Calculating dose distributions and wedge factors for photon treatment fields with dynamic wedges based on a convolution/superposition method

Dose calculation accuracies in whole breast radiotherapy treatment planning: a multi-institutional study

Our objective in this study was to evaluate the variation in the doses delivered among institutions due to dose calculation inaccuracies in whole breast radiotherapy. We have developed practical procedures for quality assurance (QA) of radiation treatment planning systems. These QA procedures are designed to be performed easily at any institution and to permit comparisons of results across institutions. The dose calculation accuracy was evaluated across seven institutions using various irradiation conditions. In some conditions, there was a >3 % difference between the calculated dose and the measured dose. The dose calculation accuracy differs among institutions because it is dependent on both the dose calculation algorithm and beam modeling. The QA procedures in this study are useful for verifying the accuracy of the dose calculation algorithm and of the beam model before clinical use for whole breast radiotherapy.

Comparison of dosimetric characteristics of physical and enhanced dynamic wedges

BACKGROUND

Wedge filters can be used as missing tissue compensators or wedge pairs to alter the shape of isodose curves so that two beams can be angled with a small hinge angle at a target volume without creating a hotspot.

AIM

In this study the dosimetric properties of Varian Enhanced Dynamic Wedge (EDW) and physical wedges (PW) were analyzed and compared.

MATERIALS AND METHODS

Ionometric measurements of open field output factor, physical wedge output factor, physical wedge factor and EDW factor for photon beams were carried out. A 3D scanning water phantom was used to scan depth dose and profiles for open and PW fields. The 2D ionization matrix was used to measure profiles of physical and EDW wedges. The isodose curves of physical and EDW angles were obtained using a therapy verification film.

RESULTS AND DISCUSSION

The PW output factors of photons were compared with the open field output factors. The physical and EDW factors were compared. The difference in percentage depth dose for open and PW fields was observed for both photon beams. The measured isodose plots for physical and EDW were compared.

CONCLUSION

The wedge field output factor increases with field size and wedge angle compared to that of the open field output factor. The number of MU to deliver a particular dose with the EDW field is less than that of the PW field due to a change in wedge factor. The dosimetric characteristics, like profile and isodose of EDW, closely match with that of the PW.

Testing of the analytical anisotropic algorithm for photon dose calculation

The analytical anisotropic algorithm (AAA) was implemented in the Eclipse (Varian Medical Systems) treatment planning system to replace the single pencil beam (SPB) algorithm for the calculation of dose distributions for photon beams. AAA was developed to improve the dose calculation accuracy, especially in heterogeneous media. The total dose deposition is calculated as the superposition of the dose deposited by two photon sources (primary and secondary) and by an electron contamination source. The photon dose is calculated as a three-dimensional convolution of Monte-Carlo precalculated scatter kernels, scaled according to the electron density matrix. For the configuration of AAA, an optimization algorithm determines the parameters characterizing the multiple source model by optimizing the agreement between the calculated and measured depth dose curves and profiles for the basic beam data. We have combined the acceptance tests obtained in three different departments for 6, 15, and 18 MV photon beams. The accuracy of AAA was tested for different field sizes (symmetric and asymmetric) for open fields, wedged fields, and static and dynamic multileaf collimation fields. Depth dose behavior at different source-to-phantom distances was investigated. Measurements were performed on homogeneous, water equivalent phantoms, on simple phantoms containing cork inhomogeneities, and on the thorax of an anthropomorphic phantom. Comparisons were made among measurements, AAA, and SPB calculations. The optimization procedure for the configuration of the algorithm was successful in reproducing the basic beam data with an overall accuracy of 3%, 1 mm in the build-up region, and 1%, 1 mm elsewhere. Testing of the algorithm in more clinical setups showed comparable results for depth dose curves, profiles, and monitor units of symmetric open and wedged beams below dmax. The electron contamination model was found to be suboptimal to model the dose around dmax, especially for physical wedges at smaller source to phantom distances. For the asymmetric field verification, absolute dose difference of up to 4% were observed for the most extreme asymmetries. Compared to the SPB, the penumbra modeling is considerably improved (1%, 1 mm). At the interface between solid water and cork, profiles show a better agreement with AAA. Depth dose curves in the cork are substantially better with AAA than with SPB. Improvements are more pronounced for 18 MV than for 6 MV. Point dose measurements in the thoracic phantom are mostly within 5%. In general, we can conclude that, compared to SPB, AAA improves the accuracy of dose calculations. Particular progress was made with respect to the penumbra and low dose regions. In heterogeneous materials, improvements are substantial and more pronounced for high (18 MV) than for low (6 MV) energies.

Development of a 3-D convolution / superposition algorithm for precise dose calculation in the skull

In this paper an algorithm for calculating 3-D dose distributions within the brain is introduced and adapted to the demands of modem radiosurgery. The dose calculation with this model is based on a 3-D distribution of the primary photon intensity which is calculated with a ray casting algorithm. A prelocated matrix takes into account field sizes as well as modifying elements as collimator positions (MLC), blocks, wedges and compensators. Monte Carlo precalculated monoenergetic kernels from 0.1 MeV to 50 MeV were at our disposal. The components of the spectrum were either determined by deconvoluting depth dose curves measured in water or analyzed with a Ge-Li detector system in the case of 60Co. The calculated fluence distribution has to be superposed to the complete kernel containing the spatial energy deposition. Inhomogeneities and tissue interface phenomena (rhoe, Z) have been investigated. The divergence of the rays and the curved surface of the patient are taken into account. Assuming homogenous media, it is possible to shorten the computation time by using the Fast Fourier Transformation (FFT) delivering a first overview within seconds. The algorithm was evaluated and verified under specific conditions of small fields as used in radiosurgery and compared to dose measurements and Monte Carlo calculations. In using both the fast algorithm (FFT) for mainly homogenous conditions on one hand and the very precise superposition for inhomogeneous cases on the other, this algorithm can be a very helpful instrument especially for critical locations in the skull.

On the practice of the clinical implementation of enhanced dynamic wedges

Practical aspects of the clinical implementation of enhanced dynamic wedges (EDW) replacing manual wedges are presented and discussed extensively. A comparison between measured and calculated data is also presented. Relative dose distributions and wedge factors were calculated with a commercially available treatment planning system and measured in a water-phantom and with an ionization chamber. Wedge factor calculations and measurements were also compared with an independent method of wedge factor calculations available from the literature. Aspects of the clinical implementation, such as safety and quality assurance, were evaluated. Measurements and calculations agreed very well and were slightly better than results of previous studies. Profiles and percentage depth doses (PDDs) agreed within 1% to 1.5% and within 0.5%, respectively. Measured and calculated wedge factors ratios agreed within 0.5% to 1%. Calculated and measured EDW dose distributions showed excellent agreement, both relative and absolute. However, for safe and practical use, specific aspects need to be taken into consideration. Once the treatment planning system is commissioned properly, the clinical implementation of EDW is rather straightforward.

Dosimetric characteristics of dynamic wedged fields: a Monte Carlo study

We have developed a Monte Carlo (MC) technique using the EGS4/BEAM system to calculate dosimetric characteristics of dynamic wedges (DW) for photon beam radiotherapy. The simulation of DW was accomplished by weighting the history numbers of the electrons, which are incident on the target in accordance with the segmented treatment table. Calculations were performed for DW with wedge angles ranging from 15 degrees to 60 degrees as well as for open fields with different field sizes for both degrees 6 and 18 MV beams. The MC-calculated percentage depth dose (PDD) and beam profiles agreed with the measurements within +/- 2% (of the dose maximum along the beam axis) or +/- 2 mm in high dose gradient region. The DW slightly affects energy spectra of photons and contaminating electrons. These slight changes have no significant effects on PDD as compared to the open field. The MC-calculated dynamic wedge factors agree with the measurements within +/- 2%. The MC method enables us to provide more detailed beam characteristics for DW fields than a measurement method. This beam characteristic includes photon energy spectra, mean energy, spectra of contaminating electrons and effects of moving jaw on off-axis beam quality. These data are potentially important for treatment planning involving dynamic wedges.

Dynamic wedge versus physical wedge: a Monte Carlo study

The purpose of this study is to analyze the characteristics of dynamic wedges (DW) and to compare DW to physical wedges (PW) in terms of their differences in affecting beam spectra, energy fluence, angular distribution, contaminated electrons, and dose distributions. The EGS4/BEAM Monte Carlo codes were used to simulate the exact geometry of a 6 MV beam and to calculate 3-D dose distributions in phantom. The DW was simulated in accordance with the segmented treatment tables (STT). The percentage depth dose curves and beam profiles for PW, DW, and open fields were measured and used to verify the Monte Carlo simulations. The Monte Carlo results were found to agree within 2% with the measurements performed using film and ionizing chambers in a water phantom. The present EGS4 calculation reveals that the effects of a DW on beam spectral and angular distributions, as well as electron contamination, are much less significant than those for a PW. For the 6 MV photon beam, a 45 degrees PW can result in a 30% increase in mean photon energy due to the effect of beam hardening. It can also introduce a 5% dose reduction in the build-up region due to the reduction of contaminated electrons by the PW. Neither this mean-energy increase nor such dose reduction is found for a DW. Compared to a DW, a PW alters the photon-beam spectrum significantly. The dosimetric differences between a DW and a PW are significant and clearly affect the clinical use of these beams. The data presented may be useful for DW commissioning.

Implementation and verification of virtual wedge in a three-dimensional radiotherapy planning system

Virtual Wedge (VW) is a Siemens treatment modality which generates wedge-shaped dose distributions by moving a collimator jaw from closed to open at a constant speed while varying the dose rate in every 2 mm jaw position. In this work, the implementation and verification of VW in a radiotherapy treatment planning (RTP) system is presented. The VW implementation models the dose delivered by VW using the Siemens monitor units (MU) analytic formalism which determines the number of MU required to generate a wedge-fluence profile at points across the VW beam. For any set of treatment parameters, the VW algorithm generates an "intensity map" that is used to model the modification of fluence emanating from the collimator. The intensity map is calculated as the ratio of MU delivered on an axis point, divided by the monitor units delivered on the central-axis MU(0). The dose calculation is then performed using either the Clarkson or Convolution/ Superposition algorithms. The VW implementation also models the operational constraints for the delivery of VW due to dose rate and jaw speed limits. Dose verifications with measured profiles were performed using both the Clarkson and Convolution/Superposition algorithms for three photon beams; Siemens Primus 6 and 23 MV, and Mevatron MD 15 MV. Agreement within 2% or 2 mm was found between calculated and measured doses, over a large set of test cases, for 15, 30, 45, and 60 degree symmetric and asymmetric VW fields, using the manufacturer's supplied mu and c values for each beam.

Dose calculations for external photon beams in radiotherapy

Dose calculation methods for photon beams are reviewed in the context of radiation therapy treatment planning. Following introductory summaries on photon beam characteristics and clinical requirements on dose calculations, calculation methods are described in order of increasing explicitness of particle transport. The simplest are dose ratio factorizations limited to point dose estimates useful for checking other more general, but also more complex, approaches. Some methods incorporate detailed modelling of scatter dose through differentiation of measured data combined with various integration techniques. State-of-the-art methods based on point or pencil kernels, which are derived through Monte Carlo simulations, to characterize secondary particle transport are presented in some detail. Explicit particle transport methods, such as Monte Carlo, are briefly summarized. The extensive literature on beam characterization and handling of treatment head scatter is reviewed in the context of providing phase space data for kernel based and/or direct Monte Carlo dose calculations. Finally, a brief overview of inverse methods for optimization and dose reconstruction is provided.