Modified fast adaptive scatter kernel superposition (mfASKS) correction and its dosimetric impact on CBCT‐based proton therapy dose calculation

Purpose While cone beam computed tomography (CBCT) is able to provide patient anatomical information, its image quality is severely degraded due to scatter contamination, which degrades the accuracy of CBCT‐based dose distribution estimation in proton therapy. In this work, we combined two existing scatter kernel correction methods: the point‐spread function (PSF)‐based scatter kernel derivation method and the fast adaptive scatter kernel superposition (fASKS) model, and evaluated the impact of the modified fASKS (mfASKS) correction on the accuracy of proton dose distribution estimation. To evaluate feasibility of the mfASKS approach using accurate scatter distributions, both Monte Carlo simulations and experiments were performed for an on‐board CBCT machine integrated with a proton therapy machine. Methods We developed a strategy to modify central intensity, constant intensity, and amplitude of the scatter kernels derived from PSFs for the fASKS model. A parameter required for the fASKS model was derived by optimizing uniformity in the mfASKS‐corrected reconstructed images. Subsequently, the mfASKS model was used to remove scatter in CBCT imaging. We quantitatively compared the Hounsfield Unit (HU) and proton stopping power ratio (SPR) images for five different phantoms. To assess improvement of dose calculation accuracy, a series of proton treatment plans were produced using the CBCT images with and without the mfASKS correction. Results The accuracies of both HU and SPR intensity quantifications are improved as a result of the mfASKS correction. Mean absolute water‐equivalent path length difference to the true value decreases from 10.3 to 0.934 mm for the Gammex phantom (simulation). At the same time, mfASKS is able to offer more accurate dose distributions, especially at the distal fall‐off region where noticeable dose overestimation is observed in the uncorrected scenario. Mean absolute relative error of proton range in the pelvic phantom improves from 5.03% to 2.57% (experiment). Conclusions mfASKS enables more accurate CBCT‐based proton dose calculation. This technique has significant implications in image‐guided radiotherapy and dose verifications in adaptive proton therapy.