Toru Umekawa

WE-EF-303-05: Development and Commissioning of Real-Time Imaging Function for Respiratory-Gated Spot-Scanning Proton Beam Therapy

Purpose: To realize real-time-image gated proton beam therapy (RGPT) for treating mobile tumors. Methods: The rotating gantry of spot scanning proton beam therapy has been designed to equip two x-ray fluoroscopy devices that enable real-time imaging of the internal fiducial markers during respiration. Three-dimensional position of the fiducial marker located near the tumor can be calculated from the fluoroscopic images obtained from orthogonal directions and therapeutic beam is gated only when the fiducial marker is within the predefined gating window. Image acquisition rate can be selected from discrete value ranging from 0.1 Hz to 30 Hz. In order to confirm the effectiveness of RGPT and apply it clinically, clinical commissioning was conducted. Commissioning tests were categorized to main three parts including geometric accuracy, temporal accuracy and dosimetric evaluation. Results: Developed real-time imaging function has been installed and its basic performances have been confirmed. In the evaluation of geometric accuracy, coincidence of three-dimensional treatment room coordinate system and imaging coordinate system was confirmed to be less than 1 mm. Fiducial markers (gold sphere and coil) were able to be tracked in simulated clinical condition using an anthropomorphic chest phantom. In the evaluation of temporal accuracy, latency from image acquisition to gate on/off signal was about 60 msec in typical case. In dosimetric evaluation, treatment beam characteristics including beam irradiation position and dose output were stable in gated irradiation. Homogeneity indices to the mobile target were 0.99 (static), 0.89 (w/o gating, motion is parallel to direction of scan), 0.75 (w/o gating, perpendicular), 0.98 (w/ gating, parallel) and 0.93 (w/ gating, perpendicular). Dose homogeneity to the mobile target can be maintained in RGPT. Conclusion: Real-time imaging function utilizing x-ray fluoroscopy has been developed and commissioned successfully in order to realize RGPT. Funding Support: This research was partially supported by Japan Society for the Promotion of Science (JSPS) through the FIRST Program. Conflict of Interest: Prof. Shirato has research fund from Hitachi Ltd, Mitsubishi Heavy Industries Ltd and Shimadzu Corporation.

SU-E-CAMPUS-J-03: Commissioning of the On-Board Cone-Beam CT System Equipped On the Rotating Gantry of a Proton Therapy System

PURPOSE Proton therapy requires highly-precise image guidance in patient setup to ensure accurate dose delivery. Cone-beam CT (CBCT) is expected to play an important role to reduce uncertainties in patient setup. Hokkaido University has developed a new proton therapy system dedicated to spot-scanning under a collaborative work with Hitachi Ltd. In our system, an orthogonal X-ray imaging system is mounted on a full-rotating gantry. On-board CBCT imaging is therefore available. We have conducted commissioning of the CBCT system for clinical use in proton therapy. METHODS The orthogonal X-ray imaging system, which consists of two sets of X-ray tubes and flat panel detectors (FPDs), are equipped on the rotating gantry. The FPDs are mounted on the proton beam nozzle and can be retracted when not in use. The distance between the X-ray source and the FPD is about 2.1 m. The maximum rotation speed of the gantry is 1 rpm, so CBCT images can be acquired in approximately 1 minute. The maximum reconstruction volume is nearly 40 cm in diameter and 20 cm in axial length. For commissioning of the CBCT system, mechanical accuracy of the rotating gantry first was evaluated. Imaging performance was examined via quantitative evaluation of image quality. RESULTS Through the mechanical test, the isocentricity of the gantry was confirmed to be less than 1 mm. Moreover, it was improved to 0.5 mm with an appropriate correction. The accurate rotation of the gantry contributes to the CBCT image quality. In the image quality test, objects with 7 line-pairs per cm, which corresponds to a line spacing of 0.071 cm, could be discerned. Spatial linearity and uniformity were also sufficient. CONCLUSION Clinical commissioning of the on-board CBCT system for proton therapy was conducted, and CBCT images with sufficient quality were successfully obtained. This research was supported by the Cabinet Office, Government of Japan and the Japan Society for the Promotion of Science (JSPS) through the Funding Program for World-Leading Innovative R&D on Science and Technology (FIRST Program), initiated by the Council for Science and Technology Policy (CSTP).