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Title: SU-F-T-207: Does the Greater Flexibility of Pencil Beam Scanning Reduce the Need for a Proton Gantry?

Abstract

Purpose: Gantry-less proton treatment facility could lower the capital cost of proton therapy. This study investigates the dosimetric feasibility of using only coplanar pencil beam scanning (PBS) beams for those patients who had beam angles that would not have been deliverable without the gantry. Those coplanar beams are implemented on gantry-less horizontal beam-line with patients in sitting or standing positions. Methods: We have selected ten patients (seven head-and-neck, one thoracic, one abdominal and one pelvic case) with clinically delivered double scattering (DS) or PBS treatment plans with beam angles that were challenging to achieve without a gantry. After removing these beams angles, PBS plans were optimized for gantry-less intensity modulated proton therapy (IMPT) or single field optimization (SFO) with multi-criteria optimization (MCO). For head-and-neck patients who were treated by DS, we generated PBS plans with non-coplanar beams for comparison. Dose-volume-histograms (DVHs), target homogeneity index (HI), mean dose, D-2 and D-98 were reported. Robustness analysis was performed with ±2.5 mm setup errors and ±3.5% range uncertainties for three head-and-neck patients. Results: PBS-gantry-less plans provided more homogenous target coverage and significant improvements on organs-at-risk (OARs) sparing, compared to passive scattering treatments with a gantry. The PBS gantry-less treatments reduced the HI formore » target coverage by 1.3% to 47.2%, except for a suprasellar patient and a liver patient. The PBS-gantry-less plans reduced the D-mean of OARs by 3.6% to 67.4%. The PBS-gantry plans had similar target coverage and only marginal improvements on OAR sparing as compared to the PBS-gantry-less plans. These two PBS plans also had similar robustness relative to range uncertainties and setup errors. Conclusion: The gantry-less plans have with less mean dose to OARs and more homogeneous target coverage. Although the PBS-gantry plans have slightly improved target coverage and OARs sparing, the overall benefit of having a gantry to provide non-coplanar beams is debatable.« less

Authors:
; ; ; ; ; ; ;  [1]
  1. Massachusetts General Hospital and Harvard Medical School, Department of Radiation Oncology, Boston, MA (United States)
Publication Date:
OSTI Identifier:
22648824
Resource Type:
Journal Article
Resource Relation:
Journal Name: Medical Physics; Journal Volume: 43; Journal Issue: 6; Other Information: (c) 2016 American Association of Physicists in Medicine; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
60 APPLIED LIFE SCIENCES; 61 RADIATION PROTECTION AND DOSIMETRY; PATIENTS; PROTON BEAMS; RADIATION DOSES; RADIOTHERAPY

Citation Formats

Yan, S, Depauw, N, Flanz, J, Adams, J, Gorissen, BL, Shih, H, Bortfeld, T, and Lu, H. SU-F-T-207: Does the Greater Flexibility of Pencil Beam Scanning Reduce the Need for a Proton Gantry?. United States: N. p., 2016. Web. doi:10.1118/1.4956345.
Yan, S, Depauw, N, Flanz, J, Adams, J, Gorissen, BL, Shih, H, Bortfeld, T, & Lu, H. SU-F-T-207: Does the Greater Flexibility of Pencil Beam Scanning Reduce the Need for a Proton Gantry?. United States. doi:10.1118/1.4956345.
Yan, S, Depauw, N, Flanz, J, Adams, J, Gorissen, BL, Shih, H, Bortfeld, T, and Lu, H. Wed . "SU-F-T-207: Does the Greater Flexibility of Pencil Beam Scanning Reduce the Need for a Proton Gantry?". United States. doi:10.1118/1.4956345.
@article{osti_22648824,
title = {SU-F-T-207: Does the Greater Flexibility of Pencil Beam Scanning Reduce the Need for a Proton Gantry?},
author = {Yan, S and Depauw, N and Flanz, J and Adams, J and Gorissen, BL and Shih, H and Bortfeld, T and Lu, H},
abstractNote = {Purpose: Gantry-less proton treatment facility could lower the capital cost of proton therapy. This study investigates the dosimetric feasibility of using only coplanar pencil beam scanning (PBS) beams for those patients who had beam angles that would not have been deliverable without the gantry. Those coplanar beams are implemented on gantry-less horizontal beam-line with patients in sitting or standing positions. Methods: We have selected ten patients (seven head-and-neck, one thoracic, one abdominal and one pelvic case) with clinically delivered double scattering (DS) or PBS treatment plans with beam angles that were challenging to achieve without a gantry. After removing these beams angles, PBS plans were optimized for gantry-less intensity modulated proton therapy (IMPT) or single field optimization (SFO) with multi-criteria optimization (MCO). For head-and-neck patients who were treated by DS, we generated PBS plans with non-coplanar beams for comparison. Dose-volume-histograms (DVHs), target homogeneity index (HI), mean dose, D-2 and D-98 were reported. Robustness analysis was performed with ±2.5 mm setup errors and ±3.5% range uncertainties for three head-and-neck patients. Results: PBS-gantry-less plans provided more homogenous target coverage and significant improvements on organs-at-risk (OARs) sparing, compared to passive scattering treatments with a gantry. The PBS gantry-less treatments reduced the HI for target coverage by 1.3% to 47.2%, except for a suprasellar patient and a liver patient. The PBS-gantry-less plans reduced the D-mean of OARs by 3.6% to 67.4%. The PBS-gantry plans had similar target coverage and only marginal improvements on OAR sparing as compared to the PBS-gantry-less plans. These two PBS plans also had similar robustness relative to range uncertainties and setup errors. Conclusion: The gantry-less plans have with less mean dose to OARs and more homogeneous target coverage. Although the PBS-gantry plans have slightly improved target coverage and OARs sparing, the overall benefit of having a gantry to provide non-coplanar beams is debatable.},
doi = {10.1118/1.4956345},
journal = {Medical Physics},
number = 6,
volume = 43,
place = {United States},
year = {Wed Jun 15 00:00:00 EDT 2016},
month = {Wed Jun 15 00:00:00 EDT 2016}
}
  • Purpose: To investigate the effect of spot size variation as function of gantry angle on the quality of treatment plans for pencil beam scanning proton plans. Method: Three homogeneous 26×26×7cm dose volumes with different ranges and SOBPs were delivered on the matrixxPT 2D array at gantry angles of 0 and 270 degrees. The spot size sigma varies by 1.8, 7.8, and 1.4%, for nominal energies of 215, 183, and 103 MeV (Range 29, 22, and 8cm, respectively). The resulting dose planes are compared and evaluated with the gamma index for 2%/2mm and 1%/1mm criteria. Results: Patient specific QA is performedmore » at a gantry angle of 0 degrees. However, beam sigmas vary as function of gantry angle because of the beam optics for each gantry. This will cause differences between the delivered and planned treatment plans. Delivered plans were compared and a gamma pass rate of 96.5% for criteria of 2%/2mm and 91.4% for 1%/1mm were seen for plans with a nominal energy of 183 MeV. For plans with a nominal energy of 103 MeV, gamma pass rates of 97.3% for 2%/2mm and 91.5% for 1%/1mm were seen. For plans with a nominal energy of 215 MeV the pass rate was 99.8% for 1%/1mm between the two gantry angles. Conclusion: Differences in beam sigma of up to 7.8% do not cause significant differences in the dose distribution of different spot size gammas.« less
  • Purpose: To investigate the dosimetric benefits of pencil beam scanning (PBS) compared with passive scattered (PS) proton therapy for treatment of pediatric head&neck patients as a function of the PBS spot size and explore the advantages of using apertures in PBS. Methods: Ten pediatric patients with head&neck cancers treated by PS proton therapy at our institution were retrospectively selected. The histologies included rhabdomyosarcoma, ependymoma, astrocytoma, craniopharyngioma and germinoma. The prescribed dose ranged from 36 to 54 Gy(RBE). Five PBS plans were created for each patient using variable spot size (average sigma at isocenter) and choice of beam specific apertures: (1)more » 10mm spots, (2) 10mm spots with apertures, (3) 6mm spots, (4) 6mm spots with apertures, and (5) 3mm spots. The plans were optimized for intensity modulated proton therapy (IMPT) with no single beam uniformity constraints. Dose volume indices as well as equivalent uniform dose (EUD) were compared between PS and PBS plans. Results: Although target coverage was clinically adequate for all cases, the plans with largest (10mm) spots provide inferior quality compared with PS in terms of dose to organs-at-risk (OAR). However, adding apertures to these plans ensured lower OAR dose than PS. The average EUD difference between PBS and PS plans over all patients and organs at risk were (1) 2.5%, (2) −5.1%, (3) -5%, (4) −7.8%, and (5) −9.5%. As the spot size decreased, more conformal plans were achieved that offered similar target coverage but lower dose to the neighboring healthy organs, while alleviating the need for using apertures. Conclusion: The application of PBS does not always translate to better plan qualities compared to PS depending on the available beam spot size. We recommend that institutions with spot size larger than ∼6mm at isocenter consider using apertures to guarantee clinically comparable or superior dosimetric efficacy to PS treatments.« less
  • Purpose: In pencil beam scanning (PBS), the delivered spot MU, position and size are slightly different at different gantry angles. We investigated the level of delivery uncertainty at different gantry angles through a log file analysis. Methods: 34 PBS fields covering full 360 degrees gantry angle spread were collected retrospectively from 28 patients treated at our institution. All fields were delivered at zero gantry angle and the prescribed gantry angle, and measured at isocenter with the MatriXX 2D array detector at the prescribed gantry angle. The machine log files were analyzed to extract the delivered MU per spot and themore » beam position from the strip ionization chambers in the treatment nozzle. The beam size was separately measured as a function of gantry angle and beam energy. Using this information, the dose was calculated in a water phantom at both gantry angles and compared to the measurement using the 3D γ-index at 2mm/2%. Results: The spot-by-spot difference between the beam position in the log files from the delivery at the two gantry angles has a mean of 0.3 and 0.4 mm and a standard deviation of 0.6 and 0.7 mm for × and y directions, respectively. Similarly, the spot-by-spot difference between the MU in the log files from the delivery at the two gantry angles has a mean 0.01% and a standard deviation of 0.7%. These small deviations lead to an excellent agreement in dose calculations with an average γ pass rate for all fields being approximately 99.7%. When each calculation is compared to the measurement, a high correlation in γ was also found. Conclusion: Using machine logs files, we verified that PBS beam delivery at different gantry angles are sufficiently small and the planned spot position and MU. This study brings us one step closer to simplifying our patient-specific QA.« less
  • Purpose: To compare the beam data for proton spot scanning beams for the first two Varian ProBeam sites in the US at the Maryland Proton Treatment Center (MPTC) and Scripps Proton Therapy Center (Scripps). To investigate how well beams can be matched between rooms. Method: Beam data were acquired with independent dosimetry systems and compared for two sites. Integrated depth dose curves (IDDs) were acquired with large volume PTW Bragg peak chambers in a 3D water tank for pencil beams at both sites. Spot profiles were acquired at different distances from the isocenter at a gantry angle of 0 degreesmore » as well as function of gantry angle. Results: IDDs for the two Varian ProBeam proton sites are similar, except in the plateau region were the Scripps data is on average 4.5% higher relative to each other, but only 1.5% relative to the maximum at the Bragg Peak. This increase in the plateau region decrease as energy increase and for energies larger than 180 MeV there is no marked difference. Range in water coincide for all energies within 0.5mm. The sigma of the spot profiles in air are within 10% of each other at isocenter. This difference increase as the detector distance from the isocenter is increased. Conclusion: Beam data of the Varian ProBeam proton spot scanning beams for two sites are very well matched. Differences will not be clinically relevant.« less
  • Purpose: The main purpose of this study is to investigate the optimum oblique-beam arrangement for bilateral metallic prosthesis prostate cancer treatment in pencil beam scanning (PBS) proton therapy. Methods: A computed tomography dataset of bilateral metallic prosthesis prostate cancer case was selected for this retrospective study. A total of four beams (rightanterior- oblique [RAO], left-anterior-oblique [LAO], left-posterior-oblique [LPO], and right-posterior-oblique [RPO]) were selected for treatment planning. PBS plans were generated using multi-field-optimization technique for a total dose of 79.2 Gy[RBE] to be delivered in 44 fractions. Specifically, five different PBS plans were generated based on 2.5% ± 2 mm rangemore » uncertainty using five different beam arrangements (i)LAO+RAO+LPO+RPO, (ii)LAO+RAO, (iii)LPO+RPO, (iv)RAO+LPO, and (v)LAO+RPO. Each PBS plan was optimized by applying identical dose-volume constraints to the PTV, rectum, and bladder. Treatment plans were then compared based on the dose-volume histograms results. Results: The PTV coverage was found to be greater than 99% in all five plans. The homogeneity index (HI) was found to be almost identical (range, 0.03–0.04). The PTV mean dose was found to be comparable (range, 81.0–81.1 Gy[RBE]). For the rectum, the lowest mean dose (8.0 Gy[RBE]) and highest mean dose (31.1 Gy[RBE]) were found in RAO+LAO plan and LPO+RPO plan, respectively. LAO+RAO plan produced the most favorable dosimetric results of the rectum in the medium-dose region (V50) and high-dose region (V70). For the bladder, the lowest (5.0 Gy[RBE]) and highest mean dose (10.3 Gy[RBE]) were found in LPO+RPO plan and RAO+LAO plan, respectively. Other dosimetric results (V50 and V70) of the bladder were slightly better in LPO+RPO plan than in other plans. Conclusion: Dosimetric findings from this study suggest that two anterior-oblique proton beams arrangement (LAO+RAO) is a more favorable option with the possibility of reducing rectal dose significantly while maintaining comparable target coverage and acceptable bladder dose.« less