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Brzezinski, K. et al. (2023). Detection of range shifts in proton beam therapy using the J-PET scanner: a patient simulation study. Phys. Med. Biol., 68(14), 145016–17pp.
Abstract: Objective. The Jagiellonian positron emission tomography (J-PET) technology, based on plastic scintillators, has been proposed as a cost effective tool for detecting range deviations during proton therapy. This study investigates the feasibility of using J-PET for range monitoring by means of a detailed Monte Carlo simulation study of 95 patients who underwent proton therapy at the Cyclotron Centre Bronowice (CCB) in Krakow, Poland. Approach. Discrepancies between prescribed and delivered treatments were artificially introduced in the simulations by means of shifts in patient positioning and in the Hounsfield unit to the relative proton stopping power calibration curve. A dual-layer, cylindrical J-PET geometry was simulated in an in-room monitoring scenario and a triple-layer, dual-head geometry in an in-beam protocol. The distribution of range shifts in reconstructed PET activity was visualized in the beam's eye view. Linear prediction models were constructed from all patients in the cohort, using the mean shift in reconstructed PET activity as a predictor of the mean proton range deviation. Main results. Maps of deviations in the range of reconstructed PET distributions showed agreement with those of deviations in dose range in most patients. The linear prediction model showed a good fit, with coefficient of determination r (2) = 0.84 (in-room) and 0.75 (in-beam). Residual standard error was below 1 mm: 0.33 mm (in-room) and 0.23 mm (in-beam). Significance. The precision of the proposed prediction models shows the sensitivity of the proposed J-PET scanners to shifts in proton range for a wide range of clinical treatment plans. Furthermore, it motivates the use of such models as a tool for predicting proton range deviations and opens up new prospects for investigations into the use of intra-treatment PET images for predicting clinical metrics that aid in the assessment of the quality of delivered treatment.
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Hueso-Gonzalez, F., Berthold, J., Wohlfahrt, P., Bortfeld, T., Khamfongkhruea, C., Tattenberg, S., et al. (2024). Inter-center comparison of proton range verification prototypes with an anthropomorphic head phantom. Phys. Med. Biol., 69(22), 225010–14pp.
Abstract: Objective. To compare in reproducible and equalized conditions the performance of two independent proton range verification systems based on prompt gamma-ray detectors from two different proton therapy centers. Approach. An anthropomorphic head phantom with calibrated stopping power, serving as ground truth, was irradiated with comparable treatment plans, spot positions and energies in both facilities. Clinical beam current, tumor contour and dose were used. The absolute range measurement was compared to the expected value according to the ground truth. The statistical precision was assessed by repeating each measurement ten times. Sensitivity to relative range shifts was evaluated by introducing 2 mm and 5 mm plastic slabs on half of the field. Main results. The resulting absolute range accuracy was within 2.4 mm in all cases. Relative range shifts were detected with deviations lower than 14%. Significance. The performance of both systems was deemed worthy of clinical application for the detection of range deviations. This study represents the first comparison of independent prompt gamma-ray-based proton range verification systems under equalized conditions with realistic treatment fields and beam currents.
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Migueis, F., Casaña, J. V., Garcia-Fernandez, D., Hueso-Gonzalez, F., Llosa, G., Prieto, A. F., et al. (2025). Sensitivity of coaxial prompt gamma-ray monitoring in heterogeneous geometries: A Monte Carlo simulation study. Radiat. Phys. Chem., 232, 112639–11pp.
Abstract: Proton beams offer significant advantages over conventional radiotherapy due to their unique interaction with matter. Specifically, the ionization density caused by these beams is higher in a well-defined region (the Bragg peak) with a sharp decline in intensity beyond a specific depth. However, variations in proton range – often caused by changes in patient anatomy and morphology during treatment – can introduce uncertainties in dose distribution. To account for this, clinicians apply conservative margins, which limit the full potential of proton therapy. Efforts have been focused on developing proton range and dose distribution monitoring systems to reduce the need for large safety margins. These systems are based on detecting and analyzing the byproducts that result from the interaction between the proton beams and tissue. In this article, we focused specifically on a system that aims to detect photons called prompt gamma (PG) rays. We conducted Monte Carlo simulations of proton beams interacting with anthropomorphic phantoms of varying densities to simulate morphological changes. A single scintillation detector was positioned coaxially with the beam and behind the phantom to capture the emitted PG rays in each scenario. Our analysis focused on discrepancies in proton range that resulted from irradiating an anthropomorphic head phantom with varying brain tissue densities and detecting secondary particles resulting from these interactions. We observed potential correlations between gamma-ray signatures and variations in proton range and energy deposition, suggesting that this monitoring technique could be effective for real-world clinical applications.
Keywords: Protons; Coaxial; Proton therapy; Prompt gamma rays; Monte Carlo; Range verification
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Ortega, P. G., Torres-Espallardo, I., Cerutti, F., Ferrari, A., Gillam, J. E., Lacasta, C., et al. (2015). Noise evaluation of Compton camera imaging for proton therapy. Phys. Med. Biol., 60(5), 1845–1863.
Abstract: Compton Cameras emerged as an alternative for real-time dose monitoring techniques for Particle Therapy (PT), based on the detection of prompt-gammas. As a consequence of the Compton scattering process, the gamma origin point can be restricted onto the surface of a cone (Compton cone). Through image reconstruction techniques, the distribution of the gamma emitters can be estimated, using cone-surfaces backprojections of the Compton cones through the image space, along with more sophisticated statistical methods to improve the image quality. To calculate the Compton cone required for image reconstruction, either two interactions, the last being photoelectric absorption, or three scatter interactions are needed. Because of the high energy of the photons in PT the first option might not be adequate, as the photon is not absorbed in general. However, the second option is less efficient. That is the reason to resort to spectral reconstructions, where the incoming. energy is considered as a variable in the reconstruction inverse problem. Jointly with prompt gamma, secondary neutrons and scattered photons, not strongly correlated with the dose map, can also reach the imaging detector and produce false events. These events deteriorate the image quality. Also, high intensity beams can produce particle accumulation in the camera, which lead to an increase of random coincidences, meaning events which gather measurements from different incoming particles. The noise scenario is expected to be different if double or triple events are used, and consequently, the reconstructed images can be affected differently by spurious data. The aim of the present work is to study the effect of false events in the reconstructed image, evaluating their impact in the determination of the beam particle ranges. A simulation study that includes misidentified events (neutrons and random coincidences) in the final image of a Compton Telescope for PT monitoring is presented. The complete chain of detection, from the beam particle entering a phantom to the event classification, is simulated using FLUKA. The range determination is later estimated from the reconstructed image obtained from a two and three-event algorithm based on Maximum Likelihood Expectation Maximization. The neutron background and random coincidences due to a therapeutic-like time structure are analyzed for mono-energetic proton beams. The time structure of the beam is included in the simulations, which will affect the rate of particles entering the detector.
Keywords: proton therapy; Compton camera; Monte Carlo methods; FLUKA; prompt gamma; range verification; MLEM
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Solevi, P., Muñoz, E., Solaz, C., Trovato, M., Dendooven, P., Gillam, J. E., et al. (2016). Performance of MACACO Compton telescope for ion-beam therapy monitoring: first test with proton beams. Phys. Med. Biol., 61(14), 5149–5165.
Abstract: In order to exploit the advantages of ion-beam therapy in a clinical setting, delivery verification techniques are necessary to detect deviations from the planned treatment. Efforts are currently oriented towards the development of devices for real-time range monitoring. Among the different detector concepts proposed, Compton cameras are employed to detect prompt gammas and represent a valid candidate for real-time range verification. We present the first on-beam test of MACACO, a Compton telescope (multi-layer Compton camera) based on lanthanum bromide crystals and silicon photo-multipliers. The Compton telescope was first characterized through measurements and Monte Carlo simulations. The detector linearity was measured employing Na-22 and Am-Be sources, obtaining about 10% deviation from linearity at 3.44 MeV. A spectral image reconstruction algorithm was tested on synthetic data. Point-like sources emitting gamma rays with energy between 2 and 7 MeV were reconstructed with 3-5 mm resolution. The two-layer Compton telescope was employed to measure radiation emitted from a beam of 150 MeV protons impinging on a cylindrical PMMA target. Bragg-peak shifts were achieved via adjustment of the PMMA target location and the resulting measurements used during image reconstruction. Reconstructed Bragg peak profiles proved sufficient to observe peak-location differences within 10 mm demonstrating the potential of the MACACO Compton Telescope as a monitoring device for ion-beam therapy.
Keywords: ion-beam therapy; range verification; prompt gamma; Compton camera; GATE
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