The clinical impact of uncertainties in the mean excitation energy of human tissues during proton therapy

Phys Med Biol. 2013 Feb 21;58(4):887-902. doi: 10.1088/0031-9155/58/4/887. Epub 2013 Jan 21.

Abstract

Uncertainties in the estimated mean excitation energies (I-values) needed for calculating proton stopping powers can be in the order of 10-15%, which introduces a fundamental limitation in the accuracy of proton range determination. Previous efforts have quantified shifts in proton depth dose distributions due to I-value uncertainties in water and homogenous tissue phantoms. This study is the first to quantify the clinical impact of I-value uncertainties on proton dose distributions within patient geometries. A previously developed Geant4 based Monte Carlo code was used to simulate a proton treatment plan for three patients (prostate, pancreases, and liver) with varying tissue I-values. A uniform variation study was conducted in which the tissue I-values were varied by ±5% and ±10% of the nominal values as well as a probabilistic variation study in which the I-values were randomly sampled according to a normal distribution with the mean equal to the nominal I-value and a standard deviation of 5 and 10% of the nominal values. Modification of tissue I-values impacted both the proton range and SOBP width. R(90) range shifts up to 7.7 mm (4.4.%) and R(80) range shifts up to 4.8 mm (1.9%) from the nominal range were recorded. Modulating the tissue I-values by 10% the nominal value resulted in up to a 3.5% difference mean dose in the target volumes and organs at risk compared to the nominal case. The range and dose differences were the largest for the deeper-seated prostate and pancreas cases. The treatments that were simulated with randomly sampled I-values resulted in range and dose differences that were generally within the upper and lower bounds set by the 10% uniform variations. This study demonstrated the impact of I-value uncertainties on patient dose distributions. Clearly, sub-millimeter precision in proton therapy would necessitate a reduction in I-value uncertainties to ensure an efficacious clinical outcome.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Algorithms
  • Humans
  • Liver Neoplasms / radiotherapy
  • Male
  • Models, Statistical
  • Monte Carlo Method
  • Pancreatic Neoplasms / radiotherapy
  • Phantoms, Imaging
  • Probability
  • Prostatic Neoplasms / radiotherapy
  • Proton Therapy / methods*
  • Radiotherapy Dosage
  • Radiotherapy Planning, Computer-Assisted / methods
  • Reproducibility of Results
  • Software
  • Tomography, X-Ray Computed / methods
  • Uncertainty