Much attention is currently being paid to imaging prompt gamma (PG) rays for in vivo proton range monitoring in proton therapy. PG imaging using a collimator is affected by neutron-related background. We study the effectiveness of background reduction experimentally, using a scanning parallel-slit PG collimator as a simplified model of a multislat PG camera. The analysis is focused on the falloff region of the PG intensity profile near the Bragg peak, which is the typical region of interest for proton range estimation. Background reduction was studied for different energy windows, with and without a shifting time-of-flight window that takes into account the proton velocity within the phantom. Practical methods are put forward that apply to cyclotron-based pencil beams. The parallel-slit collimator was placed in front of arrays of cerium-doped lutetium yttrium silicate-coupled digital silicon photomultipliers, used to measure energy and time spectra together with intensity profiles of prompt events emitted from a polymethylmethacrylate phantom irradiated with a 160-MeV proton pencil beam. The best signal-to-background ratio of ~1.6 was similar to that obtained previously with a knife-edge-slit collimator. However, the slope-over-noise ratio in the PG-profile falloff region, was ~1.2 higher for the present collimator, given its better resolution.@en

Prompt-gamma (PG) imaging has the potential for monitoring proton therapy in real time. Different approaches are investigated. We focus on developing multi-slat collimators to image PG quanta, aiming at optimizing collimator performance to detect deviations in treatment delivery. We investigated six different multi-slat configurations, which have either optimal (analytical) intrinsic spatial resolution at fixed efficiency, or otherwise; at different distances from the proton pencil-beam axis (15 cm–35 cm). We used Geant4 to simulate irradiations of the head (energy: 130 MeV) and pelvis (200 MeV) of an anthropomorphic phantom, with and without physiologic/morphologic or setup changes of clinical dosimetric relevance. The particles escaping the phantom were transported through each of these multi-slat configurations and the gamma counts profiles were recorded at the collimator exit. Median filtering was applied to the registered PG-profiles to mitigate the effects of septa shadowing and statistical fluctuations. Time-of-flight discrimination was used to enhance the signal-to-background ratio, which appeared crucial for 200 MeV irradiations. Visual detection of the artificially introduced changes was possible by comparing the PG to the depth-dose profiles. Moreover, 2 mm range shifts could be detected in the head irradiation case using a simple linear regression fit to the falloff of the PG-profile. The influence of changes in complex, patient-like dose distributions on the PG-profiles obtained with multi-slat collimation is first studied in this work, which further gives insight on collimator design optimization and highlights its potential and simplicity for detecting proton treatment deviations over a wide range of Bragg peak positions.

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Particle therapy (PT), including proton therapy, has important advantages compared to external beam photon therapy (section 1.1). This is because most of the therapeutic effect of a proton beam is localized at the endpoint, where most of its energy is imparted to the medium (Bragg peak), with nearly no dose deposited beyond that point. However, the highly localized dose deposition makes proton therapy more sensitive to (1) patient morphological alterations, including tumor progression / regression, (2) organ motion, (3) patient setup errors, (4) tissue lateral heterogeneities that render the results obtained with non-Monte-Carlo-based treatment planning algorithms unreliable to some degree, (5) beam characteristics utilized for treatment planning, and (6) the conversion of Hounsfield units (computed tomography data), to tissue density and stoichiometry. In addition, uncertainties in the mean excitation potential I, necessary to calculate the stopping power of the penetrating ions, further contribute to potential beam range inaccuracies. Given the aforementioned sources of treatment error, an imaging technique capable of providing feedback proportional to the quality of the treatment being delivered is highly desired and a very active field of research in proton therapy (section 1.2). Specifically, it is of utmost importance to develop an imaging technique capable of providing feedback with respect to the in vivo beam range, especially when highly-heterogeneous beam paths are crossed by a pencil beam. Such a imaging technique can make use of secondary gamma (γ) radiation emitted by the patient, as a result of nuclear interactions between the projectiles and the nuclei of the irradiated medium. These techniques are mainly divided into two categories, according to the type of secondary γ rays probed: (1) positron emission tomography (PET), which makes use of delayed emission, namely pairs of 511 keV annihilation photons, resulting from β+-decay; and (2) prompt gamma (PG) imaging, which makes use of the emission of single photons typically on a sub-nanosecond timescale…@en

Positron emission tomography (PET) is the imaging modality most extensively tested for treatment monitoring in particle therapy. Optimal use of PET in proton therapy requires in situ acquisition of the relatively strong ¹⁵O signal due to its relatively short half-life (∼2 min) and high oxygen content in biological tissues, enabling shorter scans that are less sensitive to biological washout. This paper presents the first performance tests of a scaled-down in situ time-of-flight (TOF) PET system based on digital photon counters (DPCs) coupled to Cerium-doped Lutetium Yttrium Silicate (LYSO:Ce) crystals, providing quantitative results representative of a dual-head tomograph that complies with spatial constraints typically encountered in clinical practice (2 × 50°, of 360°, transaxial angular acceptance). The proton-induced activity inside polymethylmethacrylate (PMMA) and polyethylene (PE) phantoms was acquired within beam pauses (in-beam) and immediately after irradiation by an actively-delivered synchrotron pencil-beam, with clinically relevant 125.67 MeV/u, 4.6 × 10⁸ protons s^-1, and 10¹⁰ total protons. 3D activity maps reconstructed with and without TOF information are compared to FLUKA simulations, demonstrating the benefit of TOF-PET to reduce limited-angle artefacts using a 382 ps full width at half maximum coincidence resolving time. The time-dependent contributions from different radionuclides to the total count-rate are investigated. We furthermore study the impact of the acquisition time window on the laterally integrated activity depth-profiles, with emphasis on 2 min acquisitions starting at different time points. The results depend on phantom composition and reflect the differences in relative contributions from the radionuclides originating from carbon and oxygen. We observe very good agreement between the shapes of the simulated and measured activity depth-profiles for post-beam protocols. However, our results also suggest that available experimental cross sections underestimate the production of ¹⁰C for in-beam acquisitions, which in PE results in an overestimation of the predicted activity range by 1.4 mm. The uncertainty in the activity range measured in PMMA using the DPC-based TOF-PET prototype setup equals 0.2 mm-0.3 mm.

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