WE-EF-303-02: BEST IN PHYSICS (JOINT IMAGING- THERAPY): A Comprehensive Simulation of Image Guided Beam Gating for Liver Tumor Treatments Using Scanned Proton Therapy




To evaluate the effectiveness of image guided beam gating for PBS liver treatments under realistic breathing conditions.


We have previously proposed a Beams’ Eye View (BEV) X-ray image system as an online motion monitoring device for deriving a gating signal for PBS proton therapy. Using dedicated 4D dose calculations (4DDC), in this work we have simulated gated liver treatments using three amplitude-based gating windows (10/5/3mm) based on motion extracted from BEV imaging of fiducial markers or the diaphragm. In order to improve motion mitigation, BEV guided gating has also been combined with either volumetric (VS) or layered (LS) rescanning. Nine 4DCT(MRI) liver data-sets have been used for the investigation, which not only consider realistic patient geometries but also motion variations between different breathing cycles. All 4D plans have been quantified in terms of plan homogeneity in the PTV (D5-D95), the total estimated treatment time and the beam-on duty cycle.


Neither gating nor rescanning can fully retrieve a comparable plan homogeneity to the static case, and considerable reductions of the duty cycle (<10%) were observed as a Result motion variations when small gating windows are used. However, once combined with rescanning, dose homogeneity within 1% of the static plan could be achieved with reasonable prolongation of the treatment time for all 9 subjects. No differences were observed between the efficacy of layered or volumetric re-scanning, or of gating signals extracted from fiducial or diaphragm motions. However, layered rescanning may be preferred over volumetric rescanning when performed in combination with gating as it is generally more time-efficient and dosimetrically robust to patient and motion variations


Combining BEV beam gating with rescanning is an efficient and effective approach to treating mobile liver tumours, and is equally effective if either the diaphragm or fiducial markers are used as motion surrogates.