The impact of treatment couch modelling on RapidArc

A planning and dosimetric study was carried out on a cohort of six CT datasets from patients treated for prostate cancer to assess the impact of couch modelling on the accuracy of dose calculation for the volumetric modulated arc technique RapidArc. For each patient, RapidArc plans were optimized using the couch while final dose calculation was performed with different conditions (thin, medium, thick and no couch). Analysis was performed in terms of dose volume histograms, dose difference histograms and 3D-gamma tests. Pre-treatment verification measurements were performed using the PTW-729 array in conjunction with the Octavius phantom (PTW, Freiburg); similarly, HU characterization of couch was performed with the same phantom and ion chamber measurements comparing calculations and experimental data. A set of Hounsfield Units (HU) valid for low and high energy and the entire couch length was found as internal structure HU = -960, surface shell HU = -700. Analysis of dose plans showed that differences larger than 1.5 Gy for a 70 Gy prescription might be observed on significant fractions of PTVs. Smaller differences are visible in the medium low-dose regions. Pre-treatment verification on composite delivery confirmed these observations and, at the same time, showed good accuracy of dose calculations in the presence of couch modelling compared to delivery in the same conditions (GAI ranging from 95% to 100%). Results confirmed the reliability of the geometrical model build in the planning system Eclipse, and (i) there is no measurable effect if the wrong segment of the couch is used in the calculations; (ii) there are significant discrepancies of potential clinical impact at the level of the target volumes if calculations are performed without couch and delivery is performed with couch, and (iii) the effect is particularly relevant at low energy (6 MV in this case) that is the configuration clinically used by most of the centres adopting technologies based on intensity-modulated arcs.