title: Advanced treatment planning methods for efficient radiation therapy with laser accelerated proton and ion beams.
abstract: OBJECTIVE
  Laser plasma acceleration can potentially replace large and expensive cyclotrons or synchrotrons for radiotherapy with protons and ions. On the way toward a clinical implementation, various challenges such as the maximum obtainable energy still remain to be solved. In any case, laser accelerated particles exhibit differences compared to particles from conventional accelerators. They typically have a wide energy spread and the beam is extremely pulsed (i.e., quantized) due to the pulsed nature of the employed lasers. The energy spread leads to depth dose curves that do not show a pristine Bragg peak but a wide high dose area, making precise radiotherapy impossible without an additional energy selection system. Problems with the beam quantization include the limited repetition rate and the number of accelerated particles per laser shot. This number might be too low, which requires a high repetition rate, or it might be too high, which requires an additional fluence selection system to reduce the number of particles. Trying to use laser accelerated particles in a conventional way such as spot scanning leads to long treatment times and a high amount of secondary radiation produced when blocking unwanted particles.
  
  
  METHODS
  The authors present methods of beam delivery and treatment planning that are specifically adapted to laser accelerated particles. In general, it is not necessary to fully utilize the energy selection system to create monoenergetic beams for the whole treatment plan. Instead, within wide parts of the target volume, beams with broader energy spectra can be used to simultaneously cover multiple axially adjacent spots of a conventional dose delivery grid as applied in intensity modulated particle therapy. If one laser shot produces too many particles, they can be distributed over a wider area with the help of a scattering foil and a multileaf collimator to cover multiple lateral spot positions at the same time. These methods are called axial and lateral clustering and reduce the number of particles that have to be blocked in the beam delivery system. Furthermore, the optimization routine can be adjusted to reduce the number of dose spots and laser shots. The authors implemented these methods into a research treatment planning system for laser accelerated particles.
  
  
  RESULTS
  The authors' proposed methods can decrease the amount of secondary radiation produced when blocking particles with wrong energies or when reducing the total number of particles from one laser shot. Additionally, caused by the efficient use of the beam, the treatment time is reduced considerably. Both improvements can be achieved without extensively changing the quality of the treatment plan since conventional intensity modulated particle therapy usually includes a certain amount of unused degrees of freedom which can be used to adapt to laser specific properties.
  
  
  CONCLUSIONS
  The advanced beam delivery and treatment planning methods reduce the need to have a perfect laser-based accelerator reproducing the properties of conventional accelerators that might not be possible without increasing treatment time and secondary radiation to the patient. The authors show how some of the differences to conventional beams can be overcome and efficiently used for radiation treatment.
authors.affiliation: Department of Radiation Oncology, Technische Universität München, Klinikum Rechts der Isar, Ismaninger Str 22, 81675 München, Germany. stefan.schell@tum.de
authors.forename: Stefan
authors.initials: S
authors.lastname: Schell
authors.forename: Jan J
authors.initials: JJ
authors.lastname: Wilkens
mesh_terms: D055592:Biophysical Phenomena; D006801:Humans; D007477:Ions / Q000627:therapeutic use*; D007834:Lasers; D009369:Neoplasms / Q000532:radiotherapy; D010315:Particle Accelerators; D061766:Proton Therapy; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods* / Q000706:statistics & numerical data; D020266:Radiotherapy, Conformal / Q000706:statistics & numerical data
chemical_list: D007477:Ions