Real-Time Gated Proton Therapy: Commissioning and Clinical Workflow for the Hitachi System

Hao Chen; Emile Gogineni; Yilin Cao; John Wong; Curtiland Deville; Heng Li

doi:10.1016/j.ijpt.2024.01.001

Real-Time Gated Proton Therapy: Commissioning and Clinical Workflow for the Hitachi System

Int J Part Ther. 2024 Apr 21:11:100001. doi: 10.1016/j.ijpt.2024.01.001. eCollection 2024 Mar.

Authors

Hao Chen¹, Emile Gogineni^{1

2}, Yilin Cao^{1

3}, John Wong¹, Curtiland Deville¹, Heng Li¹

Affiliations

¹ The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
² The Ohio State University Medical School, Columbus, Ohio, USA.
³ Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts, USA.

Abstract

Purpose: To describe the commissioning of real-time gated proton therapy (RGPT) and the establishment of an appropriate clinical workflow for the treatment of patients.

Materials and methods: Hitachi PROBEAT provides pencil beam scanning proton therapy with an advanced onboard imaging system including real-time fluoroscopy. RGPT utilizes a matching score to provide instantaneous system performance feedback and quality control for patient safety. The CIRS Dynamic System combined with a Thorax Phantom or plastic water was utilized to mimic target motion. The OCTAVIUS was utilized to measure end-to-end dosimetric accuracy for a moving target across a range of simulated situations. Using this dosimetric data, the gating threshold was carefully evaluated and selected based on the intended treatment sites and planning techniques. An image-guidance workflow was developed and applied to patient treatment.

Results: Dosimetric data demonstrated that proton plan delivery uncertainty could be within 2 mm for a moving target. The dose delivery to a moving target could pass 3%/3 mm gamma analysis following the commissioning process and application of the clinical workflow detailed in this manuscript. A clinical workflow was established and successfully applied to patient treatment utilizing RGPT. Prostate cancer patients with implanted platinum fiducial markers were treated with RGPT. Their target motion and gating signal data were available for intrafraction motion analysis.

Conclusion: Real-time gated proton therapy with the Hitachi System has been fully investigated and commissioned for clinical application. RGPT can provide advanced and reliable real-time image guidance to enhance patient safety and inform important treatment planning parameters, such as planning target volume margins and uncertainty parameters for robust plan optimization. RGPT improved the treatment of patients with prostate cancer in situations where intrafraction motion is more than defined tolerance.

Keywords: Image-guided proton therapy; Intrafractional motion management; Motion management for IMPT; Proton therapy for prostate cancer; Real-time gated proton therapy.