Technical note: Simulation of dose build-up in proton pencil beams.

Purpose The purpose of this study is to characterize the magnitude and depth of dose buildup in pencil beam scanning proton therapy. Methods We simulate the integrated depth-dose curve of realistic proton pencil beams in a water phantom using the Geant4 Monte Carlo toolkit. We independently characterize the electronic and protonic components of dose buildup as a function of proton beam energy from 40 to 400 MeV, both with and without an air gap. Results At clinical energies, electronic buildup over a distance of about 1 mm leads to a dose reduction at depth of the basal layer (0.07 mm) by up to 6% compared to if no buildup effect were present. Protonic buildup reduces the dose to the basal layer by up to 16% and has effects at depths of up to 150 mm. Secondary particles with a mass number A > 1 do not contribute to dose buildup. An air gap of 1 m has no significant effect on protonic buildup but reduces electronic buildup below 1%. Conclusions Protonic and electronic dose buildup are relevant for accurate dosimetry in proton therapy although a realistic air gap reduces the electronic buildup to levels where it can be safely neglected. We recommend including electrons and secondary protons in Monte Carlo-based treatment planning systems down to a predicted range of 10-20 mu m in order to accurately model the dose at depths of the basal layer, no matter the size of the air gap between nozzle and patient.