Estimating the uncertainty of calculated out-of-field organ dose from a commercial treatment planning system.

Therapeutic radiation to cancer patients is accompanied by unintended radiation to organs outside the treatment field. It is known that the model-based dose algorithm has limitation in calculating the out-of-field doses. This study evaluated the out-of-field dose calculated by the Varian Eclipse treatment planning system (v.11 with AAA algorithm) in realistic treatment plans with the goal of estimating the uncertainties of calculated organ doses. Photon beam phase-space files for TrueBeam linear accelerator were provided by Varian. These were used as incident sources in EGSnrc Monte Carlo simulations of radiation transport through the downstream jaws and MLC. Dynamic movements of the MLC leaves were fully modeled based on treatment plans using IMRT or VMAT techniques. The Monte Carlo calculated out-of-field doses were then compared with those calculated by Eclipse. The dose comparisons were performed for different beam energies and treatment sites, including head-and-neck, lung, and pelvis. For 6 MV (FF/FFF), 10 MV (FF/FFF), and 15 MV (FF) beams, Eclipse underestimated out-of-field local doses by 30%-50% compared with Monte Carlo calculations when the local dose was <1% of prescribed dose. The accuracy of out-of-field dose calculations using Eclipse is improved when collimator jaws were set at the smallest possible aperture for MLC openings. The Eclipse system consistently underestimates out-of-field dose by a factor of 2 for all beam energies studied at the local dose level of less than 1% of prescribed dose. These findings are useful in providing information on the uncertainties of out-of-field organ doses calculated by Eclipse treatment planning system.

A simple technique to improve calculated skin dose accuracy in a commercial treatment planning system.

Radiation dermatitis during radiotherapy is correlated with skin dose and is a common clinical problem for head and neck and thoracic cancer patients. Therefore, accurate prediction of skin dose during treatment planning is clinically important. The objective of this study is to evaluate the accuracy of skin dose calculated by a commercial treatment planning system (TPS). We evaluated the accuracy of skin dose calculations by the anisotropic analytical algorithm (AAA) implemented in Varian Eclipse (V.11) system. Skin dose is calculated as mean dose to a contoured structure of 0.5 cm thickness from the surface. The EGSnrc Monte Carlo (MC) simulations are utilized for the evaluation. The 6, 10 and 15 MV photon beams investigated are from a Varian TrueBeam linear accelerator. The accuracy of the MC dose calculations was validated by phantom measurements with optically stimulated luminescence detectors. The calculation accuracy of patient skin doses is studied by using CT based radiotherapy treatment plans including 3D conformal, static gantry IMRT, and VMAT treatment techniques. Results show the Varian Eclipse system underestimates skin doses by up to 14% of prescription dose for the patients studied when external body contour starts at the patient's skin. The external body contour is used in a treatment planning system to calculate dose distributions. The calculation accuracy of skin dose with Eclipse can be considerably improved to within 4% of target dose by extending the external body contour by 1 to 2 cm from the patient's skin. Dose delivered to deeper target volumes or organs at risk are not affected. Although Eclipse treatment planning system has its limitations in predicting patient skin dose, this study shows the calculation accuracy can be considerably improved to an acceptable level by extending the external body contour without affecting the dose calculation accuracy to the treatment target and internal organs at risk. This is achieved by moving the calculation entry point away from the skin.

Experimental pencil beam kernels derivation for 3D dose calculation in flattening filter free modulated fields.

This paper presents a method to obtain the pencil-beam kernels that characterize a megavoltage photon beam generated in a flattening filter free (FFF) linear accelerator (linac) by deconvolution from experimental measurements at different depths. The formalism is applied to perform independent dose calculations in modulated fields. In our previous work a formalism was developed for ideal flat fluences exiting the linac's head. That framework could not deal with spatially varying energy fluences, so any deviation from the ideal flat fluence was treated as a perturbation. The present work addresses the necessity of implementing an exact analysis where any spatially varying fluence can be used such as those encountered in FFF beams. A major improvement introduced here is to handle the actual fluence in the deconvolution procedure. We studied the uncertainties associated to the kernel derivation with this method. Several Kodak EDR2 radiographic films were irradiated with a 10 MV FFF photon beam from two linacs from different vendors, at the depths of 5, 10, 15, and 20cm in polystyrene (RW3 water-equivalent phantom, PTW Freiburg, Germany). The irradiation field was a 50mm diameter circular field, collimated with a lead block. The 3D kernel for a FFF beam was obtained by deconvolution using the Hankel transform. A correction on the low dose part of the kernel was performed to reproduce accurately the experimental output factors. Error uncertainty in the kernel derivation procedure was estimated to be within 0.2%. Eighteen modulated fields used clinically in different treatment localizations were irradiated at four measurement depths (total of fifty-four film measurements). Comparison through the gamma-index to their corresponding calculated absolute dose distributions showed a number of passing points (3%, 3mm) mostly above 99%. This new procedure is more reliable and robust than the previous one. Its ability to perform accurate independent dose calculations was demonstrated.

The accuracy of the out-of-field dose calculations using a model based algorithm in a commercial treatment planning system.

The out-of-field dose can be clinically important as it relates to the dose of the organ-at-risk, although the accuracy of its calculation in commercial radiotherapy treatment planning systems (TPSs) receives less attention. This study evaluates the uncertainties of out-of-field dose calculated with a model based dose calculation algorithm, anisotropic analytical algorithm (AAA), implemented in a commercial radiotherapy TPS, Varian Eclipse V10, by using Monte Carlo (MC) simulations, in which the entire accelerator head is modeled including the multi-leaf collimators. The MC calculated out-of-field doses were validated by experimental measurements. The dose calculations were performed in a water phantom as well as CT based patient geometries and both static and highly modulated intensity-modulated radiation therapy (IMRT) fields were evaluated. We compared the calculated out-of-field doses, defined as lower than 5% of the prescription dose, in four H&N cancer patients and two lung cancer patients treated with volumetric modulated arc therapy (VMAT) and IMRT techniques. The results show that the discrepancy of calculated out-of-field dose profiles between AAA and the MC depends on the depth and is generally less than 1% for in water phantom comparisons and in CT based patient dose calculations for static field and IMRT. In cases of VMAT plans, the difference between AAA and MC is <0.5%. The clinical impact resulting from the error on the calculated organ doses were analyzed by using dose-volume histograms. Although the AAA algorithm significantly underestimated the out-of-field doses, the clinical impact on the calculated organ doses in out-of-field regions may not be significant in practice due to very low out-of-field doses relative to the target dose.

Study of the response of plastic scintillation detectors in small-field 6 MV photon beams by Monte Carlo simulations.

PURPOSE: To investigate the response of plastic scintillation detectors (PSDs) in a 6 MV photon beam of various field sizes using Monte Carlo simulations. METHODS: Three PSDs were simulated: A BC-400 and a BCF-12, each attached to a plastic-core optical fiber, and a BC-400 attached to an air-core optical fiber. PSD response was calculated as the detector dose per unit water dose for field sizes ranging from 10 x 10 down to 0.5 x 0.5 cm2 for both perpendicular and parallel orientations of the detectors to an incident beam. Similar calculations were performed for a CC01 compact chamber. The off-axis dose profiles were calculated in the 0.5 x 0.5 cm2 photon beam and were compared to the dose profile calculated for the CC01 chamber and that calculated in water without any detector. The angular dependence of the PSDs' responses in a small photon beam was studied. RESULTS: In the perpendicular orientation, the response of the BCF-12 PSD varied by only 0.5% as the field size decreased from 10 x 10 to 0.5 x 0.5 cm2, while the response of BC-400 PSD attached to a plastic-core fiber varied by more than 3% at the smallest field size because of its longer sensitive region. In the parallel orientation, the response of both PSDs attached to a plastic-core fiber varied by less than 0.4% for the same range of field sizes. For the PSD attached to an air-core fiber, the response varied, at most, by 2% for both orientations. CONCLUSIONS: The responses of all the PSDs investigated in this work can have a variation of only 1%-2% irrespective of field size and orientation of the detector if the length of the sensitive region is not more than 2 mm long and the optical fiber stems are prevented from pointing directly to the incident source.

Monte Carlo study of the energy and angular dependence of the response of plastic scintillation detectors in photon beams.

PURPOSE: By using Monte Carlo simulations, the authors investigated the energy and angular dependence of the response of plastic scintillation detectors (PSDs) in photon beams. METHODS: Three PSDs were modeled in this study: A plastic scintillator (BC-400) and a scintillating fiber (BCF-12), both attached by a plastic-core optical fiber stem, and a plastic scintillator (BC-400) attached by an air-core optical fiber stem with a silica tube coated with silver. The authors then calculated, with low statistical uncertainty, the energy and angular dependences of the PSDs' responses in a water phantom. For energy dependence, the response of the detectors is calculated as the detector dose per unit water dose. The perturbation caused by the optical fiber stem connected to the PSD to guide the optical light to a photodetector was studied in simulations using different optical fiber materials. RESULTS: For the energy dependence of the PSDs in photon beams, the PSDs with plastic-core fiber have excellent energy independence within about 0.5% at photon energies ranging from 300 keV (monoenergetic) to 18 MV (linac beam). The PSD with an air-core optical fiber with a silica tube also has good energy independence within 1% in the same photon energy range. For the angular dependence, the relative response of all the three modeled PSDs is within 2% for all the angles in a 6 MV photon beam. This is also true in a 300 keV monoenergetic photon beam for PSDs with plastic-core fiber. For the PSD with an air-core fiber with a silica tube in the 300 keV beam, the relative response varies within 1% for most of the angles, except in the case when the fiber stem is pointing right to the radiation source in which case the PSD may over-response by more than 10%. CONCLUSIONS: At +/- 1% level, no beam energy correction is necessary for the response of all three PSDs modeled in this study in the photon energy ranges from 200 keV (monoenergetic) to 18 MV (linac beam). The PSD would be even closer to water equivalent if there is a silica tube around the sensitive volume. The angular dependence of the response of the three PSDs in a 6 MV photon beam is not of concern at 2% level.

Measuring output factors of small fields formed by collimator jaws and multileaf collimator using plastic scintillation detectors.

PURPOSE: As the practice of using high-energy photon beams to create therapeutic radiation fields of subcentimeter dimensions (as in intensity-modulated radiotherapy or stereotactic radiosurgery) grows, so too does the need for accurate verification of beam output at these small fields in which standard practices of dose verification break down. This study investigates small-field output factors measured using a small plastic scintillation detector (PSD), as well as a 0.01 cm3 ionization chamber. Specifically, output factors were measured with both detectors using small fields that were defined by either the X-Y collimator jaws or the multileaf collimator (MLC). METHODS: A PSD of 0.5 mm diameter and 2 mm length was irradiated with 6 and 18 MV linac beams. The PSD was positioned vertically at a source-to-axis distance of 100 cm, at 10 cm depth in a water phantom, and irradiated with fields ranging in size from 0.5 x 0.5 to 10 x 10 cm2. The field sizes were defined either by the collimator jaws alone or by a MLC alone. The MLC fields were constructed in two ways: with the closed leaves (i.e., those leaves that were not opened to define the square field) meeting at either the field center line or at a 4 cm offset from the center line. Scintillation light was recorded using a CCD camera and an estimation of error in the median-filtered signals was made using the bootstrapping technique. Measurements were made using a CC01 ionization chamber under conditions identical to those used for the PSD. RESULTS: Output factors measured by the PSD showed close agreement with those measured using the ionization chamber for field sizes of 2.0 x 2.0 cm2 and above. At smaller field sizes, the PSD obtained output factors as much as 15% higher than those found using the ionization chamber by 0.6 x 0.6 cm2 jaw-defined fields. Output factors measured with no offset of the closed MLC leaves were as much as 20% higher than those measured using a 4 cm leaf offset. CONCLUSIONS: The authors' results suggest that PSDs provide a useful and possibly superior alternative to existing dosimetry systems for small fields, as they are inherently less susceptible to volume-averaging and perturbation effects than larger, air-filled ionization chambers. Therefore, PSDs may provide more accurate small-field output factor determination, regardless of the collimation mechanism.

Replacement correction factors for plane-parallel ion chambers in electron beams.

PURPOSE: Plane-parallel chambers are recommended by dosimetry protocols for measurements in (especially low-energy) electron beams. In dosimetry protocols, the replacement correction factor P(repl) is assumed unity for "well-guarded" plane-parallel chambers in electron beams when the front face of the cavity is the effective point of measurement. There is experimental evidence that ion chambers which are not well-guarded (e.g., Markus) have nonunity P(repl) values. Monte Carlo simulations are employed in this study to investigate the replacement correction factors for plane-parallel chambers in electron beams. METHODS: Using previously established Monte Carlo calculation methods, the values of P(repl) are calculated with high statistical precision for the cavities of a variety of plane-parallel chambers in a water phantom irradiated by various electron beams. The dependences of the values of P(repl) on the beam quality, phantom depth, as well as the guard ring width are studied. RESULTS: In the dose fall-off region for low-energy beams, the P(repl) values are very sensitive to depth. It is found that this is mainly due to the gradient effect, which originates from the fact that the effective point of measurement for many plane-parallel chambers should not be at the front face of the cavity but rather shifted toward the center of the cavity by a fraction of a millimeter. Using the front face of the cavity as the effective point of measurement, the calculated values of P(repl) at d(ref) are not unity for some well-guarded plane-parallel chambers. The calculated P(repl) values for the Roos chamber are close to 1 for all electron beams. The calculation results for the Markus chamber are in good agreement with the measured values. CONCLUSIONS: The appropriate selection of the effective point of measurement for plane-parallel chambers in electron beams is an important issue. If the effective point of measurement is correctly accounted for, the P(repl) values would be almost independent of depth. Both the guard ring width and the ratio of the collecting volume diameter to the cavity thickness can influence the values of P(repl) For a diameter to thickness ratio of 5 (e.g., NACP02 chamber), the guard width has to be 6 mm for the chamber to be considered as well-guarded, i.e., have a P(repl) value of 1.00.

Monte Carlo study of si diode response in electron beams.

Silicon semiconductor diodes measure almost the same depth-dose distributions in both photon and electron beams as those measured by ion chambers. A recent study in ion chamber dosimetry has suggested that the wall correction factor for a parallel-plate ion chamber in electron beams changes with depth by as much as 6%. To investigate diode detector response with respect to depth, a silicon diode model is constructed and the water/silicon dose ratio at various depths in electron beams is calculated using EGSnrc. The results indicate that, for this particular diode model, the diode response per unit water dose (or water/diode dose ratio) in both 6 and 18 MeV electron beams is flat within 2% versus depth, from near the phantom surface to the depth of R50 (with calculation uncertainty <0.3%). This suggests that there must be some other correction factors for ion chambers that counter-balance the large wall correction factor at depth in electron beams. In addition, the beam quality and field-size dependence of the diode model are also calculated. The results show that the water/diode dose ratio remains constant within 2% over the electron energy range from 6 to 18 MeV. The water/diode dose ratio does not depend on field size as long as the incident electron beam is broad and the electron energy is high. However, for a very small beam size (1 X 1 cm(2)) and low electron energy (6 MeV), the water/diode dose ratio may decrease by more than 2% compared to that of a broad beam.

Estimation of the focal spot size and shape for a medical linear accelerator by Monte Carlo simulation.

The focal spot size and shape of a medical linac are important parameters that determine the dose profiles, especially in the penumbral region. A relationship between the focal spot size and the dose profile penumbra has been studied and established from simulation results of the EGSnrc Monte Carlo code. A simple method is proposed to estimate the size and the shape of a linac's focal spot from the measured dose profile data.

An analytic model for the response of a CZT detector in diagnostic energy dispersive x-ray spectroscopy.

A CdZnTe detector (CZTD) can be very useful for measuring diagnostic x-ray spectra. The semiconductor detector does, however, exhibit poor hole transport properties and fluorescence generation upon atomic de-excitations. This article describes an analytic model to characterize these two phenomena that occur when a CZTD is exposed to diagnostic x rays. The analytical detector response functions compare well with those obtained via Monte Carlo calculations. The response functions were applied to 50, 80, and 110 kV x-ray spectra. Two 50 kV spectra were measured; one with no filtration and the other with 1.35 mm Al filtration. The unfiltered spectrum was numerically filtered with 1.35 mm of Al in order to see whether the recovered spectrum resembled the filtered spectrum actually measured. A deviation curve was obtained by subtracting one curve from the other on an energy bin by bin basis. The deviation pattern fluctuated around the zero line when corrections were applied to both spectra. Significant deviations from zero towards the lower energies were observed when the uncorrected spectra were used. Beside visual observations, the exposure obtained using the numerically attenuated unfiltered beam was compared to the exposure calculated with the actual filtered beam. The percent differences were 0.8% when corrections were applied and 25% for no corrections. The model can be used to correct diagnostic x-ray spectra measured with a CdZnTe detector.