A study of the dosimetry of small field photon beams used in intensity modulated radiation therapy in inhomogeneous media: Monte Carlo simulations, and algorithm comparisons and corrections

Abstract

There is an increasing interest in the use of inhomogeneity corrections for lung, air, and bone in radiotherapy treatment planning. Traditionally, corrections based on physical density have been used. Modern algorithms use the electron density derived from CT images. Small fields are used in both conformal radiotherapy and IMRT, however, their beam characteristics in inhomogeneous media have not been extensively studied. This work compares traditional and modern treatment planning algorithms to Monte Carlo simulations in and near low-density inhomogeneities. Field sizes ranging from [formula omitted] in diameter are projected onto a phantom containing inhomogeneities and depth dose curves are compared. Comparisons of the Dose Perturbation Factors (DPF) are presented as functions of density and field size. Dose Correction Factors (DCF), which scale the algorithms to the Monte Carlo data, are compared for each algorithm. Physical scaling algorithms such as Batho and Equivalent Pathlength (EPL) predict an increase in dose for small fields passing through lung tissue, where Monte Carlo simulations show a sharp dose drop. The physical model-based collapsed cone convolution (CCC) algorithm correctly predicts the dose drop, but does not accurately predict the magnitude. Because the model-based algorithms do not correctly account for the change in backscatter, the dose drop predicted by CCC occurs farther downstream compared to that predicted by the Monte Carlo simulations. Beyond the tissue inhomogeneity all of the algorithms studied predict dose distributions in close agreement with Monte Carlo simulations. Dose–volume relationships are important in understanding the effects of radiation to the lung. The dose within the lung is affected by a complex function of beam energy, lung tissue density, and field size. Dose algorithms vary in their abilities to correctly predict the dose to the lung tissue. A thorough analysis of the effects of density, and field size on dose to the lung and how modern dose calculation algorithms compare to Monte Carlo data is presented in this research project. This work can be used as a basis to further refine an algorithm’s accuracy in low-density media or to correct prior dosimetric results. © 2004, American Association of Physicists in Medicine. All rights reserved.