A Model for Secondary Monitor Unit Calculations of PBS Proton Therapy Treatment Plans

This article summarizes a volume-based method by which secondary monitor unit (MU) calculations may be performed for pencil beam scanning, single field uniform dose (SFUD) proton therapy treatment plans.

Treatment planning system (TPS) simulations were performed by using the local beam model to define relationships between planning target volume (PTV) characteristics and the MUs required to deliver a uniform dose for a given beam orientation. Relevant target attributes included volume, depth (ie, beam range), range-shifter air gap, and the projected area of the target volume in the beam's eye view (BEV). The proposed model approximates the PTV as a simplified cuboid region of interest as defined by its volume and BEV projected area. Output factors (cGy/MU) were then tabulated for the idealized geometry through TPS simulations using region of interests with a range of dimensions expected to be seen clinically. Correction factors were applied that account for differences between the PTV and the idealized conditions, and MUs for each beam were then scaled according to the measured spread out Bragg peak (SOBP) dose in water.

Our model was applied to various treatment sites, including pelvis, brain, lung, and head and neck. Monitor units prescribed by the TPS were compared to those predicted by using the model for 78 treatment beams. The total mean percentage difference for all beams was -0.2% ± 3.8%.

This work demonstrates the potential for reasonably accurate secondary verification of MUs in pencil beam scanning proton therapy for SFUD treatment plans with the proposed method. Required inputs are few, and are readily accessible, facilitating automation and clinical application. Further investigation will expand the current model to accommodate a broader range of potential optimization problems, and intensity-modulated proton therapy treatment plans.