Sensitivity of a prompt-gamma slit-camera to detect range shifts for proton treatment verification

Background and Purpose: Prompt-gamma imaging (PGI) was recently applied successfully in first clinical patient treatments in pencil beam scanning (PBS) and double scattering (DS). Still, systematic evaluations on its capability in clinical conditions are desirable. Here, the performance of the slit-camera is systematically assessed in well-defined error scenarios using realistic treatment deliveries to an anthropomorphic phantom.
Materials and Methods: The sensitivity to detect global and local range shifts with the slit camera was investigated in PBS and DS irradiations of a head phantom. For PBS, measured PGI information for shifted geometries was compared spot-wise with either simulated or measured un-shifted PGI-information to evaluate the sensitivity to detect deviations from the treatment plan and interfractional shifts, respectively.
Results: Deviations from the treatment plan can be detected with an accuracy of 1.5 and 3 mm for global and local shifts in PBS, respectively. Interfractional comparisons are more affected by noise in the measurements. Evaluation of the average PGI signal of the whole field allows the detection of global shifts also in DS mode.
Conclusions: PGI-based detection of global and local range shifts under clinical conditions is possible. Especially for PBS treatments, both high sensitivity and high accuracy in shift detection were found.