Proton IDE V1.0.4.6 2021 Full Version
Proton IDE V1.0.4.6 2021 Full Version
Proton IDE V1.0.4.6 Full Version
Figure 2 also shows mean dose-normalized OAR dose values for all treatment plans and delivery scenarios, i.e., total doses of the OAR divided by the dose of the target. Unlike DADR, OAR dose rates of beam intensity-variable deliveries clearly varied with fraction dose. Higher dose rates were achieved for arc treatment plans compared with clinical plans, in the theoretical spot-wise, arc-shoot-through, and multiple-arc delivery scenarios. The combination of small spot sizes and proton dose profiles allows a large fraction dose coverage by a single spot, resulting in high dose rates. This leads to increased local OAR doses. However, when varying the intensity between spots, dose rates are significantly reduced in the arc-shoot-through and multiple-arc scenarios compared with spot-reduced plans. For beam-intensity-variable treatment plans, all OARs were dose-limited, and NTCP of the kidneys was particularly high. For the theoretical spot-wise delivery scenario, V30Gy to the kidneys was 2.5 times higher than the arc-shoot-through scenario. Theoretical spot-wise delivery resulted in the highest OAR dose rate, with V40Gy to the kidneys being 5.3 times higher than the spot-reduced scenario. In contrast, clinical treatment plans showed significantly lower OAR dose rates. Fractionated delivery using spot-reduced arcs or multiple beams resulted in V30Gy and V40Gy to the kidneys lower by approximately 60% and 70%, respectively, than the standard dose-per-fraction delivery using a single beam with intensity-variable spots. Hypofractionated delivery resulted in significantly higher OAR dose rates, leading to a V40Gy and V45Gy to the kidneys approximately 20% and 10% higher than for the standard fractionation. In conclusion, the theoretical spot-wise delivery resulted in increased OAR doses, whereas the clinical treatment plan and the multiple-beam delivery scenarios resulted in considerably lower OAR doses. These results are in agreement with previous publications [ 3, 10, 37, 39, 42 ].
In order to benchmark the penetration of the actual beam profile, the study by Amelink and Boev (this issue) proposed a novel software approach to accurately predict the spot size in the reference volume for a pencil beam algorithm. In this work, the actual spot size calculated by a pencil beam algorithm is compared to the prediction. We investigated two factors which lead to deviations in the calculated spot size: changes in the target volume and beam profile. Both factors were simulated on a laboratory scale and validated by comparing to measurements in water with Monte Carlo simulations. The study demonstrated that the combination of an accurate model of the target volume and the beam profile are essential to make pencil beam algorithms suitable for dose prediction in the MRiPT setting. Next generation treatment systems (e.g. by IBA, or by an MRiPT consortium) might require further improvements in accuracy, such as the development of new model evaluation strategies. The study by Eicker et al. (this issue) showed that multileaf collimator (MLC) leaf motion during arc therapy planning produces artifacts in dose calculations caused by the distorted beam profile at the MLC edges. Furthermore, in this study it was shown that these artifacts can be reduced by a multi-grid algorithm that uses square cells of one millimeter edge length. These studies highlight the importance of utilizing the most appropriate algorithms for your particular application. Another factor to consider is the accuracy of the proton beam model. For proton beams, high-energy transport Monte Carlo (ESTRO, GSI) models have been proven to produce in-field dose distributions that are accurate down to the sub-millimeter level [ 16 ]. The study by Beukeboom et al. (this issue) shows that the current pencil beam algorithm for proton therapy lacks accuracy, although a commercial proton treatment planning system (CyberKnife, Accuray, Sunnyvale, CA, USA) uses this algorithm. This investigation aimed to study the accuracy of the currently implemented dose calculation algorithm used in proton treatment planning system PRIMO (Elekta AB, Stockholm, Sweden), and to investigate the dose distributions for 21Ci protons, in comparison to nominal and measured dose distributions using 3D gamma analysis. We used Farmer scintillation detectors and hadron-chamber gafchromic dosimeters to measure the dose distributions in water for 21Ci protons and compared these measurements to reference data provided by the vendor (Cobra, IBA). A threshold of 7.5% for percent of passing points was considered within the PTV. The results showed that the doses to the PTV were calculated with good agreement to nominal for all three plans. The study showed that current dose distributions of PRIMO plans are accurate for protons of energies up to 180MeV. The current algorithm could require further improvements in the dose calculation accuracy with respect to the profile shape and the more detailed beam model.]
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