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Purpose: Beam delivery latency in respiratory-gated particle therapy systems is a crucial issue to dose delivery accuracy. The aim of this study is to develop a multi-channel signal acquisition platform for investigating gating latencies occurring within RPM respiratory gating system (Varian, USA) and ProBeam proton treatment system (Varian, USA) individually., Methods: The multi-channel signal acquisition platform consisted of several electronic components, including a string position sensor for target motion detection, a photodiode for proton beam sensing, an interfacing board for accessing the trigger signal between the respiratory gating system and the proton treatment system, a signal acquisition device for sampling and synchronizing signals from the aforementioned components, and a laptop for controlling the signal acquisition device and data storage. RPM system latencies were determined by comparing the expected gating phases extracted from the motion signal with the trigger signal's state turning points. ProBeam system latencies were assessed by comparing the state turning points of the trigger signal with the beam signal. The total beam delivery latencies were calculated as the sum of delays in the respiratory gating system and the cyclotron proton treatment system. During latency measurements, simulated sinusoidal motion were applied at different amplitudes and periods for complete beam delivery latency evaluation under different breathing patterns. Each breathing pattern was repeated 30 times for statistical analysis., Results: The measured gating ON/OFF latencies in the RPM system were found to be 104.20 ± 13.64 ms and 113.60 ± 14.98 ms, respectively. The measured gating ON/OFF delays in the ProBeam system were 108.29 ± 0.85 ms and 1.20 ± 0.04 ms, respectively. The total beam ON/OFF latencies were determined to be 212.50 ± 13.64 ms and 114.80 ± 14.98 ms., Conclusion: With the developed multi-channel signal acquisition platform, it was able to investigate the gating lags happened in both the respiratory gating system and the proton treatment system. The resolution of the platform is enough to distinguish the delays at the millisecond time level. Both the respiratory gating system and the proton treatment system made contributions to gating latency. Both systems contributed nearly equally to the total beam ON latency, with approximately 100 ms. In contrast, the respiratory gating system was the dominant contributor to the total beam OFF latency., (© 2024 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals LLC on behalf of American Association of Physicists in Medicine.)

Purpose: Our group previously introduced an in vivo proton range verification methodology in which a silicon diode array system is used to correlate the dose rate profile per range modulation wheel cycle of the detector signal to the water-equivalent path length (WEPL) for passively scattered proton beam delivery. The implementation of this system requires a set of calibration data to establish a beam-specific response to WEPL fit for the selected 'scout' beam (a 1 cm overshoot of the predicted detector depth with a dose of 4 cGy) in water-equivalent plastic. This necessitates a separate set of measurements for every 'scout' beam that may be appropriate to the clinical case. The current study demonstrates the use of Monte Carlo simulations for calibration of the time-resolved diode dosimetry technique., Methods: Measurements for three 'scout' beams were compared against simulated detector response with Monte Carlo methods using the Tool for Particle Simulation (TOPAS). The 'scout' beams were then applied in the simulation environment to simulated water-equivalent plastic, a CT of water-equivalent plastic, and a patient CT data set to assess uncertainty., Results: Simulated detector response in water-equivalent plastic was validated against measurements for 'scout' spread out Bragg peaks of range 10 cm, 15 cm, and 21 cm (168 MeV, 177 MeV, and 210 MeV) to within 3.4 mm for all beams, and to within 1 mm in the region where the detector is expected to lie., Conclusion: Feasibility has been shown for performing the calibration of the detector response for three 'scout' beams through simulation for the time-resolved diode dosimetry technique in passive scattered proton delivery., (© 2017 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, Inc. on behalf of American Association of Physicists in Medicine.)

Purpose: In SBRT for prostate cancer, higher fractional dose to the rectum is a major toxicity concern due to using smaller PTV margin and hypofractionation. We investigate the dosimetric impact on rectum using endorectal balloon (ERB) in prostate SBRT., Materials and Methods: Twenty prostate cancer patients were included in a retrospective study, ten with ERB and 10 without ERB. Optimized SBRT plans were generated on CyberKnife MultiPlan for 5 × 7.25 Gy to PTV under RTOG-0938 protocol for early-stage prostate cancer. For the rectum and the anterior half rectum, mean dose and percentage of volumes receiving 50%, 80%, 90%, and 100% prescription dose were compared., Results: Using ERB, mean dose to the rectum was 62 cGy (P = 0.001) lower per fraction, and 50 cGy (P = 0.024) lower per fraction for the anterior half rectum. The average V 50% , V 80% , V 90% , and V 100% were lower by 9.9% (P = 0.001), 5.3% (P = 0.0002), 3.4% (P = 0.0002), and 1.2% (P = 0.005) for the rectum, and lower by 10.4% (P = 0.009), 8.3% (P = 0.0004), 5.4% (P = 0.0003), and 2.1% (P = 0.003) for the anterior half rectum., Conclusions: Significant reductions of dose to the rectum using ERB were observed. This may lead to improvement of the rectal toxicity profiles in prostate SBRT., (© 2017 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, Inc. on behalf of American Association of Physicists in Medicine.)

This study explores the potential of cone-beam computed tomography (CBCT) for monitoring relative beam range variations due to daily changes in patient anatomy for prostate treatment by anterior proton beams. CBCT was used to image an anthropomorphic pelvic phantom, in eight sessions on eight different days. In each session, the phantom was scanned twice, first at a standard position as determined by the room lasers, and then after it was shifted by 10 mm translation randomly along one of the X, Y, or Z directions. The filling of the phantom bladder with water was not refreshed from day to day, inducing gradual change of the water-equivalent path length (WEPL) across the bladder. MIMvista (MIM) software was used to perform image registration and re-alignment of all the scans with the scan from the first session. The XiO treatment planning system was used to perform data analysis. It was found that, although the Hounsfield unit numbers in CBCT have substantially larger fluctuations than those in diagnostic CT, CBCT datasets taken for daily patient positioning could potentially be used to monitor changes in patient anatomy. The reproducibility of the WEPL, computed using CBCT along anterior-posterior (AP) paths across and around the phantom prostate, over a volume of 360 cc, is sufficient for detecting daily WEPL variations that are equal to or larger than 3 mm. This result also applies to CBCT scans of the phantom after it is randomly shifted from the treatment position by 10 mm. limiting the interest to WEPL variation over a specific path within the same CBCT slice, one can detect WEPL variation smaller than 1 mm. That is the case when using CBCT for tracking daily change of the WEPL across the phantom bladder that was induced by spontaneous change in the bladder filling due to evaporation. In summary, the phantom study suggests that CBCT can be used for monitoring day to day WEPL variations in a patient. The method can detect WEPL variation equal to or greater than 3 mm. The study calls for further investigation using the CBCT data from real patients. If confirmed with real patients' data, CBCT could become, in addition to patient setup, a standard tool for proton therapy pretreatment beam range check.

While a few physicists have designed new plan check automation solutions for their clinics, fewer, if any, managed to adapt existing solutions. As complex and varied as the systems they check, these programs must gain the full confidence of those who would run them on countless patient plans. The present automation effort, planCheck, therefore focuses on versatility and ease of implementation and verification. To demonstrate this, we apply planCheck to proton gantry, stereotactic proton gantry, stereotactic proton fixed beam (STAR), and IMRT treatments.

We report the development of a new system for interactive patient posture, position and respiratory control during radiation therapy treatment. The system consists of an infrared camera, retro-reflective markers and dedicated software that makes it practical to use in the clinic. The system is designed to be used with multiple retro-reflective markers to monitor not only position, but also the posture of the patient in real time. Specific features of the system include: 1. The system reports an absolute misalignment at several points on a patients, and also provides feedbacks on any necessary adjustments in terms of site specific set-up parameters, such as focus to surface distance (PIN), superior and inferior alignment, chest-wall angle, etc. 2. The system is based on the set of predefined templates containing number and position of control points and feedback parameters developed for different treatment sites. 3. A "virtual portal vision" procedure is developed to project organ contours in the beams-eye-view (BEV) based on the marker locations obtained in real time and compare them with digitally reconstructed radiographs (DRRs) from CT simulation. Assuming good correlation between external markers and internal anatomy, the system offers the possibility of mimicking a verification procedure without taking port-films, which can potentially reduce the setup time. In this paper, we concentrate on system properties and performance, while initial applications on a number of clinical sites is ongoing. Accuracy and precision of this system are evaluated in the context of breast/chest treatments using rigid phantoms. The system has an intrinsic uncertainty of +/- 1 mm; and when two systems in different rooms (CT and treatment room) are used for correlating positional information, the uncertainty is less than 2 mm.

While the majority of patients receiving external beam radiation therapy treatment are planned by CT simulation, a significant number of them are still planned using conventional simulators for various reasons. The information-collection process in a conventional simulation is often fragmented and done with primitive tools. For example, in many institutions body contours are still acquired using solder wires and tracing paper, a time-consuming and error-prone procedure. We have developed a 3D digitization system to assist the information-acquisition process at conventional simulations. The system consists of an infrared camera assembly, a wireless digitizer probe, and Windows-based software. The system can provide 3D coordinates of any points in space accessible by the probe with submillimeter accuracy. It can be used to capture body contours, to record the coordinates of portal points, and to take various measurements for dose calculations as well as for patient setup. The software can display all the captured data together with the planned treatment fields, providing a comprehensive geometric verification of the treatment configuration. The system can also transfer all the information to dose planning programs in DICOM-RT format, providing an integrated information flow from simulation to dose planning.

The analysis of dynamic multileaf collimator (MLC) positions for the delivered intensity-modulated radiotherapy (IMRT) plans is crucial in that it may capture dose delivery problems otherwise difficult to observe and quantify in the conventional dosimetric measurements with film or with an ionization chamber. In some IMRT systems, delivery of IMRT fields starts with a maximum MLC opening (roughly the shape of the target in the beam's-eye view) and then proceeds to the subsequent dynamic MLC subfields. No irradiation is required in going from the initial segment (maximum opening) to the next one, and theoretically, no dose should be delivered in that initial moment. However, due to a finite sampling time of the MLC controller, the finite speed of the MLC, and a finite leaf tolerance, there may be some dose delivered between the first and the second segment. The amount of the excess dose is higher for larger dose rates and for a smaller number of the total monitor units per IMRT field. The magnitude of the dose errors could be in the order of a few percent. Effects similar to the maximum MLC opening may occur in other situations as well, for instance, when leaves are forced to move over large distances in a short time. Confounding this are dose errors due to the uncertainty in the MLC transmission. The analysis of the actual leaf positions recorded in the dynamic MLC log file is helpful in differentiating between the two types of errors and in determining the optimal dynamic MLC delivery parameters.