Photon beam dosimetry with EBT3 film in heterogeneous regions: Application to the evaluation of dose-calculation algorithms

For a better understanding of the accuracy of state-of-the-art-radiation therapies, 2-dimensional dosimetry in a patient-like environment will be helpful. Therefore, the dosimetry of EBT3 films in non-water-equivalent tissues was investigated, and the accuracy of commercially-used dose-calculation algorithms was evaluated with EBT3 measurement. Dose distributions were measured with EBT3 films for an in-house-designed phantom that contained a lung or a bone substitute, i.e., an air cavity (3 × 3 × 3 cm3) or teflon (2 × 2 × 2 cm3 or 3 × 3 × 3 cm3), respectively. The phantom was irradiated with 6-MV X-rays with field sizes of 2 × 2, 3 × 3, and 5 × 5 cm2. The accuracy of EBT3 dosimetry was evaluated by comparing the measured dose with the dose obtained from Monte Carlo (MC) simulations. A dose-to-bone-equivalent material was obtained by multiplying the EBT3 measurements by the stopping power ratio (SPR). The EBT3 measurements were then compared with the predictions from four algorithms: Monte Carlo (MC) in iPlan, acuros XB (AXB), analytical anisotropic algorithm (AAA) in Eclipse, and superposition-convolution (SC) in Pinnacle. For the air cavity, the EBT3 measurements agreed with the MC calculation to within 2% on average. For teflon, the EBT3 measurements differed by 9.297% (±0.9229%) on average from the Monte Carlo calculation before dose conversion, and by 0.717% (±0.6546%) after applying the SPR. The doses calculated by using the MC, AXB, AAA, and SC algorithms for the air cavity differed from the EBT3 measurements on average by 2.174, 2.863, 18.01, and 8.391%, respectively; for teflon, the average differences were 3.447, 4.113, 7.589, and 5.102%. The EBT3 measurements corrected with the SPR agreed with 2% on average both within and beyond the heterogeneities with MC results, thereby indicating that EBT3 dosimetry can be used in heterogeneous media. The MC and the AXB dose calculation algorithms exhibited clinically-acceptable accuracy (<5%) in heterogeneities.