Reducing pitfalls in composite plan evaluations of dose-weighted linear energy transfer (LETd) through a field-by-field approach

Key Points

• This research aims to enhance the evaluation of dose-weighted linear energy transfer (LETd) to better understand its impact on tissue response.
• Conducted evaluations of LETd both as composite plans and through a field-by-field approach.
• Analyzed the contributions of high-LET regions in relation to biological responses of tissues.
• Compared prediction outcomes of complications in proton therapy using both methods.
• Field-by-field approaches revealed significant contributions of high-LET regions to tissue responses.
• Composite assessments potentially masked critical areas affecting biological outcomes.
• Improved predictions of complications in proton therapy were noted with the new evaluation technique.