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Proton Therapy Delivery and Its Clinical Application in Select Solid Tumor Malignancies
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A method for acquiring random range uncertainty probability distributions in proton therapy.

S M Holloway1, M D Holloway, S J Thomas

  • 1Department of Oncology, University of Cambridge, Cambridge, United Kingdom. Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom.

Physics in Medicine and Biology
|October 21, 2017
PubMed
Summary

This study introduces a new method to quantify range uncertainties in proton therapy due to patient movement between treatments. Accurate range uncertainty models are crucial for effective proton therapy planning, ensuring optimal target dosing and organ-at-risk protection.

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Area of Science:

  • Medical Physics
  • Radiation Oncology
  • Image Guidance

Background:

  • Accurate geometric and range uncertainties are critical for effective proton therapy treatment planning.
  • Inaccurate uncertainty models can lead to under-dosing of targets and over-dosing of organs at risk (OAR).
  • Quantifying inter-fraction motion is essential for improving proton therapy uncertainty models.

Purpose of the Study:

  • To develop and validate a method for quantifying center- and site-specific population range uncertainties caused by inter-fraction motion.
  • To enhance the accuracy of uncertainty models used in proton therapy planning.
  • To provide data that can inform robust optimization and adaptive planning protocols.

Main Methods:

  • Utilized daily volumetric MVCT data from radiotherapy patients to assess inter-fraction changes in water-equivalent path-length (WEPL).
  • Applied image-guidance scans and rigid transformations to correct for CTV position changes.
  • Employed an effective depth algorithm to calculate residual range changes after corrections, analyzing WEPL within the CTV across multiple beam angles.

Main Results:

  • Quantified inter-fraction range uncertainties for head and neck patients (e.g., [Formula: see text] mm, [Formula: see text] mm, overall [Formula: see text] mm) and prostate patients (e.g., [Formula: see text] mm, [Formula: see text] mm, overall [Formula: see text] mm).
  • Found that beam angle choice significantly impacted range error for prostate but not for head and neck patients.
  • Observed greater range changes with lateral beams compared to anterior beams for prostate due to anatomical motion relative to beam angles.

Conclusions:

  • A novel method has been established to quantify population range changes due to inter-fraction motion, adaptable for clinical use.
  • The findings underscore the necessity of robust planning and analysis in proton therapy.
  • This quantified uncertainty information can improve robust optimization, treatment plan analysis, beam start conditions, and adaptive planning protocols.