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Prompt-gamma based range verification in proton therapy: Can we do better? Shall we do better?

Pausch, G.


Prompt gamma-ray imaging (PGI) with a knife-edge slit camera has proven to be useful for range monitoring in proton therapy (PT). It is meanwhile applied in a prostate patient study at OncoRay. Together with an improved range prediction based on dual-energy CT and robust planning methods it could finally allow reducing the range margins, thus saving normal tissue in PT treatments. Translating these emerging techniques in clinical routine is a long but important process that will require considerable efforts.
Nevertheless we are also dealing with the far end of the translational conveyer, asking if and how in-vivo range verification could be improved. So far, PGI does not allow measuring range deviations of single pencil beams with the necessary precision. The reason is the short delivery time of such a beam spot, and the poor event statistics that can be accessed in this period. It is obvious to exploit not only spatial, but also spectroscopic and timing information of the gamma rays registered for range verification. The prompt gamma-ray spectroscopy method developed at MGH in Boston and the prompt gamma-ray timing technique explored at OncoRay in Dresden represent reasonable alternatives to PGI; but can these approaches be combined in a single, preferable simple and light-weight, clinically applicable system distinguished by minimum interference with beam and patient couch? Could such a combination improve the accuracy and allow single-spot range verification, maybe even for the non-distal spots comprising much less protons?
The talk will present our thoughts and approaches to answer this question. This includes recent results concerning prompt gamma-ray timing (PGT) and single-plane Compton imaging (SPCI). Part of the research performed in this context could also affect gamma-ray imaging in nuclear medicine.

Keywords: PGI; PGT; prompt gamma ray; proton therapy; range verification; treatment verification

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