Experimental Assessment of Proton Dose Calculation Accuracy in Small-Field Delivery Using a Mevion S250 Proton Therapy System

PURPOSE: Dose calculation accuracy of the Varian Eclipse treatment planning system (TPS) is empirically assessed for small-aperture fields using a Mevion S250 double scattering proton therapy system. MATERIALS AND METHODS: Five spherical pseudotumors were modeled in a RANDO head phantom. Plans were generated for the targets with apertures of 1, 2, 3, 4, or 5 cm diameter using one, two, and three beams. Depth-dose curves and lateral profiles of the beams were taken with the planned blocks and compared to Eclipse calculations. Dose distributions measured with EBT3 films in the phantom were also compared to Eclipse calculations. Film quenching effect was simulated and considered. RESULTS: Depth-dose scans in water showed a range pullback (up to 2.0 mm), modulation widening (up to 9.5 mm), and dose escalation in proximal end and sub-peak region (up to 15.5%) when compared to the Eclipse calculations for small fields. Measured full width at half maximum and penumbrae for lateral profiles differed <1.0 mm from calculations for most comparisons. In the phantom study, Eclipse TPS underestimated sub-peak dose. Gamma passing rates improved with each beam added to the plans. Greater range pullback and modulation degradation versus water scans were observed due to film quenching, which became more noticeable as target size increased. CONCLUSIONS: Eclipse TPS generates acceptable target coverage for small targets with carefully arranged multiple beams despite relatively large dose discrepancy for each beam. Surface doses higher than Eclipse calculations can be mitigated with multiple beams. When using EBT3 film, the quenching effect should be considered.