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A Method to Determine the Optimal Proton Scanned Beam Angle to Ensure Robust Treatment Planning

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J Blanco Kiely

J Blanco Kiely*, B White , S Both , University of Pennsylvania, Philadelphia, PA


SU-E-T-42 (Sunday, July 12, 2015) 3:00 PM - 6:00 PM Room: Exhibit Hall

Purpose: The ability of pencil beam scanning (PBS) to deliver highly conformal dose distributions may be affected by patient- and physics-related uncertainties. In clinical practice, selection of proton beam angles is determined qualitatively. This study investigates whether an optimal proton PBS beam angle could be quantitatively determined to ensure robust planning for pelvic targets.

Methods: PBS beam angles were optimized based on two independent criteria; shortest and most homogeneous path from the patient surface to the distal edge of the target. The beam angle optimization criteria for gantry angles between 90°-270° were quantified in 10° increments for each ray, calculated as the straight line distance from the surface of the skin to the CTV’s distal edge. The goal was to minimize the path length of a proton PBS beam from the patient surface to the distal edge of the CTV, relative to the entry point, while minimizing HU inhomogeneity along the ray. HU homogeneity (i.e. HU variation) was quantitatively defined as the standard deviation of the average intra-ray HU intensity distribution of the rays comprising a single beam. This method was validated relative to inter-fraction changes on ten consecutive, locally advanced, rectal cancer patients, who underwent an average 4 verification CTs. The displacement of the 95-98% isodose lines was determined from forward calculated dose distributions on verification CTs.

Results: The posterior beam (180°) had the average shortest path length, 132.7±17.2mm, and the most homogenous path, 31.9±4.3HU. The 95-98% isodose lines from all plans verified our path length to within 2.3±1.2% and HU homogeneity to within 1.2±0.5%.

Conclusion: The proposed optimization algorithm determined the posterior beam dose distribution as the most robust relative to inter-fraction variation for large pelvic targets treated with PBS and was validated via verification CT for our patient cohort. Future work will focus on further algorithm development.

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