title: Modeling of couch transmission in the RayStation treatment planning system.
abstract: OBJECTIVE
  To present our methods and results regarding the modeling of a carbon fiber couch (Varian Exact IGRT) in the RayStation treatment planning system (TPS).
  
  
  METHODS
  Three geometrical-models (GMs) were implemented in the TPS to represent the three different regions of the couch (thick, medium and thin). The materials and densities of each GM component were tuned to maximize the agreement between measured and calculated attenuations. Moreover, a couch computed-tomography (CT) scan was acquired and dosimetrically compared with the GMs. For validation, plan-specific quality assurance (QA) of VMAT plans (TG-119 cases, 5 prostate and 5 H&N clinical cases) was performed by comparing measured dose distributions with doses computed with and without including the GMs in the TPS.
  
  
  RESULTS
  Couch attenuations up to 4.3% were measured (energy: 6MV). Compared to couch CT, GMs could be modified to optimize the agreement with measurements and reduce dependence on the dose grid resolution. For both couch CT and GM, absolute deviations between measured and calculated attenuations were within 1.0%. When including the GMs in plan-specific QA, global 2%/2mm γ-pass rates showed an average improvement of 4.8% (p-value<0.001, max +18.6%). The couch reduced the mean dose to targets by up to 2.4% of the prescribed dose for prostate cases and up to 1.4% for H&N cases.
  
  
  CONCLUSIONS
  RayStation accurately considers the implemented couch GMs replicating measured attenuations within an uncertainty of 1.0%. Materials and densities are proposed for the Varian Exact IGRT couch. The results obtained justify introducing couch GMs in clinical routine.
authors.affiliation: Medical Physics Department, AUSL 4 Teramo - Hospital G. Mazzini, Piazza Italia 1, 64100 Teramo (TE), Italy; Post-graduate School in Medical Physics, University of L'Aquila, Piazzale Salvatore Tommasi 1, 67100 L'Aquila (AQ), Italy. Electronic address: alessandro.savini@aslteramo.it.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Savini
authors.affiliation: Medical Physics Department, AUSL 4 Teramo - Hospital G. Mazzini, Piazza Italia 1, 64100 Teramo (TE), Italy.
authors.forename: Floriana
authors.initials: F
authors.lastname: Bartolucci
authors.affiliation: Medical Physics Department, AUSL 4 Teramo - Hospital G. Mazzini, Piazza Italia 1, 64100 Teramo (TE), Italy.
authors.forename: Christian
authors.initials: C
authors.lastname: Fidanza
authors.affiliation: Medical Physics Department, AUSL 4 Teramo - Hospital G. Mazzini, Piazza Italia 1, 64100 Teramo (TE), Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Rosica
authors.affiliation: Medical Physics Department, AUSL 4 Teramo - Hospital G. Mazzini, Piazza Italia 1, 64100 Teramo (TE), Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Orlandi
mesh_terms: D002244:Carbon / Q000737:chemistry; D000077482:Carbon Fiber; D006801:Humans; D008297:Male; D015233:Models, Statistical; D009369:Neoplasms / Q000532:radiotherapy; D019047:Phantoms, Imaging; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D011874:Radiometry / Q000379:methods*; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*; D015203:Reproducibility of Results; D012984:Software; D014057:Tomography, X-Ray Computed
chemical_list: D000077482:Carbon Fiber; D002244:Carbon
keywords: Carbon fiber couch; Couch modeling; RayStation treatment planning system; Varian IGRT couch