Sensitivity evaluation of prompt γ-ray based range verification with a slit camera

Purpose
The dose distribution and range of proton beams are exceedingly prone to uncertainties and anatomical changes, demanding for an in-vivo range verification. A promising approach is prompt γ-ray imaging (PGI), which was recently implemented clinically in Dresden using a so-called PGI slit camera [1,2] in double scattering (DS). However, the detectability of local range shifts, affecting only part of the lateral field in DS, is limited. The spot-wise dose deposition in pencil beam scanning (PBS) promises a finer spatial resolution of range shifts. The purpose of this study is to comprehensively investigate the sensitivity to detect range shifts in DS and PBS using a head phantom in a clinical setup.

Materials and Methods
For a realistic brain tumor treatment, treatment plans in DS and PBS (2 beams, 60 GyE,
2 GyE/fx), were created. One beam (1 GyE) was applied to a CIRS head phantom and monitored with the PGI slit camera. To investigate the influence of the spot dose, the same beam with 5 GyE was also delivered and measured. Global and local (5 cm in diameter) range shifts were introduced and the PGI profiles (prompt-γ counts over depth) with and without shifts were compared. Sum profiles containing prompt-γ counts over the entire fraction were used for the comparison of DS and PBS. Moreover, PGI profiles measured in PBS were analyzed spot-wise and will also be compared with simulated profiles for absolute range determination.
 
Results
A good agreement between introduced and measured global shifts was found in the sum profile evaluation for both modalities, PBS and DS (Table 1). Relative differences were below 2, 7 and 12 % for the 10, 7 and 4 mm shifts, respectively. Local shifts are not detectable using sum profiles. For the applied local shifts, a spot-wise comparison of PGI profiles in PBS allows the detection and localization of global and local shifts (Figure 1). For interpretation, neighboured spots should be clustered, as shifts detected for single spots are less reliable due to low statistics. Higher doses (5 vs. 1 GyE) allow the detection of smaller shifts as shown in Figure 1 for the 4 mm local shift.

Conclusion
The systematic sensitivity study revealed the capability of the PGI slit camera to detect range shifts under clinical conditions. In both treatment modalities, global range shifts can be detected. Additionally, in PBS a spot-wise comparison allows also the determination of interfractional local range shifts. Moreover, a still ongoing evaluation of PBS measured and simulated spot-wise profiles for absolute range verification will be presented.