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/概要 质子弧疗法已经落后于光子弧疗法，光子弧疗法现在在临床上很常见，主要是由于 以减慢质子能量转换时间，这使得治疗持续时间不切实际。快速能量调制 系统现在临床上可用，并且通过应用递送优化工具， 随着机架旋转，质子弧治疗即将成为临床现实， 计划输送速度和相对于常规固定场质子治疗的范围不确定性的鲁棒性。 然而，在没有动态横向射束准直的情况下，质子弧治疗肿瘤剂量符合性将劣于 固定场准直质子治疗计划。这是一个主要的问题，特别是对大脑和头颈部 使用射束准直可以使正常组织免受显著辐射剂量的癌症患者。的 长期目标是开发下一代笔形束扫描（PBS）质子治疗输送 最大化可实现的肿瘤剂量一致性、鲁棒性和递送速度的系统。整体 本建议的目的是通过扩展动态准直弧基PBS 瞄准系统（DCS）技术是在R37建议书的第一部分中开发的，它提供了以下能力： 对于快速的、肿瘤适形的剂量分布递送，其对布拉格峰中的不确定性更鲁棒 位置放置比那些提供固定场质子治疗。该项目的基本原理是， 特定能量准直和旋转弧的组合将产生上级治疗计划 质子治疗是一种比任何一种单独的技术都更好的治疗方法，从而提高了质子治疗的护理质量。指导 通过来自我们的计算机处理计划研究和构建的DCS原型的强有力的初步数据， 准直质子弧治疗的发展将通过追求三个具体目标来进行：1）发展 用于动态准直质子治疗的基于弧的治疗计划和递送方法，2）增强 临床DCS原型，用于执行质子弧治疗，以及3）调整现有治疗验证 质量保证的方法。在具体目标1下，建立了多射野治疗计划 技术，剂量计算和优化，将扩展到包括优化微调和 对于旋转台架的情况，能量排序。根据具体目标2，实时反馈机制将 可用于监控龙门架角度并使其与高速修剪刀片的顺序同步。 在具体目标3下，将开发和演示实验和计算技术， 使动态准直质子弧治疗能够成功调试。这项研究提出， 应用是创新的，因为它代表了两个有前途的和协同的新组合。 技术：动态准直和质子弧治疗。预计这一贡献将是巨大的，因为 这两种技术结合在一起，可以保持准直PBS所获得的一致性改进，同时增加 ARC疗法可实现的稳健性和输送速度益处，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.

使用铅笔梁扫描质子治疗中的外部准直仪对网格曲线的剂量计增强。

• 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