Objective. To assess the viability of a physics-based, deterministic and adjoint-capable algorithm for performing treatment planning system independent dose calculations and for computing dosimetric differences caused by anatomical changes. Approach. A semi-numerical approach is employed to solve two partial differential equations for the proton phase-space density which determines the deposited dose. Lateral hetereogeneities are accounted for by an optimized (Gaussian) beam splitting scheme. Adjoint theory is applied to approximate the change in the deposited dose caused by a new underlying patient anatomy. Main results. The dose engine’s accuracy was benchmarked through three-dimensional gamma index comparisons against Monte Carlo simulations done in TOPAS. For a lung test case, the worst passing rate with (1 mm, 1%, 10% dose cut-off) criteria is 94.55%. The effect of delivering treatment plans on repeat CTs was also tested. For non-robustly optimized plans the adjoint component was accurate to 5.7% while for a robustly optimized plan it was accurate to 4.8%. Significance. Yet anOther Dose Algorithm is capable of accurate dose computations in both single and multi spot irradiations when compared to TOPAS. Moreover, it is able to compute dosimetric differences due to anatomical changes with small to moderate errors thereby facilitating its use for patient-specific quality assurance in online adaptive proton therapy.

In this paper we propose a solution to the need for a fast particle transport algorithm in Online Adaptive Proton Therapy capable of cheaply, but accurately computing the changes in patient dose metrics as a result of changes in the system parameters. We obtain the proton phase-space density through the product of the numerical solution to the one-dimensional Fokker-Planck equation and the analytical solution to the Fermi-Eyges equation. Moreover, a corresponding adjoint system was derived and solved for the adjoint flux. The proton phase-space density together with the adjoint flux and the metric (chosen as the energy deposited by the beam in a variable region of interest) allowed assessing the accuracy of our algorithm to different perturbation ranges in the system parameters and regions of interest. The algorithm achieved negligible errors ((Formula presented.)) for small Hounsfield unit (HU) perturbation ranges (–40 HU to 40 HU) and small to moderate errors (3% to 17%)–in line with the well-known limitation of adjoint approaches–for large perturbation ranges (–400 HU to 400 HU) in the case of most clinical interest where the region of interest surrounds the Bragg peak. Given these results coupled with the capability of further improving the timing performance it can be concluded that our algorithm presents a viable solution for the specific purpose of Online Adaptive Proton Therapy.