Electron dose optimisation based on tumour thickness and shape for photon multi-leaf collimated megavoltage electrons

This study developed an optimisation method that considers tumour thickness for modulated electron radiation treatment (MERT) at a treatment distance of 60 cm. It comprises forming a tumour bed matrix from which a transformed tumour bed matrix is derived. From the discrete tumour bed depth data, electron beam segments were extracted, which were further decomposed into sub-beams. The EGSnrc-based Monte Carlo codes BEAMnrc and DOSXYZnrc were used to model a linear accelerator and to score 3-D dose data for various field sizes (sub-beams) in a water phantom model. The use of different energy and intensity-modulated electron sub-beams to irradiate a parotid lesion was investigated by applying the developed optimisation method. After each sub-beam energy was determined, a least square cost function minimisation was invoked to deliver a minimum dose to the tumour volume and produce a set of weight factors synonymous with beam intensity modulation. This study describes a technique to derive apertures and suitable sub-beam energy to provide a method for planning a robust MERT technique that yields dose-covering results and dose spread within the tumour that aligns with literature studies.

Delivery time reduction for mixed photon-electron radiotherapy by using photon MLC collimated electron arcs

Objective. Electron arcs in mixed-beam radiotherapy (Arc-MBRT) consisting of intensity-modulated electron arcs with dynamic gantry rotation potentially reduce the delivery time compared to mixed-beam radiotherapy containing electron beams with static gantry angle (Static-MBRT). This study aims to develop and investigate a treatment planning process (TPP) for photon multileaf collimator (pMLC) based Arc-MBRT.Approach. An existing TPP for Static-MBRT plans is extended to integrate electron arcs with a dynamic gantry rotation and intensity modulation using a sliding window technique. The TPP consists of a manual setup of electron arcs, and either static photon beams or photon arcs, shortening of the source-to-surface distance for the electron arcs, initial intensity modulation optimization, selection of a user-defined number of electron beam energies based on dose contribution to the target volume and finally, simultaneous photon and electron intensity modulation optimization followed by full Monte Carlo dose calculation. Arc-MBRT plans, Static-MBRT plans, and photon-only plans were created and compared for four breast cases. Dosimetric validation of two Arc-MBRT plans was performed using film measurements.Main results. The generated Arc-MBRT plans are dosimetrically similar to the Static-MBRT plans while outperforming the photon-only plans. The mean heart dose is reduced by 32% on average in the MBRT plans compared to the photon-only plans. The estimated delivery times of the Arc-MBRT plans are similar to the photon-only plans but less than half the time of the Static-MBRT plans. Measured and calculated dose distributions agree with a gamma passing rate of over 98% (3% global, 2 mm) for both delivered Arc-MBRT plans.Significance. A TPP for Arc-MBRT is successfully developed and Arc-MBRT plans showed the potential to improve the dosimetric plan quality similar as Static-MBRT while maintaining short delivery times of photon-only treatments. This further facilitates integration of pMLC-based MBRT into clinical practice.

Robust mixed electron-photon radiation therapy planning for soft tissue sarcoma

BACKGROUND

Mixed electron-photon beam radiation therapy (MBRT) is an emerging technique in which external electron and photon beams are simultaneously optimized into a single treatment plan. MBRT exploits the steep dose falloff and high surface dose of electrons while maintaining target conformity by leveraging the sharp penumbra of photons.

PURPOSE

This study investigates the dosimetric benefits of MBRT for soft tissue sarcoma (STS) patients.

MATERIAL AND METHODS

A retrospective cohort of 22 STS of the lower extremity treated with conventional photon-based Volumetric Modulated Arc Therapy (VMAT) were replanned with MBRT. Both VMAT and MBRT treatments were planned on the Varian TrueBeam linac using the Millenium multi-leaf collimator. No electron applicator, cutout or additional collimating devices were used for electron beams of MBRT plans. MBRT plans were optimized to use a combination of 6 MV photons and five electron energies (6, 9, 12, 16, 20 MeV) by a robust column generation algorithm. Electron beams in this study were planned at standard 100 cm source-axis distance (SAD). The dose to the clinical target volume (CTV), bone, normal tissue strip and other organs-at-risk (OARs) were compared using a Wilcoxon signed-rank test.

RESULTS

As part of the original VMAT treatment, tissue-equivalent bolus was required in 10 of the 22 patients. MBRT plans did not require bolus by virtue of the higher electron entrance dose. CTV coverage by the prescription dose was found to be clinically equivalent between plans of either modality:V 50Gy $V_{\text{50Gy}}$ (MBRT) = 97.9 ± 0.2% versusV 50Gy $V_{\text{50Gy}}$ (VMAT) = 98.1 ± 0.6% (p=0.34). Evaluating the absolute paired difference between doses to OARs in MBRT and VMAT plans, we observed lowerV 20Gy $V_{\text{20Gy}}$ to normal tissue in MBRT plans by 14.9 ± 3.2% (p < 10 - 6 $p<10^{-6}$ ). Similarly,V 50Gy $V_{\text{50Gy}}$ to bone was found to be decreased by 8.2 ± 4.0% (p < 10 - 3 $p<10^{-3}$ ) of the bone volume.

CONCLUSION

For STS with subcutaneous involvement, MBRT offers statistically significant sparing of OARs without sacrificing target coverage when compared to VMAT. MBRT plans are deliverable on conventional linacs without the use of electron applicators, shortened source-to-surface distance (SSD) or bolus. This study shows that MBRT is a logistically feasible technique with clear dosimetric benefits.

Auto-commissioning of a Monte Carlo electron beam model with application to photon MLC shaped electron fields

Objective.Presently electron beam treatments are delivered using dedicated applicators. An alternative is the usage of the already installed photon multileaf collimator (pMLC) enabling efficient electron treatments. Currently, the commissioning of beam models is a manual and time-consuming process. In this work an auto-commissioning procedure for the Monte Carlo (MC) beam model part representing the beam above the pMLC is developed for TrueBeam systems with electron energies from 6 to 22 MeV.Approach.The analytical part of the electron beam model includes a main source representing the primary beam and a jaw source representing the head scatter contribution each consisting of an electron and a photon component, while MC radiation transport is performed for the pMLC. The auto-commissioning of this analytical part relies on information pre-determined from MC simulations, in-air dose profiles and absolute dose measurements in water for different field sizes and source to surface distances (SSDs). For validation calculated and measured dose distributions in water were compared for different field sizes, SSDs and beam energies for eight TrueBeam systems. Furthermore, a sternum case in an anthropomorphic phantom was considered and calculated and measured dose distributions were compared at different SSDs.Main results.Instead of the manual commissioning taking up to several days of calculation time and several hours of user time, the auto-commissioning is carried out in a few minutes. Measured and calculated dose distributions agree generally within 3% of maximum dose or 2 mm. The gamma passing rates for the sternum case ranged from 96% to 99% (3% (global)/2 mm criteria, 10% threshold).Significance.The auto-commissioning procedure was successfully implemented and applied to eight TrueBeam systems. The newly developed user-friendly auto-commissioning procedure allows an efficient commissioning of an MC electron beam model and eases the usage of advanced electron radiotherapy utilizing the pMLC for beam shaping.

Efficiency enhancements of a Monte Carlo beamlet based treatment planning process: implementation and parameter study

Objective.The computational effort to perform beamlet calculation, plan optimization and final dose calculation of a treatment planning process (TPP) generating intensity modulated treatment plans is enormous, especially if Monte Carlo (MC) simulations are used for dose calculation. The goal of this work is to improve the computational efficiency of a fully MC based TPP for static and dynamic photon, electron and mixed photon-electron treatment techniques by implementing multiple methods and studying the influence of their parameters.Approach.A framework is implemented calculating MC beamlets efficiently in parallel on each available CPU core. The user can specify the desired statistical uncertainty of the beamlets, a fractional sparse dose threshold to save beamlets in a sparse format and minimal distances to the PTV surface from which 2 × 2 × 2 = 8 (medium) or even 4 × 4 × 4 = 64 (large) voxels are merged. The compromise between final plan quality and computational efficiency of beamlet calculation and optimization is studied for several parameter values to find a reasonable trade-off. For this purpose, four clinical and one academic case are considered with different treatment techniques.Main results.Setting the statistical uncertainty to 5% (photon beamlets) and 15% (electron beamlets), the fractional sparse dose threshold relative to the maximal beamlet dose to 0.1% and minimal distances for medium and large voxels to the PTV to 1 cm and 2 cm, respectively, does not lead to substantial degradation in final plan quality compared to using 2.5% (photon beamlets) and 5% (electron beamlets) statistical uncertainty and no sparse format nor voxel merging. Only OAR sparing is slightly degraded. Furthermore, computation times are reduced by about 58% (photon beamlets), 88% (electron beamlets) and 96% (optimization).Significance.Several methods are implemented improving computational efficiency of beamlet calculation and plan optimization of a fully MC based TPP without substantial degradation in final plan quality.

A fast GPU-accelerated Monte Carlo engine for calculation of MLC-collimated electron fields

BACKGROUND

Although intensity-modulated radiation therapy and volumetric arc therapy have revolutionized photon external beam therapies, the technological advances associated with electron beam therapy have fallen behind. Modern linear accelerators contain technologies that would allow for more advanced forms of electron treatments, such as beam collimation, using the conventional photon multi-leaf collimator (MLC); however, no commercial solutions exist that calculate dose from such beam delivery modes. Additionally, for clinical adoption to occur, dose calculation times would need to be on par with that of modern dose calculation algorithms.

PURPOSE

This work developed a graphics processing unit (GPU)-accelerated Monte Carlo (MC) engine incorporating the Varian TrueBeam linac head geometry for a rapid calculation of electron beams collimated using the conventional photon MLC.

METHODS

A compute unified device architecture framework was created for the following: (1) transport of electrons and photons through the linac head geometry, considering multiple scattering, Bremsstrahlung, Møller, Compton, and pair production interactions; (2) electron and photon propagation through the CT geometry, considering all interactions plus the photoelectric effect; and (3) secondary particle cascades through the linac head and within the CT geometry. The linac head collimating geometry was modeled according to the specifications provided by the vendor, who also provided phase-space files. The MC was benchmarked against EGSnrc/DOSXYZnrc/GEANT by simulating individual interactions with simple geometries, pencil, and square beam dose calculations in various phantoms. MC-calculated dose distributions for MLC and jaw-collimated electron fields were compared to measurements in a water phantom and with radiochromic film.

RESULTS

Pencil and square beam dose distributions are in good agreement with DOSXYZnrc. Angular and spatial distributions for multiple scattering and secondary particle production in thin slab geometries are in good agreement with EGSnrc and GEANT. Dose profiles for MLC and jaw-collimated 6-20-MeV electron beams showed an average absolute difference of 1.1 and 1.9 mm for the FWHM and 80%-20% penumbra from measured profiles. Percent depth doses showed differences of <5% for as compared to measurement. The computation time on an NVIDIA Tesla V100 card was 2.5 min to achieve a dose uncertainty of <1%, which is ∼300 times faster than published results in a similar geometry using a single-CPU core.

CONCLUSIONS

The GPU-based MC can quickly calculate dose for electron fields collimated using the conventional photon MLC. The fast calculation times will allow for a rapid calculation of electron fields for mixed photon and electron particle therapy.

Ion chamber and film-based quality assurance of mixed electron-photon radiation therapy

PURPOSE

In previous work, we demonstrated that mixed electron-photon radiation therapy (MBRT) produces treatment plans with improved normal tissue sparing and similar target coverage, when compared to photon-only plans. The purpose of this work was to validate the MBRT delivery process on a Varian TrueBeam accelerator and laying the groundwork for a patient-specific quality assurance (QA) protocol based on ion chamber point measurements and 2D film measurements.

METHODS

MC beam models used to calculate the MBRT dose distributions of each modality (photons/electrons) were validated with a single-angle beam MBRT treatment plan delivered on a slab of Solid Water phantom with a film positioned at a depth of 2 cm. The measured film absorbed dose was compared to the calculated dose. To validate clinical deliveries, a polymethyl methacrylate (PMMA) cylinder was machined and holes were made to fit an ionization chamber. A complex MBRT plan involving a photon arc and three electron delivery angles was created with the aim of reproducing a clinically realistic dose distribution in typical soft tissue sarcoma tumours of the extremities. The treatment plan was delivered on the PMMA cylinder. Point measurements were taken with an Exradin A1SL chamber at two nominal depths: 1.4 cm and 2.1 cm. The plan was also delivered on a second identical phantom with an insert at 2 cm depth, where a film was placed. An existing EGSnrc user-code, SPRRZnrc, was modified to calculate the stopping power ratios between any materials in the same voxelized geometry used for dose calculation purposes. This modified code, called SPRXYZnrc, was used to calculate a correction factor, k MBRT , accounting for the differences in electron fluence spectrum at the measurement point compared to that at reference conditions. The uncertainty associated with neglecting potential ionization chamber fluence perturbation correction factors using this approach was estimated.

RESULTS

The film measurement from the Solid Water phantom treatment plan was in good agreement with the simulated dose distribution, with a gamma pass rate of 96.1% for a 3%/2 mm criteria. For the PMMA phantom delivery, for the same gamma criteria, the pass rate was 97.3%. The ion chamber measurements of the total delivered dose agreed with the MC-simulated dose within 2.1%. The beam quality correction factors amounted to, at most, a 4% correction on the ion chamber measurement. However, individual contribution of low electron energies proved difficult to precisely measure due to their steep dose gradients, with disagreements of up to 28% ± 15% at 2.1 cm depth (6 MeV). Ion chamber measurement procedure of electron beams was achieved in less than 5 min, and the entire validation process including phantom setup was performed in less than 30 min.

CONCLUSION

The agreement between measured and simulated MBRT doses indicates that the dose distributions obtained from the MBRT treatment planning algorithm are realistically achievable. The SPRXYZnrc MC code allowed for convenient calculations of k MBRT simultaneously with the dose distributions, laying the groundwork for patient-specific QA protocol practical for clinical use. Further investigation is needed to establish the accuracy of our ionization chamber correction factors k MBRT calculations at low electron energies.

TriB-RT: Simultaneous optimization of photon, electron and proton beams

PURPOSE

To develop a novel treatment planning process (TPP) with simultaneous optimization of modulated photon, electron and proton beams for improved treatment plan quality in radiotherapy.

METHODS

A framework for fluence map optimization of Monte Carlo (MC) calculated beamlet dose distributions is developed to generate treatment plans consisting of photon, electron and spot scanning proton fields. Initially, in-house intensity modulated proton therapy (IMPT) plans are compared to proton plans created by a commercial treatment planning system (TPS). A triple beam radiotherapy (TriB-RT) plan is generated for an exemplary academic case and the dose contributions of the three particle types are investigated. To investigate the dosimetric potential, a TriB-RT plan is compared to an in-house IMPT plan for two clinically motivated cases. Benefits of TriB-RT for a fixed proton beam line with a single proton field are investigated.

RESULTS

In-house optimized IMPT are of at least equal or better quality than TPS-generated proton plans, and MC-based optimization shows dosimetric advantages for inhomogeneous situations. Concerning TriB-RT, for the academic case, the resulting plan shows substantial contribution of all particle types. For the clinically motivated case, improved sparing of organs at risk close to the target volume is achieved compared to IMPT (e.g. myelon and brainstem [Formula: see text] -37%) at cost of an increased low dose bath (healthy tissue V _10% +22%). In the scenario of a fixed proton beam line, TriB-RT plans are able to compensate the loss in degrees of freedom to substantially improve plan quality compared to a single field proton plan.

CONCLUSION

A novel TPP which simultaneously optimizes photon, electron and proton beams was successfully developed. TriB-RT shows the potential for improved treatment plan quality and is especially promising for cost-effective single-room proton solutions with a fixed beamline in combination with a conventional linac delivering photon and electron fields.

Technical Note: A dose calculation framework for dynamic electron arc radiotherapy (DEAR) using VirtuaLinac Monte Carlo simulation tool

PURPOSE

Dynamic electron arc radiotherapy (DEAR) is a novel dynamic technique that achieves highly conformal dose through simultaneous couch and gantry motion during delivery. The purpose of this study is to develop a framework integrating a Monte Carlo dose engine (VirtuaLinac) to a treatment planning system (TPS, Eclipse) for DEAR. A quality assurance (QA) procedure is also developed.

METHODS AND MATERIALS

The interfaces include the following: computed tomography image export and conversion for VirtuaLinac; VirtuaLinac computation tasks management through application programming interface (API); and dose matrix processing and evaluation. The framework was validated with both static beam and DEAR plan with a 3 × 3 cm² cutout for both 6 and 9 MeV electrons. Verification plans for DEAR were created on flat phantom and a hybrid dose calculation technique was developed which convolves precalculated small field kernel with the beam trajectory, and the resulting dose was compared with the full VirtuaLinac calculation and film measurement.

RESULTS

Excellent agreement between VirtuaLinac and eMC was observed with three-dimensional γ pass rate of 98% at 1%/1 mm criteria for both 6 and 9 MeV electrons. Film measurement shows two-dimensional (2D) γ passing rate of 99.8 % (6 MeV) and 97.1% (9 MeV) at 2%/2 mm criteria. For DEAR plans the comparison of VirtuaLinac and measurement shows the 2D γ passing rates of 94% at 2%/2 mm for 6 MeV. The dose distributions from hybrid method in phantom are identical to the full VirtuaLinac simulations, but can be done instantly.

CONCLUSIONS

A framework has been developed for DEAR dose calculation using VirtuaLinac Monte Carlo dose engine. The VirtuaLinac calculated dose was validated against measurement. A feasible and practical DEAR QA method has been developed for dose measurement in phantom. The hybrid dose calculation technique is efficient and suitable for DEAR QA purpose.

Electron modulated arc therapy (EMAT) using photon MLC for postmastectomy chest wall treatment I: Monte Carlo-based dosimetric characterizations

PURPOSE

To study the dosimetric properties of electron arc beams delivered by photon-beam multi-leaf collimators (pMLC) in electron modulated arc therapy (EMAT) for postmastectomy chest wall treatments.

METHODS

Using the Monte Carlo method, we simulated a 2100EX Varian linear accelerator and verified the beam models in a water tank. Dosimetric characterizations were performed on cylindrical water phantoms of elliptical bases with various field sizes, arc ranges and source-to-surface distances (SSDs) for 6, 9 and 12 MeV beam energy.

RESULTS

The arc beam has a higher bremsstrahlung dose than the static beam at the isocenter due to crossfire, but choosing a field size greater than 5 cm effectively reduces the bremsstrahlung dose. The depths of the 90% maximum dose located at 1.7, 2.8 and 4.1 cm for 6, 9 and 12 MeV, respectively, are similar to those of the static beams and independent of the field size and arc range.

CONCLUSION

Based on the study, we recommend using the 5 cm field width for electron arc beams considering both bremsstrahlung dose at the isocenter and the arc profile penumbra. To ensure sufficient PTV edge coverage, we recommend a field length extension of at least 4 cm from PTV's edge for all beam energies and an arc extension of around 7°, 5°, and 5° for beam energies 6, 9, and 12 MeV, respectively. These dosimetric characterizations are the basis of pMLC-delivered EMAT treatment planning for postmastectomy chest wall patients.

Feasibility of clinical electron beam formation using polymer materials produced by fused deposition modeling

The main challenge in electron external beam radiation therapy with clinical accelerators is the absence of integrated systems to form irregular fields. The current approach to provide conformal irradiation is to use additional metallic shaping blocks, with inefficient and expensive workflows. This work presents a simple method to form therapeutic electron fields using 3D printed samples. These samples are manufactured by fused deposition modeling, which can affect crucial properties, such as material homogeneity, due to the presence of residual air-filled cavities. The applicability of this method was therefore investigated with a set of experiments and Monte Carlo simulations aimed at determining the electron depth dose distribution in polymer materials. The results show that therapeutic electron beams with energies 6-20 MeV can be effectively absorbed using these polymeric samples. The model developed in this study provides a way to assess the dose distribution in such materials and to calculate the appropriate thickness of polymer samples for therapeutic electron beam formation. It is shown that for total absorption of 6 MeV electron beams the material thickness should be at least 4 cm, while this value should be at least 8 cm for 12 MeV and 11 cm for 20 MeV, respectively. The results can be used to further develop 3D printing procedures for medical electron beam profile formation, allowing the creation of a collimator or absorber with patient-specific configuration using rapid prototyping systems, thus contributing to improve the accuracy of dose delivery in electron radiotherapy within a short manufacturing time.

Part 2: Dynamic mixed beam radiotherapy (DYMBER): Photon dynamic trajectories combined with modulated electron beams

PURPOSE

The purpose of this study was to develop a treatment technique for dynamic mixed beam radiotherapy (DYMBER) utilizing increased degrees of freedom (DoF) of a conventional treatment unit including different particle types (photons and electrons), intensity and energy modulation and dynamic gantry, table, and collimator rotations.

METHODS

A treatment planning process has been developed to create DYMBER plans combining photon dynamic trajectories (DTs) and step and shoot electron apertures collimated with the photon multileaf collimator (pMLC). A gantry-table path is determined for the photon DTs with minimized overlap of the organs at risk (OARs) with the target. In addition, an associated dynamic collimator rotation is established with minimized area between the pMLC leaves and the target contour. pMLC sequences of photon DTs and electron pMLC apertures are then simultaneously optimized using direct aperture optimization (DAO). Subsequently, the final dose distribution of the electron pMLC apertures is calculated using the Swiss Monte Carlo Plan (SMCP). The pMLC sequences of the photon DTs are then re-optimized with a finer control point resolution and with the final electron dose distribution taken into account. Afterwards, the final photon dose distribution is calculated also using the SMCP and summed together with the one of the electrons. This process is applied for a brain and two head and neck cases. The resulting DYMBER dose distributions are compared to those of dynamic trajectory radiotherapy (DTRT) plans consisting only of photon DTs and clinically applied VMAT plans. Furthermore, the deliverability of the DYMBER plans is verified in terms of dosimetric accuracy, delivery time and collision avoidance. For this purpose, The DYMBER plans are delivered to Gafchromic EBT3 films placed in an anthropomorphic head phantom on a Varian TrueBeam linear accelerator.

RESULTS

For each case, the dose homogeneity in the target is similar or better for DYMBER compared to DTRT and VMAT. Averaged over all three cases, the mean dose to the parallel OARs is 16% and 28% lower, D2% to the serial OARs is 17% and 37% lower and V10% to normal tissue is 12% and 4% lower for the DYMBER plans compared to the DTRT and VMAT plans, respectively. The DYMBER plans are delivered without collision and with a 4-5 min longer delivery time than the VMAT plans. The absolute dose measurements are compared to calculation by gamma analysis using 2% (global)/2 mm criteria with passing rates of at least 99%.

CONCLUSIONS

A treatment technique for DYMBER has been successfully developed and verified for its deliverability. The dosimetric superiority of DYMBER over DTRT and VMAT indicates utilizing increased DoF to be the key to improve brain and head and neck radiation treatments in future.

Validation of Varian TrueBeam electron phase-spaces for Monte Carlo simulation of MLC-shaped fields

PURPOSE

This work evaluates Varian's electron phase-space sources for Monte Carlo simulation of the TrueBeam for modulated electron radiation therapy (MERT) and combined, modulated photon and electron radiation therapy (MPERT) where fields are shaped by the photon multileaf collimator (MLC) and delivered at 70 cm SSD.

METHODS

Monte Carlo simulations performed with EGSnrc-based BEAMnrc/DOSXYZnrc and penelope-based PRIMO are compared against diode measurements for 5 × 5, 10 × 10, and 20 × 20 cm(2) MLC-shaped fields delivered with 6, 12, and 20 MeV electrons at 70 cm SSD (jaws set to 40 × 40 cm(2)). Depth dose curves and profiles are examined. In addition, EGSnrc-based simulations of relative output as a function of MLC-field size and jaw-position are compared against ion chamber measurements for MLC-shaped fields between 3 × 3 and 25 × 25 cm(2) and jaw positions that range from the MLC-field size to 40 × 40 cm(2).

RESULTS

Percent depth dose curves generated by BEAMnrc/DOSXYZnrc and PRIMO agree with measurement within 2%, 2 mm except for PRIMO's 12 MeV, 20 × 20 cm(2) field where 90% of dose points agree within 2%, 2 mm. Without the distance to agreement, differences between measurement and simulation are as large as 7.3%. Characterization of simulated dose parameters such as FWHM, penumbra width and depths of 90%, 80%, 50%, and 20% dose agree within 2 mm of measurement for all fields except for the FWHM of the 6 MeV, 20 × 20 cm(2) field which falls within 2 mm distance to agreement. Differences between simulation and measurement exist in the profile shoulders and penumbra tails, in particular for 10 × 10 and 20 × 20 cm(2) fields of 20 MeV electrons, where both sets of simulated data fall short of measurement by as much as 3.5%. BEAMnrc/DOSXYZnrc simulated outputs agree with measurement within 2.3% except for 6 MeV MLC-shaped fields. Discrepancies here are as great as 5.5%.

CONCLUSIONS

TrueBeam electron phase-spaces available from Varian have been implemented in two distinct Monte Carlo simulation packages to produce dose distributions and outputs that largely reflect measurement. Differences exist in the profile shoulders and penumbra tails for the 20 MeV phase-space off-axis and in the outputs for the 6 MeV phase-space.