Impact of geometric distortion on dose deviation for photon and proton treatment plans

We investigated the dose deviation related to geometric distortion and dose gradient on magnetic resonance‐only treatment planning for intensity‐modulated radiation therapy and proton therapy. The residual geometric distortion of two different magnetic resonance imaging (MRI) sequences (A) and (B) was applied in the computed tomography image and the structure set of each patient through a polynomial MRI geometric distortion model to simulate MRI‐based treatment planning. A 3D histogram was generated to specify the relationship of dose deviation to geometric distortion and dose gradient. When the dose gradient (G(d)) approached zero, the maximum dose deviation reached 1.64% and 2.71% for photon plans of sequences A and B, respectively. For proton plans, the maximum dose deviation reached 3.15% and 4.89% for sequences A and B, respectively. When the geometric distortion (d) was close to zero, the maximum dose deviation was less than 0.8% for photon and proton plans of both sequences. Under extreme conditions (d = 2 mm and G(d) = 4.5%/mm), the median value of dose deviation reached 3% and 3.49% for photon and proton plans, respectively for sequence A, and 2.93% and 4.55% for photon and proton plans, respectively, for sequence B. We demonstrate that the dose deviation is specific to MRI hardware parameters. Compared to the photon plan, the proton plan is more sensitive to the changes in geometric distortion. For typical clinical MRI geometric distortion (d ≤2 mm), the median dose deviation is expected to be within 3% and 5% for photon and proton plans, respectively.