Development of a Geant4 based Monte Carlo Algorithm to evaluate the MONACO VMAT treatment accuracy

A method to evaluate the dosimetric accuracy of volumetric modulated arc therapy (VMAT) treatment plans, generated with the MONACO™ (version 3.0) treatment planning system in realistic CT-data with an independent Geant4 based dose calculation algorithm is presented. Therefore a model of an Elekta Synergy linear accelerator treatment head with an MLCi2 multileaf collimator was implemented in Geant4. The time dependent linear accelerator components were modeled by importing either logfiles of an actual plan delivery or a DICOM-RT plan sequence. Absolute dose calibration, depending on a reference measurement, was applied. The MONACO as well as the Geant4 treatment head model was commissioned with lateral profiles and depth dose curves of square fields in water and with film measurements in inhomogeneous phantoms. A VMAT treatment plan for a patient with a thoracic tumor and a VMAT treatment plan of a patient, who received treatment in the thoracic spine region including metallic implants, were used for evaluation. MONACO, as well as Geant4, depth dose curves and lateral profiles of square fields had a mean local gamma (2%, 2mm) tolerance criteria agreement of more than 95% for all fields. Film measurements in inhomogeneous phantoms with a global gamma of (3%, 3mm) showed a pass rate above 95% in all voxels receiving more than 25% of the maximum dose. A dose-volume-histogram comparison of the VMAT patient treatment plans showed mean deviations between Geant4 and MONACO of -0.2% (first patient) and 2.0% (second patient) for the PTVs and (0.5±1.0)% and (1.4±1.1)% for the organs at risk in relation to the prescription dose. The presented method can be used to validate VMAT dose distributions generated by a large number of small segments in regions with high electron density gradients. The MONACO dose distributions showed good agreement with Geant4 and film measurements within the simulation and measurement errors.

Clinical relevance of different dose calculation strategies for mediastinal IMRT in Hodgkin's disease

BACKGROUND AND PURPOSE

Conventional algorithms show uncertainties in dose calculation already for three-dimensional conformal radiotherapy (3D-CRT). Intensity-modulated radiotherapy (IMRT) might even increase these. We wanted to assess differences in dose distribution for pencil beam (PB), collapsed cone (CC), and Monte Carlo (MC) algorithm for both 3D-CRT and IMRT in patients with mediastinal Hodgkin lymphoma.

PATIENTS AND METHODS

Based on 20 computed tomograph (CT) datasets of patients with mediastinal Hodgkin lymphoma, we created treatment plans according to the guidelines of the German Hodgkin Study Group (GHSG) with PB and CC algorithm for 3D-CRT and with PB and MC algorithm for IMRT. Doses were compared for planning target volume (PTV) and organs at risk.

RESULTS

For 3D-CRT, PB overestimated PTV(95) and V(20) of the lung by 6.9% and 3.3% and underestimated V(10) of the lung by 5.8%, compared to the CC algorithm. For IMRT, PB overestimated PTV(95), V(20) of the lung, V(25) of the heart and V(10) of the female left/right breast by 8.1%, 25.8%, 14.0% and 43.6%/189.1%, and underestimated V(10) of the lung, V(4) of the heart and V(4) of the female left/right breast by 6.3%, 6.8% and 23.2%/15.6%, compared to MC.

CONCLUSION

The PB algorithm underestimates low doses to the organs at risk and overestimates dose to PTV and high doses to the organs at risk. For 3D-CRT, a well-modeled PB algorithm is clinically acceptable; for IMRT planning, however, an advanced algorithm such as CC or MC should be used at least for part of the plan optimization.