ArticleMedical physics2025
Dose distributions of proton therapy plans are robust against lowering the resolution of CTs combined with increasing noise.
Article in Medical physics, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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Who cites it
2 citing papers in PubMed.
- Comparison of cone beam computed tomography post-processing methods for online adaptive proton therapy of prostate cancer.Physics and imaging in radiation oncology · 2025Article
- Dose distributions of proton therapy plans are robust against lowering the resolution of CTs combined with increasing noise.Medical physics · 2025Article
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Authors and funding
8 authors.
Funding
Abstract
backgroundTreatment planning in radiation therapy (RT) is performed on image sets acquired with commercial x-ray computed tomography (CT) scanners. Considering an increased frequency of verification scans for adaptive RT and the advent of alternatives to x-ray CTs, there is a need to review the requirements for image sets used in RT planning. PURPOSE: This study aims to derive the required image quality (IQ) for the computation of the dose distribution in proton therapy (PT) regarding spatial resolution and the combination of spatial resolution and noise. The knowledge gained is used to explore the potential for dose reduction in tomography-guided PT.
methodsMathematical considerations indicate that the required spatial resolution for dose computation is on the scale of the set-up margins fed into the robust optimization. This hypothesis was tested by processing retrospectively 12 clinical PT cases, which reflect a variety of tumor localizations. Image sets were low-pass filtered and were made noisy in a generic manner. Dose distributions on the modified CT scans were computed with a Monte-Carlo dose engine. The similarity of these dose distributions with clinical ones was quantified with the gamma-index (1 mm/1%). The potential reduction of the x-ray exposure compared to the planning CT scan was estimated.
resultsDose distributions within the irradiated volume were robust against low-pass filtering of the CTs with kernels up to a full-width-at-half-maximum of 4 mm, that is, the gamma pass rate (1 mm/1%) was
conclusionsThe requirements on IQ in terms of spatial resolution in combination with noise for computing the dose in PT are clearly lower than the IQ of current clinical planning. The results apply, for example, to ultra-low dose x-ray CTs, proton CTs with coarse spatial detection, and attenuation images from the joint reconstruction of time-of-flight PET scans.
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