Analysis of characteristics of images acquired with a prototype clinical proton radiography system

TL;DR

This study evaluates the accuracy, image quality, and clinical potential of a prototype proton radiography system for patient verification and alignment in proton therapy, demonstrating its capability to detect anatomical changes and proton range errors.

Contribution

The paper introduces a clinical prototype proton radiography system and assesses its performance in terms of WET accuracy, spatial resolution, and ability to detect range errors, advancing clinical integration.

Findings

WET measurement errors were within acceptable clinical limits.

The system achieved high spatial resolution suitable for patient alignment.

Proton radiography detected simulated anatomical changes and range errors effectively.

Abstract

Verification of patient specific proton stopping powers obtained in the patient treatment position can be used to reduce the distal margins needed in particle beam planning. Proton radiography can be used as a pre-treatment instrument to verify integrated stopping power consistency with the treatment planning CT. Although a proton radiograph is a pixel by pixel representation of integrated stopping powers, the image may also be of high enough quality and contrast to be used for patient alignment. This investigation qualifies the accuracy and image quality of a prototype proton radiography system on a clinical proton delivery system. We have developed a clinical prototype proton radiography system designed for integration into efficient clinical workflows. We tested the images obtained by this system for water-equivalent thickness (WET) accuracy, image noise, and spatial resolution. We evaluated the WET accuracy by comparing the average WET and rms error in several regions of interest (ROI) on a proton radiograph of a custom peg phantom. We measured the spatial resolution on a CATPHAN Line Pair phantom and a custom edge phantom by measuring the 10% value of the modulation transfer function (MTF). In addition, we tested the ability to detect proton range errors due to anatomical changes in a patient with a customized CIRS pediatric head phantom and inserts of varying WET placed in the posterior fossae of the brain. We took proton radiographs of the phantom with each insert in place and created difference maps between the resulting images. Integrated proton range was measured from an ROI in the difference maps.