Superficial dose evaluation of four dose calculation algorithms

Accurate superficial dose calculation is of major importance because of the skin toxicity in radiotherapy, especially within the initial 2 mm depth being considered more clinically relevant. The aim of this study is to evaluate superficial dose calculation accuracy of four commonly used algorithms in commercially available treatment planning systems (TPS) by Monte Carlo (MC) simulation and film measurements. The superficial dose in a simple geometrical phantom with size of 30 cm x 30 cm x 30 cm was calculated by PBC (Pencil Beam Convolution), AAA (Analytical Anisotropic Algorithm), AXB (Acuros XB) in Eclipse system and CCC (Collapsed Cone Convolution) in Raystation system under the conditions of source to surface distance (SSD) of 100 cm and field size (FS) of 10 x 10 cm(2). EGSnrc (BEAMnrc/DOSXYZnrc) program was performed to simulate the central axis dose distribution of Varian Trilogy accelerator, combined with measurements of superficial dose distribution by an extrapolation method of multilayer radiochromic films, to estimate the dose calculation accuracy of four algorithms in the superficial region which was recommended in detail by the ICRU (International Commission on Radiation Units and Measurement) and the ICRP (International Commission on Radiological Protection). In superficial region, good agreement was achieved between MC simulation and film extrapolation method, with the mean differences less than 1%, 2% and 5% for 0, 30 degrees and 60 degrees, respectively. The relative skin dose errors were 0.84%, 1.88% and 3.90%; the mean dose discrepancies (0, 30 and 60) between each of four algorithms and MC simulation were (2.41 +/- 1.55%, +/- 3.11 2.40%, and 1.53 +/- 1.05%), (3.09 +/- 3.00%, 3.10 +/- 3.01%, and 3.77 +/- 3.59%), (3.16 +/- 1.50%, 8.70 +/- 2.84%, and 18.20 +/- 4.10%) and (14.45 +/- 4.66%, 10.74 +/- 4.54%, and 334 +/- 3.26%) for AXB, CCC, AAA and PBC respectively. Monte Carlo simulation verified the feasibility of the superficial dose measurements by multilayer Gafchromic films. And the rank of superficial dose calculation accuracy of four algorithms was AXB > CCC > AAA > PBC. Care should be taken when using the AAA and PBC algorithms in the superficial dose calculation. (C) 2016 Elsevier Ltd. All rights reserved.