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Title: SU-E-T-292: Sensitivity of Fractionated Lung IMPT Treatments to Setup Uncertainties and Motion Effects

Purpose: Evaluate the sensitivity of intensity-modulated proton therapy (IMPT) lung treatments to systematic and random setup uncertainties combined with motion effects. Methods: Treatment plans with single-field homogeneity restricted to ±20% (IMPT-20%) were compared to plans with no restriction (IMPT-full). 4D Monte Carlo simulations were performed for 10 lung patients using the patient CT geometry with either ±5mm systematic or random setup uncertainties applied over a 35 × 2.5Gy(RBE) fractionated treatment course. Intra-fraction, inter-field and inter-fraction motions were investigated. 50 fractionated treatments with systematic or random setup uncertainties applied to each fraction were generated for both IMPT delivery methods and three energy-dependent spot sizes (big spots - BS σ=18-9mm, intermediate spots - IS σ=11-5mm, small spots - SS σ=4-2mm). These results were compared to a Monte Carlo recalculation of the original treatment plan, with results presented as the difference in EUD (ΔEUD), V{sub 95} (ΔV{sub 95}) and target homogeneity (ΔD{sub 1}–D{sub 99}) between the 4D simulations and the Monte Carlo calculation on the planning CT. Results: The standard deviations in the ΔEUD were 1.95±0.47(BS), 1.85±0.66(IS) and 1.31±0.35(SS) times higher in IMPT-full compared to IMPT-20% when ±5mm systematic setup uncertainties were applied. The ΔV{sub 95} variations were also 1.53±0.26(BS), 1.60±0.50(IS) and 1.38±0.38(SS)more » times higher for IMPT-full. For random setup uncertainties, the standard deviations of the ΔEUD from 50 simulated fractionated treatments were 1.94±0.90(BS), 2.13±1.08(IS) and 1.45±0.57(SS) times higher in IMPTfull compared to IMPT-20%. For all spot sizes considered, the ΔD{sub 1}-D{sub 99} coincided within the uncertainty limits for the two IMPT delivery methods, with the mean value always higher for IMPT-full. Statistical analysis showed significant differences between the IMPT-full and IMPT-20% dose distributions for the majority of scenarios studied. Conclusion: Lung IMPT-full treatments are more sensitive to both systematic and random setup uncertainties compared to IMPT-20%. This work was supported by the NIH R01 CA111590.« less
Authors:
; ;  [1]
  1. Massachusetts General Hospital and Harvard Medical School, Boston, MA (United States)
Publication Date:
OSTI Identifier:
22351111
Resource Type:
Journal Article
Resource Relation:
Journal Name: Medical Physics; Journal Volume: 41; Journal Issue: 6; Other Information: (c) 2014 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; COMPUTERIZED SIMULATION; ENERGY DEPENDENCE; LUNGS; MONTE CARLO METHOD; PATIENTS; RADIATION DOSE DISTRIBUTIONS; RADIOTHERAPY; RBE