Experimental validation of daily adaptive proton therapy.

Nenoff, Lena; Matter, Michael; Charmillot, Marjolaine; Krier, Serge; Uher, Klara; Weber, Damien Charles; Lomax, Antony John; Albertini, Francesca (2021). Experimental validation of daily adaptive proton therapy. Physics in medicine and biology, 66(20) Institute of Physics Publishing IOP 10.1088/1361-6560/ac2b84

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Anatomical changes during proton therapy require rapid treatment plan adaption to mitigate the associated dosimetric impact. This in turn requires a highly efficient workflow that minimizes the time between imaging and delivery. At the Paul Scherrer Institute, we have developed an online adaptive workflow, which is specifically designed for treatments in the skull-base/cranium, with the focus set on simplicity and minimizing changes to the conventional workflow. The dosimetric and timing performance of this daily adaptive proton therapy (DAPT) workflow has been experimentally investigated using an in-house developed DAPT software and specifically developed anthropomorphic phantom. After a standard treatment preparation, which includes the generation of a template plan, the treatment can then be adapted each day, based on daily imaging acquired on an in-room CT. The template structures are then rigidly propagated to this CT and the daily plan is fully re-optimized using the same field arrangement, DVH constraints and optimization settings of the template plan. After a dedicated plan QA, the daily plan is delivered. To minimize the time between imaging and delivery, clinically integrated software for efficient execution of all online adaption steps, as well as tools for comprehensive and automated QA checks, have been developed. Film measurements of an end-to-end validation of a multi-fraction DAPT treatment showed high agreement to the calculated doses. Gamma pass rates with a 3%/3 mm criteria were >92% when comparing the measured dose to the template plan. Additionally, a gamma pass rate >99% was found comparing measurements to the Monte Carlo dose of the daily plans reconstructed from the logfile, accumulated over the delivered fractions. With this, we experimentally demonstrate that the described adaptive workflow can be delivered accurately in a timescale similar to a standard delivery.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Radiation Oncology

UniBE Contributor:

Weber, Damien Charles


600 Technology > 610 Medicine & health




Institute of Physics Publishing IOP




Beatrice Scheidegger

Date Deposited:

03 Dec 2021 17:46

Last Modified:

05 Dec 2022 15:54

Publisher DOI:


PubMed ID:


Uncontrolled Keywords:

adaptive therapy antropomorphic phantom end to end test online adaption proton therapy workflow implementation





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