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SU‐E‐T‐621: Analysis of Robustness of Proton Pencil Beam Scanning Technique for Delivery of Craniospinal Irradiation
Author(s) -
Lin H,
Kirk M,
Zhai H,
Ding X,
Liu H,
HillKayser C,
Lustig R,
Tochner Z,
McDonough J,
Both S
Publication year - 2014
Publication title -
medical physics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.473
H-Index - 180
eISSN - 2473-4209
pISSN - 0094-2405
DOI - 10.1118/1.4888957
Subject(s) - isocenter , imaging phantom , proton therapy , nuclear medicine , pencil beam scanning , irradiation , dosimetry , field size , materials science , physics , optics , beam (structure) , medicine , nuclear physics
Purpose: To investigate the robustness and safety of craniospinal irradiation (CSI) planned with a proton pencil beam scanning (PBS) technique which overcomes the complexity of the planning associated with feathering match lines. Methods: Six CSI patients were planned with gradient‐dose matching using PBS technique. Uniform dose coverage to the entire target volumes was achieved with averaged junction lengths of 6.9±0.3 cm. Robustness of the plans was evaluated by shifting the isocenter of each treatment field by ±3 mm in longitudinal direction and compared with the original non‐shifted plan with metrics of conformity number (CN) and homogeneity index (HI). An anthropomorphic phantom study using film measurements was also carried out on a plan with 5 cm junction length. Results: For a given junction length, the dose errors were directly proportional to the setup errors. Setup errors of 3 mm from each field caused on average 3.5% lower CN and 2.1% higher HI. Minimal D95% to PTV and D98% to CTV were reduced by 2.2%±1.5% and 2.8%±1.7% respectively. A drop of maximal 6.8%±5.5% on the minimal dose to the cribriform plate was also observed. When the junction length was 5cm or longer, these 3mm setup errors from each field resulted in up to 12% dose errors. Consistent results were reached between film measurements and planned dose profiles in the junction area. Due to near‐zero exit doses beyond the target volume, sparing of anterior organs such as heart, liver, lung and kidney were observed. Conclusions: Longitudinal setup errors directly reduce the dosimetric accuracy of the CSI treatment with matched proton fields. The reported technique creates a slow dose gradient in the junction area, which makes the treatment more robust and safe to longitudinal setup errors compared to conventional feathering methods.