An optimized approach for robust spot placement in proton pencil beam scanning.

Maintaining a sharp lateral dose falloff in pencil beam scanning (PBS) proton therapy is crucial for sparing organs at risk (OARs), especially when they are in close proximity to the target volume. The most common approach to improve lateral dose falloff is through the use of physical beam shaping devices, such as brass apertures or collimator based systems. A recently proposed approach focuses on proton beam spot placements, moving away from traditional grid-based placements to concentric-contours based schemes. This improves lateral dose falloff in two ways: (1) by better conforming all spots to the tumor boundary and (2) allowing for 'edge enhancement', where boundary spots deliver higher fluence than more central spots, thereby creating a steeper lateral dose falloff. However, these benefits come at the expense of maintaining uniformity of spot distribution inside the target volume. In this work we have developed a new optimized spot placement scheme that provides robust spot distributions inside the target. This approach achieves the boundary conformity of a concentric-contours based approach and uses a fast-iterative method to distribute the interior spots in a highly uniform fashion in an attempt to improve both the lateral dose falloff and uniformity. Furthermore, we quantified the impact of this new approach through direct comparison with grid, contour, and hybrid spot placements schemes, showing improvements for this new approach. The results were validated in homogeneous medium for two different target shapes having concave and convex geometry.