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Our first in-beam PET measurements of the beta+ activation induced by proton irradiation are presented. Monoenergetic proton beams in the energy and intensity range suited for the treatment of deep-seated tumours were delivered by the synchrotron of the Gesellschaft für Schwerionenforschung Darmstadt (GSI). They were stopped in PMMA blocks placed in the centre of the field of view of the positron camera that is installed in the heavy ion tumour treatment facility at GSI. The beta+ activity signal was found to be three times larger than that produced by carbon ions at the same range and applied physical dose. The reconstructed spatial beta+ activity distributions were analysed and compared with the production of positron emitters predicted by a calculation based on experimental cross-sections and on the proton flux given by the FLUKA Monte Carlo code. The shape of the depth-activity profiles was well reproduced by the model and the correlation with the proton range and the depth-dose distributions was carefully investigated. Despite the non-trivial range determination from the beta+ activity distribution in the proton case, our experimental investigation supports the feasibility of an in situ proton therapy monitoring by means of in-beam PET, as already clinically implemented for the monitoring of carbon ion therapy at GSI Darmstadt.

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Irradiation of moving targets using a scanned ion beam can cause clinically intolerable under- and overdosages within the target volume due to the interplay effect. Several motion mitigation techniques such as gating, beam tracking and rescanning are currently investigated to overcome this restriction. To enable detailed experimental studies of potential mitigation techniques a complex thorax phantom was developed. The phantom consists of an artificial thorax with ribs to introduce density changes. The contraction of the thorax can be controlled by a stepping motor. A robotic driven detector head positioned inside the thorax mimics e.g. a lung tumour. The detector head comprises 20 ionization chambers and 5 radiographic films for target dose measurements. The phantom's breathing as well as the 6D tumour motion (3D translation, 3D rotation) can be programmed independently and adjusted online. This flexibility allows studying the dosimetric effects of correlation mismatches between internal and external motions, irregular breathing, or baseline drifts to name a few. Commercial motion detection systems, e.g. VisionRT or Anzai belt, can be mounted as they would be mounted in a patient case. They are used to control the 4D treatment delivery and to generate data for 4D dose calculation. To evaluate the phantom's properties, measurements addressing reproducibility, stability, temporal behaviour and performance of dedicated breathing manoeuvres were performed. In addition, initial dosimetric tests for treatment with a scanned carbon beam are reported.

These data demonstrate the clinical efficiency and safety of scanning beam delivery of carbon ion beams in patients with skull base chordomas and chondrosarcomas. The observation of tumor regressions at a dose level of 60 GyE may indicate that the biological effectiveness of carbon ions in chordomas and chondrosarcomas is higher than initially estimated.