A Proton imaging device: design and <i>status</i> of realization

Proton radiation therapy is a precise form of cancer therapy, which requires verification of the patient position and the accurate knowledge of the dose delivered to the patient. At present in the proton treatment centre, patients are positioned with X-ray radiography and dose calculations rely on the patient's morphology and electron densities obtained by X-ray computed tomography [U. Schneider, E. Pedroni, Med. Phys. 22 (1995) 353]. A proton imaging device can improve the accuracy of proton radiation therapy treatment planning and the alignment of the patient with the proton beam. Our collaboration has developed a pCR prototype consisting of a silicon microstrip tracker and a calorimeter to detect the residual energy [R. Shulte, et al., IEEE Trans. Nucl. Sci. 51 (2004) 866-872]. In this contribution we will show some results obtained testing the front-end board of the tracker and measurements performed at LNS (Laboratori Nazionali del Sud) and in LLUMC (Loma Linda University Medical Centre) using 60 and 200 MeV proton beams to test the calorimeter

Characterization of a silicon strip detector and a YAG:Ce calorimeter for a proton computed radiography apparatus

Today, there is a steadily growing interest in the use of proton beams for tumor therapy, as they permit to tightly shape the dose delivered to the target reducing the exposure of the surrounding healthy tissues. Nonetheless, accuracy in the determination of the dose distribution in proton-therapy is up to now limited by the uncertainty in stopping powers, which are presently calculated from the photon attenuation coefficients measured by X-ray tomography. Proton computed tomography apparatus (pCT) has been proposed to directly measure the stopping power and reduce this uncertainty. Main problem with proton imaging is the blurring effect introduced by multiple Coulomb scattering: single proton tracking is a promising technique to face this difficulty. As a first step towards a pCT system, we designed a proton radiography (pCR) prototype based on a silicon microstrip tracker (to characterize particle trajectories) and a segmented YAG:Ce calorimeter (to measure their residual energy). Aim of the system is to detect protons with a ~1 MHz particle rate of and with kinetic energy in the range 250-270 MeV, high enough to pass through human body. Design and development of the pCR prototype, as well as the characterization of its single components, are described in this paper

Towards a proton imaging system

Hadron therapy for tumor treatment is nowadays used in several medical centres. The main advantage in using protons or light ions beams is the possibility of tightly shaping the radiation dose to the target volume. Presently the spatial accuracy of the therapy is limited by the uncertainty in stopping power distribution, which is derived, for each treatment, from the photon attenuation coefficients measured by X-ray tomography. A direct measurement of the stopping powers will help in reducing this uncertainty. This can be achieved by using a proton beam and a detection system able to reconstruct a tomography image of the patient. As a first step towards such a system an apparatus able to perform a proton transmission radiography (pCR) has been designed. It consists of a silicon microstrip tracker, measuring proton trajectories, and a YAG:Ce calorimeter to determine the particle residual energy. Proton beam and laboratory tests have been performed on the system components prototypes: the main results will be shown and discussed.</br

Cardiac Magnetic Resonance for Prophylactic Implantable-Cardioverter Defibrillator Therapy in Ischemic Cardiomyopathy: The DERIVATE-ICM International Registry

Background: Implantable cardioverter-defibrillator (ICD) therapy is the most effective prophylactic strategy against sudden cardiac death (SCD) in patients with ischemic cardiomyopathy (ICM) and left ventricle ejection fraction (LVEF)&nbsp;≤35% as detected by transthoracic echocardiograpgy (TTE). This approach has been recently questioned because of the low rate of ICD interventions in patients who received implantation and the not-negligible percentage of patients who experienced SCD despite not fulfilling criteria for implantation. Objectives: The DERIVATE (CarDiac MagnEtic Resonance for Primary Prevention Implantable CardioVerter DebrillAtor ThErapy)-ICM registry (NCT03352648) is an international, multicenter, and multivendor study to assess the net reclassification improvement (NRI) for the indication of ICD implantation by the use of cardiac magnetic resonance (CMR) as compared to TTE in patients with ICM. Methods: A total of 861 patients with ICM (mean age 65 ± 11 years, 86% male) with chronic heart failure and TTE-LVEF&nbsp;&lt;50% participated. Major adverse arrhythmic cardiac events (MAACE) were the primary endpoints. Results: During a median follow-up of 1,054&nbsp;days, MAACE occurred in 88 (10.2%). Left ventricular end-diastolic volume index (HR: 1.007 [95%&nbsp;CI: 1.000-1.011]; P = 0.05), CMR-LVEF (HR: 0.972 [95%&nbsp;CI: 0.945-0.999]; P = 0.045) and late gadolinium enhancement (LGE) mass (HR: 1.010 [95%&nbsp;CI: 1.002-1.018]; P = 0.015) were independent predictors of MAACE. A multiparametric CMR weighted predictive derived score identifies subjects at high risk for MAACE compared with TTE-LVEF cutoff of 35% with a NRI of 31.7% (P = 0.007). Conclusions: The DERIVATE-ICM registry is a large multicenter registry showing the additional value of CMR to stratify the risk for MAACE in a large cohort of patients with ICM compared with standard of care