Superficial dose distribution in breast for tangential radiation treatment, Monte Carlo evaluation of Eclipse algorithms in case of phantom and patient geometries

Purpose: The aim of this study is to examine experimentally and by the Monte Carlo method the accuracy of the Eclipse Pencil Beam Convolution (PBC) and Analytical Anisotropic Algorithm (AAA) algorithms in the superficial region (0-2 cm) of the breast for tangential photon beams in a phantom case as well as in a number of patient geometries. The aim is also to identify differences in how the patient computer tomography data are handled by the treatment planning system and in the Monte Carlo simulations in order to reduce influences of these effects on the evaluation. Materials and methods: Measurements by thermoluminescent dosimeters and gafchromic film are performed for six MV tangential irradiation of the cylindrical solid water phantom. Tangential treatment of seven patients is investigated considering open beams. Dose distributions are obtained by the Eclipse PBC and AAA algorithms. Monte Carlo calculations are carried out by BEAMnrc/DOSXYZnrc code package. Calculations are performed with a calculation grid of 1.25 x 1.25 x 5 mm(3) for PBC and 2 x 2 x 5 mm(3) for AAA and Monte Carlo, respectively. Dose comparison is performed in both dose and spatial domains by the normalized dose difference method. Results: Experimental profiles from the surface toward the geometrical center of the cylindrical phantom are obtained at the beam entrance and exit as well as laterally. Full dose is received beyond 2 mm in the lateral superficial region and beyond 7 mm at the beam entrance. Good agreement between experimental, Monte Carlo and AAA data is obtained, whereas PBC is seen to underestimate the entrance dose the first 3-4 mm and the lateral dose by more than 5% up to 8 mm depth. In the patient cases considered, AAA and Monte Carlo show agreement within 3% dose and 4 mm spatial tolerance. PBC systematically underestimates the dose at the breast apex. The dimensions of region out of tolerance vary with the local breast shape. Different interpretations of patient boundaries in Monte Carlo and the Eclipse are found to influence the evaluation. Computer tomography marker wire may introduce local disturbance effects on the comparison as well. These factors are not related to the accuracy of the calculation algorithms and their effect is taken into account in the evaluation. Conclusions: The accuracy of AAA in the case of the solid water phantom is comparable with that of the Monte Carlo method. The AAA-Monte Carlo differences in the patient cases considered are within 3%, 4 mm tolerance. The PBC algorithm does not give equivalent results. In the phantom case, PBC underestimates the lateral dose by more than 5% up to 8 mm depth. The PBC-Monte Carlo differences in the patient cases are outside the tolerance at the breast apex. The dimension of region varies with the breast shape being typically 8-10 mm long and 6-8 mm deep. (C) 2011 Elsevier Ireland Ltd. All rights reserved. Radiotherapy and Oncology 102 (2012) 102-107