In particle therapy, the uncertainty of the delivered particle range during the patient irradiation limits the optimization of the treatment planning. Therefore, an in vivo treatment verification device is required, not only to improve the plan robustness, but also to detect significant interfractional morphological changes during the treatment itself. In this article, an effective and robust analysis to detect regions with a significant range discrepancy is proposed. This study relies on an in vivo treatment verification by means of in-beam Positron Emission Tomography (PET) and was carried out with the INSIDE system installed at the National Center of Oncological Hadrontherapy (CNAO) in Pavia, which is under clinical testing since July 2019. Patients affected by head-and-neck tumors treated with protons have been considered. First, in order to tune the analysis parameters, a Monte Carlo (MC) simulation was carried out to reproduce a patient who required a replanning because of significant morphological changes found during the treatment. Then, the developed approach was validated on the experimental measurements of three patients recruited for the INSIDE clinical trial (ClinicalTrials.gov ID: NCT03662373), showing the capability to estimate the treatment compliance with the prescription both when no morphological changes occurred and when a morphological change did occur, thus proving to be a promising tool for clinicians to detect variations in the patients treatments.

在颗粒疗法中，在患者辐照期间输送的颗粒范围的不确定性限制了治疗计划的优化。因此，需要一种体内治疗验证装置，不仅要提高计划的鲁棒性，而且要在治疗本身期间检测出明显的分数形态变化。在本文中，提出了一种有效且鲁棒的分析以检测具有较大范围差异的区域。这项研究依靠通过电子束正电子发射断层扫描（PET）进行的体内治疗验证，并使用安装在帕维亚国家肿瘤医学中心（CNAO）的INSIDE系统进行，该系统自7月开始接受临床测试2019年。已考虑用质子治疗受头颈部肿瘤影响的患者。第一，为了调整分析参数，进行了蒙特卡洛（MC）模拟以重现需要重新计划的患者，因为在治疗期间发现了明显的形态变化。然后，该开发的方法在INSIDE临床试验招募的三名患者的实验测量中得到了验证（ClinicalTrials.gov ID：NCT03662373），显示了在未发生形态学变化和发生形态学变化时都可以根据处方估计治疗依从性的能力，因此被证明是临床医生检测患者治疗方法变化的有前途的工具。