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1 Bio-Algorithms and Med-Systems

1 2024

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First PET Studies of a FLASH Proton Beam: Summary and Future Prospects

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Cesar J. P. , Abouzahr F. , Crespo P. , Gajda M. , Kuo A. , Mawlawi O. , Morozov A. , Ojha A. , Poenisch F. , Proga M. , Sahoo N. , Seco J. , Takaoka T. , Tavienier S. , Titt U. , Wang X. , Zhu X. , Lang K.

tom Vol. 20, Special issue

49--54

Objectives: Proton therapy, while highly effective and successful, still lacks a key feature: the ability to assess, in-vivo, the dose and end-point location of irradiations. Known as proton range verification, this capability can be realized by incorporating positron emission tomography (PET) systems in both conventional and emerging modalities, such as FLASH proton therapy. FLASH itself may revolutionize radiation oncology with its purported ability to better spare healthy tissues, but only if the underlying mechanisms can be understood. We summarize our work towards establishing in-beam PET modalities and elucidating the mystery of the FLASH effect. Materials: We've developed a PET scanner designed for live, in-beam imaging during therapeutic proton irradiations that can use short-lived positron emitting species (PES) activated by the beam to validate the range and dose of proton depositions. This scanner is made up of PET modules consisting of arrays of LYSO (lutetium-yttrium oxyorthosilicate) scintillating crystals coupled one-to-one to silicon photomultiplier (SiPM) arrays. These modules are readout by electronics based on the TOFPET2 ASIC platform from PETsys Electronics. Methods: Our collaboration with MD Anderson Cancer Center has given us opportunities to take real in-beam data using a non-clinical beamline capable of delivering FLASH proton irradiations into target phantoms made of polymethyl methacrylate (PMMA), high density polyethylene (HDPE), and water. Data collected both during and afterirradiations were used to perform novel analyses and to reconstruct images of PES activity due to the beam. Results: Exploratory studies, using a subset of our PET scanner, have demonstrated successful data acquisition during and after FLASH beam spills including quantitative imaging and dosimetry of activated phantoms. The full results, explored in this work, are highly promising and prove that in-beam PET can deliver on its goals. Upcoming experiments conducted using both FLASH and conventional beams will employ the full PET scanner and involve a rich experimental program with novel ideas for irradiation targets, beam characterization, and in-depth comparisons of the two irradiation modalities. Conclusions: This work demonstrates the unprecedented proof-of-principle for the capabilities of an in-beam PET scanner for imaging and dosimetry of both conventional and FLASH proton beams. These results open a new PET modality with proton beams which is particularly attractive for FLASH therapy but can serve effectively all proton irradiations, leading to improved treatment monitoring and image-guided therapy.