Experimental comparison of clinically used ion beams for imaging applications using a range telescope

In particle therapy, the x-ray based treatment planning converting photon attenuation values to relative stopping power ratio (RSP) introduces clinically relevant range uncertainties. Recently, novel imaging technologies using transmission ion beams have been investigated to directly assess the water equivalent thickness (WET) of tissue, showing improved accuracy in RSP reconstruction, while potentially reducing the imaging dose. Due to their greater availability, protons have been mostly used for ion imaging. To this end, in this work, the influence of three ion species (protons, helium and carbon ions) on the image quality of radiographic WET retrieval has been explored with a dedicated experimental setup and compared to Monte Carlo (MC) simulations. Three phantom setups with different tissue interfaces and features have been irradiated with clinically validated proton, helium and carbon ion pencil beams under comparable imaging dose and beam settings at the Heidelberg Ion-Beam Therapy Center. Ion radiographies (iRADs) were acquired with an integration mode detector, that functions as a range telescope with 61 parallel plate ionization chambers. For comparison, experiments were reproduced in-silico with FLUKA MC simulations. Carbon ions provide iRADs with highest image quality in terms of normalized root mean square error, followed by helium ions and protons. All ions show similar capabilities of resolving WET for the considered phantoms, as shown by the similar average relative error < 3%. Besides for the slab phantom, MC simulations yielded better results than the experiment, indicating potential improvement of the experimental setup. Our results showed that the ability to resolve the WET is similar for all particles, intrinsically limited by the granularity of the detector system. While carbon ions are best suited for acquiring iRADs with the investigated integration mode detector, helium ions are put forward as a less technical challenging alternative