Flattening of proton dose distributions for large-field radiotherapy

Methods for obtaining flattened charged-particle dose distributions over large areas are described. The system being used at Harvard for proton radiotherapy is discussed in detail. It is an extension of usual multiple-scattering techniques to include blocking out some of the central peak, followed by rescattering to fill in the profile, resulting in flat distributions up to 30 cm in diameter. The unusually long source-to-skin distance (4.6-m SSD) plus the small lateral spread (2 mm rms) from multiple scattering in the patient results in little divergence of the beam throughout the treatment volume.