This study aims at selecting and evaluating a ripple filter design compatible with non-isocentric proton and carbon ion scanning beam treatment delivery for a compact nozzle. The use of non-isocentric treatments when the patient is shifted as close as possible towards the nozzle exit allows for a reduction in the air gap and thus an improvement in the quality of scanning proton beam treatment delivery. Reducing the air gap is less important for scanning carbon ions, but ripple filters are still necessary for scanning carbon ion beams to reduce the number of energy steps required to deliver homogeneous SOBP. The proper selection of ripple filters also allows a reduction in the possible transverse and depth-dose inhomogeneities that could appear in non-isocentric conditions in particular. A thorough review of existing ripple filter designs over the past 16 years is performed and a design for non-isocentric treatment delivery is presented. A unique ripple filter quality index (QI_RiFi) independent of the particle type and energy and representative of the ratio between energy modulation and induced scattering is proposed. The Bragg peak width evaluated at the 80% dose level (BPW₈₀) is proposed to relate the energy modulation of the delivered Bragg peaks and the energy layer step size allowing the production of homogeneous SOBP. Gate/Geant4 Monte Carlo simulations have been validated for carbon ion and ripple filter simulations based on measurements performed at CNAO and subsequently used for a detailed analysis of the proposed ripple filter design. A combination of two ripple filters in a series has been validated for non-isocentric delivery and did not show significant transverse and depth-dose inhomogeneities. Non-isocentric conditions allow a significant reduction in the spot size at the patient entrance (up to 350% and 200% for protons and carbon ions with range shifter, respectively), and therefore in the lateral penumbra in the patients.

We present GATE version 10, a major evolution of the open-source Monte Carlo simulation application for medical physics, built on Geant4. This release marks a transformative evolution, featuring a modern Python-based user interface, enhanced multithreading and multiprocessing capabilities, the ability to be embedded as a library within other software, and a streamlined framework for collaborative development. In this Part 1 paper, we outline GATE’s position among other Monte Carlo codes, the core principles driving this evolution, and the robust development cycle employed. We also detail the new features and improvements. Part 2 will focus on the architectural innovations and technical challenges. By combining an open, collaborative framework with cutting-edge features, such a Monte Carlo platform supports a wide range of academic and industrial research, solidifying its role as a critical tool for innovation in medical physics.

Patient specific quality assurance can be improved using an independent dose calculation system. In addition, the implementation of such a system may support light ion beam therapy facilities in reducing the needs for beam time, by substituting some of the experimental patient-specific quality assurance procedures by independent dose calculation. The GATE-RTion-based IDEAL system for light ion beam therapy was developed for this purpose. It was built in a DICOM-in, DICOM-out fashion, for easy integration into a state-of-the-art technology-based workflow for scanned ion beam therapy. This article describes the IDEAL system, followed by its clinical implementation at MedAustron for proton and carbon ion beams. Medical physics acceptance and commissioning steps are presented together with key results: for 3D proton and carbon ion reference boxes, 97% of the points agreed within 5% from the measurements. Experimental validation of stopping powers using real pig samples were between 1.8% and 3.8% for soft tissues. Finally, five clinical cases are described, i.e. two proton and three carbon ion treatments. Dosimetric benchmarking against TPS calculations are presented and discussed in details. As expected, the IDEAL software evidenced limitations arising from the pencil beam algorithm available in the TPS for carbon ions, especially in the presence of air cavities. The IDEAL system was found to satisfy the clinical requirements for independent dose calculation of scanned ion beam delivery systems and is being clinically implemented at MedAustron. The open-source code as well as the documentation was released on the OpenGATE collaboration website, thus allowing for long term maintenance and future upgrades based on a more widespread utilization.