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Purpose We analyzed interfractional robustness of scanning carbon ion radiotherapy (CIRT) for prostate cancer based on the dose distribution using daily in‐room computed tomography (CT) images. Materials and Methods We analyzed 11 consecutive patients treated with scanning CIRT for localized prostate cancer in our hospital between December 2015 and January 2016. In‐room CT images were taken under treatment conditions in every treatment session. The dose distribution on each in‐room CT image was recalculated, while retaining the pencil beam arrangement of the initial treatment plan. Then, the dose–volume histogram (DVH) parameters including the percentage of the clinical target volume (CTV) with 95% and 90% of the prescribed dose area (V95% of CTV, V90% of CTV) and V80% of rectum were calculated. The acceptance criteria for the CTV and rectum were set at V95% of CTV ≥95%, V90% of CTV ≥98%, and V80% of rectum < 10 ml. Results V95% of CTV, V90% of CTV, and V80% of rectum for the reproduced plans were 98.8 ± 3.49%, 99.5 ± 2.15%, and 4.39 ± 3.96 ml, respectively. Acceptance of V95% of CTV, V90% of CTV, and V80% of rectum was obtained in 123 (94%), 125 (95%) and 117 sessions (89%), respectively. Acceptance of the mean dose of V95% of CTV, V90% of CTV, and V80% of rectum for each patient was obtained in 10 (91%), 10 (91%), and 11 patients (100%), respectively. Conclusions We demonstrated acceptable interfractional robustness based on the dose distribution in scanning CIRT for prostate cancer.

Background/aim The present study aimed to compare the radiation dose distribution of carbon-ion radiotherapy (CIRT) for stage I esophageal cancer with three-dimensional conformal radiotherapy (3DCRT) and volumetric modulated arc therapy (VMAT). Patients and methods Fifteen patients with cT1bN0M0 esophageal cancer who received 3DCRT at Kanagawa Cancer Center between January 2014 and April 2019 were enrolled. The dose-volume histogram parameters of the target volume and normal organs planned with CIRT, 3DCRT, and VMAT were evaluated. Results The homogeneity index for the target volume of CIRT was significantly lower than that of 3DCRT and VMAT. In addition, the radiation dose of CIRT to the heart, lungs, spinal cord, and skin was significantly lower than that of 3DCRT and VMAT. Conclusion Favorable dose distributions with CIRT were demonstrated compared with 3DCRT and VMAT for esophageal cancer.

Background/aim The purpose of this study was to compare the dose distribution between scanning carbon-ion radiotherapy (sCIRT) and volumetric-modulated arc therapy with stereotactic body radiation therapy (VMAT-SBRT) for stage I non-small cell lung cancer (NSCLC). Patients and methods Fifteen patients with early-stage NSCLC who underwent sCIRT at Kanagawa Cancer Center between 2018-2020 were enrolled. Dose-volume histogram parameters of the planned target volume and normal organs for sCIRT and VMAT-SBRT were evaluated. Results The homogeneity index of the target volume of sCIRT was significantly lower than that of VMAT-SBRT. The dose of sCIRT was significantly lower than that of VMAT-SBRT at low volumes in the lung, heart, spinal cord, and esophagus. Conclusion The dose distribution of sCIRT for early-stage NSCLC was better than that of VMAT-SBRT.

A multi-layer ionization chamber (MLIC) which consists of a stack of parallel plate-type ionization chambers in which the parallel configuration is in the depth direction was developed at the National Institute of Radiological Science (NIRS) and has been used as a field dosimeter for MU calibration since 2002. Although the MLIC can measure depth dose distributions at one time, a correction is needed to obtain an accurate dose at the center of the spread-out Bragg peak (SOBP) in a water phantom. We attributed the observed difference between the correct dose at the center of the SOBP and the measured dose to the lack of water equivalence of the MLIC. In order to overcome this problem, a new MLIC was developed. It consists of polymethyl-methacrylate (PMMA) plates and graphite electrodes instead of flame retardant type 4 (FR4) and copper electrodes. The calibration coefficients of the MLICs were obtained by 160 MeV proton beam irradiation. For carbon-ion beams, the PMMA type MLIC has the capability to measure depth dose distributions in the water phantom with less than 2% error, including the fragment tail region.

To estimate the physical dose at the center of spread-out Bragg peaks (SOBP) for various conditions of the irradiation system, a semiempirical approach was applied. The dose at the center of the SOBP depends on the field size because of large-angle scattering particles in the water phantom. For a small field of 5x5 cm{sup 2}, the dose was reduced to 99.2%, 97.5%, and 96.5% of the dose used for the open field in the case of 290, 350, and 400 MeV/n carbon beams, respectively. Based on the three-Gaussian form of the lateral dose distributions of the carbon pencil beam, which has previously been shown to be effective for describing scattered carbon beams, we reconstructed the dose distributions of the SOBP beam. The reconstructed lateral dose distribution reproduced the measured lateral dose distributions very well. The field-size dependencies calculated using the reconstructed lateral dose distribution of the therapeutic carbon beam agreed with the measured dose dependency very well. The reconstructed beam was also used for irregularly shaped fields. The resultant dose distribution agreed with the measured dose distribution. The reconstructed beams were found to be applicable to the treatment-planning system.

We evaluated the CT number accuracy in determining a CT calibration method for treatment planning by use of a 256 multi-slice CT (MSCT) scanner. An electron density phantom, which extends full length in the longitudinal direction, was scanned by the 256 MSCT scanner in a single rotation. We inserted four types of samples (air, 100 % ethanol, 40 wt% aqueous K(2)HPO(4), and water) into the phantom. The regions of interest were set for all image slices, and the average CT number was calculated in the transverse and longitudinal sections. For the transverse image direction, the CT number became lower toward the center of the phantom with almost all samples. The causes of these phenomena might be attributed to the effects of scattered radiation and those of beam hardening due to the high-atomic-number material (40 wt% aqueous K(2)HPO(4)). However, the phenomena were too complicated to allow us to determine their causes only from the present studies. Meanwhile, for increasing the accuracy of the CT number calibration, a single sample should be inserted, and this step should be repeated with different samples. For the longitudinal direction, the CT number for a 40 wt % aqueous K(2)HPO(4) sample increased by 30 HU from the anode to the cathode side due to variations in the X-ray energy caused by the heel effect. The caveat is that the CT number varies in the longitudinal direction when a CT scanner with a wide beam width is used.