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ProtonVDA and collaborators have submitted two articles to the Medical Physics Journal, AAPM, describing a prototype clinical proton radiography system and the latest results on the characterization of proton images.

On September 12, 2020, we have submitted two papers describing a prototype clinical proton radiography system and the latest results on the characterization of proton images, to Medical Physics, AAPM.

Technical Note: A prototype clinical proton radiography system

Purpose: To demonstrate a proton imaging system based on well-established fast scintillator technology to achieve high performance with low cost and complexity, with the potential of a straightforward translation into clinical use. Methods: The system tracks individual protons through one (X, Y) scintillating fiber tracker plane upstream and downstream of the object and into a 13 cm-thick scintillating block residual energy detector. The fibers in the tracker planes are multiplexed into silicon photomultipliers (SiPMs) to reduce the number of electronics channels. The light signal from the residual energy detector is collected by 16 photomultiplier tubes (PMTs). Only four signals from the PMTs are output from each event, which allows for fast signal readout. A robust calibration method of the PMT signal to residual energy has been developed to obtain accurate proton images. The development of patient-specific scan patterns using multiple input energies allows for an image to be produced with minimal excess dose delivered to the patient. Results: The calibration of signals in the energy detector produces accurate residual range measurements limited by intrinsic range straggling. The use of patient-specific scan patterns using multiple input energies enables imaging with a compact range detector. Conclusions: We have developed a prototype clinical proton radiography system for pretreatment imaging in proton radiation therapy. We have optimized the system for use with pencil beam scanning systems and have achieved a reduction of size and complexity compared to previous designs.

Ethan A. DeJongh, Don F. DeJongh, Igor Polnyi, Victor Rykalin, Christina Sarosiek, George Coutrakon, Kirk L. Duffin, Nicholas T. Karonis, Caesar E. Ordoñez, Mark Pankuch, James S. Welsh, John R. Winans


A prototype proton radiography system for clinical use

Purpose: Verification of patient specific proton stopping powers obtained in the patient treatment position can be used to reduce the distal margins needed in particle beam planning. Proton radiography can be used as a pre-treatment instrument to verify integrated stopping power consistency with the treatment planning CT. Although a proton radiograph is a pixel by pixel representation of integrated stopping powers, the image may also be of high enough quality and contrast to be used for patient alignment. This investigation qualifies the accuracy and image quality of a prototype proton radiography system on a clinical proton delivery system. Methods: We have developed a clinical prototype proton radiography system designed for integration into efficient clinical workflows. We tested the images obtained by this system for water-equivalent thickness (WET) accuracy, image noise, and spatial resolution. We evaluated the WET accuracy by comparing the average WET and rms error in several regions of interest (ROI) on a proton radiograph of a custom peg phantom. We measured the spatial resolution on a CATPHAN Line Pair phantom and a custom edge phantom by measuring the 10% value of the modulation transfer function (MTF). In addition, we tested the ability to detect proton range errors due to anatomical changes in a patient with a customized CIRS pediatric head phantom and inserts of varying WET placed in the posterior fossae of the brain. We took proton radiographs of the phantom with each insert in place and created difference maps between the resulting images. Integrated proton range was measured from an ROI in the difference maps. Purpose: Verification of patient specific proton stopping powers obtained in the patient’s treatment position can be used to reduce the distal margins needed in particle beam planning. Proton radiography can be used as a pre-treatment instrument to verify integrated stopping power consistency with the treatment planning CT. Although a proton radiograph is a pixel by pixel representation of integrated stopping powers, the image may also be of high enough quality and contrast to be used for patient alignment. This investigation qualifies the accuracy and image quality of a prototype proton radiography system on a clinical proton delivery system. Results: We measured the WET accuracy of the proton radiographic images to be ±0.2 mm from known values. The spatial resolution of the images was between 0.61 lp/mm and 1.13 lp/mm. We were able to detect anatomical changes producing changes in WET as low as 0.6 mm. Conclusion: The proton radiography system produces images with image quality sufficient for pretreatment range consistency verification.

Christina Sarosiek, Ethan A. DeJongh, George Coutrakon, Don F. DeJongh, Kirk L. Duffin, Nicholas T. Karonis, Caesar E. Ordoñez, Mark Pankuch, Victor Rykalin, James S. Welsh, John R. Winans