Simultaneous imaging of luminescence and prompt x-rays during irradiation with spot-scanning proton beams at clinical dose level.

Prompt x-ray imaging is a promising method for observing the beam shape from outside a subject. However, its distribution is different from dose distribution, and thus a comparison with the dose is required. Meanwhile, luminescence imaging of water is a possible method for imaging the dose distribution. Consequently, we performed simultaneous imaging of luminescence and prompt x-rays during irradiation by proton beams to compare the distributions between these two different imaging methods. Optical imaging of water was conducted with spot-scanning proton beams at clinical dose level during irradiation to a fluorescein (FS) water phantom set in a black box. Prompt x-ray imaging was also conducted simultaneously from outside the black box using a developed x-ray camera during proton beam irradiation to the phantom. We measured images of the luminescence of FS water and prompt x-rays for various types of proton beams, including pencil beams, spread-out Bragg peak (SOBP) beams, and clinically used therapy beams. After the imaging, ranges were estimated from FS water and prompt x-rays and compared with those calculated with a treatment planning system (TPS). We could measure the prompt x-ray and FS water images simultaneously for all types of proton beams. The ranges estimated from the FS water and those calculated with the TPS closely matched, within a difference of several mm. Similar range difference was found between the results estimated from prompt x-ray images and those calculated with the TPS. We confirmed that the simultaneous imaging of luminescence and prompt x-rays were possible during irradiation with spot-scanning proton beams at a clinical dose level. This method can be applied to range estimation as well as comparison with the dose for prompt x-ray imaging or other imaging methods used in therapy with various types of proton beams at a clinical dose level.