Monte Carlo simulation of helical tomotherapy with PENELOPE

Helical tomotherapy (HT) delivers intensity-modulated radiation therapy (IMRT) using the simultaneous movement of the couch, the gantry and the binary multileaf collimator (MLC), a procedure that differs from conventional dynamic or step-and-shoot IMRT. A Monte Carlo (MC) simulation of HT in the helical mode therefore requires a new approach. Using validated phase-space files (PSFs) obtained through the MC simulation of the static mode with PENELOPE, an analytical model of the binary MLC, called the 'transfer function' (TF), was first devised to perform the transport of particles through the MLC much faster than time-consuming MC simulation and with no significant loss of accuracy. Second, a new tool, called TomoPen, was designed to simulate the helical mode by rotating and translating the initial coordinates and directions of the particles in the PSF according to the instantaneous position of the machine, transporting the particles through the MLC (in the instantaneous configuration defined by the sinogram), and computing the dose distribution in the CT structure using PENELOPE. Good agreement with measurements and with the treatment planning system of tomotherapy was obtained, with deviations generally well within 2%/1 mm, for the simulation of the helical mode for two commissioning procedures and a clinical plan calculated and measured in homogeneous conditions.