Technical note: development and validation of a Monte Carlo tool for analysis of patient-generated photon scatter

Performance optimization of a tri-hybrid method for estimation of patient scatter into the EPID

On‐treatment EPID images are contaminated with patient‐generated scattered photons. If this component can be accurately estimated, its effect can be removed, and therefore a corresponding in vivo patient dose estimate will be more accurate. Our group previously developed a "tri‐hybrid" (TH) algorithm to provide fast but accurate estimates of patient‐generated photon scatter. The algorithm uses an analytical method to solve for singly‐scattered photon fluence, a modified Monte Carlo hybrid method to solve for multiply‐scattered photon fluence, and a pencil beam scatter kernel method to solve for electron interaction generated scattered photon fluence. However, for efficient clinical implementation, spatial and energy sampling must be optimized for speed while maintaining overall accuracy.

In this work, the most significant sampling issues were examined, including spatial sampling settings for the patient voxel size, the number of Monte Carlo histories used in the modified hybrid MC method, scatter order sampling for the hybrid method, and also a range of energy spectrum sampling (i.e., energy bin sizes).

The total predicted patient‐scattered photon fluence entering the EPID was compared with full MC simulation (EGSnrc) for validation. Three phantoms were tested with 6 and 18 MV beam energies, field sizes of 4 × 4, 10 × 10, and 20 × 20 cm², and source‐to‐imager distance of 140 cm to develop a set of optimal sampling settings.

With the recommended sampling, accuracy and precision of the total‐scattered energy fluence of the TH patient scatter prediction method are within 0.9% and 1.2%, respectively, for all test cases compared with full MC simulation results. For the mean energy spectrum across the imaging plane, comparison of TH with full MC simulation showed 95% overlap.

This study has optimized sampling settings so that they have minimal impact on patient scatter prediction accuracy while maintaining maximum execution speed, a critical step for future clinical implementation.

A tri-hybrid method to estimate the patient-generated scattered photon fluence components to the EPID image plane

In vivo dosimetry methods can verify the prescription dose is delivered to the patient during treatment. Unfortunately, in exit dosimetry, the megavoltage image is contaminated with patient-generated scattered photons. However, estimation and removal of the effect of this fluence improves accuracy of in vivo dosimetry methods. This work develops a 'tri-hybrid' algorithm combining analytical, Monte Carlo (MC) and pencil-beam scatter kernel methods to provide accurate estimates of the total patient-generated scattered photon fluence entering the MV imager. For the multiply-scattered photon fluence, a modified MC simulation method was applied, using only a few histories. From each second- and higher-order interaction site in the simulation, energy fluence entering all pixels of the imager was calculated using analytical methods. For photon fluence generated by electron interactions in the patient (i.e. bremsstrahlung and positron annihilation), a convolution/superposition approach was employed using pencil-beam scatter fluence kernels as a function of patient thickness and air gap distance, superposed on the incident fluence distribution. The total patient-scattered photon fluence entering the imager was compared with a corresponding full MC simulation (EGSnrc) for several test cases. These included three geometric phantoms (water, half-water/half-lung, computed tomography thorax) using monoenergetic (1.5, 5.5 and 12.5 MeV) and polyenergetic (6 and 18 MV) photon beams, 10 × 10 cm² field, source-to-surface distance 100 cm, source-to-imager distance 150 cm and 40 × 40 cm² imager. The proposed tri-hybrid method is demonstrated to agree well with full MC simulation, with the average fluence differences and standard deviations found to be within 0.5% and 1%, respectively, for test cases examined here. The method, as implemented here with a single CPU (non-parallelized), takes ∼80 s, which is considerably shorter compared to full MC simulation (∼30 h). This is a promising method for fast yet accurate calculation of patient-scattered fluence at the imaging plane for in vivo dosimetry applications.