The dosimetric benefits of proton therapy may be greatly degraded when the tumor or organs move during the treatment. Hence, mitigation or adaptive methods have become topics of research interest. These techniques require dose computation on time-dependent patient geometry. We developed an open-source four-dimensional dose computation and evaluation software, Motion Simulator for Proton Therapy (MSPT), for the spot-scanning delivery technique. It aims at highlighting the impact of the patient motion during a treatment delivery by computing dose on the moving patient. The main interest of this simulator lies in the ability to render the impact of a predicted patient motion on a prescribed treatment plan. MSPT used proton pencil beam algorithm for dose computation, and the dose in patient geometry computed by MSPT was able to match that computed by the commercial treatment planning system. MSPT was able to render the impact of motion on patient data sets. This capability makes it an innovative research tool to evaluate and compare different methods of motion management or mitigation. The open-source feature makes it appealing, since it is intended to evolve, to be improved and to be the starting point of new research on patient motion in proton therapy.

MSPT: an open-source motion simulator for proton therapy

Purpose: Application of an image guided 4D Monte Carlo framework to the evaluation of intra/inter fraction motion effects between patient organ‐movement and dynamic delivery effects Materials & Methods: An IGMC toolkit that accounts for time‐dependent geometries of organ motion and dynamic delivery and provides accurate dosimetry was developed for lungcancer patients. Fluence calculation for VARIAN‐2100C/D photon accelerator is performed with EGSnrc and for patient dose calculation we use dose‐planning‐method. The time dependent beam delivery information is obtained from the treatment‐planning program in the form of MLC leaf‐sequencing files, while the organ motion pattern was obtained with the use of RPM signal and 4D‐CT. A voxel displacement map is used to quantify the motion of the organ in the voxelized geometry. The study was performed for lung patient for several breathing phases. The data analysis was performed with the freely available package VODCA. Results: Differences between the conventional CORVUS dose plan and the Monte Carlo dose results suggest that Monte Carlo dose calculation is vital for assessing effects in lungtissue. For the free breathing CT, CORVUS was under‐dosing the lung‐tumor by approximately 3Gy. When accounting for temporal effects, comparison between IGMC dose distributions for free breathing, inhale and exhale phases, show that dose coverage of the primary/secondary tumors was significant worse in the inhale phase relative to the exhale/free‐breathing phases. For inhale phase, 5–10% of the volume was receiving 10Gy less than in exhale or free‐breathing phases, leading to large cold spots inside the tumor. This is mainly due to the motion of the diaphragm, which subsequently moves the tumor in the superior‐inferior by more than 2 cm. Conclusions:Image guided 4DMC methods can significantly improve the planning of lungtumor treatments by accurately modeling the motion of the tumors and large heterogeneity in the tumor region. Supported NIH/NCI‐R01/CA111590.

TU-C-M100J-05: Image Guided 4D Monte Carlo Study of the Dosimetric Effects of Intra/inter Fraction Motion in Lung Tumors

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TU-C-M100J-05: Image Guided 4D Monte Carlo Study of the Dosimetric Effects of Intra/inter Fraction Motion in Lung Tumors