SU-D-304-01: Development of An Applicator for Treating Shallow and Moving Tumors with Respiratory-Gated Spot-Scanning Proton Therapy Using Real-Time Image Guidance

Authors

  • Matsuura T,

    1. Proton Beam Therapy Center, Hokkaido University Hospital, Sapporo, Hokkaido
    2. Hitachi, Ltd., Hitachi Research Laboratory, Hitachi, Ibaraki
    3. Faculty of Engineering, Hokkaido University, Sapporo, Hokkaido
    Search for more papers by this author
  • Fujii Y,

    1. Proton Beam Therapy Center, Hokkaido University Hospital, Sapporo, Hokkaido
    2. Hitachi, Ltd., Hitachi Research Laboratory, Hitachi, Ibaraki
    3. Faculty of Engineering, Hokkaido University, Sapporo, Hokkaido
    Search for more papers by this author
  • Takao S,

    1. Proton Beam Therapy Center, Hokkaido University Hospital, Sapporo, Hokkaido
    2. Hitachi, Ltd., Hitachi Research Laboratory, Hitachi, Ibaraki
    3. Faculty of Engineering, Hokkaido University, Sapporo, Hokkaido
    Search for more papers by this author
  • Yamada T,

    1. Proton Beam Therapy Center, Hokkaido University Hospital, Sapporo, Hokkaido
    2. Hitachi, Ltd., Hitachi Research Laboratory, Hitachi, Ibaraki
    3. Faculty of Engineering, Hokkaido University, Sapporo, Hokkaido
    Search for more papers by this author
  • Matsuzaki Y,

    1. Proton Beam Therapy Center, Hokkaido University Hospital, Sapporo, Hokkaido
    2. Hitachi, Ltd., Hitachi Research Laboratory, Hitachi, Ibaraki
    3. Faculty of Engineering, Hokkaido University, Sapporo, Hokkaido
    Search for more papers by this author
  • Miyamoto N,

    1. Proton Beam Therapy Center, Hokkaido University Hospital, Sapporo, Hokkaido
    2. Hitachi, Ltd., Hitachi Research Laboratory, Hitachi, Ibaraki
    3. Faculty of Engineering, Hokkaido University, Sapporo, Hokkaido
    Search for more papers by this author
  • Takayanagi T,

    1. Proton Beam Therapy Center, Hokkaido University Hospital, Sapporo, Hokkaido
    2. Hitachi, Ltd., Hitachi Research Laboratory, Hitachi, Ibaraki
    3. Faculty of Engineering, Hokkaido University, Sapporo, Hokkaido
    Search for more papers by this author
  • Fujitaka S,

    1. Proton Beam Therapy Center, Hokkaido University Hospital, Sapporo, Hokkaido
    2. Hitachi, Ltd., Hitachi Research Laboratory, Hitachi, Ibaraki
    3. Faculty of Engineering, Hokkaido University, Sapporo, Hokkaido
    Search for more papers by this author
  • Shimizu S,

    1. Proton Beam Therapy Center, Hokkaido University Hospital, Sapporo, Hokkaido
    2. Hitachi, Ltd., Hitachi Research Laboratory, Hitachi, Ibaraki
    3. Faculty of Engineering, Hokkaido University, Sapporo, Hokkaido
    Search for more papers by this author
  • Shirato H,

    1. Proton Beam Therapy Center, Hokkaido University Hospital, Sapporo, Hokkaido
    2. Hitachi, Ltd., Hitachi Research Laboratory, Hitachi, Ibaraki
    3. Faculty of Engineering, Hokkaido University, Sapporo, Hokkaido
    Search for more papers by this author
  • Umegaki K

    1. Proton Beam Therapy Center, Hokkaido University Hospital, Sapporo, Hokkaido
    2. Hitachi, Ltd., Hitachi Research Laboratory, Hitachi, Ibaraki
    3. Faculty of Engineering, Hokkaido University, Sapporo, Hokkaido
    Search for more papers by this author

Abstract

Purpose:

To develop a method for treating shallow and moving tumors (e.g., lung tumors) with respiratory-gated spot-scanning proton therapy using real-time image guidance (RTPT).

Methods:

An applicator was developed which can be installed by hand on the treatment nozzle. The mechanical design was considered such that the Bragg peaks are placed at the patient surface while a sufficient field of view (FOV) of fluoroscopic X-rays was maintained during the proton beam delivery. To reduce the treatment time maintaining the robustness of the dose distribution with respect to motion, a mini-ridge filter (MRF) was sandwiched between two energy absorbers. The measurements were performed to obtain a data for beam modeling and to verify the spot position-invariance of a pencil beam dose distribution. For three lung cancer patients, treatment plans were made with and without the MRF and the effects of the MRF were evaluated. Next, the effect of respiratory motion on the dose distribution was investigated.

Results:

To scan the proton beam over a 14 × 14 cm area while maintaining the φ16 cm of fluoroscopic FOV, the lower face of the applicator was set 22 cm upstream of the isocenter. With an additional range variance of 2.2 mm and peak-to-peak distance of 4 mm of the MRF, the pencil beam dose distribution was unchanged with the displacement of the spot position. The quality of the treatment plans was not worsened by the MRF. With the MRF, the number of energy layers was reduced to less than half and the treatment time by 26–37%. The simulation study showed that the interplay effect was successfully suppressed by respiratory-gating both with and without MRF.

Conclusions:

The spot-scanning proton beam was successfully delivered to shallow and moving tumors within a sufficiently short time by installing the developed applicator at the RTPT nozzle.

Ancillary