There are a couple of algorithm sheets in the content section of the course.

After looking them

over, what computer algorithms does your treatment planning computer use? Discuss with the
physicist and describe to your classmates which algorithms are used and why. What are the
advantages and disadvantages your algorithm has? No references needed for this post.

Virginia Commonwealth University Health System Massey Cancer Center utilizes

Pinnacle as the treatment planning system. In order to perform photon beam calculations
Pinnacle uses one of the three-dimensional integration methods called convolutionsuperposition.1 Convolution-superposition is a model based algorithm where dose is computed
from first principles rather than correcting measured dose distributions obtained in a water
phantom. Pinnacle utilizes Collapsed Cone Convolution Superposition (CCCS) algorithm which
is a true three-dimensional calculation algorithm. CCCS dose calculation performs kernel
stretching to account for heterogeneities. The kernel is a dose matrix generated per unit terma at
interaction site. The dose is obtained once terma and dose kernel are integrated over a volume.
Pinnacle treatment planning system has 3 dose calculation algorithms, all of which are
convolution calculations. They are the collapsed-cone, adaptive and fast convolution. Full
collapsed-cone convolution is the most accurate however is the most time consuming. Fast
convolution is faster than the other two, but less accurate in penumbra and heterogeneity
boundaries. Fast convolution is the most useful for beam optimization and rough estimates of
dose. VCUHS uses adaptive convolution which samples every 4th dose point and interpolates in
flat dose regions. Adaptive convolution is based on gradient of terma and has a capability to
switch to full collapsed-cone convolution if needed. Therefore its advantages are accuracy and
efficiency.
When it comes to electron beam computations VCUHS utilized pencil beam algorithm
which is based on Gaussian pencil beam distribution with application of multiple scattering
theory.1 The pencil beam algorithm allows for calculation of dose distributions for fields of any
shape and size, irregular or sloping surface contours, and tissue heterogeneities in 3D. The
disadvantage of this algorithm is inaccuracy at different density tissues such as tissue-lung,
tissue-bone, and bone-edges.
Massey cancer center also utilizes BrainLab treatment planning system for the stereo
cases. Pencil Beam (PB) algorithm used for computations takes an incident beam and is divided
into many pencil beams. A kernel dose distribution is applied for each beam, as well as the

heterogeneity corrections. Pencil beam algorithm is proven effective for tumors located in
homogeneous regions with similar tissue consistency such as the brain. The limitation of PB
could be when computing the dose to the extra-cranial tumors such as in the lung, and head and
neck regions where large inhomogeneities exist.
References
1. Discussion with Joshua David Evans, Medical Physicist at the Virginia Commonwealth
University Health System Massey Cancer Center. March 30, 2015.