Pencil beam algorithms are unsuitable for proton dose calculations in lung

Commercial analytic proton algorithms were compared with measurements and Monte Carlo-based algorithms in a multi-institution phantom study. The analytic algorithms dramatically and consistently overestimated delivered dose up to 31% in the iGTV and 46% in the PTV. Monte Carlo algorithms and measurements showed considerably better agreement. Proton therapy centers should implement Monte Carlo-based (or other more advanced) algorithms in proton therapy for thoracic malignancies. Pencil beam algorithms for proton dose calculation in lung are unacceptable.

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