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Dosimetric effects of quality assurance-related setup errors in passive proton therapy for prostate cancer with and without a hydrogel spacer

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Abstract

The purpose of this study was to evaluate the effect of quality assurance (QA)-related setup errors in passive proton therapy for prostate cancer with and without a hydrogel spacer. We used 20 typical computed tomography (CT) images of prostate cancer: 10 patients with and 10 patients without spacers. The following 12 model errors were assumed: output error ± 2%, range error ± 1 mm, setup error ± 1 mm for three directions, and multileaf collimator (MLC) position error ± 1 mm. We created verification plans with model errors and compared the prostate-rectal (PR) distance and dose indices with and without the spacer. The mean PR distance at the isocenter was 1.1 ± 1.3 mm without the spacer and 12.9 ± 2.9 mm with the spacer (P < 0.001). The mean rectum V53.5 GyE, V50 GyE, and V34.5 GyE in the original plan were 2.3%, 4.1%, and 12.1% without the spacer and 0.1%, 0.4%, and 3.3% with the spacer (P = 0.0011, < 0.001, and < 0.001). The effects of the range and lateral setup errors were small; however, the effects of the vertical/long setup and MLC error were significant in the cases without the spacer. The means of the maximum absolute change from original plans across all scenarios in the rectum V53.5 GyE, V50 GyE, and V34.5 GyE were 1.3%, 1.5%, and 2.3% without the spacer, and 0.2%, 0.4%, and 1.3% with the spacer (P < 0.001, < 0.001, and = 0.0019). This study indicated that spacer injections were also effective in reducing the change in the rectal dose due to setup errors.

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Acknowledgements

The authors thank Dr. Shingo Hashimoto, Dr. Koichiro Nakajima, Dr. Yukiko Hattori, and the members of the NPTC who performed the treatment planning and accuracy management associated with this study.

Funding

This work was supported by JSPS KAKENHI Grant Number 19K17181.

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Authors and Affiliations

  1. Anjo Kosei Hospital, 28 Higashi‐Hirokute, Anjo-cho, Anjo, Aichi, 446‐8602, Japan

    Yuta Omi

  2. Faculty of Radiological Technology, School of Health Sciences, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan

    Keisuke Yasui, Akari Furukawa & Naoki Hayashi

  3. Nagoya Proton Therapy Center, Nagoya City West Medical Center, 1-1-1, Hirate-cho, Kita-ku, Nagoya, Aichi, 462-8508, Japan

    Akira Shimomura, Rie Muramatsu, Hiromitsu Iwata & Hiroyuki Ogino

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  1. Yuta Omi
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Correspondence to Keisuke Yasui.

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This study did not involve any animal experiments. All the procedures involving human participants were conducted in accordance with the ethical standards of the institutional and/or national research committee as well as with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all the individuals included in the study.

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Omi, Y., Yasui, K., Shimomura, A. et al. Dosimetric effects of quality assurance-related setup errors in passive proton therapy for prostate cancer with and without a hydrogel spacer. Radiol Phys Technol 14, 328–335 (2021). https://doi.org/10.1007/s12194-021-00632-4

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  • DOI: https://doi.org/10.1007/s12194-021-00632-4

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