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Table 3 Comparison of dose (mean and maximum) to cardiac substructures between proton plan with free breathing (FB), protons with deep inspiration breath hold (DIBH), and photons with DIBH. Proton plans were optimized with Monte Carlo dose algorithm and calculated with a variable relative biological effectiveness (RBE)

From: Comparative photon and proton dosimetry for patients with mediastinal lymphoma in the era of Monte Carlo treatment planning and variable relative biological effectiveness

  Median, Gy (IQR)
FB MCMC vRBE DIBH MCMC vRBE DIBH photon
Mean left main coronary 23.9 (16.8–27.7) 22.4 (17.1–27.3) 23.0 (19.3–29.0)
Max left main coronary 26.5 (16.9–28.6) 26.8 (22.6–29.7) 29.5 (26.4–31.1)
Mean left anterior descending 12.4 (4.9–22.3) 13.7 (4.8–20.8) 12.4 (6.3–22.5)
Max left anterior descending 29.3 (19.7–31.0) 29.5 (21.9–31.3) 28.3 (23.9–32.1)
Mean left circumflex 9.5 (4.3–16.3) 8.0 (3.1–11.8) 10.8 (6.8–17.0)
Max left circumflex 29.1 (18.4–30.0) 27.3 (18.1–30.0) 29.9 (18.7–31.3)
Mean right coronary artery 23.8 (14.6–26.1) 20.8 (10.3–26.5) 23.8 (8.5–29.0)
Max right coronary artery 31.3 (30.8–31.8) 31.1 (30.3–31.9) 31.8 (30.5–32.1)
Mean left atrium 9.4 (4.5–18.3) 6.4 (3.4–12.0) 11.8 (7.7–16.8)
Max left atrium 31.3 (23.6–32.2) 31.8 (25.9–32.2) 31.8 (30.5–32.2)
Mean left ventricle 5.7 (0.2–9.0) 4.2 (0.3–7.0) 6.2 (4.1–10.8)
Max left ventricle 30.0 (8.7–32.3) 30.8 (10.7–32.3) 31.6 (22.2–32.4)
Mean right atrium 10.4 (8.1–19.0) 11.2 (5.5–18.1) 21.3 (6.1–26.1)
Max right atrium 31.9 (31.1–32.3) 32.0 (31.6–32.4) 32.4 (32.1–32.6)
Mean right ventricle 12.5 (6.6–14.1) 8.3 (6.0–15.7) 11.0 (8.0–15.7)
Max right ventricle 32.1 (31.6–32.7) 32.8 (32.4–33.3) 32.3 (31.9–33.2)
Mean aortic valve 11.6 (5.8–18.6) 9.3 (3.3–13.1) 12.5 (9.1–21.1)
Max aortic valve 26.7 (21.8–29.5) 23.9 (20.2–25.9) 28.7 (25.7–30.4)
Mean mitral valve 2.2 (0.1–5.8) 0.9 (0.1–2.1) 6.1 (3.5–9.7)
Max mitral valve 9.8 (0.5–23.1) 4.9 (0.4–19.8) 11.5 (6.3–24.3)
Mean pulmonic valve 27.4 (26.5–29.9) 28.3 (26.8–30.0) 29.6 (23.6–30.7)
Max pulmonic valve 30.8 (30.5–31.5) 30.9 (30.5–31.7) 32.1 (31.9–32.3)
Mean tricuspid valve 4.2 (1.9–6.9) 1.8 (0.4–8.1) 10.2 (2.4–20.9)
Max tricuspid valve 26.4 (19.5–28.8) 22.7 (3.2–30.1) 26.2 (5.7–32.1)
  1. Abbreviations: FB, free breathing; DIBH, deep inspiration breath hold; cRBE, constant RBE; MCMC, plan optimized and calculated with Monte Carlo algorithm; PBMC, plan optimized with pencil-beam algorithm and re-calculated with Monte Carlo algorithm; PBPB, plan optimized and calculated with pencil-beam algorithm; vRBE, variable RBE