title: Water equivalent thickness of immobilization devices in proton therapy planning - Modelling at treatment planning and validation by measurements with a multi-layer ionization chamber.
abstract: OBJECTIVE
  To investigate the range errors made in treatment planning due to the presence of the immobilization devices along the proton beam path.
  
  
  METHODS
  The measured water equivalent thickness (WET) of selected devices was measured by a high-energy spot and a multi-layer ionization chamber and compared with that predicted by treatment planning system (TPS). Two treatment couches, two thermoplastic masks (both un-stretched and stretched) and one headrest were selected. At TPS, every immobilization device was modelled as being part of the patient. The following parameters were assessed: CT acquisition protocol, dose-calculation grid-sizes (1.5 and 3.0mm) and beam-entrance with respect to the devices (coplanar and non-coplanar). Finally, the potential errors produced by a wrong manual separation between treatment couch and the CT table (not present during treatment) were investigated.
  
  
  RESULTS
  In the thermoplastic mask, there was a clear effect due to beam entrance, a moderate effect due to the CT protocols and almost no effect due to TPS grid-size, with 1mm errors observed only when thick un-stretched portions were crossed by non-coplanar beams. In the treatment couches the WET errors were negligible (<0.3mm) regardless of the grid-size and CT protocol. The potential range errors produced in the manual separation between treatment couch and CT table were small with 1.5mm grid-size, but could be >0.5mm with a 3.0mm grid-size. In the headrest, WET errors were negligible (0.2mm).
  
  
  CONCLUSIONS
  With only one exception (un-stretched mask, non-coplanar beams), the WET of all the immobilization devices was properly modelled by the TPS.
authors.affiliation: Proton Therapy Unit, Hospital of Trento, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Fellin
authors.affiliation: Proton Therapy Unit, Hospital of Trento, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Righetto
authors.affiliation: Proton Therapy Unit, Hospital of Trento, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Fava
authors.affiliation: Medical Physics Department, Hospital of Trento, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy.
authors.forename: Diego
authors.initials: D
authors.lastname: Trevisan
authors.affiliation: Proton Therapy Unit, Hospital of Trento, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy.
authors.forename: Dante
authors.initials: D
authors.lastname: Amelio
authors.affiliation: Proton Therapy Unit, Hospital of Trento, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy. Electronic address: paolofarace@gmail.com.
authors.forename: Paolo
authors.initials: P
authors.lastname: Farace
mesh_terms: D001932:Brain Neoplasms / Q000532:radiotherapy; D006258:Head and Neck Neoplasms / Q000532:radiotherapy; D006801:Humans; D007103:Immobilization / Q000295:instrumentation*; D008962:Models, Theoretical; D010386:Pelvic Neoplasms / Q000532:radiotherapy; D061766:Proton Therapy / Q000295:instrumentation*; D011874:Radiometry; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods; D014057:Tomography, X-Ray Computed / Q000295:instrumentation / Q000379:methods; D014867:Water
chemical_list: D014867:Water
keywords: Immobilization devices; Proton therapy; Range; Treatment planning system; Water equivalent thickness