Optimizing field patching in passively scattered proton therapy with the use of beam current modulation.

Treatment plans for patched-field proton therapy may not be clinically acceptable due to the dose heterogeneity introduced in the target when combining the dose distributions from two separate fields. MCNPX simulations were performed for various configurations of the Mevion S250 beamline to determine spread-out Bragg peak dose distributions and patched-field treatment plans delivered using a rotating modulator wheel to depths in the clinically relevant range between 5.0 and 30.0?cm. The dose non-uniformity (DNU) metric was defined as the difference between the maximum and minimum dose relative to the prescription observed in a patched dose distribution. The DNU was first evaluated for dose distributions from a standard delivery using constant beam current and combining through-field lateral dose profiles and with patch-field distal dose profiles. Patch-field distal dose profiles were then optimized using beam current modulation in an attempt to better complement the through-field lateral dose profiles when combined into a patched dose distribution. Using standard deliveries, DNU was 10% or less only when patching lateral profiles 12.5?17.5?cm deep. Significantly greater DNU was observed for patches outside of this range, at times exceeding 35%. Using optimized distal profiles, DNU was reduced to 10% or less for all lateral profiles deeper than 15.0?cm. Optimizing beam current modulation was found to create distal profiles with more gradual dose falloff than found in a standard delivery, allowing optimized distal dose distributions to sum more homogeneously with lateral dose distributions. The hot or cold spots that often appear in patched dose distributions from standard deliveries may therefore be mitigated by optimizing beam current. This method may also be applied to systems other than the Mevion system to further improve patched-field dose homogeneity.