Purpose:
To describe the dosimetric commissioning and quality assurance (QA) of the actively scanned proton and carbon ion beams at the Italian National Center for Oncological Hadrontherapy.
Methods:
...The laterally integrated depth‐dose‐distributions (IDDs) were acquired with the PTW Peakfinder, a variable depth water column, equipped with two Bragg peak ionization chambers. fluka Monte Carlo code was used to generate the energy libraries, the IDDs in water, and the fragment spectra for carbon beams. EBT3 films were used for spot size measurements, beam position over the scan field, and homogeneity in 2D‐fields. Beam monitor calibration was performed in terms of number of particles per monitor unit using both a Farmer‐type and an Advanced Markus ionization chamber. The beam position at the isocenter, beam monitor calibration curve, dose constancy in the center of the spread‐out‐Bragg‐peak, dose homogeneity in 2D‐fields, beam energy, spot size, and spot position over the scan field are all checked on a daily basis for both protons and carbon ions and on all beam lines.
Results:
The simulated IDDs showed an excellent agreement with the measured experimental curves. The measured full width at half maximum (FWHM) of the pencil beam in air at the isocenter was energy‐dependent for both particle species: in particular, for protons, the spot size ranged from 0.7 to 2.2 cm. For carbon ions, two sets of spot size are available: FWHM ranged from 0.4 to 0.8 cm (for the smaller spot size) and from 0.8 to 1.1 cm (for the larger one). The spot position was accurate to within ±1 mm over the whole 20 × 20 cm2 scan field; homogeneity in a uniform squared field was within ±5% for both particle types at any energy. QA results exceeding tolerance levels were rarely found. In the reporting period, the machine downtime was around 6%, of which 4.5% was due to planned maintenance shutdowns.
Conclusions:
After successful dosimetric beam commissioning, quality assurance measurements performed during a 24‐month period show very stable beam characteristics, which are therefore suitable for performing safe and accurate patient treatments.
Purpose:
This paper describes the system for the dose delivery currently used at the Centro Nazionale di Adroterapia Oncologica (CNAO) for ion beam modulated scanning radiotherapy.
Methods:
CNAO ...Foundation, Istituto Nazionale di Fisica Nucleare and University of Torino have designed, built, and commissioned a dose delivery system (DDS) to monitor and guide ion beams accelerated by a dedicated synchrotron and to distribute the dose with a full 3D scanning technique. Protons and carbon ions are provided for a wide range of energies in order to cover a sizable span of treatment depths. The target volume, segmented in several layers orthogonally to the beam direction, is irradiated by thousands of pencil beams which must be steered and held to the prescribed positions until the prescribed number of particles has been delivered. For the CNAO beam lines, these operations are performed by the DDS. The main components of this system are two independent beam monitoring detectors, called BOX1 and BOX2, interfaced with two control systems performing the tasks of real‐time fast and slow control, and connected to the scanning magnets and the beam chopper. As a reaction to any condition leading to a potential hazard, a DDS interlock signal is sent to the patient interlock system which immediately stops the irradiation. The essential tasks and operations performed by the DDS are described following the data flow from the treatment planning system through the end of the treatment delivery.
Results:
The ability of the DDS to guarantee a safe and accurate treatment was validated during the commissioning phase by means of checks of the charge collection efficiency, gain uniformity of the chambers, and 2D dose distribution homogeneity and stability. A high level of reliability and robustness has been proven by three years of system activity needing rarely more than regular maintenance and working with 100% uptime. Four identical and independent DDS devices have been tested showing comparable performances and are presently in use on the CNAO beam lines for clinical activity.
Conclusions:
The dose delivery system described in this paper is one among the few worldwide existing systems to operate ion beam for modulated scanning radiotherapy. At the time of writing, it has been used to treat more than 350 patients and it has proven to guide and control the therapeutic pencil beams reaching performances well above clinical requirements. In particular, in terms of dose accuracy and stability, daily quality assurance measurements have shown dose deviations always lower than the acceptance threshold of 5% and 2.5%, respectively.
Highlights • A systematic characterization of Lynx® for proton and carbon ion beams is presented. • Single spot and scanned beam characterization results against EBT3 films are shown. • Real time ...analysis allows time sparing in daily quality assurance procedures.
The proof of concept of a new device, capable of determining in a few seconds the energy of clinical proton beams by measuring the time of flight (ToF) of protons, is presented. The prototype ...consists of two thin ultra fast silicon detector (UFSD) pads, aligned along the beam direction in a telescope configuration and readout by a digitizer. The method developed for extracting the energy at the isocenter from the measured ToF, validated by Monte Carlo simulations, and the procedure used to calibrate the system are also presented and discussed in detail. The prototype was tested at the Centro Nazionale di Adroterapia Oncologica (CNAO, Pavia, Italy), at several beam energies, covering the entire clinical range, and using different distances between the sensors. The measured beam energies were benchmarked against the nominal CNAO energy values, obtained during the commissioning of the centre from the measured ranges in water. Deviations of few hundreds of keV have been achieved for all considered proton beam energies for distances between the two sensors larger than 60 cm, indicating a sensitivity to the corresponding beam range in water smaller than the clinical tolerance of 1 mm. Moreover, few seconds of irradiation were necessary to collect the required statistics. These preliminary results indicate that a telescope of UFSDs could achieve in a short time the accuracy required for the clinical application and therefore encourage further investigations towards the improvement and the optimization of the present prototype.
The high dose conformity and healthy tissue sparing achievable in Particle Therapy when using C ions calls for safety factors in treatment planning, to prevent the tumor under-dosage related to the ...possible occurrence of inter-fractional morphological changes during a treatment. This limitation could be overcome by a range monitor, still missing in clinical routine, capable of providing on-line feedback. The Dose Profiler (DP) is a detector developed within the INnovative Solution for In-beam Dosimetry in hadronthErapy (INSIDE) collaboration for the monitoring of carbon ion treatments at the CNAO facility (Centro Nazionale di Adroterapia Oncologica) exploiting the detection of charged secondary fragments that escape from the patient. The DP capability to detect inter-fractional changes is demonstrated by comparing the obtained fragment emission maps in different fractions of the treatments enrolled in the first ever clinical trial of such a monitoring system, performed at CNAO. The case of a CNAO patient that underwent a significant morphological change is presented in detail, focusing on the implications that can be drawn for the achievable inter-fractional monitoring DP sensitivity in real clinical conditions. The results have been cross-checked against a simulation study.
Abstract
The Heavy Ion Therapy Research Integration plus (HITRIplus) is an European project that aims to integrate and propel research and technologies related to cancer treatment with heavy ion ...beams. Among the ambitious goals of the project, a specific work package includes the design of a gantry for carbon ions, based on superconducting magnets. The first milestone to achieve is the choice of the fundamental gantry parameters, namely the beam optics layout, the superconducting magnet technology, and the main user requirements. Starting from a reference 3 T design, the collaboration widely explored dozens of possible gantry configurations at 4 T, aiming to find the best compromise in terms of footprint, capital cost, and required R&D. We present here a summary of these configurations, underlying the initial correlation between the beam optics, the mechanics and the main superconducting dipoles design: the bending field (up to 4 T), combined function features (integrated quadrupoles), magnet aperture (up to 90 mm), and angular length (30° – 45°). The resulting main parameters are then listed, compared, and used to drive the choice of the best gantry layout to be developed in HITRI
plus
.
Beam monitoring in particle therapy is a critical task that, because of the high flux and the time structure of the beam, can be challenging for the instrumentation. Recent developments in thin ...silicon detectors with moderate internal gain, optimized for timing applications (Ultra Fast Silicon Detectors, UFSD), offer a favourable technological option to conventional ionization chambers. Thanks to their fast collection time and good signal-to-noise ratio, properly segmented sensors allow discriminating and counting single protons up to the high fluxes of a therapeutic beam, while the excellent time resolution can be exploited for measuring the proton beam energy using time-of-flight techniques. We report here the results of the first tests performed with UFSD detector pads on a therapeutic beam. It is found that the signal of protons can be easily discriminated from the noise, and that the very good time resolution is confirmed. However, a careful design is necessary to limit large pile-up inefficiencies and early performance degradation due to radiation damage.
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