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Background: The Dynamic Collimation System (DCS) has been shown to produce superior treatment plans to uncollimated pencil beam scanning (PBS) proton therapy using an in‐house treatment planning system (TPS) designed for research. Clinical implementation of the DCS requires the development and benchmarking of a rigorous dose calculation algorithm that accounts for pencil beam trimming, performs monitor unit calculations to produce deliverable plans at all beam energies, and is ideally implemented with a commercially available TPS. Purpose: To present an analytical Pencil bEam TRimming Algorithm (PETRA) for the DCS, with and without its range shifter, implemented in the Astroid TPS (.decimal, Sanford, Florida, USA). Materials: PETRA was derived by generalizing an existing pencil beam dose calculation model to account for the DCS‐specific effects of lateral penumbra blurring due to the nickel trimmers in two different planes, integral depth dose variation due to the trimming process, and the presence and absence of the range shifter. Tuning parameters were introduced to enable agreement between PETRA and a measurement‐validated Dynamic Collimation Monte Carlo (DCMC) model of the Miami Cancer Institute's IBA Proteus Plus system equipped with the DCS. Trimmer position, spot position, beam energy, and the presence or absence of a range shifter were all used as variables for the characterization of the model. The model was calibrated for pencil beam monitor unit calculations using procedures specified by International Atomic Energy Agency Technical Report Series 398 (IAEA TRS‐398). Results: The integral depth dose curves (IDDs) for energies between 70 MeV and 160 MeV among all simulated trimmer combinations, with and without the ranger shifter, agreed between PETRA and DCMC at the 1%/1 mm 1‐D gamma criteria for 99.99% of points. For lateral dose profiles, the median 2‐D gamma pass rate for all profiles at 1.5%/1.5 mm was 99.99% at the water phantom surface, plateau, and Bragg peak depths without the range shifter and at the surface and Bragg peak depths with the range shifter. The minimum 1.5%/1.5 mm gamma pass rates for the 2‐D profiles at the water phantom surface without and with the range shifter were 98.02% and 97.91%, respectively, and, at the Bragg peak, the minimum pass rates were 97.80% and 97.5%, respectively. Conclusion: The PETRA model for DCS dose calculations was successfully defined and benchmarked for use in a commercially available TPS. [ABSTRACT FROM AUTHOR]

Objective. Pencil beam scanning (PBS) proton therapy target dose conformity can be improved with energy layer-specific collimation. One such collimator is the dynamic collimation system (DCS), which consists of four nickel trimmer blades that intercept the scanning beam as it approaches the lateral extent of the target. While the dosimetric benefits of the DCS have been demonstrated through computational treatment planning studies, there has yet to be experimental verification of these benefits for composite multi-energy layer fields. The objective of this work is to dosimetrically characterize and experimentally validate the delivery of dynamically collimated proton therapy with the DCS equipped to a clinical PBS system. Approach. Optimized single field, uniform dose treatment plans for 3 × 3 × 3 cm3 target volumes were generated using Monte Carlo dose calculations with depths ranging from 5 to 15 cm, trimmer-to-surface distances ranging from 5 to 18.15 cm, with and without a 4 cm thick polyethylene range shifter. Treatment plans were then delivered to a water phantom using a prototype DCS and an IBA dedicated nozzle system and measured with a Zebra multilayer ionization chamber, a MatriXX PT ionization chamber array, and Gafchromic™ EBT3 film. Main results. For measurements made within the SOBPs, average 2D gamma pass rates exceeded 98.5% for the MatriXX PT and 96.5% for film at the 2%/2 mm criterion across all measured uncollimated and collimated plans, respectively. For verification of the penumbra width reduction with collimation, film agreed with Monte Carlo with differences within 0.3 mm on average compared to 0.9 mm for the MatriXX PT. Significance. We have experimentally verified the delivery of DCS-collimated fields using a clinical PBS system and commonly available dosimeters and have also identified potential weaknesses for dosimeters subject to steep dose gradients. [ABSTRACT FROM AUTHOR]

Purpose: The radiobiological benefits afforded by spatially fractionated (GRID) radiation therapy pairs well with the dosimetric advantages of proton therapy. Inspired by the emergence of energy‐layer specific collimators in pencil beam scanning (PBS), this work investigates how the spot spacing and collimation can be optimized to maximize the therapeutic gains of a GRID treatment while demonstrating the integration of a dynamic collimation system (DCS) within a commercial beamline to deliver GRID treatments and experimentally benchmark Monte Carlo calculation methods. Methods: GRID profiles were experimentally benchmarked using a clinical DCS prototype that was mounted to the nozzle of the IBA‐dedicated nozzle system. Integral depth dose (IDD) curves and lateral profiles were measured for uncollimated and GRID‐collimated beamlets. A library of collimated GRID dose distributions were simulated by placing beamlets within a specified uniform grid and weighting the beamlets to achieve a volume‐averaged tumor cell survival equivalent to an open field delivery. The healthy tissue sparing afforded by the GRID distribution was then estimated across a range of spot spacings and collimation widths, which were later optimized based on the radiosensitivity of the tumor cell line and the nominal spot size of the PBS system. This was accomplished by using validated models of the IBA universal and dedicated nozzles. Results: Excellent agreement was observed between the measured and simulated profiles. The IDDs matched above 98.7% when analyzed using a 1%/1‐mm gamma criterion with some minor deviation observed near the Bragg peak for higher beamlet energies. Lateral profile distributions predicted using Monte Carlo methods agreed well with the measured profiles; a gamma passing rate of 95% or higher was observed for all in‐depth profiles examined using a 3%/2‐mm criteria. Additional collimation was shown to improve PBS GRID treatments by sharpening the lateral penumbra of the beamlets but creates a trade‐off between enhancing the valley‐to‐peak ratio of the GRID delivery and the dose‐volume effect. The optimal collimation width and spot spacing changed as a function of the tumor cell radiosensitivity, dose, and spot size. In general, a spot spacing below 2.0 cm with a collimation less than 1.0 cm provided a superior dose distribution among the specific cases studied. Conclusions: The ability to customize a GRID dose distribution using different collimation sizes and spot spacings is a useful advantage, especially to maximize the overall therapeutic benefit. In this regard, the capabilities of the DCS, and perhaps alternative dynamic collimators, can be used to enhance GRID treatments. Physical dose models calculated using Monte Carlo methods were experimentally benchmarked in water and were found to accurately predict the respective dose distributions of uncollimated and DCS‐collimated GRID profiles. [ABSTRACT FROM AUTHOR]

Purpose: When designing a collimation system for pencil beam spot scanning proton therapy, a decision must be made whether or not to rotate, or focus, the collimator to match beamlet deflection as a function of off‐axis distance. If the collimator is not focused, the beamlet shape and fluence will vary as a function of off‐axis distance due to partial transmission through the collimator. In this work, we quantify the magnitude of these effects and propose a focused dynamic collimation system (DCS) for use in proton therapy spot scanning. Methods: This study was done in silico using a model of the Miami Cancer Institute's (MCI) IBA Proteus Plus system created in Geant4‐based TOPAS. The DCS utilizes rectangular nickel trimmers mounted on rotating sliders that move in synchrony with the pencil beam to provide focused collimation at the edge of the target. Using a simplified setup of the DCS, simulations were performed at various off‐axis locations corresponding to beam deflection angles ranging from 0° to 2.5°. At each off‐axis location, focused (trimmer rotated) and unfocused (trimmer not rotated) simulations were performed. In all simulations, a 4 cm water equivalent thickness range shifter was placed upstream of the collimator, and a voxelized water phantom that scored dose was placed downstream, each with 4 cm airgaps. Results: Increasing the beam deflection angle for an unfocused trimmer caused the collimated edge of the beamlet profile to shift 0.08–0.61 mm from the baseline 0° simulation. There was also an increase in low‐dose regions on the collimated edge ranging from 14.6% to 192.4%. Lastly, the maximum dose, Dmax, was 0–5% higher for the unfocused simulations. With a focused trimmer design, the profile shift and dose increases were all eliminated. Conclusions: We have shown that focusing a collimator in spot scanning proton therapy reduces dose at the collimated edge compared to conventional, unfocused collimation devices and presented a simple, mechanical design for achieving focusing for a range of source‐to‐collimator distances. [ABSTRACT FROM AUTHOR]

Purpose: To introduce a method to model the 3D dose distribution of laterally asymmetric proton beamlets resulting from collimation. The model enables rapid beamlet calculation for spot scanning (SS) delivery using a novel penumbra-reducing dynamic collimation system (DCS) with two pairs of trimmers oriented perpendicular to each other. Methods: Trimmed beamlet dose distributions in water were simulated with MCNPX and the collimating effects noted in the simulations were validated by experimental measurement. The simulated beamlets were modeled analytically using integral depth dose curves along with an asymmetric Gaussian function to represent fluence in the beam's eye view (BEV). The BEV parameters consisted of Gaussian standard deviations (sigmas) along each primary axis (<σx1 σx2σy1σy2) together with the spatial location of the maximum dose (μx, μy). Percent depth dose variation with trimmer position was accounted for with a depth-dependent correction function. Beamlet growth with depth was accounted for by combining the in-air divergence with Hong's fit of the Highland approximation along each axis in the BEV. Results: The beamlet model showed excellent agreement with the Monte Carlo simulation data used as a benchmark. The overall passing rate for a 3D gamma test with 3%/3 mm passing criteria was 96.1% between the analytical model and Monte Carlo data in an example treatment plan. Conclusions: The analytical model is capable of accurately representing individual asymmetric beamlets resulting from use of the DCS. This method enables integration of the DCS into a treatment planning system to perform dose computation in patient datasets. The method could be generalized for use with any SS collimation system in which blades, leaves, or trimmers are used to laterally sharpen beamlets. [ABSTRACT FROM AUTHOR]

Purpose: In the absence of a collimation system the lateral penumbra of spot scanning (SS) dose distributions delivered by low energy proton beams is highly dependent on the spot size. For current commercial equipment, spot size increases with decreasing proton energy thereby reducing the benefit of the SS technique. This paper presents a dynamic collimation system (DCS) for sharpening the lateral penumbra of proton therapy dose distributions delivered by SS. Methods: The collimation system presented here exploits the property that a proton pencil beam used for SS requires collimation only when it is near the target edge, enabling the use of trimmers that are in motion at times when the pencil beam is away from the target edge. The device consists of two pairs of parallel nickel trimmer blades of 2 cm thickness and dimensions of 2 cm x 18 cm in the beam's eye view. The two pairs of trimmer blades are rotated 90° relative to each other to form a rectangular shape. Each trimmer blade is capable of rapid motion in the direction perpendicular to the central beam axis by means of a linear motor, with maximum velocity and acceleration of 2.5 m/s and 19.6 m/s2, respectively. The blades travel on curved tracks to match the divergence of the proton source. An algorithm for selecting blade positions is developed to minimize the dose delivered outside of the target, and treatment plans are created both with and without the DCS Results: The snout of the DCS has outer dimensions of 22.6 × 22.6 cm² and is capable of delivering a minimum treatment field size of 15 × 15 cm². Using currently available components, the constructed system would weigh less than 20 kg. For irregularly shaped fields, the use of the DCS reduces the mean dose outside of a 2D target of 46.6 cm² by approximately 40% as compared to an identical plan without collimation. The use of the DCS increased treatment time by 1-3 s per energy layer. Conclusions: The spread of the lateral penumbra of low-energy SS proton treatments may be greatly reduced with the use of this system at the cost of only a small penalty in delivery time. [ABSTRACT FROM AUTHOR]

Background Purpose Methods Results Conclusions The dynamic collimation system (DCS) provides energy layer‐specific collimation for pencil beam scanning (PBS) proton therapy using two pairs of orthogonal nickel trimmer blades. While excellent measurement‐to‐calculation agreement has been demonstrated for simple cube‐shaped DCS‐trimmed dose distributions, no comparison of measurement and dose calculation has been made for patient‐specific treatment plans.To validate a patient‐specific quality assurance (PSQA) process for DCS‐trimmed PBS treatment plans and evaluate the agreement between measured and calculated dose distributions.Three intracranial patient cases were considered. Standard uncollimated PBS and DCS‐collimated treatment plans were generated for each patient using the Astroid treatment planning system (TPS). Plans were recalculated in a water phantom and delivered at the Miami Cancer Institute (MCI) using an Ion Beam Applications (IBA) dedicated nozzle system and prototype DCS. Planar dose measurements were acquired at two depths within low‐gradient regions of the target volume using an IBA MatriXX ion chamber array.Measured and calculated dose distributions were compared using 2D gamma analysis with 3%/3 mm criteria and low dose threshold of 10% of the maximum dose. Median gamma pass rates across all plans and measurement depths were 99.0% (PBS) and 98.3% (DCS), with a minimum gamma pass rate of 88.5% (PBS) and 91.2% (DCS).The PSQA process has been validated and experimentally verified for DCS‐collimated PBS. Dosimetric agreement between the measured and calculated doses was demonstrated to be similar for DCS‐collimated PBS to that achievable with noncollimated PBS. [ABSTRACT FROM AUTHOR]

Purpose: Patients receiving pencil beam scanning (PBS) proton therapy with the addition of a dynamic collimation system (DCS) are potentially subject to an additional neutron dose from interactions between the incident proton beam and the trimmer blades. This study investigates the secondary neutron dose rates for both single-field uniform dose (SFUD) and intensity modulated proton therapy treatments.Methods and Materials: Secondary neutron dose distributions were calculated for both a dynamically collimated and an uncollimated, dual-field chordoma treatment plan and compared with previously published neutron dose rates from other contemporary scanning treatment modalities. Monte Carlo N-Particle transport code was used to track all primary and secondary particles generated from nuclear reactions within the DCS during treatment through a model of the patient geometry acquired from the computed tomography planning data set. Secondary neutron ambient dose equivalent distributions were calculated throughout the patient using a meshgrid with a tally resolution equivalent to that of the treatment planning computed tomography.Results: The median healthy-brain neutron ambient dose equivalent for a dynamically collimated intracranial chordoma treatment plan using a DCS was found to be 0.97 mSv/Gy for the right lateral SFUD field, 1.37 mSv/Gy for the apex SFUD field, and 1.24 mSv/Gy for the composite intensity modulated proton therapy distribution from 2 fields.Conclusions: These results were at least 55% lower than what has been reported for uniform scanning modalities with brass apertures. However, they still reflect an increase in the excess relative risk of secondary cancer incidence compared with an uncollimated PBS treatment using only a graphite range shifter. Regardless, the secondary neutron dose expected from the DCS for these PBS proton therapy treatments appears to be on the order of, or below, what is expected for alternative collimated proton therapy techniques. [ABSTRACT FROM AUTHOR]