Proton radiography to improve proton radiotherapy: Simulation study at different proton beam energies
A.K. Biegun, Jun Takatsu, M-J. van Goethem, E.R. van der Graaf, M. van, Beuzekom, J. Visser, and S. Brandenburg

TL;DR
This simulation study explores how proton radiography at different energies can enhance proton therapy by reducing uncertainties in tissue stopping power measurements, thereby improving treatment accuracy.
Contribution
It demonstrates the potential of proton radiography using simulations to improve proton therapy by directly measuring tissue stopping powers at various clinical beam energies.
Findings
Proton radiography can reduce range uncertainties in proton therapy.
Simulations show effective imaging with different proton energies.
Potential for improved treatment planning accuracy.
Abstract
To improve the quality of cancer treatment with protons, a translation of X-ray Computed Tomography (CT) images into a map of the proton stopping powers needs to be more accurate. Proton stopping powers determined from CT images have systematic uncertainties in the calculated proton range in a patient of typically 3-4\% and even up to 10\% in region containing bone~\cite{USchneider1995,USchneider1996,WSchneider2000,GCirrone2007,HPaganetti2012,TPlautz2014,GLandry2013,JSchuemann2014}. As a consequence, part of a tumor may receive no dose, or a very high dose can be delivered in healthy ti\-ssues and organs at risks~(e.g. brain stem)~\cite{ACKnopf2013}. A transmission radiograph of high-energy protons measuring proton stopping powers directly will allow to reduce these uncertainties, and thus improve the quality of treatment. The best way to obtain a sufficiently accurate radiograph is…
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