title: The effect of different lung densities on the accuracy of various radiotherapy dose calculation methods: implications for tumour coverage.
abstract: OBJECTIVE
  To evaluate against Monte-Carlo the performance of various dose calculations algorithms regarding lung tumour coverage in stereotactic body radiotherapy (SBRT) conditions.
  
  
  METHODS
  Dose distributions in virtual lung phantoms have been calculated using four commercial Treatment Planning System (TPS) algorithms and one Monte Carlo (MC) system (EGSnrc). We compared the performance of the algorithms in calculating the target dose for different degrees of lung inflation. The phantoms had a cubic 'body' and 'lung' and a central 2-cm diameter spherical 'tumour' (the body and tumour have unit density). The lung tissue was assigned five densities (rho(lung)): 0.01, 0.1, 0.2, 0.4 and 1g/cm(3). Four-field treatment plans were calculated with 6- and 18 MV narrow beams for each value of rho(lung). We considered the Pencil Beam Convolution (PBC(Ecl)) and the Analytical Anisotropic Algorithm (AAA(Ecl)) from Varian Eclipse and the Pencil Beam Convolution (PBC(OMP)) and the Collapsed Cone Convolution (CCC(OMP)) algorithms from Oncentra MasterPlan.
  
  
  RESULTS
  When changing rho(lung) from 0.4 to 0.1g/cm(3), the MC median target dose decreased from 89.2% to 74.9% for 6 MV and from 83.3% to 61.6% for 18 MV (of dose maximum in the homogenous case at both energies), while for both PB algorithms the median target dose was virtually independent of lung density.
  
  
  CONCLUSIONS
  Both PB algorithms overestimated the target dose, the overestimation increasing as rho(lung) decreased. Concerning target dose, the AAA(Ecl) and CCC(OMP) algorithms appear to be adequate alternatives to MC.
authors.affiliation: Department of Radiation Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. lasse.rye@rh.dk
authors.forename: Lasse Rye
authors.initials: LR
authors.lastname: Aarup
authors.forename: Alan E
authors.initials: AE
authors.lastname: Nahum
authors.forename: Christina
authors.initials: C
authors.lastname: Zacharatou
authors.forename: Trine
authors.initials: T
authors.lastname: Juhler-Nøttrup
authors.forename: Tommy
authors.initials: T
authors.lastname: Knöös
authors.forename: Håkan
authors.initials: H
authors.lastname: Nyström
authors.forename: Lena
authors.initials: L
authors.lastname: Specht
authors.forename: Elinore
authors.initials: E
authors.lastname: Wieslander
authors.forename: Stine S
authors.initials: SS
authors.lastname: Korreman
mesh_terms: D000465:Algorithms; D016880:Anisotropy; D003198:Computer Simulation; D004307:Dose-Response Relationship, Radiation; D006801:Humans; D008168:Lung / Q000473:pathology; D008175:Lung Neoplasms / Q000473:pathology* / Q000532:radiotherapy*; D009010:Monte Carlo Method; D011874:Radiometry / Q000379:methods; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted