Image-guided treatment adaptation is a game changer in oncological particle therapy (PT), especially for younger patients. The purpose of this study is to present a cycle generative adversarial network (CycleGAN)-based method for synthetic computed tomography (sCT) generation from cone beam CT (CBCT) towards adaptive PT (APT) of paediatric patients. Firstly, 44 CBCTs of 15 young pelvic patients were pre-processed to reduce ring artefacts and rigidly registered on same-day CT scans (i.e., verification CT scans, vCT scans) and then inputted to the CycleGAN network (employing either Res-Net and U-Net generators) to synthesise sCT. In particular, 36 and 8 volumes were used for training and testing, respectively. Image quality was evaluated qualitatively and quantitatively using the structural similarity index metric (SSIM) and the peak signal-to-noise ratio (PSNR) between registered CBCT (rCBCT) and vCT and between sCT and vCT to evaluate the improvements brought by CycleGAN. Despite limitations due to the sub-optimal input image quality and the small field of view (FOV), the quality of sCT was found to be overall satisfactory from a quantitative and qualitative perspective. Our findings indicate that CycleGAN is promising to produce sCT scans with acceptable CT-like image texture in paediatric settings, even when CBCT with narrow fields of view (FOV) are employed.

Intra-fractional respiratory management represents one of the greatest challenges of modern cancer radiotherapy (RT), as significant breathing-induced lesion motion might affect target coverage and organs at risk (OARs) sparing, jeopardizing oncological and toxicity outcomes. The detrimental effects on dosage of uncompensated organ motion are exacerbated in RT with charged particles (e.g., protons and carbon ions), due to their higher ballistic selectivity. The simplest strategies to counteract this phenomenon are the use of larger treatment margins and reductions in or control of respiration (e.g., by means of compression belts, breath hold). Gating and tracking, which synchronize beam delivery with the respiratory signal, also represent widely adopted solutions. When tracking the tumor itself or surrogates, invasive procedures (e.g., marker implantation), an unnecessary imaging dose (e.g., in X-ray-based fluoroscopy), or expensive equipment (e.g., magnetic resonance imaging, MRI) is usually required. When chest and abdomen excursions are measured to infer internal tumor displacement, the additional devices needed to perform this task, such as pressure sensors or surface cameras, present inherent limitations that can impair the procedure itself. In this context, radars have intrigued the radiation oncology community, being inexpensive, non-invasive, contactless, and insensitive to obstacles. Even if real-world clinical implementation is still lagging behind, there is a growing body of research unraveling the potential of these devices in this field. The purpose of this narrative review is to provide an overview of the studies that have delved into the potential of radar-based technologies for motion-adaptive photon and particle RT applications.

This study describes a method for setup optimization in patient simulation for ocular proton therapy (OPT) at the National Center for Oncological Hadrontherapy (CNAO) in Pavia, Italy, with the aim of minimizing the occupancy time of clinical areas and streamlining the actual procedure. Setup repeatability is ensured by patient-specific immobilization tools and relies on the patient’s ability to maintain a stable gaze direction according to the treatment plan. This is facilitated by aligning a light source (LED) on a patient-specific base along the prescribed gaze direction. At CNAO, a dedicated Eye-Tracking System (ETS) was designed to provide the patient with a visible source of light aligned to the desired gaze direction. The ETS position is defined prior to treatment planning, relying on optical-tracking guidance and comparing the position of passive markers fixed on the ETS chassis with patient-specific models prepared offline in accordance with the desired geometry. OPT at CNAO started in 2016 and may be considered as a consolidated clinical routine. However, all the preparation phases, including patient-specific ETS models and setup, still require long sessions in clinical areas such as the computed tomography (CT) and the treatment rooms, with a non-negligible impact on other activities. This study describes a novel approach for patient-specific definition of the ETS position and orientation, aiming at minimizing the time required for preparatory activities inside clinical areas. To minimize the occurrence of biases and to reproduce as much as possible a real end-to-end approach, we included in the analysis data of patients that received OPT in our facility. The study was performed in parallel, carrying out the alignment with the standard method currently used in the clinical workflow of CNAO and with the proposed method. Results are presented as 3D residuals and gaze deviations, comparing ETS alignment based on the new approach with respect to the clinical standard method. The preliminary results of this study are evidence of the capability of the procedure to align the ETS position, allowing performing of the procedure in a non-clinical dedicated room.

The purpose of this retrospective study was to simulate a daily pre-alignment strategy to mitigate systematic positioning errors in image-guided pediatric hadron therapy. All pediatric patients (32 patients, 853 fractions) treated from December 2021 and September 2022 at our Institution were retrospectively considered. For all fractions, daily correction vectors (CVs) resulting from image registration for patient positioning were retrieved in the form of txt files from the hospital database. For each fraction, an adjusted correction vector (V′) was then computed as the difference between the actual one (V) and the algebraic average of the previous ones, as to simulate patient pre-alignment before imaging. The Euclidean norm of each V′ was computed and normalized with respect to that of the corresponding V to derive N. Pre-correcting all the coordinate values led to a 46% average reduction (min 20%, max 60%) in CVs, considering the first 27 fractions (average value in this cohort of patients). Such a potential improvement (N < 1) was observed for the most patients’ fractions (781/853, 91.6%). For the remaining 72/853 cases (8.4%), a remarkable worsening (N > 2) involved only 7/853 (0.82%) fractions. The presented strategy shows promising outcomes in order to ameliorate pediatric patient setup before imaging. However, further investigations to identify patients most likely to benefit from this approach are warranted.