A modular dose delivery system for treating moving targets with scanned ion beams: Performance and safety characteristics, and preliminary tests

Lis, Michelle; Donetti, M.; Newhauser, Wayne D.; Durante, Marco; Dey, Joyoni; Weber, Ulrich; Wolf, Moritz; Steinsberger, Timo; Graeff, Christian

doi:10.1016/j.ejmp.2020.07.029

Cited by 14 publications

(42 citation statements)

References 25 publications

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“…The delivery progresses in sequence until the tumor position has entered into another motion phase and delivery is redirected to the plan from the plan library that corresponds to the detected motion phase. Further information on the M-DDS is described by Lis et al (30).…”

Section: Methodsmentioning

confidence: 99%

“…The two most important extensions to the DDS were to make it portable and to allow for motion mitigation by synchronizing beam delivery to anatomical motion. The performance of the prototype motion-mitigation DDS was previously demonstrated, including preliminary tests such as the delivery of conformal, motion-synchronized beams ( 30 ). These results focused on proof of concept and the preliminary characterization of performance, but not safety.…”

Section: Methodsmentioning

confidence: 99%

“…The prospective risk analysis was performed on a DDS, with integrated capabilities for target motion compensation ( 30 ). For convenience, the general characteristics of the M-DDS are summarized here.…”

Section: Methodsmentioning

confidence: 99%

“…amplitudes, detected from an optical laser distance sensor (OD100 − 35P840; SICK, Waldkirch, Germany), were converted into motion states (30). For each test, the clinical (non-moving) procedure was performed first, followed by the motion-compensation variant.…”

Section: Daily Weekly and Annual Qamentioning

confidence: 99%

“…Though several motion handling strategies with ion beams exist (25)(26)(27)(28), few of these motion handling strategies are integrated into their beam delivery systems (29). Relatively less is known about the safety risks of a modular motion-synchronized dose delivery system (M-DDS) for ion beam therapy (30), and no comprehensive assessment of the safety of a dose delivery system with integrated motion compensation has been reported in the scientific literature.…”

Section: Introductionmentioning

confidence: 99%

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A Modular System for Treating Moving Anatomical Targets With Scanned Ion Beams at Multiple Facilities: Pre-Clinical Testing for Quality and Safety of Beam Delivery

et al. 2021

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BackgroundQuality management and safety are integral to modern radiotherapy. New radiotherapy technologies require new consensus guidelines on quality and safety. Established analysis strategies, such as the failure modes and effects analysis (FMEA) and incident learning systems have been developed as tools to assess the safety of several types of radiation therapies. An extensive literature documents the widespread application of risk analysis methods to photon radiation therapy. Relatively little attention has been paid to performing risk analyses of nascent radiation therapy systems to treat moving tumors with scanned heavy ion beams. The purpose of this study was to apply a comprehensive safety analysis strategy to a motion-synchronized dose delivery system (M-DDS) for ion therapy.MethodsWe applied a risk analysis method to new treatment planning and treatment delivery processes with scanned heavy ion beams. The processes utilize a prototype, modular dose delivery system, currently undergoing preclinical testing, that provides new capabilities for treating moving anatomy. Each step in the treatment process was listed in a process map, potential errors for each step were identified and scored using the risk probability number in an FMEA, and the possible causes of each error were described in a fault tree analysis. Solutions were identified to mitigate the risk of these errors, including permanent corrective actions, periodic quality assurance (QA) tests, and patient specific QA (PSQA) tests. Each solution was tested experimentally.ResultsThe analysis revealed 58 potential errors that could compromise beam delivery quality or safety. Each of the 14 binary (pass-or-fail) tests passed. Each of the nine QA and four PSQA tests were within anticipated clinical specifications. The modular M-DDS was modified accordingly, and was found to function at two centers.ConclusionWe have applied a comprehensive risk analysis strategy to the M-DDS and shown that it is a clinically viable motion mitigation strategy. The described strategy can be utilized at any ion therapy center that operates with the modular M-DDS. The approach can also be adapted for use at other facilities and can be combined with existing safety analysis systems.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Daily Weekly and Annual Qamentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A Modular System for Treating Moving Anatomical Targets With Scanned Ion Beams at Multiple Facilities: Pre-Clinical Testing for Quality and Safety of Beam Delivery

et al. 2021

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Real‐time image‐guided treatment of mobile tumors in proton therapy by a library of treatment plans: a simulation study

Hamaide

Souris²,

Dasnoy

et al. 2022

Medical Physics

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To improve target coverage and reduce the dose in the surrounding organs-at-risks (OARs), we developed an image-guided treatment method based on a precomputed library of treatment plans controlled and delivered in real-time. Methods: A library of treatment plans is constructed by optimizing a plan for each breathing phase of a four dimensional computed tomography (4DCT).Treatments are delivered by simulation on a continuous sequence of synthetic computed tomographies (CTs) generated from real magnetic resonance imaging (MRI) sequences. During treatment, the plans for which the tumor are at a close distance to the current tumor position are selected to deliver their spots. The study is conducted on five liver cases. Results: We tested our approach under imperfect knowledge of the tumor positions with a 2 mm distance error. On average, compared to a 4D robustly optimized treatment plan, our approach led to a dose homogeneity increase of 5% (defined as 1 − D 5 −D 95 prescription ) in the target and a mean liver dose decrease of 23%. The treatment time was roughly increased by a factor of 2 but remained below 4 min on average. Conclusions: Our image-guided treatment framework outperforms state-ofthe-art 4D-robust plans for all patients in this study on both target coverage and OARs sparing, with an acceptable increase in treatment time under the current accuracy of the tumor tracking technology.

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Modular treatment approach for drinking water and wastewater

Larios-Martínez

Barrales-Fernández

Alvarez-Chavez

et al. 2022

Modular Treatment Approach for Drinking Water and Wastewater

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A modular dose delivery system for treating moving targets with scanned ion beams: Performance and safety characteristics, and preliminary tests

Cited by 14 publications

References 25 publications

A Modular System for Treating Moving Anatomical Targets With Scanned Ion Beams at Multiple Facilities: Pre-Clinical Testing for Quality and Safety of Beam Delivery

A Modular System for Treating Moving Anatomical Targets With Scanned Ion Beams at Multiple Facilities: Pre-Clinical Testing for Quality and Safety of Beam Delivery

Real‐time image‐guided treatment of mobile tumors in proton therapy by a library of treatment plans: a simulation study

Modular treatment approach for drinking water and wastewater

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