Emulating the Delivery of Sawtooth Proton Arc Therapy Plans on a Cyclotron-Based Proton Beam Therapy System

Simple Summary The overall delivery time of proton arc therapy (PAT) plans on current clinical systems must be evaluated due to high upward energy layer switching times (ELSTs) in order to identify clinically suitable methods of PAT planning and delivery. We present the application of an emulator for modelling the delivery of 'sawtooth' PAT plans on an existing cyclotron-based system. We show that this method of PAT planning consistently requires a longer delivery time than static intensity modulated proton therapy (IMPT) and that delivering PAT using a continuous gantry rotation remains the optimum delivery method on such systems. This analysis shows that the delivery of PAT plans generated using the simplified sawtooth PAT planning approach may be clinically infeasible without further developments to the existing clinical technologies.Abstract Purpose: To evaluate and compare the deliverability of 'sawtooth' proton arc therapy (PAT) plans relative to static intensity modulated proton therapy (IMPT) at a cyclotron-based clinical facility. Methods: The delivery of single and dual arc Sawtooth PAT plans for an abdominal CT phantom and multiple clinical cases of brain, head and neck (H&N) and base of skull (BoS) targets was emulated under the step-and-shoot and continuous PAT delivery regimes and compared to that of a corresponding static IMPT plan. Results: Continuous PAT delivery increased the time associated with beam delivery and gantry movement in single/dual PAT plans by 4.86/7.34 min (brain), 7.51/12.40 min (BoS) and 6.59/10.57 min (H&N) on average relative to static IMPT. Step-and-shoot PAT increased this delivery time further by 4.79 min on average as the delivery was limited by gantry motion. Conclusions: The emulator can approximately model clinical sawtooth PAT delivery but requires experimental validation. No clear benefit was observed regarding beam-on time for sawtooth PAT relative to static IMPT.