The Trento Azienda Provinciale per i Servizi Sanitari (APSS) in Italy has become the first IBA proton therapy facility to clinically utilize in-room CT.

As proton therapy treatments are performed, there are variables that can lead to necessary adjustments in the way treatment is executed. Utilizing CT at the point of treatment allows physicians to evaluate dose distribution in real time and confirm if any changes need to be made.

"We intend to stay on the cutting edge of technology, embracing every feature that brings our proton therapy installation closer to its full potential," said Dr. Marco Schwarz, head of medical physics at the APSS proton therapy center, in a statement.

Matteo Pasini, IBA site manager, said there is another milestone they intend to accomplish this year and that it would include the first positioning application with in-room CT.

Ultimately, bringing CT to proton therapy will allow for adaptive treatment in which tumor shrinking, weight loss, or even organ movement can be accounted for at each treatment session. According to IBA, ongoing research is being done toward online re-planning, which will require rapid indicators to immediately assess target accuracy and integrate contour propagation.

Last March, HCB News reported that the CT scanner is a large bore, 64-slice system. It features low dose and pediatric imaging protocols, optimized workflow, and high performance iterative reconstruction.

The Trento proton therapy facility utilizes pencil beam scanning and is the first center in Italy to operate with isocentric gantries. The facility focuses on treating children and adults with tumors in the brain, the base of skull and the cervical-cephalic region.

Once the center ramps up to full operational capacity it expects to treat approximately 700 patients annually.

Eventually, IBA and the APSS hope that CT integration will allow for reassessment and possible adaption between each individual fraction.

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