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BackgroundA study was realised to evaluate and determine relative figures of merit of a new algorithm for photon dose calculation when applied to inhomogeneous media.MethodsThe new Acuros XB algorithm implemented in the Varian Eclipse treatment planning system was compared against a Monte Carlo method (VMC++), and the Analytical Anisotropic Algorithm (AAA). The study was carried out in virtual phantoms characterized by simple geometrical structures. An insert of different material and density was included in a phantom built of skeletal-muscle and HU = 0 (setting "A"): Normal Lung (lung, 0.198 g/cm3); Light Lung (lung, 0.035 g/cm3); Bone (bone, 1.798 g/cm3); another phantom (setting "B") was built of adipose material and including thin layers of bone (1.85 g/cm3), adipose (0.92 g/cm3), cartilage (1.4745 g/cm3), air (0.0012 g/cm3). Investigations were performed for 6 and 15 MV photon beams, and for a large (13 × 13 cm2) and a small (2.8 × 13 cm2) field.ResultsResults are provided in terms of depth dose curves, transverse profiles and Gamma analysis (3 mm/3% and 2 mm/2% distance to agreement/dose difference criteria) in planes parallel to the beam central axis; Monte Carlo simulations were assumed as reference. Acuros XB gave an average gamma agreement, with a 3 mm/3% criteria, of 100%, 86% and 100% for Normal Lung, Light Lung and Bone settings, respectively, and dose to medium calculations. The same figures were 86%, 11% and 100% for AAA, where only dose rescaled to water calculations are possible.ConclusionsIn conclusion, Acuros XB algorithm provides a valid and accurate alternative to Monte Carlo calculations for heterogeneity management.

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A comparative study was performed to reveal differences and relative figures of merit of seven different calculation algorithms for photon beams when applied to inhomogeneous media. The following algorithms were investigated: Varian Eclipse: the anisotropic analytical algorithm, and the pencil beam with modified Batho correction; Nucletron Helax-TMS: the collapsed cone and the pencil beam with equivalent path length correction; CMS XiO: the multigrid superposition and the fast Fourier transform convolution; Philips Pinnacle: the collapsed cone. Monte Carlo simulations (MC) performed with the EGSnrc codes BEAMnrc and DOSxyznrc from NRCC in Ottawa were used as a benchmark. The study was carried out in simple geometrical water phantoms (rho = 1.00 g cm(-3)) with inserts of different densities simulating light lung tissue (rho = 0.035 g cm(-3)), normal lung (rho = 0.20 g cm(-3)) and cortical bone tissue (rho = 1.80 g cm(-3)). Experiments were performed for low- and high-energy photon beams (6 and 15 MV) and for square (13 x 13 cm2) and elongated rectangular (2.8 x 13 cm2) fields. Analysis was carried out on the basis of depth dose curves and transverse profiles at several depths. Assuming the MC data as reference, gamma index analysis was carried out distinguishing between regions inside the non-water inserts or inside the uniform water. For this study, a distance to agreement was set to 3 mm while the dose difference varied from 2% to 10%. In general all algorithms based on pencil-beam convolutions showed a systematic deficiency in managing the presence of heterogeneous media. In contrast, complicated patterns were observed for the advanced algorithms with significant discrepancies observed between algorithms in the lighter materials (rho = 0.035 g cm(-3)), enhanced for the most energetic beam. For denser, and more clinical, densities a better agreement among the sophisticated algorithms with respect to MC was observed.

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Ideas for quality controls used in establishing a quality assurance program when introducing FFF beams into the clinical environment are given here, keeping them similar to those used for standard FF beams. By following the suggestions in this report, the authors foresee that the introduction of FFF beams into a clinical radiotherapy environment will be as safe and well controlled as standard beam modalities using the existing guidelines.