Proton beam penumbra: effects of separation between patient and beam modifying devices.

The sharp lateral penumbra of a proton beam is often used to spare sensitive normal structures in treating clinical sites in which the target volume abuts, or even wraps around, these structures. Using Monte Carlo calculations and measurements, the factors which influence the penumbra of the proton beam at the Harvard Cyclotron Laboratory were investigated, with particular emphasis on the effects of separation between the patient and any beam modifying devices. Penumbra broadening, characterized by the distance over which the dose rises from 20% to 80% of the central dose, increases with greater amounts of scatterer introduced into the beam line. The broadening due to separation of the beam modifying devices and the patient is essentially linear with increasing air gap; the rate of increase depends on the details of these devices and on the depth of interest in the patient. For a particular portal, most of the parameters which affect the penumbra width are fixed by the patient's anatomy and the target volume. Only the thickness of the compensating bolus around the aperture edge and any air gap between the patient and the beam modifying devices can vary. Families of curves relating combinations of bolus thickness and air gap that maintain a constant penumbra width have been developed for guidelines during patient setup.