Particle Therapy Technology for Safe Treatment

Cover
Half Title
Title Page
Copyright Page
Dedication
Contents
Chapter 1: Introduction
Chapter 2: Evolution of Medical Particles
Chapter 3: A Personal Historical Perspective
Chapter 4: Flow of Requirements
	4.1. Direct Requirements
	4.2. Developmental Requirements
Chapter 5: External Beam Systems
Chapter 6: How to Damage Unwanted Cells
	6.1. Direct Effects
	6.2. Indirect Effects
Chapter 7: Exponentials
	7.1. e
	7.2. Distributions
		7.2.1. Binomial Distribution
		7.2.2. Poisson Distribution
		7.2.3. Gaussian Distribution
			7.2.3.1. Mean
			7.2.3.2. Standard Deviation
			7.2.3.3. Skewness and Kurtosis
			7.2.3.4. Gaussian Algebra
			7.2.3.5. Summation of Gaussians
	7.3. Interactions
		7.3.1. Can Hit the Broad Side of a Barn
		7.3.2. Interaction Target
		7.3.3. Target Hits
		7.3.4. Why Radiotherapy Works Mathematically
			7.3.4.1. Tolerances
		7.3.5. Attenuation
	7.4. Exercises
Chapter 8: Relativistic Dynamics
	8.1. Special Relativity (Briefly in This Time Frame)
	8.2. Dynamics
	8.3. Exercises
Chapter 9: Charged Particle Interactions in Matter
	9.1. Energy Loss
	9.2. Ionization Potential
	9.3. Linear Thickness or Mass Thickness
	9.4. Range
		9.4.1. Range Sensitivity
		9.4.2. Energy Loss, Distal Dose Falloff or Range Spread
	9.5. Scattering
	9.6. Dependence of the Bragg Peak on the Beam Size
	9.7. Energy Loss and Scattering Dependencies
	9.8. What Could Go Wrong – 1?
	9.9. Exercises
Chapter 10: Review of Charged Particle Motion
	10.1. Manipulation of Light Rays
	10.2. Electromagnetic Forces
	10.3. Equations of Motion
		10.3.1. Bending in a Magnetic Field
		10.3.2. The Form of the Force
		10.3.3. The Equations of Motion in a Magnetic Field
	10.4. Effects of Beam Transport Elements
		10.4.1. Drift Space
		10.4.2. Thin Lens Focusing Elements
	10.5. General Ray Coordinate Transformation
	10.6. Optical Matrix Examples
		10.6.1. Momentum
		10.6.2. Longitudinal Position
		10.6.3. Transverse Focusing
			10.6.3.1. Point-to-Point Focusing
			10.6.3.2. Point-to-Parallel Focusing
			10.6.3.3. Parallel-to-Point Focusing
			10.6.3.4. Achromatic Combined System
		10.6.4. Variables and Conditions
	10.7. The Orthogonal Direction
	10.8. Dipole Focusing
		10.8.1. Sector Focusing
		10.8.2. Pole Edge Focusing
	10.9. Misalignments
	10.10. What Could Go Wrong – 2?
	10.11. A Beam; A Gaussian Beam
		10.11.1. The Ellipse
		10.11.2. Phase Space Representation and Equation of the Beam
	10.12. Propagation of The Beam
		10.12.1. Propagation of a Beam in a Drift Length
		10.12.2. Representation of Apertures
		10.12.3. Dispersion
		10.12.4. The Effect of Multiple Scattering
	10.13. Beam Matching Beamlines
	10.14. What Could Go Wrong – 3?
	10.15. Exercises
Chapter 11: Clinical Perspective of Charged Particle Therapy Beams
	11.1. Longitudinal Direction
		11.1.1. Beam Range
		11.1.2. Distal Penumbra
	11.2. Transverse Direction
		11.2.1. Field Size
		11.2.2. Lateral Penumbra
	11.3. Dose Conformance
		11.3.1. Dose and Dose Rate
			11.3.1.1. Dose
			11.3.1.2. Counting Dose (Ionization Chamber)
			11.3.1.3. Dose Quantities, Dose Rate and Irradiation Time
			11.3.1.4. Maximum Count Rate
			11.3.1.5. Dose Rate Considerations
		11.3.2. Some Particle Beam Treatment-Related Considerations
		11.3.3. Beam Directions
		11.3.4. Additional Perspective
	11.4. What Could Go Wrong – 4?
	11.5. Exercises
Chapter 12: Three-Dimensional Dose Conformation
	12.1. Longitudinal Beam Conformance
		12.1.1. Degrading Methods
			12.1.1.1. Ridge Filter
			12.1.1.2. Range Modulator Wheel
			12.1.1.3. Beam Current Modulation
			12.1.1.4. Other Degrading Methods
		12.1.2. Discrete Energy Changes
		12.1.3. Range Compensation
	12.2. Transverse Beam Conformance By Scattering
		12.2.1. Single Scattering
		12.2.2. Double Scattering
			12.2.2.1. Beam Properties
			12.2.2.2. Patient-Specific Hardware
			12.2.2.3. Scattering System Components
	12.3. Transverse Beam Conformance By Scanning
		12.3.1. Scanning Methods
		12.3.2. General Description of Scanning
		12.3.3. Technical Scanning Delivery Techniques
			12.3.3.1. Time- or Dose-Driven
			12.3.3.2. Variation of Speed and/or Current
			12.3.3.3. Dimensional Priority
		12.3.4. Clinical Delivery Styles
			12.3.4.1. Uniform Scanning
			12.3.4.2. Single Field Uniform Dose
			12.3.4.3. Multi Field Delivery
			12.3.4.4. Distal Edge Tracking
		12.3.5. Beam Motion (Not Patient Motion) Effects
		12.3.6. Scanning Irradiation Time
		12.3.7. Time Sensitivities to Scanning Hardware
			12.3.7.1. Time vs. Dose
			12.3.7.2. Time vs. Current
			12.3.7.3. Time vs. Range
			12.3.7.4. Time vs. SAD
			12.3.7.5. Time vs. Magnet Current Ramp Rate
			12.3.7.6. Time vs. Beam Off Time
			12.3.7.7. Time vs. Energy Change Time
			12.3.7.8. Other Considerations
		12.3.8. Dose Rate Tolerances
		12.3.9. Pulsed Beams
		12.3.10. Scanning Hardware
			12.3.10.1. Scanning Dipoles
			12.3.10.2. Dipole Contribution to Scanning Irradiation Time
		12.3.11. Scanning Beam Parameters
			12.3.11.1. Static Beam Parameters
			12.3.11.2. Transverse Dose Distribution, Penumbra and Modulation
		12.3.12. Sensitivities (Scanning)
		12.3.13. Scan Patterns
		12.3.14. The Effects of the Scanning Nozzle on the Beam Size
			12.3.14.1. Chamber and Windows
			12.3.14.2. Downstream Materials
			12.3.14.3. Influence of the Dipole Exit Window on the Beam
			12.3.14.4. Influence of the Large Vacuum Window on the Beam Width
			12.3.14.5. Effect of the Air Gap on the Beam Width
			12.3.14.6. Beam Widths with Air Gaps Inside Target
			12.3.14.7. Effect of Range Shifter on Beam Width
		12.3.15. Scanning Control and Requirement Considerations
			12.3.15.1. More About Parameters
		12.3.16. Faster Scanning Systems
		12.3.17. Spreading Beams Summary
		12.3.18. How to Build a Scanning System
	12.4. What Could Go Wrong – 5?
		12.4.1. Longitudinal Spreading
		12.4.2. Transverse Spreading
	12.5. Exercises
Chapter 13: Accelerator Systems
	13.1. Accelerator Technology
	13.2. Time Structure of Accelerator Beams
	13.3. Cyclotron-Based Beam Production
		13.3.1. Phase Slippage
		13.3.2. Cyclotron Focusing Effects
		13.3.3. Cyclotron Parameters
			13.3.3.1. Energy
			13.3.3.2. Beam Phase Space Area
			13.3.3.3. Current
			13.3.3.4. Time Dependence
			13.3.3.5. Operability
			13.3.3.6. Size
	13.4. Degrader and Energy Selection System
		13.4.1. Beam Conditions Resulting from a Degrader
		13.4.2. Energy Selection System
		13.4.3. Degrader to Beamline Collimator Conditions
		13.4.4. Optics to Decouple Some Beamline Effects
		13.4.5. Degrader and ESS Summary
	13.5. Synchrotron-Based Systems
		13.5.1. Synchrotron Timing
		13.5.2. Equation of Motion (General Case)
			13.5.2.1. Interpretation of the Parameters of the Equation of Motion
		13.5.3. Relationship Between the Transfer Matrix and the Trajectory Equation
		13.5.4. Stability of a Closed Machine Particle Trajectory
		13.5.5. And We’re Out of Here
		13.5.6. Synchrotron Beam Parameters
			13.5.6.1. Energy
			13.5.6.2. Beam Phase Space
			13.5.6.3. Synchrotron Charges and Currents
			13.5.6.4. Timing
			13.5.6.5. Cost
		13.5.7. Existing Synchrotron Systems
		13.5.8. The Future of Synchrotrons
	13.6. Accelerators
	13.7. What Could Go Wrong – 6?
	13.8. Exercises
Chapter 14: Gantries
	14.1. Introduction
	14.2. Accelerator on a Gantry
		14.2.1. Cyclotron on a Gantry
		14.2.2. Synchrotron on a Gantry
	14.3. Gantry Geometry
		14.3.1. Issues Affecting the Gantry Design Parameters
			14.3.1.1. Physical Implications of Clinical Issues
			14.3.1.2. Physical Implications of Magnetics
			14.3.1.3. Desirable Features
			14.3.1.4. Compact Gantry Parameters
	14.4. Magnetic Spreading Geometry Considerations
	14.5. Beam Optics Considerations
		14.5.1. Beam Phase Space Conditions at the Gantry Coupling
		14.5.2. Minimizing the Gantry Dispersion Function
			14.5.2.1. Suppression of Dispersion
			14.5.2.2. Momentum Bandwidth
			14.5.2.3. Beam Profile for Beam Delivery
	14.6. Gantry Examples
		14.6.1. High-Level Gantry Requirements
		14.6.2. The Corkscrew Gantry
		14.6.3. In-Plane Gantry
		14.6.4. Compact Gantries
	14.7. Additional Gantry Considerations
		14.7.1. The Cost of Beam Size
		14.7.2. Room Size Matters
		14.7.3. There Is No Isocenter
	14.8. Gantry – Less Or More?
	14.9. What Could Go Wrong – 7?
	14.10. Exercises
Chapter 15: Safety in Radiotherapy
	15.1. Processes to Raise Safety Awareness
	15.2. Introduction to Hazards and Mitigations
	15.3. Introduction to Risks and Criticality
		15.3.1. Hierarchy of Risk Parameters
	15.4. Categories and Qualifiers of Risk
		15.4.1. RPN, Risk and Categories
		15.4.2. Brute Force Calculation
		15.4.3. Binary Combination
	15.5. Models and Methodologies
		15.5.1. Dominos, Swiss Cheese, But No Wine
		15.5.2. FRAM
		15.5.3. STAMP
		15.5.4. Tools and Methods
		15.5.5. Practical Considerations
	15.6. Hazard Analysis
		15.6.1. Pick a Hazard, Any Hazard
		15.6.2. Identify a Subsystem
		15.6.3. Hazard Table
		15.6.4. Radiotherapy Radiation Hazard and Risk Examples
	15.7. Failure Mode and Effects Analysis (FMEA)
		15.7.1. FMEA Example
		15.7.2. FMEA Limitations
	15.8. Mitigation of Risk
		15.8.1. Training
		15.8.2. Communication
		15.8.3. Standard Operating Procedures
		15.8.4. Equipment Design
	15.9. Quality Assurance
		15.9.1. Beam Quality Assurance
		15.9.2. Clinical and Machine Parameters
		15.9.3. Instrument QA
		15.9.4. How Often to Measure
	15.10. Quick Quality Assurance
	15.11. Beyond Safety
	15.12. What Could Go Wrong – 8?
	15.13. Exercises
Chapter 16: Sensitivities and Tolerances: Scattering
	16.1. Methodology
		16.1.1. Input Beam Perturbations
		16.1.2. Component Perturbations: Second Scatterer
		16.1.3. Correction Capability
		16.1.4. Ionization Chamber Perturbations
		16.1.5. Range Modulator Perturbations
	16.2. Discussion
Chapter 17: From Clinical to Technical Tolerances: Scanning
	17.1. The Chicken or the Egg
	17.2. The Acceptance Criteria
	17.3. Gamma Index
	17.4. Tolerances
		17.4.1. Clinical Cases Used for the Study
		17.4.2. Error Simulations
			17.4.2.1. Accuracy vs. Reproducibility
			17.4.2.2. Error Introduction
		17.4.3. Evaluation of Tolerances
	17.5. Flow to Technical Tolerances
		17.5.1. Beam Range
		17.5.2. Beam Size
		17.5.3. Dose Weight
		17.5.4. Beam Position
	17.6. Exercises
Chapter 18: Afterword
Acknowledgments
Appendix A: Particle Therapy Facilities (as of June 2021)
Appendix B: Some Useful Constants
Appendix C: Hazard Topics
Appendix D: Beam QA Frequency Possibility
Appendix E: Some Element and Compound Parameters
Index