Validation of linear energy transfer computed in a Monte Carlo dose engine of a commercial treatment planning system

The relative biological effectiveness (RBE) of protons is highly variable and difficult to quantify. However, RBE is related to the local ionization density, which can be related to the physical measurable dose weighted linear energy transfer (LET_D). The aim of this study was to validate the LET_D calculations for proton therapy beams implemented in a commercially available treatment planning system (TPS) using microdosimetry measurements and independent LET_D calculations (Open-MCsquare (MCS)). The TPS (RayStation v6R) was used to generate treatment plans on the CIRS-731-HN anthropomorphic phantom for three anatomical sites (brain, nasopharynx, neck) for a spherical target ( = 5 cm) with uniform target dose to calculate the LET_D distribution. Measurements were performed at the University Medical Center Groningen proton therapy center (Proteus Plus, IBA) using a µ ⁺-probe utilizing silicon on insulator microdosimeters capable of detecting lineal energies as low as 0.15 keV µm^-1 in tissue. Dose averaged mean lineal energy depth-profiles were measured for 70 and 130 MeV spots in water and for the three treatment plans in water and an anthropomorphic phantom. The measurements were compared to the LET_D calculated in the TPS and MCS independent dose calculation engine. D • was compared to D • LET_D in terms of a gamma-index with a distance-to-agreement criteria of 2 mm and increasing dose difference criteria to determine the criteria for which a 90% pass rate was accomplished. Measurements of D • were in good agreement with the D • LET_D calculated in the TPS and MCS. The 90% passing rate threshold was reached at different D • LET_D difference criteria for single spots (TPS: 1% MCS: 1%), treatment plans in water (TPS: 3% MCS: 6%) and treatment plans in an anthropomorphic phantom (TPS: 6% MCS: 1%). We conclude that D • LET_D calculations accuracy in the RayStation TPS and open MCSquare are within 6%, and sufficient for clinical D • LET_D evaluation and optimization. These findings remove an important obstacle in the road towards clinical implementation of D • LET_D evaluation and optimization of proton therapy treatment plans. Novelty and significance The dose weighed linear energy transfer (LET_D) distribution can be calculated for proton therapy treatment plans by Monte Carlo dose engines. The relative biological effectiveness (RBE) of protons is known to vary with the LET_D distribution. Therefore, there exists a need for accurate calculation of clinical LET_D distributions. Previous LET_D validations have focused on general purpose Monte Carlo dose engines which are typically not used clinically. We present the first validation of mean lineal energy measurements of the LET_D against calculations by the Monte Carlo dose engines of the Raystation treatment planning system and open MCSquare.