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Author Notes:

Liyong Lin, PhD, Emory University, 1365 Clifton Rd # 1-A, Atlanta, GA, 30322, USA, Phone: +1 (404) 778-3473, liyong.lin@emory.edu

Liyong Lin: conceptualization, project administration, supervision, writing – original draft, writing – review and editing. Paige A. Taylor: conceptualization, data curation, formal analysis, investigation, methodology, resources, software, validation, visualization, writing – original draft, writing – review and editing. Jiajian Shen: data curation, formal analysis, investigation, methodology, resources, software, validation, visualization, writing – original draft, writing – review and editing. Jatinder Saini: conceptualization, investigation, validation, visualization, writing – review and editing. Minglei Kang: investigation, validation, visualization, writing – review and editing. Charles B. Simone II: conceptualization, investigation, validation, visualization, writing – review and editing. Jeffrey D. Bradley: conceptualization, investigation, validation, visualization, writing – review and editing. Zuofeng Li: conceptualization, investigation, methodology, project administration, supervision, validation, visualization, writing – review and editing. Ying Xiao: conceptualization, funding acquisition, investigation, methodology, project administration, resources, software, supervision, writing – review and editing.

Jeffrey D. Bradley, MD, discloses personal fees from Mevion Medical Systems, Inc, AstraZeneca, Varian Medical Systems, and Genentech, outside the submitted work. Zuofeng Li, DSc, is an associate editor of the International Journal of Particle Therapy. Dr Li discloses personal fees from Ion Beam Applications, outside the submitted work. Liyong Lin, PhD, discloses a grant from Varian Medical Systems, outside the submitted work, and a pending patent (to be submitted) for Quantitative Multi Energy Computed Tomography (MECT) for the Characterization of Composition and Density Maps of Artificial and Human Materials in Proton Therapy. Charles B. Simone II, MD, discloses honorarium from Varian Medical Systems, outside the submitted work. Paige A. Taylor, MS, discloses a grant from the National Institutes of Health, during the conduct of the study. The authors have no additional relevant conflicts of interest to disclose.

Subjects:

Research Funding:

This project was supported by grants U10CA180868 (NRG Oncology Operations), U24CA180803 (IROC) from the National Cancer Institute.

Keywords:

  • Monte Carlo
  • proton therapy
  • DECT
  • MAR
  • surgical implant

NRG Oncology Survey of Monte Carlo Dose Calculation Use in US Proton Therapy Centers

Tools:

Journal Title:

International journal of particle therapy

Volume:

Volume 8, Number 2

Publisher:

, Pages 73-81

Type of Work:

Article | Final Publisher PDF

Abstract:

Purpose/Objective(s) Monte Carlo (MC) dose calculation has appeared in primary commercial treatment-planning systems and various in-house platforms. Dual-energy computed tomography (DECT) and metal artifact reduction (MAR) techniques complement MC capabilities. However, no publications have yet reported how proton therapy centers implement these new technologies, and a national survey is required to determine the feasibility of including MC and companion techniques in cooperative group clinical trials. Materials/Methods A 9-question survey was designed to query key clinical parameters: scope of MC utilization, validation methods for heterogeneities, clinical site-specific imaging guidance, proton range uncertainties, and how implants are handled. A national survey was distributed to all 29 operational US proton therapy centers on 13 May 2019. Results We received responses from 25 centers (86% participation). Commercial MC was most commonly used for primary plan optimization (16 centers) or primary dose evaluation (18 centers), while in-house MC was used more frequently for secondary dose evaluation (7 centers). Based on the survey, MC was used infrequently for gastrointestinal, genitourinary, gynecology and extremity compared with other more heterogeneous disease sites (P < .007). Although many centers had published DECT research, only 3/25 centers had implemented DECT clinically, either in the treatment-planning system or to override implant materials. Most centers (64%) treated patients with metal implants on a case-by-case basis, with a variety of methods reported. Twenty-four centers (96%) used MAR images and overrode the surrounding tissue artifacts; however, there was no consensus on how to determine metal dimension, materials density, or stopping powers. Conclusion The use of MC for primary dose calculation and optimization was prevalent and, therefore, likely feasible for clinical trials. There was consensus to use MAR and override tissues surrounding metals but no consensus about how to use DECT and MAR for human tissues and implants. Development and standardization of these advanced technologies are strongly encouraged for vendors and clinical physicists.

Copyright information:

2021 The Author(s)

This is an Open Access work distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/rdf).
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