Frontiers in Physics (Jan 2021)

Detection of Interfractional Morphological Changes in Proton Therapy: A Simulation and In Vivo Study With the INSIDE In-Beam PET

  • Elisa Fiorina,
  • Elisa Fiorina,
  • Veronica Ferrero,
  • Guido Baroni,
  • Guido Baroni,
  • Giuseppe Battistoni,
  • Nicola Belcari,
  • Nicola Belcari,
  • Niccolo Camarlinghi,
  • Niccolo Camarlinghi,
  • Piergiorgio Cerello,
  • Mario Ciocca,
  • Micol De Simoni,
  • Micol De Simoni,
  • Marco Donetti,
  • Yunsheng Dong,
  • Yunsheng Dong,
  • Alessia Embriaco,
  • Marta Fischetti,
  • Marta Fischetti,
  • Gaia Franciosini,
  • Gaia Franciosini,
  • Giuseppe Giraudo,
  • Aafke Kraan,
  • Francesco Laruina,
  • Francesco Laruina,
  • Carmela Luongo,
  • Carmela Luongo,
  • Davide Maestri,
  • Marco Magi,
  • Giuseppe Magro,
  • Etesam Malekzadeh,
  • Carlo Mancini Terracciano,
  • Carlo Mancini Terracciano,
  • Michela Marafini,
  • Michela Marafini,
  • Ilaria Mattei,
  • Enrico Mazzoni,
  • Paolo Mereu,
  • Riccardo Mirabelli,
  • Riccardo Mirabelli,
  • Riccardo Mirabelli,
  • Alfredo Mirandola,
  • Matteo Morrocchi,
  • Matteo Morrocchi,
  • Silvia Muraro,
  • Alessandra Patera,
  • Vincenzo Patera,
  • Vincenzo Patera,
  • Vincenzo Patera,
  • Francesco Pennazio,
  • Alessandra Retico,
  • Alessandra Retico,
  • Angelo Rivetti,
  • Manuel Dionisio Da Rocha Rolo,
  • Valeria Rosso,
  • Valeria Rosso,
  • Alessio Sarti,
  • Alessio Sarti,
  • Alessio Sarti,
  • Angelo Schiavi,
  • Angelo Schiavi,
  • Adalberto Sciubba,
  • Adalberto Sciubba,
  • Adalberto Sciubba,
  • Elena Solfaroli Camillocci,
  • Elena Solfaroli Camillocci,
  • Elena Solfaroli Camillocci,
  • Giancarlo Sportelli,
  • Giancarlo Sportelli,
  • Sara Tampellini,
  • Marco Toppi,
  • Marco Toppi,
  • Giacomo Traini,
  • Giacomo Traini,
  • Serena Marta Valle,
  • Francesca Valvo,
  • Barbara Vischioni,
  • Viviana Vitolo,
  • Richard Wheadon,
  • Maria Giuseppina Bisogni,
  • Maria Giuseppina Bisogni

DOI
https://doi.org/10.3389/fphy.2020.578388
Journal volume & issue
Vol. 8

Abstract

Read online

In particle therapy, the uncertainty of the delivered particle range during the patient irradiation limits the optimization of the treatment planning. Therefore, an in vivo treatment verification device is required, not only to improve the plan robustness, but also to detect significant interfractional morphological changes during the treatment itself. In this article, an effective and robust analysis to detect regions with a significant range discrepancy is proposed. This study relies on an in vivo treatment verification by means of in-beam Positron Emission Tomography (PET) and was carried out with the INSIDE system installed at the National Center of Oncological Hadrontherapy (CNAO) in Pavia, which is under clinical testing since July 2019. Patients affected by head-and-neck tumors treated with protons have been considered. First, in order to tune the analysis parameters, a Monte Carlo (MC) simulation was carried out to reproduce a patient who required a replanning because of significant morphological changes found during the treatment. Then, the developed approach was validated on the experimental measurements of three patients recruited for the INSIDE clinical trial (ClinicalTrials.gov ID: NCT03662373), showing the capability to estimate the treatment compliance with the prescription both when no morphological changes occurred and when a morphological change did occur, thus proving to be a promising tool for clinicians to detect variations in the patients treatments.

Keywords