Accuracy of using high-energy prompt gamma to verify proton beam range with a Compton camera: A Monte Carlo simulation study

Prompt gamma (PG) rays emitted during proton therapy has been used for proton range verification. Because high-energy PG emission is well correlated to the Bragg peak (BP), high-energy PG rays are well-suited for proton range verification. However, the low production and detection of high-energy PG rays often lead to inaccurate BP position estimates. The aim of this study is to improve the BP position estimates obtained from high-energy PG rays. We propose a BP position estimation method based on the local maximum closest to the distal fall-off region. We present the results of Monte Carlo simulations in which a water phantom was irradiated with a proton beam. Our results show that the BP position estimated from the 6.13 MeV PG rays can be improved using the proposed position estimation method. Moreover, the 6.92 and 7.12 MeV PG rays can be used for predicting the BP position. However, the accuracy of the BP position estimation decreases with decreasing tissue oxygen levels. We also found that the subtraction of the PG images of 6.13 MeV from those of 6.92 and 7.12 MeV can be used to predict the BP position with a mean accuracy of < 2 mm. The accurate estimation of the BP position can be achieved using different high-energy PG rays, but factors including position estimation, irradiated tissue and event selection should be carefully taken into account.