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Case study of a bolus helmet used to maintain optic chiasm and nerve sparing during
treatments to the head using IMPT

Keith Larsen 

Jenna Cimmiyotti 

Rashad Momoh

I. Abstract
II. Introduction
A. PI: Dose and side effect concerns regarding treatments to the head. (Reference:
Ali et al,1 Loganovski et al,3 Archer et al,4 Brodin et al,5 Mayo et al,6)
B. PII: Proton dose characteristics regarding treatments to the head. (Reference: Ali
et al,1 Ozkaya et al,2 Loganovski et al,3 Mayo et al,6)
C. PIII: Range shifter concept and explanation. (Reference: Gadient et al,7 Yasui et
al,8)
D. PIV: Bolus helmet concept and explanation. (Reference: Gadient et al,7 Both et
al,9)
E. PV: Summarize introduction points.
1. Problem: The problem is that traditional proton therapy
planning techniques may excessively sacrifice CTV prescription coverage
to meet dose tolerances of the optic chiasm and nerves.
2. Purpose: The purpose of this study is to determine if the addition
of a bolus helmet maintains optic chiasm and nerve sparing
while improving the CTV prescription coverage in treatments near optic
structures.
3. Hypotheses: Researchers will test the hypotheses that use of a bolus
helmet (H1A) maintains optic chiasm sparing and (H2A) optic nerve
sparing while improving CTV prescription coverage, as well as
(H3A) reducing maximum brain-CTV dose, when compared to plans
without the use of a bolus helmet.
III. Case Description
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A. Patient Selection
1. PI: Inclusion Criteria
a. Retrospective
b. Intensity modulated proton therapy treating locations near optic
structures
c. Patient planned with and without use of bolus helmet
d. Anatomical locations accepted
2. PII: Simulation
a. Two CT scans performed: one with bolus helmet and one without
bolus helmet
B. Target Delineation
1. PI: CTV and OAR (Optic chiasm and nerves)
C. Treatment Planning
1. PI: Techniques used (Table 1)
a. Planning
a. Plan optimization goals
i. NUPO optimization/pencil beam
ii. Primary goal is to spare optic structures and
secondary goal is CTV coverage
iii. Describe proximity of the target to the optic chiasm
and optic nerves
b. Planning with bolus helmet (vac machine)
c. Planning with range shifter and no bolus helmet
d. Table position and gantry angles (Table 1)
e. Field selection/Number of beams
i. How STV’s are created
f. Biologic dose
i. The biologic model that was used
ii. How biologic dose is evaluated
2. PII: OAR Constraints (Table 2)
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a. Optic chiasm and nerves: <54 Gy maximum, <60 Gy to 1%

b. Brain minus CTV
D. Statistical Analysis
1. PI: Paired T-Test and Wilcoxon Signed Rank Test
IV. Results
A. PI: CTV prescription coverage (minimum, V95%, V100%, CV95%) (Table 3)
1. CTV high
2. CTV low
B. PII: Optic nerve metrics (V54, V60, maximum, mean) (Table 3)
1. Optic nerve left
2. Optic nerve right
C. PIII: Optic chiasm metrics (V54, V60, maximum, mean) (Table 3)
D. PIV: Brain minus CTV (V60, V70, maximum, mean) (Table 3)
V. Discussion

VI. Conclusion
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References 

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does treatment modality influence the risk? Bulletin du Cancer. 2019;106(12).
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