A CT-based software tool for evaluating compensator quality in passively scattered proton therapy

We have developed a quantitative computed tomography (CT)-based quality assurance (QA) tool for evaluating the accuracy of manufactured compensators used in passively scattered proton therapy. The thickness of a manufactured compensator was measured from its CT images and compared with the planned thickness defined by the treatment planning system. The difference between the measured and planned thicknesses was calculated with use of the Euclidean distance transformation and the kd-tree search method. Compensator accuracy was evaluated by examining several parameters including mean distance, maximum distance, global thickness error and central axis shifts. Two rectangular phantoms were used to validate the performance of the QA tool. Nine patients and 20 compensators were included in this study. We found that mean distances, global thickness errors and central axis shifts were all within 1 mm for all compensators studied, with maximum distances ranging from 1.1 to 3.8 mm. Although all compensators passed manual verification at selected points, about 5% of the pixels still had maximum distances of >2 mm, most of which correlated with large depth gradients. The correlation between the mean depth gradient of the compensator and the percentage of pixels with mean distance <1 mm is -0.93 with p < 0.001, which suggests that the mean depth gradient is a good indicator of compensator complexity. These results demonstrate that the CT-based compensator QA tool can be used to quantitatively evaluate manufactured compensators.