Depth dose perturbation by a hydrogel fiducial marker in a proton beam

The purpose of this study was to evaluate proton depth dose perturbation caused by a radio-opaque hydrogel fiducial marker. Electronic proton stopping powers in the hydrogel were calculated for energies 0.5-250 MeV, and Monte Carlo simulations were generated of hydrogel vs. gold markers placed at various water phantom depths in a generic proton beam. Across the studied energy range, the gel/water stopping power ratio was 1.0146 to 1.0160. In the Monte Carlo simulation, the hydrogel marker caused no discernible perturbation of the proton percent depth-dose (PDD) curve. In contrast, the gold marker caused dose reductions of as much as 20% and dose shadowing regions as long as 6.5 cm. In contrast to gold markers, the radio-opaque hydrogel marker causes negligible proton depth dose perturbation. This factor may be taken into consideration for image-guided proton therapy at facilities with suitable imaging modalities.