Purpose: Study the contributors to treatment time as a function of Mini-Ridge Filter (MRF) thickness to determine the optimal choice for breath-hold treatment of lung tumors in a synchrotron-based spot-scanning proton machine.
Methods: Five different spot-scanning nozzles were simulated in TOPAS: four with MRFs of varying maximal thicknesses (6.15-24.6 mm) and one with no MRF. The MRFs were designed with ridges aligned along orthogonal directions transverse to the beam, with the number of ridges (4-16) increasing with MRF thickness. The material thickness given by these ridges approximately followed a Gaussian distribution. Using these simulations, Monte Carlo data were generated for treatment planning commissioning. For each nozzle, standard and stereotactic (SR) lung phantom treatment plans were created and assessed for delivery time and plan quality.
Results: Use of a MRF resulted in a reduction of the number of energy layers needed in treatment plans, decreasing the number of synchrotron spills needed and hence the treatment time. For standard plans, the treatment time per field without a MRF was 67.0 ± 0.1 s, whereas three of the four MRF plans had treatment times of less than 20 s per field; considered sufficiently low for a single breath-hold. For SR plans, the shortest treatment time achieved was 57.7 ± 1.9 s per field, compared to 95.5 ± 0.5 s without a MRF. There were diminishing gains in time reduction as the MRF thickness increased. Dose uniformity of the PTV was comparable across all plans; however, when the plans were normalized to have the same coverage, dose conformality decreased with MRF thickness, as measured by the lung V20%.
Conclusions: Single breath-hold treatment times for plans with standard fractionation can be achieved through the use of a MRF, making this a viable option for motion mitigation in lung tumors. For stereotactic plans, while a MRF can reduce treatment times, multiple breath-holds would still be necessary due to the limit imposed by the proton extraction time. To balance treatment time and normal tissue dose, the ideal MRF choice was shown to be the thinnest option that is able to achieve the desired breath-hold timing.