AUTHOR=Fiorina Elisa , Ferrero Veronica , Baroni Guido , Battistoni Giuseppe , Belcari Nicola , Camarlinghi Niccolo , Cerello Piergiorgio , Ciocca Mario , De Simoni Micol , Donetti Marco , Dong Yunsheng , Embriaco Alessia , Fischetti Marta , Franciosini Gaia , Giraudo Giuseppe , Kraan Aafke , Laruina Francesco , Luongo Carmela , Maestri Davide , Magi Marco , Magro Giuseppe , Malekzadeh Etesam , Mancini Terracciano Carlo , Marafini Michela , Mattei Ilaria , Mazzoni Enrico , Mereu Paolo , Mirabelli Riccardo , Mirandola Alfredo , Morrocchi Matteo , Muraro Silvia , Patera Alessandra , Patera Vincenzo , Pennazio Francesco , Retico Alessandra , Rivetti Angelo , Da Rocha Rolo Manuel Dionisio , Rosso Valeria , Sarti Alessio , Schiavi Angelo , Sciubba Adalberto , Solfaroli Camillocci Elena , Sportelli Giancarlo , Tampellini Sara , Toppi Marco , Traini Giacomo , Valle Serena Marta , Valvo Francesca , Vischioni Barbara , Vitolo Viviana , Wheadon Richard , Bisogni Maria Giuseppina TITLE=Detection of Interfractional Morphological Changes in Proton Therapy: A Simulation and In Vivo Study With the INSIDE In-Beam PET JOURNAL=Frontiers in Physics VOLUME=8 YEAR=2021 URL=https://www.frontiersin.org/journals/physics/articles/10.3389/fphy.2020.578388 DOI=10.3389/fphy.2020.578388 ISSN=2296-424X ABSTRACT=

In particle therapy, the uncertainty of the delivered particle range during the patient irradiation limits the optimization of the treatment planning. Therefore, an in vivo treatment verification device is required, not only to improve the plan robustness, but also to detect significant interfractional morphological changes during the treatment itself. In this article, an effective and robust analysis to detect regions with a significant range discrepancy is proposed. This study relies on an in vivo treatment verification by means of in-beam Positron Emission Tomography (PET) and was carried out with the INSIDE system installed at the National Center of Oncological Hadrontherapy (CNAO) in Pavia, which is under clinical testing since July 2019. Patients affected by head-and-neck tumors treated with protons have been considered. First, in order to tune the analysis parameters, a Monte Carlo (MC) simulation was carried out to reproduce a patient who required a replanning because of significant morphological changes found during the treatment. Then, the developed approach was validated on the experimental measurements of three patients recruited for the INSIDE clinical trial (ClinicalTrials.gov ID: NCT03662373), showing the capability to estimate the treatment compliance with the prescription both when no morphological changes occurred and when a morphological change did occur, thus proving to be a promising tool for clinicians to detect variations in the patients treatments.