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Streamlining proton beam therapy (PBT) imaging from three steps to two reduces patient treatment time and radiation dose. This optimized workflow, excluding the initial 2D kilo-voltage (2DkV) image, is now standard practice.

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Area of Science:

  • Medical Physics
  • Radiation Oncology

Background:

  • The UK's first proton beam therapy (PBT) centre implemented an initial image-guided PBT (IGPBT) workflow.
  • This workflow involved a 2-dimensional kilo-voltage (2DkV) image, cone-beam computed-tomography (CBCT), and a repeat 2DkV image.

Purpose of the Study:

  • To evaluate the on-treatment imaging workflow in PBT.
  • To reduce treatment times and unnecessary imaging doses for patients undergoing PBT.

Main Methods:

  • Data from the first 20 PBT patients (70% paediatrics, 30% TYA/adult) were analyzed.
  • Pearson correlations and Bland-Altman analysis assessed correlations between 2DkV and CBCT images to identify superfluous imaging steps.

Main Results:

  • A three-step workflow (initial 2DkV, CBCT, repeat 2DkV) added a mean imaging dose of 3.4 mGy and 5.1 minutes per patient.
  • High correspondence (R=0.94, 0.94, 0.80) was found between initial 2DkV and CBCT displacements, with narrow limits of agreement.

Conclusions:

  • Removing the initial 2DkV image streamlines the workflow to two steps, reducing treatment time and imaging dose.
  • This two-step workflow has been implemented as the standard verification protocol.
  • Further investigation is needed for challenging cases, such as paediatric patients under general anesthesia (GA).