Sharpening the edge in pencil-beam proton therapy: an aftermarket collimation system to better spare normal tissue during radiation treatment

锐化笔形束质子治疗的优势：一种售后准直系统，可在放射治疗期间更好地保护正常组织

• 批准号: 10581932
• 负责人: Daniel E. Hyer
• 金额: $ 43.52万
• 依托单位: UNIVERSITY OF IOWA
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-01 至 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10581932
• 关键词: Acceleration; Air; Algorithms; Area; Benchmarking; Brain; Brain Neoplasms; Cancer Patient; Childhood; Clinic; Clinical; Collimator; Computational Technique; Data; Development; Devices; Distal; Dose; Ensure; Equipment; Feedback; Foundations; Goals; Head and Neck Neoplasms; Individual; Industrialization; Inferior; Intelligence; Intercept; Ions; Lateral; Malignant Neoplasms; Marketing; Measurement; Measures; Mechanics; Methodology; Methods; Mission; Modeling; Monitor; Motion; Normal tissue morphology; Outcome; Parents; Patients; Photons; Planning Techniques; Plant Leaves; Positioning Attribute; Predisposition; Protons; Public Health; Quality of Care; Quality of life; Radiation Dose Unit; Radiation Toxicity; Radiation therapy; Research; Risk Reduction; Rotation; Scanning; Speed; Spottings; Surface; System; Techniques; Technology; Testing; Time; Tissues; Translating; Treatment Efficacy; Treatment outcome; Uncertainty; Validation; Work; brain tissue; care delivery; clinical care; commercialization; cost; cost effective; design; fighting; head and neck cancer patient; improved; in silico; innovation; new technology; next generation; preservation; proton beam; proton therapy; prototype; quality assurance; side effect; technology platform; tool; treatment duration; treatment planning; tumor

Abstract/Summary Proton arc therapy has lagged behind photon arc therapy, which is now commonplace in the clinic, due mostly to slow proton energy switching times which make treatment durations impractical. Fast energy modulation systems are now clinically available, and, by applying delivery optimization tools that intelligently change beam energy as the gantry rotates, proton arc therapy is on the verge of becoming a clinical reality that can improve plan delivery speed and robustness to range uncertainties relative to conventional fixed field proton therapy. Without dynamic lateral beam collimation, however, proton arc therapy tumor dose conformity will be inferior to fixed field collimated proton therapy plans. This is a major problem especially for brain and head and neck cancer patients whose normal tissues could be spared significant radiation dose using beam collimation. The long-term goal is to develop the next generation of pencil beam scanning (PBS) proton therapy delivery systems that maximize the achievable tumor dose conformity, robustness, and delivery speed. The overall objective of this proposal is to develop dynamically collimated arc-based PBS by expanding the dynamic collimation system (DCS) technology developed in the first part of this R37 proposal, providing the capability for rapid, tumor-conformal delivery of dose distributions that are more robust to uncertainties in Bragg Peak position placement than those delivered with fixed field proton therapy. The rationale for this project is that superior treatment plans will result from the combination of energy-specific collimation and rotational arc delivery than either of the individual technologies, thus improving the quality of care of proton therapy. Guided by strong preliminary data from our in-silico treatment planning studies and constructed DCS prototype, development of collimated proton arc therapy will be carried out by pursuing three specific aims: 1) develop arc-based treatment planning and delivery methods for dynamically collimated proton therapy, 2) enhance the clinical DCS prototype to perform proton arc treatments, and 3) adapt existing treatment verification methodologies for quality assurance. Under specific aim 1, established multi-field treatment planning techniques, both dose calculation and optimization, will be extended to include the optimization of trimmer and energy sequencing for the case of a rotating gantry. Under specific aim 2, real-time feedback mechanisms will be incorporated to monitor and synchronize gantry angle to the sequencing of the high-speed trimmer blades. Under specific aim 3, experimental and computational techniques will be developed and demonstrated to enable successful commissioning of dynamic collimated proton arc therapy. The research proposed in this application is innovative because it represents a new combination of two promising and synergistic technologies: dynamic collimation and proton arc therapy. This contribution is expected to be significant since the two technologies together can preserve conformity improvements gained by collimated PBS while adding the robustness and delivery speed benefits achievable with arc therapy, improving treatment outcomes.

摘要/摘要 质子弧治疗落后于光子弧治疗，该疗法现在在诊所中很普遍，主要是由于 减慢质子能量切换时间，使治疗持续时间不切实际。快速能量调制 系统现在可以临床上可用，并且通过应用交付优化工具来智能改变光束 能量随着龙门的旋转，质子弧疗法即将成为临床现实，可以改善 计划输送速度和稳健性，相对于常规固定田质子疗法，范围不确定性。 但是，如果没有动态的横向束准直接，则质子弧治疗肿瘤剂量的统一将不在 固定现场准直质子治疗计划。这是一个主要问题，尤其是大脑，头部和颈部 正常组织可以使用束准直接剂量的明显辐射剂量的癌症患者。这 长期目标是开发下一代铅笔梁扫描（PBS）质子治疗 最大化可实现的肿瘤剂量符合性，鲁棒性和递送速度的系统。总体 该建议的目的是通过扩展动态性来开发动态基于ARC的PBS 此R37提案的第一部分开发的准直系统（DCS）技术提供了能力 对于剂量分布的快速，统一的统一递送，在布拉格峰中对不确定性更强大 位置位置比使用固定田质子治疗的位置。这个项目的理由是 卓越的治疗计划将是由于能量特异性准则和旋转弧的结合而产生的 交付比任何一个单个技术，从而提高了质子治疗的护理质量。指导 通过来自我们的内部治疗计划研究的强大初步数据，并构建了DCS原型， 质子弧疗法的开发将通过追求三个特定目的进行：1）发展 基于ARC的治疗计划和动态质子疗法的交付方法，2）增强 临床DCS原型进行质子弧处理，3）适应现有的治疗验证 质量保证的方法。在特定的目标1下，已建立的多场治疗计划 剂量计算和优化的技术将扩展到包括修剪器的优化和 旋转龙门的情况下的能量测序。在特定的目标2下，实时反馈机制将 被合并以监视和同步龙门角度与高速修剪器叶片的测序。 在特定的目标3下，将开发并证明实验和计算技术 能够成功地调试动态准直的质子弧治疗。这项研究提出了 应用具有创新性，因为它代表了两个有前途和协同作用的新组合 技术：动态准则和质子弧治疗。由于 这两种技术共同可以保留准确的PBS获得的一致性改进，同时添加 通过ARC治疗可以实现的稳健性和交付速度益处，从而改善了治疗结果。

项目成果

Experimental and Monte Carlo characterization of a dynamic collimation system prototype for pencil beam scanning proton therapy.

• DOI: 10.1002/mp.14453
• 发表时间: 2020-10
• 期刊: Medical physics
• 影响因子: 3.8
• 作者: Smith BR;Pankuch M;Hyer DE;Culberson WS
• 通讯作者: Culberson WS

Innovations and the Use of Collimators in the Delivery of Pencil Beam Scanning Proton Therapy.

• DOI: 10.14338/ijpt-20-00039.1
• 发表时间: 2021
• 期刊: International journal of particle therapy
• 影响因子: 1.7
• 作者: Hyer DE;Bennett LC;Geoghegan TJ;Bues M;Smith BR
• 通讯作者: Smith BR

Dosimetric delivery validation of dynamically collimated pencil beam scanning proton therapy.

• DOI: 10.1088/1361-6560/acb6cd
• 发表时间: 2023-02-20
• 期刊: Physics in medicine and biology
• 影响因子: 3.5

The dosimetric enhancement of GRID profiles using an external collimator in pencil beam scanning proton therapy.

• DOI: 10.1002/mp.15523
• 发表时间: 2022-04
• 期刊: MEDICAL PHYSICS
• 影响因子: 3.8
• 作者: Smith, Blake R.;Nelson, Nicholas P.;Geoghegan, Theodore J.;Patwardhan, Kaustubh A.;Hill, Patrick M.;Yu, Jen;Gutierrez, Alonso N.;Allen, Bryan G.;Hyer, Daniel E.
• 通讯作者: Hyer, Daniel E.

Development and validation of the Dynamic Collimation Monte Carlo simulation package for pencil beam scanning proton therapy.

• DOI: 10.1002/mp.14846
• 发表时间: 2021-06
• 期刊: Medical physics
• 影响因子: 3.8
• 作者: Nelson NP;Culberson WS;Hyer DE;Geoghegan TJ;Patwardhan KA;Smith BR;Flynn RT;Yu J;Rana S;Gutiérrez AN;Hill PM
• 通讯作者: Hill PM