ArticleRadiation oncology (London, England)2021
Applications of various range shifters for proton pencil beam scanning radiotherapy.
Article in Radiation oncology (London, England), 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers.
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15 citing papers in PubMed, 15 citations in OpenAlex.
- Dosimetric evaluation of patient-side range shifters using two materials for superficial region treatment in spot scanning proton therapy: impact of material, air gap and setup distance.Journal of radiation research · 2026Article
- Enhancing proton therapy for superficial lesions using patient-specific bolus and multi-leaf collimator.Radiological physics and technology · 2026Article
- A Review of 3D-Printed Medical Devices for Cancer Radiation Therapy.Bioengineering (Basel, Switzerland) · 2026Review
- Novel Bragg peak FLASH radiotherapy: treatment of base-of-skull tumors within existing clinical guidelines.Frontiers in oncology · 2026Article
- Proton Therapy for Uveal Melanoma on a Pencil Beam Scanning Gantry.Advances in radiation oncology · 2025Article
- Implementation of a novel pencil beam scanning Bragg peak FLASH technique to a commercial treatment planning system.Medical physics · 2025Article
- Application of 3D-printed compensators for proton pencil beam scanning of shallowly localized pediatric tumors.Radiation oncology (London, England) · 2025Article
- ACR-ARS Practice Parameter for the Performance of Proton Beam Therapy.International journal of particle therapy · 2024Article
- Clinical Viability of an Active Spot Scanning Beam Delivery System With a Newly Developed Carbon-Ion Treatment Planning System.Advances in radiation oncology · 2024Article
- Dose Evaluation in 2-Phase Method for Advanced Esophageal Cancer by Hybrid Irradiation Techniques.International journal of particle therapy · 2024Article
- Is noncoplanar plan more robust to inter-fractional variations than coplanar plan in treating bilateral HN tumors with pencil-beam scanning proton beams?Journal of applied clinical medical physics · 2024Article
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- Comparison of the Medical Uses and Cellular Effects of High and Low Linear Energy Transfer Radiation.Toxics · 2022Review
- Dosimetric evaluation of photons versus protons in postmastectomy planning for ultrahypofractionated breast radiotherapy.Radiation oncology (London, England) · 2022Article
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Authors and funding
12 authors at 5 institutions in 2 countries.
Funding
Abstract
backgroundA range pull-back device, such as a machine-related range shifter (MRS) or a universal patient-related range shifter (UPRS), is needed in pencil beam scanning technique to treat shallow tumors.
methodsThree UPRS made by QFix (Avondale, PA, USA) allow treating targets across the body: U-shaped bolus (UB), anterior lateral bolus (ALB), and couch top bolus. Head-and-neck (HN) patients who used the UPRS were tested. The in-air spot sizes were measured and compared in this study at air gaps: 6 cm, 16 cm, and 26 cm. Measurements were performed in a solid water phantom using a single-field optimization pencil beam scanning field with the ALB placed at 0, 10, and 20 cm air gaps. The two-dimensional dose maps at the middle of the spread-out Bragg peak were measured using ion chamber array MatriXX PT (IBA-Dosimetry, Schwarzenbruck, Germany) located at isocenter and compared with the treatment planning system.
resultsA UPRS can be consistently placed close to the patient and maintains a relatively small spot size resulting in improved dose distributions. However, when a UPRS is non-removable (e.g. thick couch top), the quality of volumetric imaging is degraded due to their high Z material construction, hindering the value of Image-Guided Radiation Therapy (IGRT). Limitations of using UPRS with small air gaps include reduced couch weight limit, potential collision with patient or immobilization devices, and challenges using non-coplanar fields with certain UPRS. Our experience showed the combination of a U-shaped bolus exclusively for an HN target and an MRS as the complimentary device for head-and-neck targets as well as for all other treatment sites may be ideal to preserve the dosimetric advantages of pencil beam scanning proton treatments across the body.
conclusionWe have described how to implement UPRS and MRS for various clinical indications using the PBS technique, and comprehensively reviewed the advantage and disadvantages of UPRS and MRS. We recommend the removable UB only to be employed for the brain and HN treatments while an automated MRS is used for all proton beams that require RS but not convenient or feasible to use UB.
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