Comparison of Monaco treatment planning system algorithms and Monte Carlo simulation for small fields in anthropomorphic RANDO phantom: The esophagus case

Background: In this study, the dose distributions obtained by the algorithms used in Monaco treatment planning system (TPS) and Monte Carlo (MC) simulation were compared for small fields in the anthropomorphic RANDO phantom, and then, the results were analyzed using the gamma analysis method. Materials and Methods: In the study, dose distributions obtained from the collapse cone algorithm, MC algorithm, and MC simulation were examined. The EGSnrc was utilized for MC simulation. Results: In radiation fields smaller than 3 cm x 3 cm, the doses calculated by the CC algorithm are particularly high in the region of lung/soft-tissue interfaces. In the region of soft-tissue/vertebral interfaces, the doses calculated by the CC algorithm and the MC algorithm are compatible with the MC simulation. For each algorithm, the main reason for the non-overlapping dose curves in small fields compared to MC simulation is that the lateral electronic equilibrium loss is not taken into account by the algorithms. Conclusion: The doses calculated by the algorithms used in TPS may differ, especially in environments where density changes are sharp. Even if the radiation dose from different angles is calculated similarly in the target area by the algorithms, the calculated doses in the tissues in each radiation field path may be different. Therefore, to increase the quality of radiotherapy and to protect critical organs more accurately, the accuracy of the algorithms in TPS should be checked before treatment, especially in multi-field treatments such as stereotactic body radiation therapy and intensity-modulated radiotherapy for tumors in the abdominal region.