1. Algorithms used in heterogeneous dose calculations show systematic error as measured with the Radiological Physics Center’s anthropomorphic thorax phantom used for RTOG credentialing Stephen F. Kry Ph.D. 1, Paola Alvarez M.S. 1, Andrea Molineu M.S. 1, Carrie Amador B.S. 1, James Galvin Ph.D. 2, and David Followill Ph.D. 1 1 Radiological Physics Center, The University of Texas MD Anderson Cancer Center, Houston, TX 2 Radiation Therapy Oncology Group, Philadelphia, PA Wednesday, October 31, 2012 ASTRO Annual Meeting Boston, MA

2. Introduction Dose calculation in thorax is challenging because of heterogeneous environment. Homogeneous and low quality heterogeneous dose calculations (e.g., Batho-corrected pencil beam) are highly inaccurate These algorithms are no longer allowed in NCI- sponsored clinical trials

3. Introduction Dose calculation in thorax is challenging because of heterogeneous environment. Homogeneous and low quality heterogeneous dose calculations (e.g., Batho-corrected pencil beam) are highly inaccurate These algorithms are no longer allowed in NCI- sponsored clinical trials

4. Introduction Dose calculation in thorax is challenging because of heterogeneous environment. Homogeneous and low quality heterogeneous dose calculations (e.g., Batho-corrected pencil beam) are highly inaccurate These algorithms are no longer allowed in NCI- sponsored clinical trials Convolution-Superposition/AAA algorithms are generally considered accurate

5. Verify dose delivery: RPC phantoms (treated like a patient)

6. Verify dose delivery: RPC phantoms (treated like a patient)

7. RPC phantoms: Long history of use Homogeneous phantoms: –Average agreement of TLD and TPS: <1% (Ibbott G et al. Technol Ca Res Treat 2006;5:481) Thoracic phantom –2 TLD in center of lung target (3 cm x 5 cm) –Film in 3 planes

8. Irradiations In this study: –304 irradiations –6 MV irradiations –IMRT or 3D CRT –Moving or static –Various algorithms –All used heterogeneity corrections Evaluate –TLD dose (vs TPS) –Planar agreement DTA or gamma

9. TLD Measurement vs TPS calculation

12. TLD Dose Findings Measured doses systematically lower than calculated doses for C/S AAA algorithms (p<0.0001) No significant difference between C/S AAA algorithms For C/S AAA algorithms: No significant difference between IMRT (mean=0.963) and 3D CRT (mean=0.964) irradiations (p=0.7) No significant difference between moving (mean=0.961) and static (mean=0.964) irradiations (p=0.5) No significant trend versus irradiation date (p=0.2)

13. Planar film results Pencil Beam algorithms showed worst DTA (p=0.03) No significant difference between MC and CS/AAA Pre-2010 analysis Post-2010 analysis

14. Discussion/Conclusions Overestimation of dose with C/S AAA (3.7%) –Dose to center of target –Agreement distribution not bimodal Why difference with MC? –Radiation transport –Dose reporting –CT calibration –Combination of these Issue for dose calculation accuracy (TG-65 goal: 1-2%) Potentially issue for dose reporting/prescribing

15. Thank You! This work was supported by grants CA010953, CA081647, CA21661