Prompt Gamma Imaging for In Vivo Range Verification of Pencil Beam Scanning Proton Therapy

Purpose: To report the first clinical results and value assessment of prompt gamma imaging for in vivo proton range verification in pencil beam scanning mode. Methods and Materials: A stand-alone,trolley-mounted, prototype prompt gamma camera utilizing a knife-edge slit collimator design was used to record the prompt gamma signal emitted along the proton tracks during delivery of proton therapy for a brain cancer patient. The recorded prompt gamma depth detection profiles of individual pencil beam spots were compared with the expected profiles simulated from the treatment plan. Results: In 6 treatment fractions recorded over 3 weeks, the mean ( +/- standard deviation) range shifts aggregated over all spots in 9 energy layers were -0.8 +/- 1.3 mm for the lateral field, 1.7 +/- 0.7 mm for the right-superior-oblique field, and -0.4 +/- 0.9 mm for the vertex field. Conclusions: This study demonstrates the feasibility and illustrates the distinctive benefits of promptgamma imaging in pencil beam scanning treatmentmode. Accuracy in range verification was found in this first clinical case to be better than the range uncertainty margin applied in the treatment plan. These first results lay the foundation for additional work toward tighter integration of the system for in vivo proton range verification and quantification of range uncertainties. (C) 2017 Elsevier Inc. All rights reserved.