Ionoacoustics: A new direct method for range verification

The superior ballistic properties of ion beams may offer improved tumor-dose conformality and unprecedented sparing of organs at risk in comparison to other radiation modalities in external radiotherapy. However, these advantages come at the expense of increased sensitivity to uncertainties in the actual treatment delivery, resulting from inaccuracies of patient positioning, physiological motion and uncertainties in the knowledge of the ion range in living tissue. In particular, the dosimetric selectivity of ion beams depends on the longitudinal location of the Bragg peak, making in vivo knowledge of the actual beam range the greatest challenge to full clinical exploitation of ion therapy. Nowadays, in vivo range verification techniques, which are already, or close to, being investigated in the clinical practice, rely on the detection of the secondary annihilation photons or prompt gammas, resulting from nuclear interaction of the primary ion beam with the irradiated tissue. Despite the initial promising results, these methods utilize a not straightforward correlation between nuclear and electromagnetic processes, and typically require massive and costly instrumentation. On the contrary, the long-term known, yet only recently revisited process of "ionoacoustics", which is generated by local tissue heating especially at the Bragg peak, may offer a more direct approach to in vivo range verification, as reviewed here.