Accuracy Of Dose Calculation Algorithms Research Articles

Investigation of tube voltage dependence on CT number and its effect on dose calculation algorithms using thorax phantom in Monaco treatment planning system for external beam radiation therapy.

Introduction:The accuracy of dose calculation algorithms depends on the electron density and computed tomography (CT) number of medium scanned. Our study aimed to verify the impact of different CT scanning protocols on Hounsfield unit (HU) and effect on dose calculation algorithms.Materials and Methods:CIRS thorax phantom with different density material plugs was scanned at varying tube voltages from CT scanner and HU values were measured in treatment planning system (TPS). Calibration curves of electron density at different tube voltages were plotted and used for dose calculation with different calculation algorithms at varying high energy megavoltage photon energies.Results:Insignificant difference is obtained in electron density curves plotted at different tube voltages. The mean variation in HU values was found at different tube voltages for bone, lung, and water are 896.75 (standard deviation [SD] 122.88), −799.25 (SD 5.74), and −17.5 (SD 0.57), respectively. The estimated P values for change in HU values were 0.089, 0.258, and 0.121 for bone, lung, and water, respectively. Pencil beam (PB) convolution and collapsed cone algorithms show no significant dose difference, i.e., <1% variation and Monte Carlo (MC) shows maximum dose difference up to 1.4%.Conclusion:Third-generation algorithms such as MC shows dependence on varying tube voltages in dose calculation. Calibration curves plotted at different kVp in TPS advised to be chosen wisely to avoid any dosimetric errors in different medium.

Dose perturbation due to dental amalgam in the head and neck radiotherapy: A phantom study

Dental amalgam, causes perturbation in photon dose distribution of head and neck (H&N) radiotherapy. The aim of this study was to evaluate the effects of dental amalgam on dose distribution of H&N radiotherapy and accuracy of dose calculations algorithm of commercial treatment planning system (TPS). In this study, the measurements were performed using a constructed H&N anthropomorphic. The sample of healthy teeth and teeth filled by amalgam inserted in the desired segment of the phantom in turn. After scanning and organs segmentation of phantom, intensity-modulated radiation therapy (IMRT) plan including 7 fields in the absence (plan 1) and presence (plan 2) of dental amalgam were created separately. Phantom was irradiated using 6 MV linear accelerator (SIMENS-ARTISTE, 5918). Assessment of the effects of dental amalgam on dose distribution and the accuracy of dose calculation algorithm of TPS was done by measurement and comparing of organ's received dose using thermoluminescent dosimeter (TLDs), placed on a phantom and TPS calculations. The scattering and attenuation due to the presence of dental amalgam led to an increase in parotid glands received dose (up to 24.38%) and a decrease in mean dose (up to −6.25%) PTV70. Results of this study revealed that discrepancies between the collapsed cone convolution (CCC) algorithm calculations Prowess Panther TPS and TLD measurements were −19.77% to 27.49% in presence of amalgam and −1.09% to 5.03% in presence of healthy teeth in phantoms. Attenuation and scattering due to amalgam in IMRT of H&N cancer may lead to a significant dose perturbation which is not predictable by dose calculation of TPS.

Evaluation of Dose Calculation Algorithms Accuracy for Eclipse, PCRT3D, and Monaco Treatment Planning Systems Using IAEA TPS commissioning tests in a Heterogeneous Phantom

Introduction: The accuracy of dose calculation algorithm (DCA) is highly considered in the radiotherapy sequences. This study aims at assessing the accuracy of five dose calculation algorithms in tissue inhomogeneity corrections, based on the International Atomic Energy Agency TEC-DOC 1583. Material and Methods: A heterogeneous phantom was scanned using computed tomography and tests were planned on three-dimensional treatment planning systems (3D TPSs) based on IAEA TEC-DOC 1583.Doseswere measured for 6- and 18-MV photon beams with ion chambers and then the deviation between measured and calculated TPS doses were reported. The evaluated five DCAs include Monte Carlo (MC) algorithm employed by Monaco, pencil beam convolution (PBC) and anisotropic analytical algorithms (AAA) employed by Eclipse and Superposition (SP), and Clarkson algorithms employed by PCRT3D TPSs. Results: In Clarkson algorithm, low and high energy photons indicated 7.1% and 14.8% deviations out of agreement criteria, respectively. The SP, AAA, and PBC algorithms indicated 0.9%, 7.4%, and 13.8% for low energy photon and 9.5%, 21.3%, and 23.2% for high energy photon deviations out of agreement criteria, respectively. However, MC algorithm showed 1.8% and less than 1% deviations at high and low energy photons, respectively. Conclusion: The DCAs had different levels of accuracy in TPSs. Some simple DCAs, such as Clarkson, showed large deviations in some cases. Therefore, the transition to more advanced algorithms, such as MC would be desirable, particularly for the calculation in the presence of inhomogeneity or high energy beams.

Monte Carlo dose verification for a single-isocenter VMAT plan in multiple brain metastases

The purpose of this study was to verify the accuracy of dose calculation algorithms of a treatment planning system for a single-isocenter volumetric modulated arc therapy (VMAT) plan in multiple brain metastases, by comparing the dose distributions of treatment planning system with those of Monte Carlo (MC) simulations. We used a multitarget phantom containing 9 acrylic balls with a diameter of 15.9 mm inside a Lucy phantom measuring 17 × 17 × 17 cm3. Seven VMAT plans were created using the multitarget phantom: 1 multitarget plan (MTP) and 6 single target plans (STP). Three of the STP plans had a large jaw field setting, almost equivalent to that of the MTP, while the other plans had a jaw field setting fitted to each planning target volume. The isocenter for all VMAT plans was set to the center of the phantom. The VMAT dose distributions were calculated using the analytical anisotropic algorithm (AAA) and were also recalculated through Acuros XB (AXB) and MC simulations under the same irradiation conditions. The AAA and AXB methods tended to overestimate dosage compared with the MC method in the MTP and in STPs with large jaw field settings. The dose distribution in single-isocenter VMAT plans for multiple brain metastases was influenced by jaw field settings. Finally, we concluded that MC-VMAT dose calculations are useful for 3D dose verification of single-isocenter VMAT plans for multiple brain metastases.

40. Evaluation of the Incise2™ multileaf collimator for stereotactic radiotherapy on Cyberknife®

Introduction The CyberKnife® (Accuray) is a stereotactic robotic system using historically circular collimators to define the beam apertures. A new multileaf collimator (MLC) is now available on the Cyberknife® M6 version. The purpose of this study was to evaluate the quality of treatment plans using MLC compared to treatment plans using a variable circular aperture collimator IRIS™ for radiosurgery (SRS) and stereotactic body radiotherapy (SBRT). Methods The study was performed on a Cyberknife® M6™ v10.6. A total of 17 cases including cranial, liver, spinal and prostatic cases were investigated. For each case, two treatment plans were generated with Multiplan® v5.3 treatment planning system: one plan using the Incise2™ MLC associated with the Finite Size Pencil Beam (FSPB) dose calculation algorithm and one using the IRIS™ collimator associated with Ray Tracing or Monte Carlo dose calculation algorithm. The dose was prescribed near the 80% isodose level relative to max dose. Plans were normalized to have the same target coverage at ±0.5%. The quality of the MLC and IRIS™ treatment plans was assessed using two criteria: - Dose distribution by reporting the conformal index (COIN), Homogeneity Index (HI) and dose gradient index (GI). - Efficiency by reporting the number of delivered monitor units (MUs) and the treatment time. To evaluate the accuracy of dose calculation algorithm within heterogeneity, a typical lung treatment plan for each collimator was created on a QUASAR™ Respiratory phantom (Modus Medical Inc) with a lung target insert. Calculated planar dose was compared with measurements by radiochromic EBT3 films (Ashland). The analysis was done using gamma analysis 3% (local) / 2 mm (threshold: 30% of the max dose) Results Results are summarized in Table 1. Dose conformality and homogeneity were equivalent for both collimator systems (mean differences less than 3%) except for targets with volumes smaller than 2 cm3 for which dose conformality was better of 14% on average with the IRIS collimator. The dose gradient index was improved by 10.5% on average with the MLC and up to 26% on average for volume larger than 100 cm3. The number of MUs decreased by 25% on average (up to 70%) and the treatment times were systematically reduced with a mean reduction of 28% (max 54%) with the MLC. The comparison between calculated and measured dose in lung phantom showed a gamma passing rate of 51.6 %, 45.5 % and 98.7% for FSPB, Ray Tracing and Monte Carlo respectively. Conclusion The MLC Incise2™ on Cyberknife® allows a significant reduction of MUs and treatment time compared to circular collimators while maintaining a high degree of conformality and a steep dose gradient. For treatment of target volumes smaller than 2 cm3, circular collimators should be still used. The use of MLC for SBRT of lung targets should not be recommended currently due to the absence of type B dose calculation algorithm.

Accuracy of dose calculation algorithms for virtual heterogeneous phantoms and intensity-modulated radiation therapy in the head and neck.

This study verified the dose calculation accuracy of the analytical anisotropic algorithm (AAA), Acuros XB version 10 (AXB10), and version 11 (AXB11) installed in an Eclipse treatment planning system, by comparing with Monte Carlo (MC) simulations. First, the algorithms were compared in terms of dose distributions using four types of virtual heterogeneous multi-layer phantom for 6 and 15 MV photons. Next, the clinical head and neck intensity-modulated radiation therapy (IMRT) dose distributions for 6 MV photons were evaluated using dose volume histograms (DVHs) and three-dimensional gamma analysis. In percentage depth doses (PDDs) for virtual heterogeneous phantoms, AAA overestimated absorbed doses in the air cavity, bone, and aluminum in comparison with MC, AXB10, and AXB11. The PDDs of AXB10 almost agreed with those of MC and AXB11, except for the air cavity. The dose in the air cavity was higher for AXB10 than for AXB11, because their electron cutoff energies are set at 500 and 200 keV, respectively. For head and neck IMRT dose distributions, the D95 in the clinical target volume (CTV) for AAA was almost the same as that for AXB10 and was approximately 7 % larger than that for MC. Comparing each approach with MC using a criterion of 3 %/3 mm, the pass rates for AXB10, AXB11, and AAA were 92.4, 94.7, and 90.4 % in the CTV, respectively. In conclusion, AAA produces dose errors in heterogeneous regions, while AXB11 provides calculation accuracy comparable to MC. AXB10 overestimates the dose in regions that include an air cavity.

SU‐E‐T‐372: Evaluation and Comparison of Second‐Check Monitor Unit Calculation Software with Pinnacle Treatment Planning System

Purpose:The purpose of this study was to evaluate and compare the accuracy of dose calculation algorithms in the second check software programs Radcalc, Diamond, IMSure, and MUcheck, against the Pinnacle3 treatment planning system (TPS).Methods:Baseline accuracy of the second check software was established by comparison against Pinnacle TPS data using open square fields of 5, 10, 20, 30 and 40cm in a SAD setup. 18 previously treated patients’ files were exported from the Pinnacle3 TPS to each of the four second check softwares, consisting of 146 step and shoot intensity modulated radiotherapy (IMRT) beams and 60 Smart Arcs. Monitor unit (MU) calculated in each of the software were compared with the TPS and the values were represented as a percent difference. Open fields were calculated as a baseline for each software's accuracy using 5×5, 10×10, 20×20, 30×30, and 40×40 fields. Box plots, Pearson correlation, and Bland‐Altman analysis were used for comparison of the results.Results:The baseline accuracy was established to within 0.6%, −1.4%, −0.2%, and −1.0% for Diamond, IMSure,MUcheck, and Radcalc, respectively. In the clinical data, the dose difference represented as mean ± 1 standard deviation were 0.7%±0.1%, −0.3%±0.1%, −1.5%±0.1%, and 0.4%±0.0% for Diamond, IMSure, MUcheck, and Radcalc, respectivelyConclusion:The implementation of Clarkson algorithm for the dose calculation between each of the software in question can vary considerably. The currently used second check software, Radcalc has shown the best agreement on average, variance, and smallest percent range from Pinnacle3 TPS values. The closest in average percent difference from the TPS data was the IMSure software, but has significantly larger variance and percent range. The mean percent differences in Diamond and MUcheck were significantly larger than Radcalc and IMSure.

SU‐E‐T‐91: Accuracy of Dose Calculation Algorithms for Patients Undergoing Stereotactic Ablative Radiotherapy

Purpose:The purpose of this study was to investigate and quantify the variation in dose distributions in small field lung cancer radiotherapy using seven different dose calculation algorithms.Methods:The study was performed in 21 lung cancer patients who underwent Stereotactic Ablative Body Radiotherapy (SABR). Two different methods (i) Same dose coverage to the target volume (named as same dose method) (ii) Same monitor units in all algorithms (named as same monitor units) were used for studying the performance of seven different dose calculation algorithms in XiO and Eclipse treatment planning systems. The seven dose calculation algorithms include Superposition, Fast superposition, Fast Fourier Transform ( FFT) Convolution, Clarkson, Anisotropic Analytic Algorithm (AAA), Acurous XB and pencil beam (PB) algorithms. Prior to this, a phantom study was performed to assess the accuracy of these algorithms. Superposition algorithm was used as a reference algorithm in this study. The treatment plans were compared using different dosimetric parameters including conformity, heterogeneity and dose fall off index. In addition to this, the dose to critical structures like lungs, heart, oesophagus and spinal cord were also studied. Statistical analysis was performed using Prism software.Results:The mean±stdev with conformity index for Superposition, Fast superposition, Clarkson and FFT convolution algorithms were 1.29±0.13, 1.31±0.16, 2.2±0.7 and 2.17±0.59 respectively whereas for AAA, pencil beam and Acurous XB were 1.4±0.27, 1.66±0.27 and 1.35±0.24 respectively.Conclusion:Our study showed significant variations among the seven different algorithms. Superposition and AcurosXB algorithms showed similar values for most of the dosimetric parameters. Clarkson, FFT convolution and pencil beam algorithms showed large differences as compared to superposition algorithms. Based on our study, we recommend Superposition and AcurosXB algorithms as the first choice of algorithms in lung cancer radiotherapy involving small fields. However, further investigation by Monte Carlo simulation is required to confirm our results.

Accuracy of dose calculation algorithms for static and rotational IMRT of lung cancer: A phantom study

PurposeTo evaluate the dosimetric accuracy of Pencil beam (PB), Anisotropic Analytical Algorithm (AAA) and Collapsed Cone Convolution Superposition (CCCS) in thoracic tumours for various IMRT techniques. MethodsStep-and-shoot Linac IMRT (IMRT), arc volumetric RapidArc (RA) and Helical Tomotherapy (HT) lung treatments for different clinical situations (mediastinum tumour, single metastasis and multiple metastases) were simulated and calculated with PB/AAA, AAA, CCCS, respectively. Delivery quality assurance plans were first verified in homogeneous media (Cheese phantom and ArcCHECK); then several low-density inhomogeneous phantoms were used: the Multiplug ArcCHECK, the commercial ArcCHECK slightly modified with a low density lung–shape insert and a custom-made slab heterogeneous phantom simulating the thorax region. Absolute doses and planar dose maps were checked to assess the agreement between measured and calculated dose distributions. ResultsIn total, data referred to 195 point dose measurements and 189 planar measurements were considered. Average point absolute deviations <3% were found for all the delivery techniques/dose algorithms. In small targets completely embedded in very low density media, deviations up to 7–10% and 4–5% were found for PB and AAA/CCCS respectively. Excellent results were found for planar measurements in ArcCHECK configurations, where ≥95% of points satisfy the 3%/3 mm acceptance criteria for all the algorithms. ConclusionsA satisfactory agreement (<2%) between planned and measured doses was generally found for CCCS and AAA, excepting the very critical situation of a small tumour completely embedded in air. A significant dose overestimation (from few to 5–7%) was confirmed for PB in complex inhomogeneous arrangements.

Accuracy of dose calculation algorithms in multiplan treatment planning system in presence of heterogeneities

Accuracy of dose calculation algorithms in multiplan treatment planning system in presence of heterogeneities

The accuracy of the Acuros XB algorithm in external beam radiotherapy – a comprehensive review

The accuracy of dose calculation algorithms has been a topic of interest among the radiotherapy community throughout last decades. On one hand the advancements in computers and algorithms has improved the accuracy, but on the other hand the developments iparts of treatment process, in treatment delivery techniques and in treatment devices have always pushed the requirements to the next level. In this review article a comprehensive overview on the accu racy of a new typec � dose calculation algorith m, the Acuros XB (AXB) algorithm (Varian Medical Systems, Inc., Palo Alto, CA, USA), is provided. All the articles that have applied the AXB algorithm in terms of external beam radiotherapy are included and the research frames with reported deviations to r eference methods are described. For the homogeneous water phantoms the reported accuracy was from 1% to 2%, being of similar level for heterogeneous phantoms, in rare occasions lower. In anthropometric and anthrop o- morphic phantoms the mean deviations were about 2% and slightly larger for single points and/or small regions. With patient plans the reportedaveragediscrepancies were less than from 3% to 5%. Almost without exceptions, the algorithm has proven to perform better than other existing commercial do se calculation algorithms. The number of such papers, in which the AXB alg o- rithm is the only dose determination method, is already notable, which indicates that the accuracy of the algorithm is truste d for reference use and it also, with reported dosimetri c results, implies that the AXB algorithm has reached its maturity.

SU-E-T-626: Accuracy of Dose Calculation Algorithms in MultiPlan Treatment Planning System in Presence of Heterogeneities

Purpose: Advanced stereotactic radiotherapy (SRT) treatments require accurate dose calculation for treatment planning especially for treatment sites involving heterogeneous patient anatomy. The purpose of this study was to evaluate the accuracy of dose calculation algorithms, Raytracing and Monte Carlo (MC), implemented in the MultiPlan treatment planning system (TPS) in presence of heterogeneities. Methods: First, the LINAC of a CyberKnife radiotherapy facility was modeled with the PENELOPE MC code. A protocol for the measurement of dose distributions with EBT3 films was established and validated thanks to comparison between experimental dose distributions and calculated dose distributions obtained with MultiPlan Raytracing and MC algorithms as well as with the PENELOPE MC model for treatments planned with the homogenous Easycube phantom. Finally, bones and lungs inserts were used to set up a heterogeneous Easycube phantom. Treatment plans with the 10, 7.5 or the 5 mm field sizes were generated in Multiplan TPS with different tumor localizations (in the lung and at the lung/bone/soft tissue interface). Experimental dose distributions were compared to the PENELOPE MC and Multiplan calculations using the gamma index method. Results: Regarding the experiment in the homogenous phantom, 100% of the points passed for the 3%/3mm tolerance criteria. These criteria include the global error of the method (CT-scan resolution, EBT3 dosimetry, LINAC positionning …), and were used afterwards to estimate the accuracy of the MultiPlan algorithms in heterogeneous media. Comparison of the dose distributions obtained in the heterogeneous phantom is in progress. Conclusion: This work has led to the development of numerical and experimental dosimetric tools for small beam dosimetry. Raytracing and MC algorithms implemented in MultiPlan TPS were evaluated in heterogeneous media.

EP-1551: Accuracy of dose calculation algorithms for static and rotational IMRT in the thorax

EP-1551: Accuracy of dose calculation algorithms for static and rotational IMRT in the thorax

EP-1855: Implications for tumor coverage due to the accuracy of dose calculation algorithms for 3DCRT lung radiotherapy

EP-1855: Implications for tumor coverage due to the accuracy of dose calculation algorithms for 3DCRT lung radiotherapy

Accuracy of dose calculation algorithms in Eclipse treatment planning system: An update

Accuracy of dose calculation algorithms in Eclipse treatment planning system: An update

Dose prediction accuracy of collapsed cone convolution superposition algorithm in a multi-layer inhomogenous phantom

Purpose: Dose prediction accuracy of dose calculation algorithms is important in external beam radiation therapy. This study investigated the effect of air gaps on depth dose calculations computed by collapsed cone convolution superposition (CCCS) algorithm. Methods : A computed tomography (CT) scan of inhomogenous phantom (30 × 30 × 30 cm 3 ) containing rectangular solid-water blocks and two 5 cm air gaps was used for central axis dose calculations computed by CCCS in Pinnacle treatment planning system. Depth dose measurements were taken using a cylindrical ionization chamber for identical beam parameters and monitor units as in the depth dose computations. The calculated and the measured percent depth dose (PDDs) were then compared. The data presented in this study included 6 MV photon beam and field sizes of 3 × 3 cm 2 , 5 × 5 cm 2 , 10 × 10 cm 2 , and 15 × 15 cm 2 . Results: The results of CCCS were within ±1.4% in the first water medium. However, upon traversing the first air gap and re-entering the water medium, in comparison to the measurements, the CCCS under-predicted the dose, with difference ranged from -1.6% to -3.3% for 3 × 3 cm 2 , from -2.4% to -4.2% for 5 × 5 cm 2 , from -2.4% to -6.7% for 10 × 10 cm 2 , and from -1.6% to -6.3% for 15 × 15 cm 2 . After the second air gap, the CCCS continued to under-predict the dose, and the difference ranged from -3.2% to -3.9% for 3× 3cm 2 , from -2.4% to -5.6% for 5 × 5 cm 2 , from -2.3% to -6.0% for 10 × 10 cm 2 , and from -1.5% to -5.6% for 15 × 15 cm 2 . Conclusion : The CCCS under-predicted the dose in water medium after the photon beam traversed the air gap. Special attention must be given during the patient set-up since large air gap between the patient body and immobilization devices may lead to unacceptable dose prediction errors. ---------------------------------------------- Cite this article as: Oyewale S. Dose prediction accuracy of collapsed cone convolution superposition algorithm in a multi-layer inhomogenous phantom. Int J Cancer Ther Oncol 2013; 1 (1):01016. DOI: http://dx.doi.org/10.14319/ijcto.0101.6

SU‐E‐T‐377: Dose Calculation Accuracy of Various Commercially Available Algorithms for Treatment of Targets in Heterogeneous Media

Purpose: Lack of lateral electron equilibrium is a concern when treating lung lesions through IMRT. A comparison is made for the accuracy of dose calculation algorithms for IMRT and 3D conformal arc (CA) plans calculated by three algorithms; Iplan Monte Carlo (MC), Iplan Pencil Beam (PB), and Pinnacle Superposition‐Convolution (SC). Methods: An in‐house heterogeneous phantom was constructed to mimic the electron disequilibrium conditions that arise for lung tumors. The phantom has a cylindrical piece of polystyrene, used as a tumor surrogate, placed in balsa wood, whose density and CT# resemble that of lung tissue. A number of real patient cases with lesions of varying sizes were selected for this study. For each lesion, an IMRT and a CA plans were generated. These plans were then calculated with MC, PB, SC algorithms and mapped onto phantom for ion chamber and film measurement in three orthogonal plains. Results: Preliminary results for three lesions are given. The ion chamber/ plan measurements are, (i) Tumor1 (10cc): IMRT (MC 0.99, PB 0.94, SC 1.00) CA (MC 0.98, PB 0.90, SC 1.03); (ii) Tumor2 (20cc): IMRT (MC 1.01, PB 0.92, SC 0.97) CA (MC 0.98, PB 0.89, SC 0.97); (iii) Tumor3 (80cc): IMRT (MC 0.98, PB 0.93, SC 1.01) CA (MC 0.99, PB 0.91, SC 0.98). The percentage of points passing the 3%/3mm gamma index criteria are; (i) Tumor1: IMRT (MC 99.9%, PB 96.9%, SC 99.5%) CA (MC 97.7%, PB 97.2%); (ii) Tumor2: IMRT (MC 92.1%, PB 85.7%, SC 91.5%) CA (MC 97.7%, PB 89.5%); (iii) Tumor3: (MC 92.3%, PB 85.7%, SC 92.5%) CA (MC 97.8%, PB 91.6%). Conclusions: MC and SC algorithms accurately predict the dose while PB algorithm can under dose the target by up to 10%. IMRT is a viable option for lung tumors if dose is calculated by MC or SC algorithms. Project support provided by CARTI.

MO‐SAMS‐AUD B‐02: Stereotactic Body Radiation Therapy (SBRT) II: Physics and Dosimetry Considerations

SBRT of well defined extracranial targets in various anatomical locations demands special treatment planning considerations due to limitations of dose calculation algorithms in heterogeneous medium and small field dosimetry coupled with tumor/organ motion and multiple radiobiological constraints. Unlike conventional intracranial radiosurgery, SBRT treatment planning and delivery are confounded by reduced 3D physical space for beam placement due to possibility of treatment machine and patient collision as well as a multiplicity of surrounding serial and parallel architecture organs. Currently advanced treatment planning techniques with radiobiological considerations and precise image‐guided treatment delivery methods are practiced for SBRT delivery to a wide variety of tumor types.The physics and dosimetry presentation will include an overview of the available technology for SBRT with an emphasis on image guidance, Quality Assurance, and clinical implementation of SBRT. The presentation will also include site specific treatment planning techniques with considerations to accuracy of dose calculation algorithms, radiobiological issues, and physics reporting strategies.Educational Objectives:1. Understand the issues related to the clinical implementation and technical aspects of SBRT techniques and technology and become familiar with the preliminary reporting of AAPM Task Group 101.2. Understand the importance of QA procedures and guidelines and reporting requirements for SBRT.3. Understand the practical aspects of SBRT treatment planning for paraspinal, lung, liver, and abdominal tumors and recognize the critical issues related to each site.4. Understand the importance and limitations of dose calculation algorithms and heterogeneity correction methods for SBRT in various anatomical sites.

Evaluation of Calculation Algorithms Implemented in Different Commercial Planning Systems on an Anthropomorphic Breast Phantom Using Film Dosimetry

To evaluate the accuracy of dose calculation algorithms of different planning systems for postoperative tangential radiotherapy in breast cancer. On a CT dataset of an anthropomorphic phantom, a structure set of the left lung, clinical target volume (CTV), planning target volume, heart, and external contour were delineated. The dataset was processed by six radiation oncology centers participating in this multicenter dosimetry project. Conventional plans with two tangential wedged fields were generated in MasterPlan, Pinnacle, Eclipse, TMS, and PrecisePLAN. Plan calculations were done using the beam data of local linacs. The dose distributions were verified under local conditions with Gafchromic-EBT films. In all planning systems, deviations between calculation and measurement were around +/-3% in the CTV in the measured plane. Only small areas with deviations of +/-5% were detected. Pencil-beam (PB) calculations overestimated the dose inside the lung by up to 23%. Collapsed cone (CC) underestimated the lung dose by up to 6%. CC calculates the dose distribution more accurately than PB. Inside regions with electron disequilibrium, however, the dose is slightly underestimated.

Dose Specification and Quality Assurance of Radiation Therapy Oncology Group Protocol 95-17; a Cooperative Group Study of Iridium-192 Breast Implants as Sole Therapy

The Radiation Therapy Oncology Group (RTOG) protocol 95-17 was a Phase I/II trial to evaluate multicatheter brachytherapy as the sole method of adjuvant breast radiotherapy for Stage I/II breast carcinoma after breast-conserving surgery. Low- or high-dose-rate sources were allowed. Dose prescription and treatment evaluation were based on recommendations in the International Commission on Radiation Units and Measurements (ICRU), Report 58 and included the parameters mean central dose (MCD), average peripheral dose, dose homogeneity index (DHI), and the dimensions of the low- and high-dose regions. Three levels of quality assurance were implemented: (1) credentialing of institutions was required before entering patients into the study; (2) rapid review of each treatment plan was conducted before treatment; and (3) retrospective review was performed by the Radiological Physics Center in conjunction with the study chairman and RTOG dosimetry staff. Credentialing focused on the accuracy of dose calculation algorithm and compliance with protocol guidelines. Rapid review was designed to identify and correct deviations from the protocol before treatment. The retrospective review involved recalculation of dosimetry parameters and review of dose distributions to evaluate the treatment. Specifying both central and peripheral doses resulted in uniform dose distributions, with a mean dose homogeneity index of 0.83 +/- 0.06. Vigorous quality assurance resulted in a high-quality study with few deviations; only 4 of 100 patients were judged as representing minor variations from protocol, and no patient was judged as representing major deviation. This study should be considered a model for quality assurance of future trials.