Analysis of the dose calculation accuracy for IMRT in lung: a 2D approach

The purpose of this study was to compare the dosimetric accuracy of IMRT plans for targets in lung with the accuracy of standard uniform-intensity conformal radiotherapy for different dose calculation algorithms. Tests were performed utilizing a special phantom manufactured from cork and polystyrene in order to quantify the uncertainty of two commercial TPS for IMRT in the lung. Ionization and film measurements were performed at various measuring points/planes. Additionally, single-beam and uniform-intensity multiple-beam tests were performed, in order to investigate deviations due to other characteristics of IMRT. Helax-TMS V6.1(A) was tested for 6, 10 and 25 MV and BrainSCAN 5.2 for 6 MV photon beams, respectively. Pencil beam (PB) with simple inhomogeneity correction and 'collapsed cone' (CC) algorithms were applied for dose calculations. However, the latter was not incorporated during optimization hence only post-optimization recalculation was tested. Two-dimensional dose distributions were evaluated applying the gamma index concept. Conformal plans showed the same accuracy as IMRT plans. Ionization chamber measurements detected deviations of up to 5% when a PB algorithm was used for IMRT dose calculations. Significant improvement (deviations approximately 2%) was observed when IMRT plans were recalculated with the CC algorithm, especially for the highest nominal energy. All gamma evaluations confirmed substantial improvement with the CC algorithm in 2D. While PB dose distributions showed most discrepancies in lower (<50%) and high (>90%) dose regions, the CC dose distributions deviated mainly in the high dose gradient (20-80%) region. The advantages of IMRT (conformity, intra-target dose control) should be counterbalanced with possible calculation inaccuracies for targets in the lung. Until no superior dose calculation algorithms are involved in the iterative optimization process it should be used with great care. When only PB algorithm with simple inhomogeneity correction is used, lower energy photon beams should be utilized.