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The influence of basic plan parameters on calculated small field output factors - A multicenter study.

Maria Daniela Falco1, Marco Fusella2, Stefania Clemente3

  • 1Department of Radiation Oncology, "G. D'Annunzio" University, "SS. Annunziata" Hospital, Chieti, Italy.

Physica Medica : PM : an International Journal Devoted to the Applications of Physics to Medicine and Biology : Official Journal of the Italian Association of Biomedical Physics (AIFB)
|July 3, 2021
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Summary

Modern treatment planning systems slightly overestimate small field output factors. Grid resolution, algorithm, and field size significantly influence these calculations, impacting radiation therapy accuracy.

Keywords:
Dose calculation algorithmGrid resolutionOutput factorsSlice thicknessTPS commissioning

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Area of Science:

  • Medical Physics
  • Radiation Oncology
  • Computational Dosimetry

Background:

  • Accurate calculation of small field output factors (OFs) is crucial for stereotactic body radiation therapy (SBRT).
  • Treatment planning systems (TPS) are used to calculate these factors, but their accuracy in small fields requires validation.

Purpose of the Study:

  • To evaluate the influence of basic plan parameters on calculated small field output factors (OFs).
  • To assess the impact of slice thickness, grid resolution, algorithm type, and field size on OF calculations in a multicentric study.

Main Methods:

  • Twenty-one centers calculated OFs using homogeneous water phantoms and their TPS for small field sizes (1x1 to 3x3 cm²).
  • Calculations were performed with varying slice thicknesses (1-3 mm) and grid resolutions (1-3 mm).
  • A multivariate analysis compared calculated OFs with measured values from TPS commissioning.

Main Results:

  • A total of 509 data points were collected, showing calculated OFs were slightly higher than measured ones.
  • Multivariate analysis identified Center, Grid Resolution (GR), algorithm type, and Field Size (FS) as significant predictors of the difference between calculated and measured OFs (p < 0.001).
  • Increasing GR led to greater discrepancies in OFs for smaller FSs. Monte Carlo and Analytical Anisotropic Algorithms showed GR dependence, unlike Collapsed Cone Convolution and Acuros. Slice thickness had a negligible effect.

Conclusions:

  • Modern TPSs tend to slightly overestimate calculated small field OFs compared to measured values.
  • Grid resolution, algorithm type, center, and field size are key factors influencing the accuracy of small field OF calculations.
  • These findings highlight the importance of careful TPS parameter selection and validation for precise SBRT delivery.