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Clinical implementation of respiratory‐gated spot‐scanning proton therapy: An efficiency analysis of active motion management

PURPOSE: The aim of this work is to describe the clinical implementation of respiratory‐gated spot‐scanning proton therapy (SSPT) for the treatment of thoracic and abdominal moving targets. The experience of our institution is summarized, from initial acceptance and commissioning tests to the develo...

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Autores principales: Gelover, Edgar, Deisher, Amanda J., Herman, Michael G., Johnson, Jedediah E., Kruse, Jon J., Tryggestad, Erik J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6523004/
https://www.ncbi.nlm.nih.gov/pubmed/30972922
http://dx.doi.org/10.1002/acm2.12584
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author Gelover, Edgar
Deisher, Amanda J.
Herman, Michael G.
Johnson, Jedediah E.
Kruse, Jon J.
Tryggestad, Erik J.
author_facet Gelover, Edgar
Deisher, Amanda J.
Herman, Michael G.
Johnson, Jedediah E.
Kruse, Jon J.
Tryggestad, Erik J.
author_sort Gelover, Edgar
collection PubMed
description PURPOSE: The aim of this work is to describe the clinical implementation of respiratory‐gated spot‐scanning proton therapy (SSPT) for the treatment of thoracic and abdominal moving targets. The experience of our institution is summarized, from initial acceptance and commissioning tests to the development of standard clinical operating procedures for simulation, motion assessment, motion mitigation, treatment planning, and gated SSPT treatment delivery. MATERIALS AND METHODS: A custom respiratory gating interface incorporating the Real‐Time Position Management System (RPM, Varian Medical Systems, Inc., Palo Alto, CA, USA) was developed in‐house for our synchrotron‐based delivery system. To assess gating performance, a motion phantom and radiochromic films were used to compare gated vs nongated delivery. Site‐specific treatment planning protocols and conservative motion cutoffs were developed, allowing for free‐breathing (FB), breath‐holding (BH), or phase‐gating (Ph‐G). Room usage efficiency of BH and Ph‐G treatments was retrospectively evaluated using beam delivery data retrieved from our record and verify system and DICOM files from patient‐specific quality assurance (QA) procedures. RESULTS: More than 70 patients were treated using active motion management between the launch of our motion mitigation program in October 2015 and the end date of data collection of this study in January 2018. During acceptance procedures, we found that overall system latency is clinically‐suitable for Ph‐G. Regarding room usage efficiency, the average number of energy layers delivered per minute was <10 for Ph‐G, 10‐15 for BH and ≥15 for FB, making Ph‐G the slowest treatment modality. When comparing to continuous delivery measured during pretreatment QA procedures, the median values of BH treatment time were extended from 6.6 to 9.3 min (+48%). Ph‐G treatments were extended from 7.3 to 13.0 min (+82%). CONCLUSIONS: Active motion management has been crucial to the overall success of our SSPT program. Nevertheless, our conservative approach has come with an efficiency cost that is more noticeable in Ph‐G treatments and should be considered in decision‐making.
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spelling pubmed-65230042019-05-24 Clinical implementation of respiratory‐gated spot‐scanning proton therapy: An efficiency analysis of active motion management Gelover, Edgar Deisher, Amanda J. Herman, Michael G. Johnson, Jedediah E. Kruse, Jon J. Tryggestad, Erik J. J Appl Clin Med Phys Radiation Oncology Physics PURPOSE: The aim of this work is to describe the clinical implementation of respiratory‐gated spot‐scanning proton therapy (SSPT) for the treatment of thoracic and abdominal moving targets. The experience of our institution is summarized, from initial acceptance and commissioning tests to the development of standard clinical operating procedures for simulation, motion assessment, motion mitigation, treatment planning, and gated SSPT treatment delivery. MATERIALS AND METHODS: A custom respiratory gating interface incorporating the Real‐Time Position Management System (RPM, Varian Medical Systems, Inc., Palo Alto, CA, USA) was developed in‐house for our synchrotron‐based delivery system. To assess gating performance, a motion phantom and radiochromic films were used to compare gated vs nongated delivery. Site‐specific treatment planning protocols and conservative motion cutoffs were developed, allowing for free‐breathing (FB), breath‐holding (BH), or phase‐gating (Ph‐G). Room usage efficiency of BH and Ph‐G treatments was retrospectively evaluated using beam delivery data retrieved from our record and verify system and DICOM files from patient‐specific quality assurance (QA) procedures. RESULTS: More than 70 patients were treated using active motion management between the launch of our motion mitigation program in October 2015 and the end date of data collection of this study in January 2018. During acceptance procedures, we found that overall system latency is clinically‐suitable for Ph‐G. Regarding room usage efficiency, the average number of energy layers delivered per minute was <10 for Ph‐G, 10‐15 for BH and ≥15 for FB, making Ph‐G the slowest treatment modality. When comparing to continuous delivery measured during pretreatment QA procedures, the median values of BH treatment time were extended from 6.6 to 9.3 min (+48%). Ph‐G treatments were extended from 7.3 to 13.0 min (+82%). CONCLUSIONS: Active motion management has been crucial to the overall success of our SSPT program. Nevertheless, our conservative approach has come with an efficiency cost that is more noticeable in Ph‐G treatments and should be considered in decision‐making. John Wiley and Sons Inc. 2019-04-10 /pmc/articles/PMC6523004/ /pubmed/30972922 http://dx.doi.org/10.1002/acm2.12584 Text en © 2019 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, Inc. on behalf of American Association of Physicists in Medicine. This is an open access article under the terms of thehttp://creativecommons.org/licenses/by/4.0/License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Radiation Oncology Physics
Gelover, Edgar
Deisher, Amanda J.
Herman, Michael G.
Johnson, Jedediah E.
Kruse, Jon J.
Tryggestad, Erik J.
Clinical implementation of respiratory‐gated spot‐scanning proton therapy: An efficiency analysis of active motion management
title Clinical implementation of respiratory‐gated spot‐scanning proton therapy: An efficiency analysis of active motion management
title_full Clinical implementation of respiratory‐gated spot‐scanning proton therapy: An efficiency analysis of active motion management
title_fullStr Clinical implementation of respiratory‐gated spot‐scanning proton therapy: An efficiency analysis of active motion management
title_full_unstemmed Clinical implementation of respiratory‐gated spot‐scanning proton therapy: An efficiency analysis of active motion management
title_short Clinical implementation of respiratory‐gated spot‐scanning proton therapy: An efficiency analysis of active motion management
title_sort clinical implementation of respiratory‐gated spot‐scanning proton therapy: an efficiency analysis of active motion management
topic Radiation Oncology Physics
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6523004/
https://www.ncbi.nlm.nih.gov/pubmed/30972922
http://dx.doi.org/10.1002/acm2.12584
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