Assessment of accuracy of out-of-field dose calculations by TiGRT treatment planning system in radiotherapy

Aim: The objective was to quantify the accuracy of dose calculation for out-of-field regions by the commercially available TiGRT version 1.2 (LinaTech, Sunnyvale, CA, USA) treatment planning system (TPS) for a clinical treatment delivered on a Siemens Primus with the single energy of 6 MV. Materials and Methods: Two tangential open fields were planned by TiGRT TPS to irradiate the left breast of a RANDO phantom. Dose values to out-of-field points were calculated by TiGRT TPS. A RANDO phantom was then irradiated, and dose values at set points were measured using thermoluminescent detectors-100 (TLDs-100) which were located within the phantom. Finally, the TLD-measured dose was compared to the TPS-calculated dose and the accuracy of TPS calculations at different distances from the field edge was quantified. Results: The measurements showed that TiGRT TPS generally underestimated the dose of out-of-field points and this underestimation worsened for regions relatively close to the treatment field edge. The mean underestimation of out-of-field doses was 39%. Nevertheless, the accuracy of dose calculation by this TPS for most in-field regions was within tolerance. Conclusion: This study highlights the limitations of TiGRT TPSs in calculating of the out-of-field dose. It should be noted that out-of-field data for this TPS should only be applied with a certain understanding of the accuracy of calculated dose outside the treatment field. Therefore, using the TPS-calculated dose could lead to an underestimation of secondary cancer risk as well as a weak clinical decision for patients with implantable cardiac pacemakers or pregnant patients.