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Dosimetric Evaluation of a Left Chestwall Patient Treated with a Compact Proton Pencil Beam Gantry Utilizing Daily Setup CBCT

M Maynard

M Maynard*, K Chen , L Rosen , H Wu , Willis-Knighton Medical Center, Shreveport, LA


SU-F-J-191 (Sunday, July 31, 2016) 3:00 PM - 6:00 PM Room: Exhibit Hall

To evaluate the robustness of the gradient technique for treating a multi-isocenter left chest wall patient with a compact proton pencil beam gantry. Both CBCT and stereoscopic imaging are used to facilitate daily treatment setup.
To treat the elongated chest wall planning target volume (PTV) with the compact PBS system, a 28 fraction (5040 CcGE) treatment plan was created using two fields with gradient matching technique. Daily table shifts between treatment field isocenters were obtained from the record and verify system for each treatment fraction. Copies of the initial treatment plan were made for each fraction and the field isocenter coordinates for each plan copy were adjusted to reflect daily table shifts. Doses were re-calculated for each fraction, summed, and compared against the initial plan.
The table shifts (average and range) were 2.2 (-5.1 - +3.9), 3.0 (-6.0 - +4.0) and 3.0 (-10.1 - +1.9) millimeters in the anterior-posterior, superior-inferior and right-left directions, respectively. Dose difference to the PTV, heart and ipsilateral lung were evaluated. The percentage of the PTV receiving the prescription dose decreased from 94.6% to 89.1%. The D95 of the PTV increased from 99.6% to 99.9%. The maximum dose in PTV increased from 106.6% to 109.2% and V105 increased from 1.0% to 16.5%. The V20 of the ipsilateral lung increased from 18.5% to 21.0%. The mean heart dose difference was negligible.
Observed dose differences to lung and heart tissues due to daily setup variations remained acceptably low while maintaining sufficient dose coverage to the PTV. This initial case study demonstrates the robustness of the gradient technique to treat a large target, multi-isocenter plan with a compact proton pencil beam gantry equipped with CBCT and stereoscopic imaging modalities.

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