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Bottleneck Issues in the Clinic Implementation of Monte Carlo Method in Proton Therapy

L Lin1*, J Schuemann2*, S Leng3*, (1) Emory Proton Therapy Center, Atlanta, GA, (2) Mass General Hospital and Harvard Medical School, Boston, MA, (3) Mayo Clinic, Rochester, MN

Presentations

1:00 PM Bottleneck Issues in Proton Monte Carlo Clinical Implementation and Companion Imaging Techniques – Report of NRG Survey Results - L Lin, Presenting Author
1:20 PM Proton Monte Carlo Platforms – Treatment Planning and Latest Developments - J Schuemann, Presenting Author
1:40 PM Dual Energy Computed Tomography, Metal Artifact Reduction and Photon Counting Detectors – Latest Development and Potential for Monte Carlo Dose Calculation - S Leng, Presenting Author

SU-C-TRACK 7-0 (Sunday, 7/25/2021) 1:00 PM - 2:00 PM [Eastern Time (GMT-4)]

Monte Carlo (MC) dose calculation has recently been implemented in primary commercial treatment planning systems (TPS) as well as various in-house platforms for proton therapy. MC promises smaller dose uncertainties, particularly in patients with high heterogeneities within the treatment field (e.g. bone/lung) or large surgical implants. Newly developed dual-energy computed tomography (DECT) and metal artifact reduction (MAR) techniques compliment MC capabilities. However, there are no reports yet on how proton therapy centers implement these new technologies. Therefore, an NCI-sponsored NRG survey was distributed to operating USA proton centers in 2019 to determine the feasibility for including MC and companion techniques in cooperative group clinical trials. The use of MC for primary dose calculation and optimization is found to be prevalent and, therefore, likely feasible for clinical trials, where MC is encouraged for patients without implant materials. For patients with metal implants, there is consensus to use MAR and override tissues surrounding metals. However, there is no consensus about DECT regarding virtual mono-energetic images or the extraction of material information for implants and human tissues. The development and standardization of these advanced technologies are strongly encouraged for vendors and clinical physicists alike. In this joint imaging therapy symposium, we will review the latest developments of MC and imaging methods to facilitate their implementations in clinical trials with updated consensus practice recommendations and to mitigate the identified bottleneck issues. (max 250 words)

Learning objectives:
1. Report of NRG survey results of MC implementation and companion imaging techniques, including current status and bottleneck issues (Liyong Lin)
2. Report on the latest development of MC in commercial TPS and in-house platforms (Jan Schuemann)
3. Report on the latest development of DECT and MAR techniques (Shuai Leng)

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