Evaluation of dose distribution for targets near inhomogeneities in photon beam radiation therapy

Purpose. The purpose of this work was to evaluate the accuracy of the dose calculated in the presence of inhomogeneities by the top performing algorithms employed by some commercially available modern treatment planning systems for the external photon beam radiotherapy. Materials and methods. A new Fluence Map Monte Carlo (FMMC) method that can serve as a benchmark for such evaluation under certain conditions for a given linear accelerator was developed and tested. Dose perturbation on the inhomogeneities composed of high, low and very low density materials was measured with film dosimeters and calculated with various algorithms. The algorithms included general purpose Monte Carlo and FMMC methods as well as the treatment planning dose calculation algorithms such as pencil beam kernel convolution, point kernel convolution, and superposition, which is the most accurate of the three. Results. The dosimetric comparison results for high density materials obtained by FMMC, superposition, and measurement revealed that the superposition overestimates (up to 16%) of the dose downstream of the inhomogeneity. A very low density medium such as an air cavity was found to have an overestimation (up to 20%) of the dose by the superposition algorithm. The dose in a lung (low density medium) equivalent material was found to be significantly overestimated when calculated with either point kernel (up to 20%) or pencil beam kernel (up to 40%) convolution algorithms. Conclusion. Based on these findings it is recommended that a particular attention should be given to the verification of a dose calculated for the treatment of tumors located in anatomical sites where inhomogeneities are predominant. In many cases a verification process can be successfully performed with the proposed FMMC method which is shown to have a good match with the measurements