Journal of Medical Physics
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Year : 2020  |  Volume : 45  |  Issue : 3  |  Page : 195-196

Proton therapy physics (Second Edition)

Department of Medical Physics, Apollo Proton Cancer Centre, Chennai, Tamil Nadu, India

Date of Web Publication13-Oct-2020

Correspondence Address:
Dr. Dayananda Shamurailatpam Sharma
Department of Medical Physics, Apollo Proton Cancer Centre, Dr. Vikram Sarabhai Instronic Estate, Tharamani Road, Chennai - 600 096, Tamil Nadu
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jmp.JMP_86_20

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How to cite this article:
Sharma DS. Proton therapy physics (Second Edition). J Med Phys 2020;45:195-6

How to cite this URL:
Sharma DS. Proton therapy physics (Second Edition). J Med Phys [serial online] 2020 [cited 2020 Oct 22];45:195-6. Available from:

Editor: Prof. Dr. Harald Paganetti

Name and Location of the Publisher: CRC press, Taylor & Francis group, 6000 Broken Sound ParkWay NW, Suite 300, Boca Raton, FL 33487-2742, USA

Year of Publication: Nov 2018

Number of Pages of Book: 772

ISBN: 978-1-138-62650-8

Edition: Second

Price: $120 (Hardback)

The second edition of "Proton Therapy (PT) Physics" edited by Prof. Dr. Harald Paganetti, an acclaimed medical physicist for his work on PT, is the revised version of the highly successfulfirst edition. The present edition has been completely restructured under seven main sections and all chapters have been updated incorporating most of the latest researches and publications pertaining to beam scanning technique, relative biological effectiveness (RBE), and image guidance. Certain aspects that needed more in-depth discussion resulted in three additional chapters as compared to the previous edition. The second edition thus comprises of 23 immaculately written chapters, contributed by 30 eminent medical physicists/scholars, including the editor, from 15 leading PT centers and research institutes across the globe. The contributors' authority with regard to their defined topic areas has been well established from their highly cited peer-reviewed publications. The present edition as a whole provides an up-to-date, coherent, and instructive in-depth overview of defined topics on PT physics. This resourceful book aimed to serve as a comprehensive textbook for medical physicists and other professionals practicing in the fast-growing field of PT.

The book begins with an interesting chapter on the historical overview and clinical rationale for PT, starting from the initial proposal by Robert Wilson discussing the potential benefit of Bragg peak to treat tumor. It has also acknowledged the initial pioneering works done in various nuclear physics research institutions for the development of particle accelerators, and proton delivery techniques, as well as initial clinical experiences reported from physics research laboratories until thefirst hospital-based facility in 1990. The second chapter summarizes the atomic and nuclear physics background essential for understanding proton interactions with materials/tissues. It also presents fundamental equations/formulae required to estimate characteristics of proton beams for daily use. Chapter 3 describes the working principles and operational aspects of commonly used accelerators in PT, cyclotrons and synchrotrons, in particular. The ongoing researches towards the development of novel accelerator technologies are also briefly discussed. Chapter 4 outlines the characteristics of clinical proton beams and dependence of dosimetric parameters on the design features and operational settings of the beam delivery systems (BDS). Chapter 5 discusses passive scattered BDS, scattering technique to create a broad beam and range modulation techniques to generate a clinically desired depth-dose. The hardware required to create a conformal proton beam has been explicitly outlined. Chapter 6 encompasses detailed updates on scanning BDS, scanning hardware, as well as parameters that determine the scanning beam characteristics. The advantages of PBS over passive scattering technique can be learned from this chapter.

The radiation protection considerations during PT covering production of secondary radiation, shielding design, and stray radiation to ensure the safety of patients as well as operating personnel are discussed extensively in Chapter 7. After an introduction into the Monte Carlo (MC) particle tracking method, Chapter 8 demonstrates how MC simulations can be used to address various clinical and research questions in PT. In this 2nd edition, the dosimetry chapter has been expanded into two separate chapters namely detectors, relative dosimetry, and microdosimetry as Chapter 9 and absolute and reference dosimetry as Chapter 10. The detector characteristics, selection of detectors, measurement methodology, underlying dosimetry formalism, requirement for relative and reference dosimetry, and basic aspects of microdosimetry have been reviewed in detail in these two chapters. The chapter on quality assurance (QA) and commissioning from thefirst edition has now been split into three chapters in the current second edition; Chapter 11: "Acceptance test and commissioning"; Chapter 12: "QA," and Chapter 13: "Monitor unit calibration." Chapter 11 outlines all aspects of acceptance testing and clinical commissioning of passive scattering and PBS techniques, including treatment planning system and oncology information system commissioning. Chapter 12 focuses on machine as well as patient-specific QA, while Chapter 13 summarizes methods used for monitor unit calibration.

The next six chapters discuss "Treatment planning/delivery." Chapter 14 in this section discusses on dose calculation concepts and algorithms. The formalism of Pencil-beam dose calculationalgorithms has been succinctly reviewed from a theoretical and practical implementation point of view. Further, the MC dose calculation methods and hybrid methods have been detailed in this chapter. Chapter 15 covers proton-specific aspects of treatment planning for passive scattering and beam scanning delivery for single field uniform dose. This chapter also discusses the limitation of traditional clinical target volume to planning target volume safety margin and proposed for a new concept of proton-beam-specific margin. Chapter 16 describes treatment planning for multiple field uniform dose and intensity-modulated proton therapy using PBS. The challenges and the potential of intensity-modulated treatments are described, including uncertainties, optimization strategies, and plan robustness evaluation. This chapter sums up with a brief Fore-Cast on the future development of proton scanning beam therapy with primary focus on linear energy transfer painting and adapting planning. The subsequent two chapters discuss precision and uncertainties during treatment planning and delivery for nonmoving (chapter 17) and moving (chapter 18) targets. In Chapter 17, special emphasis has been made on the dosimetric consequences of heterogeneities and uncertainty management strategies including robust optimization. Chapter 18 deals with the clinical impacts of motion, QA issues, and practical approaches to mitigate motion-related uncertainties including four-dimensional (4D) robust optimization. Chapter 19 reviews the main aspects of treatment plan optimization, including multicriteria optimization, robust optimization, and biological optimization.

Chapter 20, which summarizes image-guided radiation therapy with special emphasis on PT, is a newly added chapter in the current edition. It covers traditional 2D and 3D localization using orthogonal radiographs, fluoroscopic imaging, imaging outside the treatment room, CT-on rail, ocular treatment imaging and recently available cone-beam computed tomography, and optical localization. Chapter 21 coversin vivo range verification based on the detection of photons caused by nuclear excitations and of annihilation photons created after the generation of positron emitters by the primary proton beam. The new field of ionoacoustics is described as well. The final two chapters discuss aspects of "Biological Effects" in PT. The biological implications of using protons are outlined from a physics perspective in chapter 22, particularly covering the issue of the RBE of proton beams. This chapter is rewritten almost completely. The separate chapter on "Late effects from scattered and secondary radiation" in 1st edition has been incorporated into chapter 22. In the present edition, Chapter 22 also deals with issues related to secondary doses and methods to estimate the risks for radiation-induced cancers. Outcome modeling as it pertains to PT is summarized in chapter 23. This chapter illustrates the use of risk models for normal tissue complications in treatment optimization.

In summary, the book covers the necessary physics aspects to serve as a comprehensive resource to seasoned professionals and even early career professionals working in the field of PT. The extensive list of references provided at the end of each chapter will be valuable to the readers who wish to investigate more into a specific area of interest. Some of the overlaps between certain chapters are unavoidable, I believe, to maintain the exclusivity of each chapter. The illustrations and tables provided in the book are appropriate and justify the purpose of the chapter. The appendices, future developments, and summary provided at the end of the chapter are quite useful. The monochromatic graphics, illustrations, and pictures could have been represented in actual colors for better understanding of the readers especially when body anatomy is being presented with isodose distribution.

As most of the recently functional and upcoming PT centers employ PBS technique, the current 2nd edition will definitely benefit professionals during the system evaluation for procurement, crucial time of acceptance, and clinical commissioning along with day-to-day practice of modern PT with the necessary understanding of previous technologies. I would strongly recommend 2nd edition of "Physics of PT" to clinical medical Physicists and radiation oncology professionals involved with the rapidly developing field of PT.


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