Fifty-eighth annual meeting of the american association of physicists in medicine
MO-FG-CAMPUS-TeP3-05: Limitations of the Dose Weighted LET Concept for Intensity Modulated Proton Therapy in the Distal Falloff Region and Beyond
Dose-weighted linear energy transfer (dLET) has been shown to be useful for the analysis of late effects in proton therapy. This study presents the results of the testing of the dLET concept for intensity modulated proton therapy (IMPT) with a discrete spot scanning beam system without use of an aperture or compensator (AC).
IMPT (no AC) and broad beams (BB) with (AC) were simulated in the TOPAS and FLUKA code systems. Information from the independently tested Monte Carlo Damage Simulation (MCDS) was integrated into the FLUKA code systems to account for spatial variations in the RBE for protons and other light ions using an endpoint of DNA double strand break (DSB) induction.
The proton spectra for IMPT beams at the depths beyond the distal edge contain a tail of high energy protons up to 100 MeV. The integral from the tail is compatible with the number of 5–8 MeV protons at the tip of the Bragg peak (BP). The dose averaged energy (dEav) decreases to 7 MeV at the tip of (BP) and then increases to about 15 MeV beyond the distal edge. Neutrons produced in the nozzle are two orders of magnitude higher for BB with AC than for IMPT in low energy part of the spectra. The dLET values beyond of the distal edge of the BP are 5 times larger for the IMPT than for BB with the AC. Contrarily, negligible differences are seen in the RBE estimates for IMPT and BB with AC beyond the distal edge of the BP.
The analysis of late effects in IMPT with a spot scanning and double scattering or scanning techniques with AC may requires both dLET and RBE as quantitative parameters to characterize effects beyond the distal edge of the BP.