Fast Individualized Delivery Adaptation in Proton Therapy

虽然适应性疗法以前已经被研究过，但以前的研究都没有涉及到独特的挑战。 (射程不确定)和独特的能力(束流优化和快速伽马成像) 心理治疗。这项提案将首次通过开发创新的硬件和 软件方法论。我们设想治疗计划和交付将完全适应内部- 患者几何形状的细微变化。 这项建议旨在预测紧接在患者体内的剂量分布(或其替代物) 提供治疗，并纠正测量剂量和预期剂量之间的任何差异 几分钟。这将使我们能够在适应的环境下提供(质子)放射治疗，并大大减少靶点 体积边缘(2 mm各向同性加上束流方向质子治疗中的2 mm射程边缘)，而 病人被放在治疗台上。 我们建议通过同时开发快速的硬件和软件工具来实现这一目标 室内快速伽马和锥束CT成像结合快速剂量计算的优势。我们 将把这项技术与一种新的Beamlet适配框架结合起来。 虽然我们的一些方法也将改进光子治疗，但我们将专注于质子治疗，因为它 为体内剂量验证提供了独特的机会，也因射程不确定而面临独特的挑战。 我们的方法将提供给整个质子治疗社区。

While adaptive therapy has been studied before, none of the previous studies deals with the unique challenges (range uncertainties) and unique capabilities (beamlet optimization and prompt gamma imaging) of proton therapy. This proposal will for the first time address these aspects by developing innovative hardware and software methodologies. We envision treatment planning and delivery to be fully adaptive in terms of intra- fractional changes in patient geometry. This proposal aims at predicting the dose distribution (or a surrogate thereof) in the patient immediately prior to treatment delivery and correct for any discrepancies between the measured and intended dose in less than 2 minutes. This will enable us to deliver (proton) radiation therapy in an adaptive setting and much reduced target volume margins (2mm isotropic plus 2mm range margin in proton therapy in the beam direction) daily while the patient is positioned on the treatment table. We propose to achieve this goal by simultaneously developing fast hardware and software tools that take advantage of in-room prompt gamma and cone-beam CT imaging in combination with fast dose calculation. We will combine this technology with a novel framework on beamlet adaptation. While some of our methods will improve photon therapy as well, we will focus on proton therapy because it offers unique opportunities to dose verification in vivo as well as unique challenges due to range uncertainties. Our methodology will be made available to the entire proton therapy community.