The impetus behind our study was to establish a quantitative comparison between the IRIS collimator and the InCise multileaf collimator (MLC) (Accuray Inc. Synnyvale, CA) for prostate stereotactic body radiation therapy (SBRT). Treatment plans for ten prostate cancer patients were performed on MultiPlan™ 5.1.2 treatment planning system utilizing MLC and IRIS for 36.25 Gy in five fractions. To reduce the magnitude of variations between cases, the planning tumor volume (PTV) was defined and outlined for treating prostate gland only, assuming no seminal vesicle or ex-capsule involvement. Evaluation indices of each plan include PTV coverage, conformity index (CI), Paddick's new CI, homogeneity index, and gradient index. Organ at risk (OAR) dose sparing was analyzed by the bladder wall Dmax and V37Gy, rectum Dmax and V36Gy. The radiobiological response was evaluated by tumor control probability and normal tissue complication probability based on equivalent uniform dose. The dose delivery efficiency was evaluated on the basis of planned monitor units (MUs) and the reported treatment time per fraction. Statistical significance was tested using the Wilcoxon signed rank test. The studies indicated that CyberKnife M6™ IRIS and InCise™ MLC produce equivalent SBRT prostate treatment plans in terms of dosimetry, radiobiology, and OAR sparing, except that the MLC plans offer improvement of the dose fall-off gradient by 29% over IRIS. The main advantage of replacing the IRIS collimator with MLC is the improved efficiency, determined from the reduction of MUs by 42%, and a 36% faster delivery time.

Purpose The purpose of this study was to present the proton beam characteristics of the first clinical single‐room ProBeam Compact™ proton therapy system (SRPT) and comparison against multi‐room ProBeam™ system (MRPT). Materials and Methods A newly designed SRPT with proton beam energies ranging from 70 to 220 MeV was commissioned in late 2019. Integrated depth doses (IDDs) were scanned using 81.6 mm diameter Bragg peak chambers and normalized by outputs at 15 mm WET and 1.1 RBE offset, following the methodology of TRS 398. The in‐air beam spot profiles were acquired by a planar scintillation device, respectively, at ISO, upper and down streams, fitted with single Gaussian distribution for beam modeling in Eclipse v15.6. The field size effect was adjusted for the best overall accuracy of clinically relevant field QAs. The halo effects at near surface were quantified by a pinpoint ionization chamber. Its major dosimetric characteristics were compared against MRPT comparable beam dataset. Results Contrast to MRPT, an increased proton straggling in the Bragg peak region was found with widened beam distal falloffs and elevated proximal transmission dose values. Integrated depth doses showed 0.105–0.221 MeV (energy sigma) or 0.30–0.94 mm broader Bragg peak widths (Rb80–Ra80) for 130 MeV or higher energy beams and up to 0.48–0.79 mm extended distal falloffs (Rb20–Rb80). Minor differences were identified in beam spot sizes, spot divergences, proton particles/MU, and field size output effects. High passing scores are reported for independent end‐to‐end dosimetry checks by IROC and for initial 108 field‐specific QAs at 3%/3 mm Gamma index with fields regardless with or without range shifters. Conclusions The author highlighted the dosimetry differences in IDDs mainly caused by the shortened beam transport system of SRPT, for which new acceptance criteria were adapted. This report offers a unique reference for future commissioning, beam modeling, planning, and analysis of QA and clinical studies.

Two of the five patients had central tumors (within 2cm from critical midline structure). The following table shows the relevant structures and parameters. Coverage was kept consistent between plans with an average of 4750 cGy (95%) to the PTV volume. Conclusion: This study demonstrates the feasibility and advantages of SBRT treatment planning with DIBH. PTV volumes in FB were significantly larger due to the physiologic lung changes at peak inspiration and expiration. A reduction in PTV volume subsequently reduced mean OAR dose. Limitations in our study include few patients analyzed with various lung tumor locations of variable sizes. The patients with centrally located tumors appear to derive a greater dosimetric benefit with DIBH due to improved physiologic separation of tumor volume from nearby OARs. Though further investigation is warranted, and some patients are limited by their underlying pulmonary function, DIBH appears to be an effective technique for reducing PTV volumes and mean doses to OARs. Benefits should be assessed on an individualized basis. Abstract 2812; Table Structure and Parameter FB-4DCT DIBH p-value PTV Volume (cm 3) 33 30 0.02 Ipsilateral Lung Volume (cm 3) 1875 2486 0.03 Mean Ipsilateral Lung Dose (cGy) 411 321 0.06 Max Heart Dose (cGy) 628 449 0.34 Mean Heart Dose (cGy) 45 38 0.20 Mean Left Anterior Descending a. Dose (cGy) 51 44 0.04 Mean Right Coronary a. Dose (cGy) 69 120 0.38 Mean Left Circumflex a. Dose (cGy) 54 45 0.32

Purpose: Exploring appropriate offset values in dose optimization with pencil beam (PB) algorithm to minimize dosimetric differences with plans calculated with Monte Carlo (MC) for lung cancer treatment with Stereotactic Body Radiotherapy (SBRT). Methods: 20 cases of Non‐Small Cell Lung Cancer, treated with gated full motion range SBRT were selected. According to the proximity of the Gross Tumor Volume (GTV) to the chest wall, two groups are defined: peripherally located when GTV merges with the chest wall for at least 50% of the lesion diameter, and centrally located when the GTV is surrounded by lung tissue. Treatment plans were created on 4D average intensity projection (AIP) CT set with Brainlab iPlanDose 4.1.2 planning system. The D97 of PTV was normalized to 50Gy using the fast PB and compared with MC. The optimized plan was then recomputed over each 4D respiratory phase, and compared with MC using the same plan MU' s. Results: The mean difference in the PB and MC D97 of the ITV was 10.5% (±0.8%) of the prescription dose (50Gy). PB algorithm showed 2.3–2.4% less overestimation to the D97 of the ITV, when comparing to MC, in the maximum exhalation phase than in the maximal inhalation phase. Significantly smaller dose difference between PB and MC is also shown in plans for peripheral lesions (7.7 ± 0.7%) versus for central lesions (12.7±0.8%) (p< 0.01). Conclusion: The dosimetric differences between PB and MC can be reasonably predicted depending on the location of lesion in the lung, and may be used as offset value in dose optimization with PB. Since the maximal exhalation phase demonstrates less dose discrepancy between the two algorithms than that in maximal inhalation phase, caution is suggested when the latter is included as a major phase portion in the respiration gated lung SBRT.