Intensity modulated proton therapy and its sensitivity to treatment uncertainties 1: the potential effects of calculational uncertainties

TLDR

The study investigates how calculational uncertainties affect 3D and distal edge tracking (DET) intensity‑modulated proton therapy plans and recommends routine uncertainty analysis for all IMPT treatments. The authors compared analytical and Monte Carlo dose calculations, varied CT values by ±3 %, and altered intra‑field gradients to assess range and calculation uncertainties. Results show the 3D approach yields superior agreement (87.1 % vs 80.3 %) and is robust to uncertainties, while the DET approach is more sensitive, with CTV doses changing by up to 5 % when CT values shift by 3 %.

Abstract

The effects of calculational uncertainties on 3D and distal edge tracking (DET) intensity modulated proton therapy (IMPT) treatment plans have been investigated. Dose calculation uncertainties have been assessed by comparing analytical and Monte Carlo dose calculations, and potential range uncertainties by recalculating plans with all CT values modified by ±3%. Analysis of the volume of PTV agreeing to within ±3% between the two calculations shows that the 3D approach provides significantly improved agreement (87.1 versus 80.3% of points for the 3D and DET approaches, respectively). For the DET approach, doses in the CTV have also been found to globally change by 5% as a result of 3% changes in CT value. When varying the intra-field gradients of the plans a similar trend is seen, but with the more complex plans also being found to be more sensitive to both uncertainties. In conclusion, the DET approach has been found to be relatively sensitive to the calculational errors investigated here. In contrast, the 3D approach appears to be quite robust, unless strong internal gradients are present. Nevertheless, the routine use of uncertainty analysis is advised when assessing all forms of IMPT plans.