Simulation of consequences of using nonideal detectors during beam data commissioning measurements.

Abstract

Beam data commissioning is a core task of radiotherapy physicists. Despite multiple detectors available, a feasible measurement program compromises between detector properties and time constraints. Therefore, it is important to understand how nonideal measurement data propagates into patient dose calculation. We simulated the effects of realistic errors, due to beam commissioning with presumably nonoptimal detectors, on the resulting patient dose distributions. Additionally, the detectability of such beam commissioning errors during patient plan quality assurance (QA) was evaluated. A clinically used beam model was re-commissioned introducing changes to depth dose curves, output factors, profiles or combinations of those. Seventeen altered beam models with incremental changes of the modelling parameters were created to analyze dose changes on simplified anatomical phantoms. Additionally, fourteen altered models incorporate changes in the order of signal differences reported for typically used detectors. Eighteen treatment plans of different types were recalculated on patient CT data sets using the altered beam models. For the majority of clinical plans, dose distributions in the target volume recalculated on the patient computed tomography data were similar between the original and the modified beam models, yielding global 2%/2mm gamma pass rates above 98.9%. Larger changes were observed for certain combinations of beam modelling errors and anatomical sites, most extreme for output factor changes in a small target volume plan with a pass rate of 80.6%. Modelling an enlarged penumbra as if measured with a 0.125cm3 ion chamber had the largest effect on the dose distribution (average pass rate of 96.5%, lowest 85.4%). On different QA phantom geometries, dose distributions between calculations with modified and unmodified models typically changed too little to be detected in actual measurements. While the simulated errors during beam modelling had little effect on most plans, in some cases changes were considerable. High-quality penumbra and small field output factor should be a main focus of commissioning measurements. Detecting modelling issues using standard patient QA phantoms is unlikely. Verification of a beam model should be performed especially for plans with high modulation and in different depths or geometries representing the variety of situations expected clinically.