Fast range switching of passively scattered proton beams using a modulation wheel and dynamic beam current modulation

In proton radiotherapy, the range of particles in the patient body is determined by the energy of the protons. For most systems, the energy selection time is on the order of a few seconds, which becomes a serious obstacle for continuous dose delivery techniques requiring adaptive range modulation. This work analyses the feasibility of using the range modulation wheel, an element in the beamline used to form the spread-out Bragg peak (SOBP), to produce near-instantaneous changes not only in the modulation, but also in the range of the beam. While delivering proton beams in double scattering mode, the beam current can be synchronized with the range modulation wheel rotation by defining a current modulation pattern. Different current modulation patterns were computed from Monte Carlo simulations of our double scattering nozzle to range shift an SOBP of initial range 15 cm by varying degrees of up to ∼9 cm. These patterns were passed to the treatment control system at our institution and the resulting measured depth-dose distributions were analysed in terms of flatness, distal penumbra and relative irradiation time per unit mid-SOBP dose. Suitable SOBPs were obtained in all cases, with the maximum range shift being limited only by the maximum thickness of the wheel. The distal dose fall-off (80% to 20%) of the shifted peaks was broadened to about 1 cm, from the original 0.5 cm, and the predicted overhead in delivery time showed a linear increase with the amount of the shift. By modulating the beam current in clinical scattered proton beams equipped with a modulation wheel, it is possible to dynamically modify the in-patient range of the SOBP without adding any specific hardware or compensators to the beamline. A compromise between sharper distal dose fall-off and lower delivery time can be achieved and is subject to optimization. (note)