Clinical beam test of inter- and intra-fraction relative range monitoring in carbon ion radiotherapy

Abstract

Interaction Vertex Imaging (IVI) is used for range monitoring (RM) in carbon ion radiotherapy. The purpose of RM is to measure the Bragg peak (BP) position for each contributing beam, and detect any changes. Currently, there is no consensus on a clinical RM method, the use of which would improve the safety and consistency of treatment. The prototype filtered IVI (fIVI) Range Monitoring System is the first system to apply large-area and high-rate-capable silicon detectors to IVI. Two layers of these detectors track prompt secondary fragments for use in RM. This device monitored 16 cm and 32 cm diameter cylindrical plastic phantoms irradiated by clinical carbon ion beams at the Heidelberg Ion Beam Therapy Center. Approximately 20 different BP depths were delivered to each phantom, with a minimum depth difference of 0.8 mm and a maximum depth difference of 51.9 mm and 82.5 mm respectively. For large BP range differences, the relationship between the true depth difference and that measured by fIVI is quadratic, although for small differences, the deviation from a linear relationship with a slope of 1 is negligible. RM performance is strongly dependent on the number of tracked particles, particularly in the clinically-relevant regime. Significant performance differences exist between the two phantoms, with millimetric precision at clinical doses being achieved only for the 16 cm phantom. The performance achieved by the prototype fIVI Range Monitoring System is consistent with previous investigations of IVI, despite measuring at more challenging shallow BP positions. Further significant improvements are possible through increasing the sensitive area of the tracking system beyond the prototype, which will both allow an improvement in precision for the most intense points of a scanned treatment plan and expand the number of points for which millimetric precision may be achieved.