No abstract

In situ and in vivo treatment plan verification and beam monitoring as well as dose control during heavy-ion tumour therapy can be performed in principle by measurements of range distributions of beta(+)-emitting nuclei by means of PET techniques. For this purpose the performance of different types of positron camera as well as the results of in-beam PET experiments using beams of beta(+)-active heavy ions (15O, 17F and 19Ne with energies of 300-500 A MeV) are presented. Following the deduced performance requirements a PET scanner that is designed for clinical use in experimental heavy-ion therapy at GSI Darmstadt has been built. This limited angle tomograph consists of two large-area detector heads based on position sensitive BGO detectors and is predicted to perform the measurement of the end point of a beta(+)-emitting ion beam for the verification of a treatment plan with a precision better than 1 mm. The maximum dose applied in the patient thereby is of the magnitude of 10 mGy.

Positron emission mammography (PEM) provides images of biochemical activity in the breast with spatial resolution matching individual ducts (1.5 mm full-width at half-maximum). This spatial resolution, supported by count efficiency that results in high signal-to-noise ratio, allows confident visualization of intraductal as well as invasive breast cancers. Clinical trials with a full-breast PEM device have shown high clinical accuracy in characterizing lesions identified as suspicious on the basis of conventional imaging or physical examination (sensitivity 93%, specificity 83%, area under the ROC curve of 0.93), with high sensitivity preserved (91%) for intraductal cancers. Increased sensitivity did not come at a cost of reduced specificity. Considering that intraductal cancer represents more than 30% of reported cancers, and is the form of cancer with the highest probability of achieving surgical cure, it is likely that the use of PEM will complement anatomic imaging modalities in the areas of surgical planning, high-risk monitoring, and minimally invasive therapy. The quantitative nature of PET promises to assist researchers interested studying the response of putative cancer precursors (e.g., atypical ductal hyperplasia) to candidate prevention agents.

At the new heavy ion tumor therapy facility of the Gesellschaft für Schwerionenforschung at Darmstadt positron emission tomography (PET) has been implemented for in-beam and in-situ therapy control, i.e. during the tumor irradiation. The components necessary for this dedicated PET-imaging and their integration into the framework of therapy planning and quality assurance of heavy ion cancer treatments are presented. Results of the first application of this PET-method to patient treatments are reported.

An in-beam dual-head positron camera is used to monitor the dose application in situ during the tumour irradiation with carbon ion beams at the experimental heavy ion therapy facility at GSI Darmstadt. Therefore, a positron emission tomograph has been mounted directly at the treatment site. A fully 3D reconstruction algorithm based on the maximum likelihood expectation maximization (MLEM) algorithm has been developed and adapted to this spatially varying imaging situation. The scatter and attenuation correction are included in the forward projection step of the maximum likelihood image reconstruction. This requires an attenuation map containing the information on the material composition and densities. This information is derived from the x-ray computed tomograms of the patient and the patient fixation system including the head-rest. The normalization of scattered events relative to the unscattered events is done by a global scatter fraction factor which is estimated by means of a Monte Carlo simulation. The feasibility of the proposed algorithm is shown by means of computer simulations, phantom measurements as well as patient data.