A comparison of two photon planning algorithms for 8 MV and 25 MV X-ray beams in lung

We report results of a comparison of two photon planning algorithms, the Clarkson Scatter Integration algorithm and the Equivalent Tissue-air Ratio algorithm, using a simple lung phantom for 8 MV and 25 MV X-ray beams of field sizes 5 cm x 5cm and 10 cm x 10 cm. Central axis depth-dose distributions were measured with a thimble chamber or a Markus parallel-plate chamber. Dose profile distributions were measured with TLD rods and films. Measured dose distributions were then compared to predicted dose distributions. Both agorithms overestimate the dose at mid-lung as they do not account for the effect of electronic disequilibrium. The Clarkson algorithm consistently shows less accurate results in comparison with the ETAR algorithm. There is additional error in the case of the Clarkson algorithm because of the assumption of a unit density medium in calculating scatter, which gives an overestimate in the effective scatter-air ratios in lung. For a 5 cm x 5 cm field, the error of dose prediction (Dpredicted-Dmeasured) for 25 MV x-ray beam at mid-lung is 15.8% and 12.8% for Clarkson and ETAR algorithm respectively. At 8 MV the error is 9.3% and 5.1% respectively. In addition, both algorithms underestimate the penumbral width at mid-lung as they do not account for the penumbral flaring effect in low density medium. It is very important for medical physicists, radiation therapists and clinicians to be aware of the limitation of their radiotherapy treatment planning systems.