A clinical study of MLC-based IMRT lung dose calculation accuracy on plan evaluation parameters

Intensity Modulated Radiation Therapy (IMRT) is widely accepted as an appropriate method to treat tumors at many different anatomic locations including lung. Dose calculation algorithms that have different degrees of accuracy are used to produce clinical IMRT treatment plans. In this study, Monte Carlo (MC) dose calculation was used to evaluate the reliability of plan evaluation parameters compared to a pencil beam (PB) dose calculation for IMRT of the lung.Twenty five lung IMRT cases were randomly selected for analysis. Plan evaluation parameters were calculated using PB and MC methods for the targets and organs at risk (OARs). Comparisons were made using dose-volume histograms, mean dose, and equivalent uniform dose. The following doses-volume histogram points were compared: D₉₈, D₉₅ of the GTV and PTV, V₂₀ and V₃₀ for the lungs, D₃₃ for the heart and esophagus and D_max for the spinal cord. Mean dose differences were 3.6 ± 2.3% and 4.3 ± 2.8% for the GTV and PTV, respectively. The average EUD differences were 4.1 ± 2.4% for the GTV and 5.7 ± 4.9% for the PTV. Less than 2% differences were observed between the MC and PB algorithms for all OAR plan evaluation parameters. However, minimum and maximum differences for some plan evaluation parameters ranged from about ±20%.There are appreciable differences in plan evaluation parameters between the PB and MC calculations for the targets. The mean dose and EUD have a weak but statistically significant inverse dependence on the number of fields, total MU, GTV volume and PTV volume for the targets. There can be large case-to-case differences between PB and MC for both the targets and OARs. Accurate MC calculations can remove those remaining systematic errors from treatment plans compared to PB calculations.