Dosimetric accuracy of tomotherapy dose calculation in thorax lesions

Background: To analyse limits and capabilities in dose calculation of collapsed-cone-convolution (CCC) algorithm implemented in helical tomotherapy (HT) treatment planning system for thorax lesions. Methods: The agreement between measured and calculated dose was verified both in homogeneous (Cheese Phantom) and in a custom-made inhomogeneous phantom. The inhomogeneous phantom was employed to mimic a patient's thorax region with lung density encountered in extreme cases and acrylic inserts of various dimensions and positions inside the lung cavity. For both phantoms, different lung treatment plans (single or multiple metastases and targets in the mediastinum) using HT technique were simulated and verified. Point and planar dose measurements, both with radiographic extended-dose-range (EDR2) and radiochromic external beam therapy (EBT2) films, were performed. Absolute point dose measurements, dose profile comparisons and quantitative analysis of gamma function distributions were analyzed. Results: An excellent agreement between measured and calculated dose distributions was found in homogeneous media, both for point and planar dose measurements. Absolute dose deviations < 3% were found for all considered measurement points, both inside the PTV and in critical structures. Very good results were also found for planar dose distribution comparisons, where at least 96% of all points satisfied the gamma acceptance criteria (3%-3 mm), both for EDR2 and for EBT2 films. Acceptable results were also reported for the inhomogeneous phantom. Similar point dose deviations were found with slightly worse agreement for the planar dose distribution comparison: 96% of all points passed the gamma analysis test with acceptable levels of 4%-4 mm and 5%-4 mm, for EDR2 and EBT2 films respectively. Lower accuracy was observed in high dose/low density regions, where CCC seems to overestimate the measured dose around 4-5%. Conclusions: Very acceptable accuracy was found for complex lung treatment plans calculated with CCC algorithm implemented in the tomotherapy TPS even in the heterogeneous phantom with very low lung-density.