conjunction with the pencil-beam scanning delivery mode at a horizontal, clinical treatment head based on commercial hardware and software components. Furthermore, clinical cases, which comprised craniopharyngiomas, re-irradiations and ocular tumors, were evaluated. The dosimetric benefits of 31 treatment plans using apertures were compared to the corresponding plans without aperture. Furthermore, an overview of the radiation protection aspects is given. Regarding the results, robust optimization considering range and setup uncertainties was combined with apertures. The treatment plan optimizations followed a single-field uniform dose or a restricted multi-field optimization approach. Robustness evaluation was expanded to account for possible deviations of the center of the pencil-beam delivery and the mechanical center of the aperture holder. Supplementary apertures improved the conformity index on average by 15.3%. The volume of the dose gradient surrounding the PTV (evaluated between 80 and 20% dose levels) was decreased on average by 17.6%. The mean dose of the hippocampi could be reduced on average by 2.9 GyRBE. In particular cases the apertures facilitated a sparing of an organ-at-risk, e.g. the eye lens or the brainstem. For six craniopharyngioma cases the inclusion of apertures led to a reduction of the mean dose of 1.5 GyRBE (13%) for the brain and 3.1 GyRBE (16%) for the hippocampi.https://www.frontiersin.org/articles/10.3389/fonc.2021.599018/fullproton therapypencil-beam scanningaperturequality assuranceradiation protectionbrain tumors |
| spellingShingle | Christian Bäumer Christian Bäumer Christian Bäumer Christian Bäumer Sandija Plaude Sandija Plaude Dalia Ahmad Khalil Dalia Ahmad Khalil Dalia Ahmad Khalil Dirk Geismar Dirk Geismar Dirk Geismar Dirk Geismar Paul-Heinz Kramer Paul-Heinz Kramer Kevin Kröninger Christian Nitsch Jörg Wulff Jörg Wulff Beate Timmermann Beate Timmermann Beate Timmermann Beate Timmermann Clinical Implementation of Proton Therapy Using Pencil-Beam Scanning Delivery Combined With Static Apertures Frontiers in Oncology proton therapy pencil-beam scanning aperture quality assurance radiation protection brain tumors |
| title | Clinical Implementation of Proton Therapy Using Pencil-Beam Scanning Delivery Combined With Static Apertures |
| title_full | Clinical Implementation of Proton Therapy Using Pencil-Beam Scanning Delivery Combined With Static Apertures |
| title_fullStr | Clinical Implementation of Proton Therapy Using Pencil-Beam Scanning Delivery Combined With Static Apertures |
| title_full_unstemmed | Clinical Implementation of Proton Therapy Using Pencil-Beam Scanning Delivery Combined With Static Apertures |
| title_short | Clinical Implementation of Proton Therapy Using Pencil-Beam Scanning Delivery Combined With Static Apertures |
| title_sort | clinical implementation of proton therapy using pencil beam scanning delivery combined with static apertures |
| topic | proton therapy pencil-beam scanning aperture quality assurance radiation protection brain tumors |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2021.599018/full |
| work_keys_str_mv | AT christianbaumer clinicalimplementationofprotontherapyusingpencilbeamscanningdeliverycombinedwithstaticapertures AT christianbaumer clinicalimplementationofprotontherapyusingpencilbeamscanningdeliverycombinedwithstaticapertures AT christianbaumer clinicalimplementationofprotontherapyusingpencilbeamscanningdeliverycombinedwithstaticapertures AT christianbaumer clinicalimplementationofprotontherapyusingpencilbeamscanningdeliverycombinedwithstaticapertures AT sandijaplaude clinicalimplementationofprotontherapyusingpencilbeamscanningdeliverycombinedwithstaticapertures AT sandijaplaude clinicalimplementationofprotontherapyusingpencilbeamscanningdeliverycombinedwithstaticapertures AT daliaahmadkhalil clinicalimplementationofprotontherapyusingpencilbeamscanningdeliverycombinedwithstaticapertures AT daliaahmadkhalil clinicalimplementationofprotontherapyusingpencilbeamscanningdeliverycombinedwithstaticapertures AT daliaahmadkhalil clinicalimplementationofprotontherapyusingpencilbeamscanningdeliverycombinedwithstaticapertures AT dirkgeismar clinicalimplementationofprotontherapyusingpencilbeamscanningdeliverycombinedwithstaticapertures AT dirkgeismar clinicalimplementationofprotontherapyusingpencilbeamscanningdeliverycombinedwithstaticapertures AT dirkgeismar clinicalimplementationofprotontherapyusingpencilbeamscanningdeliverycombinedwithstaticapertures AT dirkgeismar clinicalimplementationofprotontherapyusingpencilbeamscanningdeliverycombinedwithstaticapertures AT paulheinzkramer clinicalimplementationofprotontherapyusingpencilbeamscanningdeliverycombinedwithstaticapertures AT paulheinzkramer clinicalimplementationofprotontherapyusingpencilbeamscanningdeliverycombinedwithstaticapertures AT kevinkroninger clinicalimplementationofprotontherapyusingpencilbeamscanningdeliverycombinedwithstaticapertures AT christiannitsch clinicalimplementationofprotontherapyusingpencilbeamscanningdeliverycombinedwithstaticapertures AT jorgwulff clinicalimplementationofprotontherapyusingpencilbeamscanningdeliverycombinedwithstaticapertures AT jorgwulff clinicalimplementationofprotontherapyusingpencilbeamscanningdeliverycombinedwithstaticapertures AT beatetimmermann clinicalimplementationofprotontherapyusingpencilbeamscanningdeliverycombinedwithstaticapertures AT beatetimmermann clinicalimplementationofprotontherapyusingpencilbeamscanningdeliverycombinedwithstaticapertures AT beatetimmermann clinicalimplementationofprotontherapyusingpencilbeamscanningdeliverycombinedwithstaticapertures AT beatetimmermann clinicalimplementationofprotontherapyusingpencilbeamscanningdeliverycombinedwithstaticapertures |