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Advanced proton beam dosimetry part II: Monte Carlo vs. pencil beam-based planning for lung cancer

	author = {Dominic Maes and Jatinder Saini and Jing Zeng and Ramesh Rengan and Tony Wong and Stephen R. Bowen},
	title = {Advanced proton beam dosimetry part II: Monte Carlo  vs . pencil beam-based planning for lung cancer},
	journal = {Translational Lung Cancer Research},
	volume = {7},
	number = {2},
	year = {2018},
	keywords = {},
	abstract = {Background: Proton pencil beam (PB) dose calculation algorithms have limited accuracy within heterogeneous tissues of lung cancer patients, which may be addressed by modern commercial Monte Carlo (MC) algorithms. We investigated clinical pencil beam scanning (PBS) dose differences between PB and MC-based treatment planning for lung cancer patients.
Methods: With IRB approval, a comparative dosimetric analysis between RayStation MC and PB dose engines was performed on ten patient plans. PBS gantry plans were generated using single-field optimization technique to maintain target coverage under range and setup uncertainties. Dose differences between PB-optimized (PBopt), MC-recalculated (MCrecalc), and MC-optimized (MCopt) plans were recorded for the following region-of-interest metrics: clinical target volume (CTV) V95, CTV homogeneity index (HI), total lung V20, total lung VRX (relative lung volume receiving prescribed dose or higher), and global maximum dose. The impact of PB-based and MC-based planning on robustness to systematic perturbation of range (±3% density) and setup (±3 mm isotropic) was assessed. Pairwise differences in dose parameters were evaluated through non-parametric Friedman and Wilcoxon sign-rank testing.
Results: In this ten-patient sample, CTV V95 decreased significantly from 99–100% for PBopt to 77–94%for MCrecalc and recovered to 99–100% for MCopt (P},
	issn = {2226-4477},	url = {}