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Treatment of ocular tumors on dedicated scattering-based proton therapy systems is standard afforded due to sharp lateral and distal penumbras. However, most newer proton therapy centers provide pencil beam scanning treatments. In this paper, we present a pencil beam scanning (PBS)-based ocular treatment solution. The design, commissioning, and validation of an applicator mount for a conventional PBS snout to allow for ocular treatments are given. In contrast to scattering techniques, PBS-based ocular therapy allows for inverse planning, providing planners with additional flexibility to shape the radiation field, potentially sparing healthy tissues. PBS enables the use of commercial Monte Carlo algorithms resulting in accurate dose calculations in the presence of heterogeneities and fiducials. The validation consisted of small field dosimetry measurements of point doses, depth doses, and lateral profiles relevant to ocular therapy. A comparison of beam properties achieved through the applicator against published literature is presented. We successfully showed the feasibility of PBS-based ocular treatments.

The objective of this study was to confirm the feasibility of three-dimensionally-printed (3D-printed), personalized whole-body anthropomorphic phantoms for radiation dose measurements in a variety of charged and uncharged particle radiation fields. We 3D-printed a personalized whole-body phantom of an adult female with a height of 154.8 cm, mass of 90.7 kg, and body mass index of 37.8 kg/m2. The phantom comprised of a hollow plastic shell filled with water and included a watertight access conduit for positioning dosimeters. It is compatible with a wide variety of radiation dosimeters, including ionization chambers that are suitable for uncharged and charged particles. Its mass was 6.8 kg empty and 98 kg when filled with water. Watertightness and mechanical robustness were confirmed after multiple experiments and transportations between institutions. The phantom was irradiated to the cranium with therapeutic beams of 170-MeV protons, 6-MV photons, and fast neutrons. Radiation absorbed dose was measured from the cranium to the pelvis along the longitudinal central axis of the phantom. The dose measurements were made using established dosimetry protocols and well-characterized instruments. For the therapeutic environments considered in this study, stray radiation from intracranial treatment beams was the lowest for proton therapy, intermediate for photon therapy, and highest for neutron therapy. An illustrative example set of measurements at the location of the thyroid for a square field of 5.3 cm per side resulted in 0.09, 0.59, and 1.93 cGy/Gy from proton, photon, and neutron beams, respectively. In this study, we found that 3D-printed personalized phantoms are feasible, inherently reproducible, and well-suited for therapeutic radiation measurements. The measurement methodologies we developed enabled the direct comparison of radiation exposures from neutron, proton, and photon beam irradiations.

Recently, a commercial treatment planning system (TPS) has implemented aperture collimators for PBS dose calculations which can serve to reduce lateral penumbra. This study characterized the variation in magnitude of lateral penumbra for collimated and un-collimated PBS fields versus the parameters of air gap, depth, and range shifter thickness. Comparisons were performed in a homogenous geometry between measured data and calculations made by a commercial TPS. Beam-specific target volumes were generated for collimated and un-collimated PBS fields and optimized for various range shifter thicknesses and air gaps. Lateral penumbra (80%-20% distance) was measured across each target volume to characterize penumbra variation with depth and air gap. An analytic equation was introduced to predict the reduction in lateral penumbra between un-collimated and collimated PBS treatments. Calculated penumbra values increased with depth across all combinations of range shifters for a constant air gap. At 2 cm depth, the reductions in penumbra due to the aperture were 2.7 mm, 3.7 mm and 4.2 mm when using range shifter thicknesses of 0 cm, 4.0 cm and 7.5 cm, respectively. At a depth of approximately 20 cm and air gap of 5 cm, differences between penumbras of collimated and un-collimated beams were less than 1 mm. Penumbra reductions for the collimated beams were largest at small air gaps. All TPS-calculated penumbra values derived in this study were within 1 mm of film measurement values. Finally, the analytic equation was tested using a clinical CT scan, and we found good dosimetric agreement between the model predictions and the result calculated by the TPS. In conclusion, application of collimators to PBS fields can sharpen penumbra by several mm and are most beneficial for shallow targets. Furthermore, measurements indicate that the dose calculation accuracy in the penumbra region of PBS-collimated fields is adequate for clinical use.