The LET enhancement of energy-specific collimation in pencil beam scanning proton therapy.

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To computationally characterize the LET distribution during dynamic collimation in PBS and quantify its impact on the resultant dosedistribution. Monte Carlo simulations using Geant4 were used to model the production of low-energy proton scatter produced in the collimating components of a novel PBS collimator. Custom spectral tallies were created to quantify the energy, track- and dose-averaged LET resulting from individual beamlet and composite fields simulated from a model of the IBA dedicated nozzle system. The composite dose distributions were optimized to achieve a uniform physical dose coverage of a cubical and pyramidal target, and the resulting dose-average LET distributions were calculated for uncollimated and collimated PBS deliveries and used to generate RBE-weighted dosedistributions. For collimated beamlets, the scattered proton energy fluence is strongly dependent on collimator position relative to the central axis of the beamlet. When delivering a uniform profile, the distribution of dose-average LET was nearly identical within the target and increased between 1 and within 10mm surrounding the target. Dynamic collimation resulted in larger dose-average LET changes: increasing the dose-average LET between 1 and within 10mm of a pyramidal target while reducing the dose-average LET outside this margin by as much as . Biological dose distributions are improved with energy-specific collimation in reducing the lateralpenumbra. The presence of energy-specific collimation in PBS can lead to dose-average LET changes relative to an uncollimated delivery. In some clinical situations, the placement and application of energy-specific collimation may require additional planning considerations based on its reduction to the lateral penumbra and increase in high-dose conformity. Future applications may embody these unique dosimetric characteristics to redirect high-LET portions of a collimated proton beamlet from healthy tissues while enhancing the dose-average LET distribution withintarget.