Potential margin reduction in prostate cancer proton therapy with prompt gamma imaging for online treatment verification.

The potential of proton therapy is currently limited due to large safety margins. We estimated the potential reduction of clinical margins when using prompt gamma imaging (PGI) for online treatment verification of prostate cancer. For two adaptive scenarios a potential reduction relative to clinical practice was evaluated. The use of a trolley-mounted PGI system for online treatment verification to trigger an adaptation reduced the current range margins from 7 mm to 3 mm. In a case example, the dose reduction due to reduced range margins was substantially larger compared to reduced setup margins when using pre-treatment volumetric imaging.