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Background Proton imaging makes use of high‐energy, low‐intensity proton beams that fully traverse the patient and has been suggested to reduce range uncertainty in proton therapy. Upright patient positioning with proton imaging is being considered for a fixed beam room of a new proton therapy facility currently under construction. Considering that the yield and energy spectrum of secondary radiation from high‐energy proton beams is proton beam energy dependent, an assessment of radiation shielding at the energies required for proton imaging should be performed prior to use. Furthermore, NCRP 144 recommends that pion production be considered for proton energies greater than 300 MeV, which are not typically utilized for proton therapy but may be required for proton imaging. Purpose The purpose of this work was to determine whether proton treatment and imaging with an upright patient positioning system on a fixed beamline were acceptable from a radiation shielding perspective. This is the first report on radiation shielding assessment of proton imaging applications and includes consideration of pion production at the proton beam energy of 330 MeV. Methods The Geant4 Monte Carlo toolkit was used for the radiation shielding assessment. The calculations consisted of the generation of secondary particle phase‐space files by simulating the passage of high‐energy proton beams in two target materials, and subsequent simulation of the secondary particles in the proton therapy facility geometry. Particle fluence was converted to operational and protection radiation safety quantities with a custom python script for assessment of instantaneous and annual doses, respectively. Results The total yields of pions from a 330‐MeV proton beam were many orders of magnitude less than that of neutrons and photons. Three‐dimensional maps of ambient dose rate for a 330‐MeV proton beam showed doses arising from secondary neutrons and photons far exceed those arising from pion production. Incorporating representative annual workloads into the calculation demonstrated that proton imaging doses outside the shielded area were negligible compared to those arising from proton therapy. Conclusions Pion production has a negligible impact on the radiation shielding of proton imaging at 330 MeV relative to neutron and photon production. Radiation shielding designed for proton therapy is adequate for high‐energy proton imaging applications.
Background Proton imaging makes use of high‐energy, low‐intensity proton beams that fully traverse the patient and has been suggested to reduce range uncertainty in proton therapy. Upright patient positioning with proton imaging is being considered for a fixed beam room of a new proton therapy facility currently under construction. Considering that the yield and energy spectrum of secondary radiation from high‐energy proton beams is proton beam energy dependent, an assessment of radiation shielding at the energies required for proton imaging should be performed prior to use. Furthermore, NCRP 144 recommends that pion production be considered for proton energies greater than 300 MeV, which are not typically utilized for proton therapy but may be required for proton imaging. Purpose The purpose of this work was to determine whether proton treatment and imaging with an upright patient positioning system on a fixed beamline were acceptable from a radiation shielding perspective. This is the first report on radiation shielding assessment of proton imaging applications and includes consideration of pion production at the proton beam energy of 330 MeV. Methods The Geant4 Monte Carlo toolkit was used for the radiation shielding assessment. The calculations consisted of the generation of secondary particle phase‐space files by simulating the passage of high‐energy proton beams in two target materials, and subsequent simulation of the secondary particles in the proton therapy facility geometry. Particle fluence was converted to operational and protection radiation safety quantities with a custom python script for assessment of instantaneous and annual doses, respectively. Results The total yields of pions from a 330‐MeV proton beam were many orders of magnitude less than that of neutrons and photons. Three‐dimensional maps of ambient dose rate for a 330‐MeV proton beam showed doses arising from secondary neutrons and photons far exceed those arising from pion production. Incorporating representative annual workloads into the calculation demonstrated that proton imaging doses outside the shielded area were negligible compared to those arising from proton therapy. Conclusions Pion production has a negligible impact on the radiation shielding of proton imaging at 330 MeV relative to neutron and photon production. Radiation shielding designed for proton therapy is adequate for high‐energy proton imaging applications.
Upright positioning has seen a surge in interest recently as a means to reduce radiotherapy (RT) cost, improve patient comfort, and, in selected cases, benefit treatment quality. In particle therapy, eliminating the need for a gantry can present massive reduction of upfront investment, and would drastically reduce the facility footprint. For patients with pre-existing conditions that make lying down uncomfortable, or for target sites in intimate body regions, upright RT presents a promising option toward a more comfortable, patient centred treatment. With more evidence for benefits of upright patient postures in RT emerging, several centres across the globe, mainly in particle therapy, are currently in the process of installing commercially available or prototype upright positioning devices or have already commenced treatment with upright patient postures. Yet, there remain many challenges and open questions to embed upright positioning in the modern RT workflow, no international guidelines exist to support clinical practice in upright RT, and there is a lack of professionals trained for upright patient positioning. Much work is still needed to justify the many changes necessary for upright RT. Modern image guidance is paramount to upright RT, and it is yet unclear which imaging modalities are necessary to support upright postures with the same quality as recumbent positioning. In works on prototype upright positioning systems, external alignment similar to recumbent positioning was reported for small patient or volunteer cohorts. Certain clinical advantages, such as reduced breathing motion in upright position, have been reported, but limited cohort sizes do not allow resilient conclusions on the expected treatment quality yes. Redesign of RT equipment for upright positioning, such as immobilization accessories for various body regions, is necessary, where innovations have been presented in recent literature. This review discusses the opportunities of upright RT and puts them in perspective to the current challenges.
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