A Monte Carlo dose calculation algorithm for proton therapy

Matthias Fippela)
Abteilung für Medizinische Physik, Universitätsklinikum Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen,
Germany
Martin Soukup
Department of Dosimetry and Application of Ionizing Radiation, Czech Technical University in Prague,
Brehova 7, 11519 Praha, Czech Republic
共Received 17 March 2004; revised 13 May 2004; accepted for publication 18 May 2004;
published 23 July 2004兲
A Monte Carlo 共MC兲 code 共VMCpro兲 for treatment planning in proton beam therapy of cancer is
introduced. It is based on ideas of the Voxel Monte Carlo algorithm for photons and electrons and
is applicable to human tissue for clinical proton energies. In the present paper the implementation
of electromagnetic and nuclear interactions is described. They are modeled by a Class II condensed
history algorithm with continuous energy loss, ionization, multiple scattering, range straggling,
␦-electron transport, nuclear elastic proton nucleus scattering and inelastic proton nucleus reactions.
VMCpro is faster than the general purpose MC codes FLUKA by a factor of 13 and GEANT4 by a
factor of 35 for simulations in a phantom with inhomogeneities. For dose calculations in patients
the speed improvement is larger, because VMCpro has only a weak dependency on the heteroge-
neity of the calculation grid. Dose distributions produced with VMCpro are in agreement with
GEANT4 results. Integrated or broad beam depth dose curves show maximum deviations not larger
than 1% or 0.5 mm in regions with large dose gradients for the examples presented here. © 2004
American Association of Physicists in Medicine. 关DOI: 10.1118/1.1769631兴

Key words: proton therapy, Monte Carlo, treatment planning

I. INTRODUCTION rithms, because ray-tracing must be performed for time de-

Presently, pencil beam algorithms1– 8 are employed for dose
calculation in proton therapy. They have the advantage of
short calculation times, which is especially useful for inten-
sity modulated proton therapy.9 On the other hand, pencil
beam algorithms show accuracy limitations mainly because
of the one-dimensional density scaling of proton pencil
beams in water.10 To overcome these difficulties more so-
phisticated scaling methods have been introduced.10,11 These
methods could improve dose calculation considerably. How-
ever, close to material interfaces there are remaining discrep-
ancies to Monte Carlo calculated dose distributions.11 The
reason is, multiple elastic Coulomb scattering in heteroge-
neous media as well as elastic and inelastic nuclear reactions
can be implemented in pencil beam algorithms only approxi-
mately. Further improvement of proton dose calculation can
be achieved using Monte Carlo 共MC兲 algorithms.
Some of the most serious problems in proton therapy to-
day are patient set-up errors and organ motion. These uncer-
tainties have a large impact on the treatment success, because
the dose of proton beams can be placed with high precision
to specific locations within the patient. A small displacement
of the Bragg–Peak can easily lead to tumor underdosage as
well as overdosage to organs at risk. Presently these effects
are taken into account during treatment planning by adding
margins to the clinical target volume. But in this manner the
high precision of proton dose distributions decreases. Thus, it
will be extremely useful to reduce the margins by taking
motion effects into account during treatment planning. How-
ever, they are difficult to simulate with pencil beam algo-
pendent density distributions. This increases calculation time
and may be clinically impractical. For MC algorithms, on the
other hand, it is easy to model these effects by choosing the
density in each voxel randomly from a pre-defined uncer-
tainty distribution before starting the particle history. This
can be realized without increasing the calculation time com-
pared to static Monte Carlo. Of course, the distribution func-
tion of densities in each voxel must be known, e.g., by a time
dependent set of computerized tomography 共CT兲 cubes.
Therefore, in near future MC algorithms will be preferred for
treatment planning in proton therapy if they are fast enough.
Recently, Kohno et al. developed a simplified Monte
Carlo 共SMC兲 planning algorithm for proton beams based on
measured depth dose distributions in water.12 They stated,
that in relatively short calculation time SMC agrees well
with experimental results in a heterogeneous phantom. How-
ever, further investigations will be necessary to quantify the
calculation time as well as the influence of these simplifica-
tions on the results.
Another option is the implementation of established gen-
eral purpose MC codes like GEANT4,13 FLUKA,14,15 or MCNP16
for treatment planning. However, as we will show in Sec.
III E, these codes are still too slow for this type of simula-
tions. For proton therapy treatment planning in future fast
and accurate MC dose calculation algorithms are required.
In the present paper a MC algorithm for proton beams,
called VMCpro, is introduced. Here the implementation of
electromagnetic and nuclear interactions is described. In the
next section the properties of the transport model are ex-
plained. It is discussed how the cross sections and transport

2263 Med. Phys. 31 „8…, August 2004 0094-2405Õ2004Õ31„8…Õ2263Õ11Õ$22.00 © 2004 Am. Assoc. Phys. Med. 2263
2264 M. Fippel and M. Soukup: A Monte Carlo dose calculation algorithm
parameters are determined from a given distribution of mass
densities. In Sec. III the new code is benchmarked using
GEANT4 and FLUKA in terms of accuracy and calculation
time.
II. METHODS
For treatment planning and optimization the models of
patients are given by sets of computerized tomography 共CT兲
images. Using standard CT calibration techniques these sets
of images can be converted into three-dimensional 共3D兲
grids of mass densities, called density matrices. Thus, the
transport of protons and secondary particles has to be simu-
lated within voxelized geometries. This is identical to the
situation in traditional radiation therapy where the transport
of photons and electrons must be simulated. This allows us
to reuse ideas developed for the Voxel Monte Carlo 共VMC兲
algorithm.17–19 Therefore, the Monte Carlo code for proton
beams, presented here, is called VMCpro.
A. Proton transport algorithm
The most important component of VMCpro is the algo-
rithm to model the transport of protons with different ener-
gies through human tissue. This transport is influenced by
elastic and inelastic Coulomb collisions with atomic nuclei
and atomic electrons as well as elastic and inelastic nuclear
reactions.
Protons undergo a huge number 共more than 106 per cm)
of elastic Coulomb interactions. Simulating this collision by
collision 共analog Monte Carlo兲 would require too much cal-
culation time. Therefore, a Class II condensed history
algorithm20 is implemented with production of ␦-electrons
共ionizations兲 above the threshold energy T min and continuous
e
energy loss below T min min
e . The parameter T e can be specified
by the user. It influences the ionization cross section 共see
Sec. II B兲 and thus the number of ␦-electrons during the
simulation.
The transport simulation starts with a proton of definite
kinetic energy T p and momentum at the surface of the cal-
culation grid. The kinetic energy of this proton is absorbed
locally if it is smaller than the minimum energy T min p . This
parameter can be defined by the user. We usually choose
p ⫽0.5 MeV. The range of protons with smaller energy
T min
共less than 0.01 mm in water兲 is negligible with respect to the
voxel resolution. Even in air cavities this choice will be suf-
ficient because of the small stopping power and nuclear in-
teraction cross sections. T min
p is also used to control the end
of the simulation of each proton. The transport stops if the
kinetic energy becomes smaller than the minimum energy.
There is also a maximum energy T max p ⫽500 MeV. It is used
as upper limit of proton transport data tabulations. Thus the
typical clinical energies 共from 60 to 270 MeV兲 are included.
The VMCpro transport procedure traces protons through
the grid step by step. One step is defined by the distance
between two voxel boundaries if there is no discrete interac-
tion in the present voxel. If there is a discrete interaction
共ionization or nuclear reaction兲 one step is until this interac-
tion point. The distance to the discrete interaction point is
Medical Physics, Vol. 31, No. 8, August 2004
2264
determined in energy space using the modified fictitious in-
teraction method as described by Kawrakow21 taking into
account ionization, elastic and inelastic nuclear reactions.
Using the mass density ␳ in the present voxel, the stopping
power ratio to water f S ( ␳ ,T p ) can be determined 关see Sec.
II C, Eq. 共13兲兴. This allows scaling of the geometrical step
length ⌬z to the corresponding step length in water ⌬z w
according to:
␳
⌬z w ⫽ f S 共 ␳ ,T p 兲 ⌬z. 共1兲
␳w
The energy loss ⌬E is identical for protons with geometrical
step length ⌬z in a medium with density ␳ and protons of the
same energy with step length ⌬z w in water. Using the re-
e ) 共see Sec. II D兲
stricted stopping power in water L w (T p ,T min
and the integral
⌬z w ⫽⫺ 冕 Tp
end
Tp dT ⬘p
L w 共 T ⬘p ,T min
e 兲
, 共2兲
it is possible to calculate the mean kinetic energy of the
proton at the end of the step:
p ⫽T p ⫺⌬E.
T end 共3兲
The real proton energy T end
p at the end of the step fluctuates
around its mean value. In Sec. II E the implementation of this
energy straggling is discussed.
After moving the proton to the new position a multiple
scattering angle is sampled 共see Sec. II F兲 and the proton is
rotated according to this angle. The energy loss ⌬E is scored
in the present voxel and the new energy T end p is assigned to
the proton. If there is a discrete interaction at the end of the
step this interaction is simulated 共see Secs. II B and II H兲.
This can lead to secondary particles, e.g., ␦-electrons or sec-
ondary protons. In this case the transport of these particles is
also simulated 共see, e.g., Sec. II G兲.
The proton history ends if it leaves the calculation grid or
its energy becomes smaller than T min p . Otherwise the proce-
dure continues with the simulation of a new step.
B. Ionization
For kinematic reasons the maximum energy T max e transfer-
able to free electrons during ionization interactions is given
by 共see, e.g., ‘‘The Review of Particle Physics’’ 22兲:
2m e ␤ 2 ␥ 2
e ⫽
T max . 共4兲
1⫹2 ␥ m e /m p ⫹ 共 m e /m p 兲 2
Here, m e and m p are the electron and proton rest masses in
units of energy, respectively, ␤ is the ratio of proton velocity
to the velocity of light and the relativistic parameter ␥ is
given by ␥ ⫽E p /m p with the total energy of the proton E p
⫽T p ⫹m p .
The differential macroscopic cross section for the produc-
tion of ␦-electrons with kinetic energy T e ⬎T min
e is calculated
by 共see, e.g., GEANT4, Physics Reference Manual 200323兲:
2265 M. Fippel and M. Soukup: A Monte Carlo dose calculation algorithm 2265

d⌺
dT e
ne 1 Te
冋
⫽2 ␲ r 2e m e 2 2 1⫺ ␤ 2 max ⫹
␤ Te Te
T 2e
2E 2p
, 册 共5兲

for materials with electron density n e , r e is the electron ra-

e ⭐Te . Using Eq. 共5兲
dius. This cross section is zero for T max min

the total macroscopic cross section

e 兲⫽
⌺ 共 n e ,T p ,T min 冕 Te
min
Te
max
dT e
d⌺
dT e
, 共6兲

and the first moment

e 兲⫽
M 共 n e ,T p ,T min 冕 max
Te
min
Te
dT e T e
d⌺
dT e
, 共7兲

can be calculated analytically. Equation 共5兲 also provides a

rejection method to sample the kinetic energy of the
␦-electron. First of all, this energy is sampled from distribu-
tion
FIG. 1. Mass stopping power ratios of all materials from ICRU Report 46
T min
e Te
max
1 共Ref. 24兲 to the mass stopping power of water for 10 MeV and 100 MeV
f 共 Te兲⫽ , 共8兲 protons 共crosses兲. The lines represent the fit of Eq. 共13兲 for both energies.
e ⫺T e
T max min 2
Te
i.e., with ␩ being a uniformly distributed random number in
关0:1兴, T e is calculated according to: ␳ w S 共 ␳ ,T p 兲
f S 共 ␳ ,T p 兲 ⫽ . 共12兲
T min
e Te
max
␳ S w共 T p 兲
T e⫽ . 共9兲
共 1⫺ ␩ 兲 T e ⫹ ␩ T min
max
e After analyzing the tabulations and calculations of ICRU Re-
Then, function port 46,24 ICRU Report 49,25 and the computer tool PSTAR26
we develop the following fit formula:
Te T 2e
1.0123⫺3.386 10⫺5 T p ⫹0.291共 1⫹T ⫺0.3421

g 共 T e 兲 ⫽1⫺ ␤ 2
⫹ ,
T max 2E 2p
e ⫻共 ␳
can be used as rejection weight.
The polar scattering angle of the ␦-electron follows from
the kinematics of this process. The azimuthal scattering
angle is sampled from a uniform distribution. Because of the
large proton mass compared to the electron mass a direction
change of the proton can be neglected. The proton direction
mainly changes due to multiple elastic scatter with the
atomic nuclei 共see Sec. II F兲 or due to elastic nuclear colli-
sions 共see Sec. II H兲.
C. Stopping power ratio
The total proton stopping power is given by the sum of
the electronic stopping power and the nuclear stopping
power. Above 1 MeV kinetic energy the nuclear stopping
power is negligible, i.e., protons are slowed down mainly
because of inelastic interactions with the atomic electrons.
The mass stopping power of a proton with kinetic energy
T p is defined by the energy loss dT p along the path length dz
and normalized by the mass density ␳, i.e.,
S 共 ␳ ,T p 兲 1 dT p 共 ␳ ,T p 兲
⫽ ,
␳ ␳ dz
with S( ␳ ,T p ) being the linear stopping power. For human
tissue, it is possible to express the stopping power of a ma-
terial with mass density ␳ as a function of the mass stopping
power in water S w (T p )/ ␳ w . For this reason we define the
stopping power ratio
冦
共10兲 p 兲
⫺0.7
⫺1 兲 for ␳ ⭓0.9
f S 共 ␳ ,T p 兲 ⫽ 0.9925 for ␳ ⫽0.26 共 lung兲
0.8815 for ␳ ⫽0.0012 共 air兲
interpolate for all other ␳ ⭐0.9,
共13兲
with the kinetic proton energy T p in MeV and mass density ␳
in g cm⫺3 . Figure 1 shows this function for two proton en-
ergies 共10 and 100 MeV兲 compared to the ICRU Report 46
data.24 Beside the outliers 共Gallstone, Protein, Carbohydrate
and Urinary Stone兲, Eq. 共13兲 provides an accuracy of better
than 1%. This fit allows the scaling of Eq. 共1兲 during MC
simulations based on mass densities only. Knowledge of the
atomic composition in each voxel is not necessary. Equation
共13兲 can also be applied to pencil beam algorithms.
D. Restricted stopping power in water
The restricted stopping power in water L w (T p ,T min
e ) must
be known to calculate the energy loss of protons based on
Eq. 共2兲. This value depends on the total stopping power in
water and the first moment of the ionization cross section
共11兲 due to:
e 兲 ⫽S w 共 T p 兲 ⫺M w 共 T p ,T e 兲 .
L w 共 T p ,T min 共14兲
min
M w (T p ,T min
e ) is determined using Eq. 共7兲, therefore, the re-
stricted stopping power depends on T min
e . It models ioniza-
tion processes below the energy threshold. The total stopping
power S w (T p ) is taken from PSTAR.26 L w (T p ,T min
e ) is cal-

Medical Physics, Vol. 31, No. 8, August 2004

2266 M. Fippel and M. Soukup: A Monte Carlo dose calculation algorithm 2266

culated and tabulated during the initialization of VMCpro for

the given T min
e . In the neighborhood of T p it can be param-
eterized as
⫺[b(T p )⫺1]
L w 共 T p 兲 ⫽a 共 T p 兲 T p , 共15兲
with b(T p ) being an almost constant function. If the param-
eter b(T p ) is also calculated and tabulated prior to the MC
simulation, the integral of Eq. 共2兲 can be evaluated efficiently
and accurately.

E. Energy straggling
The production of secondary electrons during ionization
interactions leads to energy fluctuations of the primary pro-
tons. This influences the steepness of the depth dose distri-
bution behind the Bragg–Peak and must be taken into ac-
count during dose calculation. It is taken into account
automaticly for ␦-electron production above T mine . That is, if FIG. 2. Central axis depth dose distributions in water for monoenergetic
we choose T min
e small enough the dose is correctly predicted proton pencil beams of 100 MeV, calculated with GEANT4 version 5.1,
without the need for applying energy straggling. However, GEANT4 version 5.2 and FLUKA2002. Nuclear reactions are switched off.

the calculation time increases because a huge number of

␦-electrons is created. Even if the energy of these electrons is
absorbed locally, the computation time remains unacceptably
long. Therefore, we have implemented the sub-threshold
straggling distribution introduced by Bohr27 and described in
ICRU Report 4925 and the GEANT4 Physics Reference
Manual.23 That is, we model the straggling function by a
Gaussian with mean ⌬E from Eq. 共3兲 and variance:
sion 5.2 was released, we modified the value to E s
⫽12.0 MeV. This was necessary because the implementa-
tion of multiple scattering in GEANT4 has changed between
the versions. By using FLUKA2002.414,15 instead of GEANT4 for
fitting, the parameter must be changed to E s ⫽12.9 MeV.
Figure 2 shows central axis depth dose curves in water of

冉 冊
100 MeV pencil beams with a voxel resolution of 1 mm
min共 T min max
e ,T e 兲 ␤2 calculated with GEANT4 version 5.1, GEANT4 version 5.2, and
⍀ 2 ⫽2 ␲ r 2e m e n e ⌬z 1⫺ . 共16兲
␤2 2 FLUKA2002.4, without nuclear reactions. The differences can
be explained by different multiple scattering distributions
The last term (1⫺ ␤ 2 /2) provides a relativistic correction to
implemented in GEANT4 and FLUKA. Strictly speaking, the
Bohr’s variance.
parameter E s should be determined by measurement or a
Using this approach we have calculated proton beam dose
theoretical computation. Therefore, additional investigations
distributions in water for various threshold energies T mine . will be necessary. But this is not the task of the present
The final result 共especially in the Bragg–Peak region兲 does
paper, we just provide a method to adjust our model to any
not depend on the parameter T min
e . This means, the condition multiple scattering algorithm. Furthermore, the differences
of long step lengths to implement Bohr’s model is valid for
vanish for integrated or broad beam depth dose curves. They
our purposes. Only the calculation time is affected by T min
e . have only a slight influence on broad beam profile doses in
the Bragg–Peak region.
F. Multiple scattering To determine the radiation length X 0 ( ␳ ) for a material
Protons traversing matter are mainly scattered because of with mass density ␳ in the present voxel we define the ratio:
elastic Coulomb interactions with atomic nuclei. This leads ␳w Xw
to many small-angle deflections. Therefore, the small-angle f X 0共 ␳ 兲 ⫽ 共18兲
␳ X 0共 ␳ 兲
approximation can be applied to the multiple scattering
theory. This leads to a Gaussian distribution22 with a width with the radiation length of water X w ⫽36.0863 cm. The
introduced by Rossi and Greisen:28 crosses in Fig. 3 show this ratio as a function of ␳ for all

冉 冊
materials defined in ICRU Report 46.24 As in EGSnrc,21 the
Es 2
⌬z radiation lengths X w and X 0 ( ␳ ) for elements are calculated
␪ 20 ⫽ . 共17兲
␤p X 0共 ␳ 兲 using Tsai’s formula29 and the radiation lengths for com-
Here, p is the proton momentum and X 0 ( ␳ ) is the radiation pounds are derived from the elemental values. The density
length of the material. E s is a constant parameter, indepen- dependence of f X 0 ( ␳ ) can be represented accurately using
the fit:

再
dent on proton energy and material composition.
The parameter E s is determined by fitting differential dose 1.19⫹0.44 ln共 ␳ ⫺0.44兲 for ␳ ⭓0.9
distributions as calculated by VMCpro to simulations using
13
GEANT4 in water with nuclear reactions switched off. Using f X 0共 ␳ 兲 ⫽ 1.0446⫺0.2180 ␳ for 0.26⭐ ␳ ⭐0.9, 共19兲
GEANT4 version 5.1 we estimated E s ⫽12.4 MeV. When ver- 0.9857⫹0.0085 ␳ for ␳ ⭐0.26

Medical Physics, Vol. 31, No. 8, August 2004

2267 M. Fippel and M. Soukup: A Monte Carlo dose calculation algorithm
FIG. 3. Ratios of the radiation lengths of all materials from ICRU Report 46
共Ref. 24兲 to the radiation length of water 共crosses兲. The solid line represents
the fit of Eq. 共19兲.
if the outliers are neglected as in Eq. 共13兲. The solid line in
Fig. 3 shows the fit function. That is, knowledge of the
atomic composition in each voxel is unnecessary, mass den-
sity is sufficient for modeling multiple scattering.
An algorithm for path lengths corrections and lateral de-
flections is not implemented in VMCpro. The results in Sec.
III show that this is not necessary for proton beam therapy
dose calculations if step sizes not larger than the voxel reso-
lution are used.
G. Transport of ␦-electrons
According to Eq. 共4兲 the maximum energy transferable to
␦-electrons during 250 MeV proton ionization interactions is
e ⬇0.6 MeV. This corresponds to a range in water
about T max
of less than 2.5 mm. This range is smaller for smaller proton
energies. That is, electron transport can be modeled by the
continuous slowing down approximation 共CSDA兲. For this
reason, the CSDA range of water calculated using the com-
puter tool ESTAR26 is implemented in VMCpro and electron
stopping power ratio fits comparable to the fits as imple-
mented in VMC17 are used.
The minimum energy of ␦-electrons is given by the pa-
rameter T min
e specified by the user. We prefer a value of
T min
e ⫽0.1 MeV, corresponding to ranges of less than 0.15
mm in water. This selection provides a reasonable compro-
mise between accuracy and calculation speed. But as shown
by Verhaegen and Palmans, the simulation of secondary elec-
trons should not be neglected.30
H. Nuclear interactions
The probability of nuclear reactions compared to ioniza-
tion interactions is less than 5% for 50 MeV protons with
e ⫽0.1 MeV in water. For larger proton energies this
T min
probability becomes smaller, e.g., less than 1% for 200 MeV
protons. Therefore, the influence of nuclear interactions of
protons with atomic nuclei can be treated as correction to the
Medical Physics, Vol. 31, No. 8, August 2004
2267
FIG. 4. Dose contributions from different reaction channels for 150 MeV
protons in water.
electromagnetic processes. This can be concluded also from
Fig. 4. Here the dose contributions from different reaction
channels for 150 MeV protons in water are shown. This fig-
ure is different to a similar plot presented by Paganetti.31 He
has classified the dose contributions by the particle type. In
our plot the dose contributions from different reaction chan-
nels during nuclear interactions of the primary protons are
presented. For example, the curve labeled with ‘‘neutrons’’ is
the contribution of all particles resulting from neutrons pro-
duced in inelastic nuclear reactions of primary protons with
oxygen nuclei. That is, it is the contribution of particles of
different type created during secondary nuclear interactions
of these neutrons. This classification is necessary to estimate
the influence of nuclear interaction products of the primary
protons.
According to ICRU Report 46,24 most of the soft tissue
types consist mainly of the elements hydrogen, carbon, ni-
trogen, and oxygen. The weight proportions are about 10%
to 11% hydrogen, 85%–90% carbon plus oxygen and a small
amount 共up to 5%兲 of nitrogen. According to ICRU Report
63,32 the microscopic nuclear cross sections of protons with
carbon, nitrogen, or oxygen ions, normalized by the atomic
mass 共to calculate the macroscopic cross sections兲 are in the
same order of magnitude. Therefore, we assume, soft tissue
behaves like water in terms of nuclear interactions.
This is not quite true for various components of the skel-
eton, because they contain 5%–20% of calcium. The elastic
and inelastic proton–nucleus cross sections of calcium nor-
malized by the atomic mass are about 25% smaller compared
to oxygen. This means, the relative nuclear cross section er-
ror can be up to 5% if we also estimate bone tissues by water.
However, this error should become much smaller if we take
into account all processes, i.e., electromagnetic and nuclear
processes. Therefore, the influence of this error to dose dis-
tributions is assumed to be negligible. Later 共see Sec. III兲 we
will show that this assumption is valid for applications in
proton therapy.
2268 M. Fippel and M. Soukup: A Monte Carlo dose calculation algorithm
Because of these assumptions, in VMCpro nuclear inter-
actions in human tissue of different type 共including bone兲 are
modeled by nuclear interactions in water. That is, nuclear
cross sections and interaction models are implemented for
elastic proton–proton scattering as well as elastic and inelas-
tic proton–oxygen nucleus scattering.
1. Nuclear elastic proton – proton interactions
The macroscopic cross section ⌺ pp (T p ) of proton–proton
collisions in water normalized by the mass density ␳ is cal-
culated from the microscopic cross section ␴ pp (T p ) accord-
ing to:
1 wH
⌺ pp 共 T p 兲 ⫽N A ␴ 共 T 兲. 共20兲
␳ A H pp p
N A is the Avogadro constant, w H is the weight proportion of
hydrogen in water and A H is the atomic weight of hydrogen.
␴ pp (T p ) can be determined, e.g., by the partial-wave analy-
sis database SAID.33 Instead we use an analytical fit to the
SAID data between 10 and 300 MeV, i.e., the cross section
⌺ pp (T p )/ ␳ in cm2 /g is calculated by:
1 scopic cross section ␴ in(T p ) by:
⌺ 共 T 兲 ⫽0.315 T ⫺1.126⫹3.78 10⫺6 T p , 共21兲
␳ pp p p 1
with the kinetic proton energy T p in MeV.
The angular distribution of protons after the collision can
also by evaluated using the differential cross sections of
SAID,33 however, in the center-of-mass system this distribu-
tion is almost isotropic. Because of kinematic reasons, this
corresponds to an uniform distribution of the proton energy
in the laboratory system. Therefore, in VMCpro the kinetic
proton energy after elastic proton–proton interactions is
sampled from an uniform distribution. By convention the
proton with smaller energy is called the recoil proton. After
the collision both protons are tracked like primary protons by
executing the proton transport algorithm recursively.
2. Nuclear elastic proton – oxygen interactions
As in Eq. 共20兲 the total macroscopic elastic cross section
⌺ el (T p ) of protons incident on oxygen nuclei is given by:
1 wO
⌺ el 共 T p 兲 ⫽N A ␴ 共T 兲 共22兲
␳ A O el p
with w O being the weight proportion of oxygen in water and
A O being the atomic weight of oxygen. In VMCpro the mi-
croscopic cross section ␴ el (T p ) is fitted to data from ICRU
Report 6332 in the energy range between 50 and 250 MeV.
This leads to:
1 1.88
⌺ el 共 T p 兲 ⫽ ⫹4.0 10⫺5 T p ⫺0.014 75. 共23兲
␳ Tp
Again ⌺ el (T p )/ ␳ is in units of cm2 /g and T p is in MeV.
max
The maximum energy T O transferable to the recoil
nucleus after the collision is given by Eq. 共4兲 if the electron
mass m e is replaced by the mass of the oxygen nucleus m O .
The average kinetic energy T O of the recoil nucleus as a
Medical Physics, Vol. 31, No. 8, August 2004
2268
function of the incident proton energy T p is tabulated in
ICRU Report 63. In VMCpro the fit to these data
T O⫽0.65 exp共 ⫺0.0013 T p 兲 ⫺0.71 exp共 ⫺0.0177 T p 兲 ,
共24兲
is implemented. The real energy of the oxygen nucleus after
elastic collisions T O is sampled from the exponential distri-
bution:
冉 冊
1 TO
f 共 T O兲 ⫽ exp ⫺ , with T O⭐T O
max
. 共25兲
TO TO
This distribution is an estimate of the emission spectra tabu-
lated in ICRU Report 63. The range of oxygen ions in water
is very small, therefore, in VMCpro the energy T O is ab-
sorbed locally, contributing in this manner to the dose in the
present voxel. The direction change of the proton results
from its new energy after the collision.
3. Nuclear inelastic proton – oxygen interactions
The macroscopic inelastic cross section ⌺ in(T p ) of pro-
tons incident on oxygen nuclei is calculated from the micro-
wO
⌺ in共 T p 兲 ⫽N A ␴ 共 T 兲. 共26兲
␳ A O in p
Again ␴ in(T p ) is fitted to ICRU Report 63 data in the energy
range between 7 and 250 MeV leading to:
再 冉 冊
1 7.85
⌺ in共 T p 兲 ⫽0.001 1.64共 T p ⫺7.9兲 exp ⫺0.064T p ⫹
␳ Tp
冎
⫹9.86 . 共27兲
Equation 共27兲 becomes negative below 7 MeV. In this case
the cross section is set to zero.
As a result of inelastic nuclear collisions a variety of dif-
ferent reaction products can arise. Beside secondary protons
there are neutrons, deuterons, tritons, alphas and heavier
fragments, photons, electrons, etc. To take all these effects
into account a complicated algorithm is required like the
GEANT4 Binary Cascade or pre-compound models.
13,23
How-
ever, we assume that models of this complexity are not
needed for proton therapy dose calculation.
The empirical approach presented here is mainly based on
ICRU Report 6332 and the ENDF database.34 According to
these tabulations, in inelastic nuclear collisions about 50% of
the primary kinetic proton energy is released to secondary
protons. A significant amount of energy is also released to
neutrons, deuterons, alpha particles and heavier nucleus frag-
ments 共see Fig. 4兲. The neutron energy is distributed over
large distances. On the other hand, nuclear fragments have
short ranges, approximately their energy is absorbed locally.
Therefore, it is convenient to subdivide the reaction products
into three classes: Protons, short range particles and long
range particles. Furthermore, binding and minimum energies
must be taken into account during simulation of inelastic
collisions.
2269 M. Fippel and M. Soukup: A Monte Carlo dose calculation algorithm
FIG. 5. Secondary proton energy spectrum after inelastic nuclear collisions
of 200 MeV protons incident on Oxygen nuclei. The data represented by the
solid line are from ICRU Report 63.32 The dashed line is calculated using
the inelastic nuclear model implemented in VMCpro.
In the model the energy of secondary particles is sampled
from a uniform distribution between the minimum energy
and the remaining energy of the system consisting of the
incident proton and the nucleus. At the beginning of this
iteration loop the remaining energy is given by the energy of
the incident proton minus binding energy. With a probability
of one half the secondary particle is a proton. Otherwise it is
a short or a long range particle. Then the new remaining
energy of the system is calculated by subtracting the energy
of the first secondary particle and an additional binding en-
ergy. A second secondary particle energy can be sampled if
there is enough remaining energy, i.e., the iteration loop con-
tinues. In this manner the loop continues until the whole
energy of the system is consumed. For 200 MeV protons
incident on oxygen nuclei the model leads to a secondary
proton energy spectrum as presented by the dashed line in
Fig. 5. The solid line in Fig. 5 shows the corresponding
spectrum from ICRU Report 63. The minimum energy pa-
rameter of the nuclear model is determined by adjusting the
low energy peaks of both spectra. This leads to a value of 3
MeV. During the iteration loop the binding energy changes
from 5 MeV to smaller values. As shown in Fig. 5 this leads
to a maximum secondary proton energy about 5 MeV smaller
than the incident energy. Therefore, the overall shape of the
spectra is similar. However especially at low energies the
model spectrum is narrower compared to the ICRU data.
Integration of these spectra leads to the total proton produc-
tion multiplicities as represented by the upper plot of Fig. 6.
The lower plot shows the average secondary proton energy
as a function of the incident proton energy. Again the solid
lines 共with circles兲 are from ICRU Report 63 and the dashed
lines 共with triangles兲 result from the model. In ICRU Report
63 the total cross sections are tabulated with an accuracy of
5%–10%. The angle-integrated emission spectra are accurate
to 20%–30% standard deviation. Taking this into account,
the curves in Fig. 6 are in agreement.
Medical Physics, Vol. 31, No. 8, August 2004
2269
FIG. 6. Total proton production multiplicity 共upper plot兲 and average sec-
ondary proton energy 共lower plot兲 as functions of the incident proton energy
after inelastic nuclear collisions. The data represented by solid lines and
circles are from ICRU Report 63.32 The dashed lines and triangles are cal-
culated using the inelastic nuclear model implemented in VMCpro.
The ratio between long range energy and short range en-
ergy is determined by adjusting depth dose curves as calcu-
lated with GEANT4 and VMCpro in water. This leads to 7%
short range energy and 93% long range energy. Short range
energy is deposited locally, long range energy is neglected.
All secondary protons are handled like primary protons. If
p ⫽0.5 MeV it is absorbed
their energy is smaller than T min
locally, otherwise they are tracked by invoking the proton
transport procedure recursively. According to ICRU Report
63 the angular distribution of secondary protons is forward
peaked for large energies but approximately isotropic for
small energies. In VMCpro this is realized by sampling the
cosine of the radial scattering angle ␪ s from a uniform dis-
tribution in the interval:
Ts
2 ⫺1⭐cos ␪ s ⭐1. 共28兲
Tp
T s is the kinetic energy of the secondary proton, T p is the
incident proton energy.
III. RESULTS AND DISCUSSION
To verify the results of VMCpro, the general purpose
Monte Carlo code GEANT413 version 5.2 is used as bench-
mark. GEANT4 is very flexible and allows to choose between
physical processes and models via the ‘‘physics list.’’ This
provides an easy way to switch on and off nuclear reactions.
A. Verification of electromagnetic processes
For verification of electromagnetic processes, elastic and
inelastic nuclear reactions are switched off in the following
examples. The dose calculations are performed in homoge-
neous phantoms consisting of various media. The phantom
size is 4.1⫻4.1⫻30 cm3 with 1 mm voxel resolution in each
direction. Dose distributions of monoenergetic proton pencil
beams with different energies are calculated. Pencil beam
2270 M. Fippel and M. Soukup: A Monte Carlo dose calculation algorithm 2270

FIG. 7. Integral depth dose distributions in adult soft tissue ( ␳ FIG. 8. Central axis depth dose distributions in adult soft tissue
⫽1.03 g/cm3 ) and adult skeleton ( ␳ ⫽1.46 g/cm3 ) for monoenergetic ( ␳ ⫽1.03 g/cm3 ) and adult skeleton ( ␳ ⫽1.46 g/cm3 ) for monoenergetic
proton pencil beams of 100 MeV and 200 MeV, calculated with GEANT4 and proton pencil beams of 100 MeV and 200 MeV, calculated with GEANT4 and
VMCpro. Nuclear reactions are switched off in both MC codes. VMCpro. Nuclear reactions are switched off in both MC codes.

dose distributions are more sensitive compared to broad

results of GEANT4 simulations without and with nuclear re-
beams with respect to the model assumptions and the behav-
actions as well as FLUKA with nuclear reactions. It shows that
ior of the MC code. Therefore, broad beam results are not
these processes cannot be neglected for dose calculation.
presented here. But it is possible to integrate pencil beam
This result is consistent with experiences of other research
dose distributions perpendicular to the beam axis. The result-
groups.31,35 The nuclear reactions seem to be more important
ing dose distributions are equivalent to broad beam depth
for high proton energies 共200 MeV兲 compared to lower en-
dose curves.
ergies 共100 MeV兲. This is mainly an accumulative effect,
Integrated depth dose curves in adult soft tissue and adult
because for larger proton energies and for larger penetration
skeleton as defined in ICRU Report 4624 for two typical en-
depths there is an increased chance of nuclear interactions.
ergies in proton beam therapy 共100 and 200 MeV兲 are shown
Thus, the height of the Bragg–Peak becomes smaller.
in Fig. 7. Slight differences between both MC codes can be
Figure 10 shows the same comparison between GEANT4
detected only near the Bragg–Peak. The maximum devia-
and VMCpro as Fig. 7, however, this time all nuclear inter-
tions are smaller than 1% or 0.5 mm. The differences are
actions are switched on in both MC codes. The maximum
larger 共especially the proton range兲 if we use standard
GEANT4 proton stopping powers. To have identical conditions
we employed the low energy extension with ICRU – R49p
option in GEANT4.
Differential depth dose curves through the central voxels
for the same beam and phantom configurations are shown in
Fig. 8. These curves are sensitive especially with respect to
the implementation of multiple scattering. It shows that the
proton transport algorithm with small-angle multiple scatter-
ing approximation, without path length correction and with-
out lateral deflections works well for this type of applica-
tions.
Figures 7 and 8 demonstrate also the accuracy of the den-
sity scaling functions Eq. 共13兲 and Eq. 共19兲. Only the mass
density is used as input for VMCpro. GEANT4, on the other
hand, takes into account the real atomic composition. Espe-
cially the dose calculations in a phantom consisting only of
bone tissue are extremely unrealistic. Nevertheless, the
agreement is quite good.

B. Verification of nuclear processes FIG. 9. Integral depth dose distributions in water for monoenergetic proton
pencil beams of 100 MeV and 200 MeV, calculated using GEANT4 with
To motivate the implementation of elastic and inelastic nuclear reactions switched off and on as well as FLUKA with nuclear reac-
nuclear collisions into VMCpro Fig. 9 is shown. It represents tions.

Medical Physics, Vol. 31, No. 8, August 2004

2271 M. Fippel and M. Soukup: A Monte Carlo dose calculation algorithm 2271

FIG. 10. Same as Fig. 7, but this time nuclear reactions are switched on in FIG. 12. Central axis depth dose distributions 共upper plot兲 in the phantom
both MC codes. consisting of water, bone and lung tissue 共see Fig. 11兲 for monoenergetic
proton pencil beams of 150 MeV, calculated with GEANT4 and VMCpro. The
lower plot shows the difference of both curves in % of the dose maximum.

deviations between the two algorithms are still smaller than

1% or 0.5 mm. Especially the agreement in skeleton demon-
strates that precise knowledge of the atomic composition is
ment of both curves is acceptable, although there is a slight
not necessary to correctly model nuclear processes for treat-
overestimation 共see lower plot兲 of the dose calculated with
ment planning purposes. The approximation of proton–
VMCpro between 5 and 15 cm depth. This overestimation
nucleus collisions by nuclear proton–hydrogen and proton–
can also be observed in the profile plots of Fig. 13, especially
oxygen collisions is sufficient.
in 13 cm depth. The reason is, VMCpro underestimates the
multiple scattering angle slightly in lung. Only the mass den-
C. Verification using an inhomogeneous phantom sity of lung (0.26 g/cm3 ) is used as input for VMCpro. On
For verification in inhomogeneous geometries we con- the other hand, there is still a problem with multiple scatter-
struct a water phantom of size 4⫻4⫻30 cm3 , again with 1 ing in GEANT4, because different program versions produce
mm voxel resolution 共see Fig. 11兲. The phantom contains different results 共see Fig. 2兲. These differences vanish for
two rectangular inhomogeneities of size 1⫻2⫻5 cm3 . They broader, clinically more realistic, proton beams or laterally
consist of bone and lung tissue and are placed starting at 5 integrated dose distributions 共see Fig. 14兲.
cm depth. The inhomogeneities are located adjacent to each
other with the interface between them being on the pencil
beam axis, i.e., the whole inhomogeneity is of size 2⫻2
⫻5 cm3 .
The central axis depth dose distribution of a 150 MeV
pencil beam is shown in Fig. 12. Because in this case there is
no central voxel with respect to x and y as in the homoge-
neous cases, the presented curve is averaged over the four
central voxels. This leads to smaller doses 共by a factor of
about four兲, because the pencil beam spreads energy equally
to four voxels instead of one. The positions of both Bragg–
Peaks, resulting from the inhomogeneities, are well repro-
duced by VMCpro compared to GEANT4. The overall agree-

FIG. 11. Phantom consisting of water, bone and lung tissue for the bench-
mark calculations. The proton pencil beam of 150 MeV hits the inhomoge- FIG. 13. Profiles in depths of 13 cm and 18 cm for the example of Figs. 11
neity at the interface between bone and lung. and 12.

Medical Physics, Vol. 31, No. 8, August 2004

2272 M. Fippel and M. Soukup: A Monte Carlo dose calculation algorithm
FIG. 14. Integral depth dose distributions for the example of Figs. 11 and 12.
D. Dose calculation based on CT images
The conversion functions Eqs. 共13兲 and 共19兲 as well as
the implementation of nuclear interactions in VMCpro al-
lows dose calculations based on mass density distributions.
That is, knowledge of the atomic composition in each
voxel is not required using this method. Mass density is a
material parameter. It is not dependent on CT scanner ener-
gies like Hounsfield numbers. However, mass density can be
determined if the CT is calibrated appropriately. Figure 15
shows an example of dose calculation using VMCpro. It
FIG. 15. Dose distribution of a 5⫻5cm2 proton beam of 100 MeV in a
patient’s head. The spatial resolution of the density and dose grids is 2⫻2
⫻2 mm3 .
Medical Physics, Vol. 31, No. 8, August 2004
2272
is a 100 MeV 5⫻5 cm2 proton beam incident on a human
head. Besides the fact that this is not a clinical case,
the influence of air cavities and bone structures on the dose
distribution can be clearly observed. The voxel resolution
is 2⫻2⫻2 mm3 and 500 000 histories are simulated. The
calculation time is 106 seconds using an AMD Athlon
PC 2400⫹. The statistical variance is about 1.5% of the
maximum dose.
E. Calculation time comparison
The inhomogeneous phantom example of Sec. III C is
also used to compare the calculation times of the different
MC codes. To compute the dose distributions one half mil-
lion histories are simulated using an AMD Athlon PC 2400
⫹. For dose calculation, GEANT4 is used with low energy
extension. This was necessary to have the proton stopping
powers from ICRU Report 49. However, this slows down the
computation time by about 30%. GEANT4 共with low energy
extension兲, GEANT4 共without low energy extension兲, FLUKA
and VMCpro—all with identical electron cut-off energies—
require 99 min, 65 min, 37 min, and 168 s CPU time, respec-
tively. That is, VMCpro is about 35 times faster than GEANT4
with low energy extension, about 23 times faster than
GEANT4 without low energy extension and 13 times faster
than FLUKA. The CPU time reduction is larger for dose cal-
culations in patients, because VMCpro calculation times are
similar in homogeneous phantoms and heterogeneous geom-
etries. This is not the case for GEANT4 and FLUKA. The re-
quirement of a large material data base for the cross sections
makes simulations in patient geometries slower.
IV. CONCLUSIONS
In the present paper a Monte Carlo algorithm for treat-
ment planning in proton beam therapy of cancer is intro-
duced. The algorithm, called VMCpro, is faster than the gen-
eral purpose MC codes FLUKA and GEANT4 by at least one
order of magnitude for simulations in a water phantom with
inhomogeneities. For dose calculations in patients the speed
improvement is larger. The results produced with VMCpro
are in agreement with the GEANT4 results. For integrated or
broad beam depth dose curves the maximum deviations are
not larger than 1% or 0.5 mm in regions with large dose
gradients. For differential pencil beam dose distributions the
deviation can be larger, because these representations are
generally more sensitive compared to broad beam dose dis-
tributions. However, normalized to the dose maximum, the
agreement is still within 2%.
VMCpro shows larger deviations compared to FLUKA.
There are also deviations in the results of different versions
of GEANT4 or between GEANT4 and FLUKA. This is mainly
due to various multiple scattering distributions in these mod-
els. Therefore, further research will be necessary to deter-
mine, which of the distributions is correct. Fortunately,
VMCpro can be adjusted to any model. The multiple scatter-
ing distribution of VMCpro is fitted to GEANT4 version 5.2.
Thus the deviations between VMCpro and GEANT4 version
5.2 are much smaller than the deviations between the differ-
2273 M. Fippel and M. Soukup: A Monte Carlo dose calculation algorithm
ent general purpose Monte Carlo codes. A second reason for
disagreement between VMCpro and FLUKA are different
stopping power implementations. VMCpro is based on ICRU
Report 49,25 therefore, especially in bone tissue the proton
ranges can be different by about 1 mm. In GEANT4 we can
switch on the ICRU – R49p option to be conform to ICRU Re-
port 49.
ACKNOWLEDGMENTS
Financial support for the work presented here was pro-
vided by the Deutsche Forschungsgemeinschaft. One of us
共M. Soukup兲 is supported by a Marie Curie Fellowship of the
European Commission. We would like to thank Johannes-
Peter Wellisch from CERN for his suggestions regarding the
nuclear interaction models in GEANT4.
a兲
Electronic mail: msfippel@med.uni-tuebingen.de
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