Phys. Med. Biol. 45 (2000) 29312945.

Printed in the UK

PII: S0031-9155(00)13708-X

Accuracy of the phase space evolution dose calculation model for clinical 25 MeV electron beams
Erik W Korevaar, Abdelhad Akhiat, Ben J M Heijmen and Henk Huizenga
Daniel den Hoed Cancer Center, University Hospital Rotterdam, PO Box 5201, 3008 AE Rotterdam, The Netherlands Joint Center for Radiation Oncology ArnhemNijmegen, University Medical Center Nijmegen, PO Box 9101, 6500 HB Nijmegen, The Netherlands E-mail: korevaar@kfih.azr.nl Received 4 May 2000 Abstract. The phase space evolution (PSE) model is a dose calculation model for electron beams in radiation oncology developed with the aim of a higher accuracy than the commonly used pencil beam (PB) models and with shorter calculation times than needed for Monte Carlo (MC) calculations. In this paper the accuracy of the PSE model has been investigated for 25 MeV electron beams of a MM50 racetrack microtron (Scanditronix Medical AB, Sweden) and compared with the results of a PB model. Measurements have been performed for tests like non-standard SSD, irregularly shaped elds, oblique incidence and in phantoms with heterogeneities of air, bone and lung. MC calculations have been performed as well, to reveal possible errors in the measurements and/or possible inaccuracies in the interaction data used for the bone and lung substitute materials. Results show a good agreement between PSE calculated dose distributions and measurements. For all points the differencesin absolute dosewere generally well within 3% and 3 mm. However, the PSE model was found to be less accurate in large regions of low-density material and errors of up to 6% were found for the lung phantom. Results of the PB model show larger deviations, with differences of up to 6% and 6 mm and of up to 10% for the lung phantom; at shortened SSDs the dose was overestimated by up to 6%. The agreement between MC calculations and measurement was good. For the bone and the lung phantom maximum deviations of 4% and 3% were found, caused by uncertainties about the actual interaction data. In conclusion, using the phase space evolution model, absolute 3D dose distributions of 25 MeV electron beams can be calculated with sufcient accuracy in most cases. The accuracy is signicantly better than for a pencil beam model. In regions of lung tissue, a Monte Carlo model yields more accurate results than the current implementation of the PSE model.

1. Introduction At present the pencil beam (PB) method is the most widespread method for electron beam dose calculations in radiotherapy (Hogstrom et al 1981, Brahme et al 1981). An alternative is the Monte Carlo (MC) method (Nelson et al 1985, Ma et al 1999), which has the advantage of a higher accuracy but the disadvantage of relatively long calculation times. In the past alternative electron beam dose calculation models have been developed in an attempt to compute the dose faster than Monte Carlo yet retain an accuracy that is sufcient for application in radiation oncology. Examples of such models based on the Monte Carlo method are macro Monte Carlo, super Monte Carlo and voxel Monte Carlo (Neuenschwander and Born 1992, Neuenschwander et al 1995, Keall and Hoban 1996, Kawrakow et al 1996). The subject of the present study is
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the phase space evolution (PSE) model, also developed with the aims of increased calculation speed and accuracy but being a numerical solution to the transport equation in phase space (Huizenga and Storchi 1989, Morawska-Kaczy nska and Huizenga 1992, Janssen et al 1994, 1997a, Korevaar et al 1996). The version of the phase space evolution model studied here is a research version that was coupled to the CADPLAN treatment planning system (VarianDosetek version 6.0.4). Two main modications were made in comparison to the model described by Janssen et al (1997a), i.e. the use of a diverging calculation grid and a new model to derive the initial phase space from a few measured depth dose distributions in water (Janssen et al 1997b). The aim of the present paper is to investigate the accuracy of the PSE model for clinical, high-energy electron beams and to compare the PSE results with the results of a commonly used implementation of the pencil beam method. In this study it was investigated whether and to what extent, the accuracy of electron beam dose calculations can be improved by using the PSE model instead of a PB model. The pencil beam model studied here was the pencil beam algorithm implemented in CADPLAN (version 3.1.2). This is a generalized Gaussian pencil beam model (Hy odynmaa 1991); however, in the 2250 MeV energy range a single Gaussian pencil beam model is used. Recent publications have already shown that the accuracy of the pencil beam model in CADPLAN is sufcient in many cases, with the exception of complex geometries with heterogeneities (Samuelsson et al 1998, Ding et al 1999). The accuracies of the PSE model and the PB model have been determined by comparisons of calculated and measured results in water phantoms and in phantoms with heterogeneities. The test cases were selected to best reect situations frequently encountered in clinical treatment planning and are similar to tests described by other authors (Shiu et al 1992, Muller-Runkel and Cho 1997, Blomquist et al 1996). For some geometries, Monte Carlo simulations have been done with the EGS4 code to verify the measured results. Furthermore, the comparison of calculated results from the PSE and PB models with MC calculations allowed analysis of the whole 3D dose distribution, whereas the comparison with measured results was limited to a few lines and/or planes for practical reasons. 2. Methods and materials 2.1. Measurements Measurements have been done for 25 MeV, multileaf collimator shaped electron beams of an MM50 racetrack microtron (Karlsson et al 1992). The purpose of the measurements was to collect input data for the conguration of the dose calculation models and to obtain benchmark data to assess the accuracy of the models. The measurements performed to collect data for conguration of the dose calculation models are specied in table 1. To test the dose calculation models for the 25 MeV electron beam, measurements were performed in both water and heterogeneous phantoms (table 2). The standard sourcesurface distance (SSD) adopted was 900 mm. Non-standard SSD measurements were performed in water as were the irregular eld shape (gure 1(a)) and the oblique incidence (gure 1(b)). For tests in heterogeneous phantoms three polystyrene based phantoms were used: one containing an air cavity, one containing a cavity with a bone substitute and one with a lung substitute (gures 1(c), 1(d ) and 1(e)). To determine the accuracy of the dose calculation models for polystyrene measurements were performed in a homogeneous polystyrene phantom. These measurements utilized a cylindrical ionization chamber inserted into a milled space within a slab (gure 1(c)). Depth dose curves were measured by variation of the depth of this slab. Ionization readings were converted to dose in polystyrene by multiplication with the air to

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Table 1. Measured input data to congure the 25 MeV electron beam for the PSE model and the PB model. (For the PSE model the depth dose curve of the blocked eld was not used. For the PB model only the depth dose curves at 1000 mm SSD (sourcesurface distance) for the largest eld size and the blocked eld were used.) Name Depth dose curve Depth dose curve svir x SSD (mm) 900, 1000 1000 8001300 8001500 Field sizes (mm2 ) 310 400, 150 150, 100 100, 50 50 Completely blocked eld 310 400 100 100 Measurement Diode in water tank Diode in water tank Ionization chamber in water tank Film in air

Scanditronix linear diode array in an RFA 300 scanning system. Distance from the virtual point source to the plane through the isocentre (ICRU 1984). svir has been determined by the inverse square law method for the largest eld size. NACP type ionization chamber. Root of the angular variance at the level of the multileaf collimator, derived from penumbra widths measured in air at various SSDs (van Battum and Huizenga 1999). Table 2. Summary of tests. Field sizes are dened at the level of the isocentre. Measurement positions have been specied in gure 1. SSD (mm) Non-standard SSD L-shaped eld Oblique incidence (30 ) Polystyrene phantom Phantom with air cavity Phantom with bone Lung phantom 850, 950 900 1000 900 900 900 900 Field size (mm2 ) 100 100 40/80 100/150 150 150 100 100 140 140 140 140 100 100 Phantom Water Water Water PS PS/air PS/bone PS/cork /PS Detector type Diode Diode IC, lm IC IC, lm IC, lm IC, lm

IC = ionization chamber, type PTW Semiex Tube, 0.125 cm3 , Waterproof; T31002. PS = white polystyrene, density 1.05 g cm3 . Bone = hard bone-equivalent material, density 1.92 g cm3 (SB5, ICRU 1989). Cork density = 0.23 g cm3 .

polystyrene stopping power ratio at the corresponding depth (AAPM 1983). The stopping power ratios applied to measurements behind the air or bone heterogeneity were determined by calculation of the equivalent thickness of the heterogeneity, i.e. the actual thickness of the heterogeneity times the density of air or bone. No measurements were done inside the bone material. The effective point of measurement was taken as half the chamber radius above the centre of the chamber (ICRU 1984). Film (Kodak X-omat V) was used to measure dose distributions in planes perpendicular to the beam axis in the phantom with the air cavity and the phantom with bone. The lms were scanned using a Wellh ofer densitometer (WP102) and optical densities were converted to dose by application of density to dose curves (van Battum and Huizenga 1990). The dose proles measured with lm have been normalized according to the depth dose curve measured with the ionization chamber. Film was also used to determine a depth dose curve in the phantom with lung substitute, i.e. cork. Film was preferred over ionization chamber measurements, since in low-density material the chamber wall (density 1 g cm3 ) introduces uence perturbations. It has been shown that lm with an orientation perpendicular to the beam axis can be used as a reliable dosimeter in cork (El-Khatib et al 1992). After application of the optical density to dose conversion, dose to the photographic emulsion was known and the dose to the phantom material was determined

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Figure 1. Measurement geometries. (a) Beams-eye-view of the L-shaped eld formed by the leaves of the multileaf collimator. Depth dose curves (at positions indicated by points) and dose proles (dotted lines) have been measured with a diode in water in a plane through the isocentre (1) and in a plane 50 mm off-axis (2). (b) For oblique incidence the beam axis and eld edges have been indicated (dashed lines). Diode measurements have been done in water along the beam axis and along lines at depths of 30 mm, 75 mm and 100 mm from the water surface (dotted lines). (c) Side view of the phantom with T-shaped heterogeneity consisting of three slabs of polystyrene (30 mm), two slabs of polystyrene with a heterogeneity (20 mm) and 11 slabs of polystyrene (110 mm). The dashed lines indicate the beam axis and the eld edges. Ionization chamber measurements have been done along the beam axis (open circles) and dose proles have been measured at depths of 60 mm, 80 mm and 100 mm, using lm (thick lines). (d ) Beams-eye-view of the phantom with T-shaped heterogeneity with the eld edges and x , y axes indicated by dashed lines. (e) Side view of the lung phantom consisting of three slabs of polystyrene (30 mm), 10 slabs of cork (155 mm) and ve slabs of polystyrene (50 mm). The beam axis and eld edges have been indicated (dashed lines), as well as the positions of the lms (thick lines).

by multiplication of the photographic emulsion to medium stopping power ratio. In this case, the stopping power ratios were calculated as the ratios of collisional stopping powers for the mean energy at depth, assuming a linear decrease of energy with depth. This method was described by Harder and is expected to be accurate to within 23% (Klevenhagen 1993). Since reliable stopping power ratios for cork were not available, this material was considered as water equivalent with a density of 0.23 g cm3 . For the calculation with the PSE and MC models the same assumption about cork was made to describe energy loss and scattering of particles in this medium (i.e. the interaction data for water with a modied density were used). Monte Carlo calculations have been done to estimate the magnitude of the error that is made by using this assumption. The differences between depth dose curves calculated for a phantom with water and for a phantom with cellulose (C6 O5 H5 ), both of density 0.23 g cm3 , were

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within 2% (cellulose is the main component of cork). For the PB calculations the default method of heterogeneity correction was applied (section 2.3). All measured dose values have been normalized to the same reference dose, i.e. the dose maximum in water (approximately 30 mm depth) of the 25 MeV electron beam with a 100 100 mm2 eld size at an SSD of 1000 mm. The machine is calibrated to give 1 cGy per monitor unit (MU) as reference dose. 2.2. Phase space evolution model The PSE model requires as input an initial phase space, i.e. directions and energies of electrons and photons in a plane in front of the surface of the phantom or patient. Initial phase spaces corresponding to the 25 MeV electron beams of the MM50 were determined using the beam model of Janssen et al (1997b). This beam model consists of a main beam component describing the direct electrons and photons and a secondary beam component describing electrons and photons that have interacted with the collimating system (i.e. blocks or multileaf collimator for the MM50). The two additional beam components that normally model the lower collimator scatter and transmission have not been used, since these components are superuous due to the design of the treatment head of the MM50. (This accelerator utilizes a scanning beam with thin scattering foils and a double focused multileaf collimator.) The energy spectra of the beam components were derived by tting a sum of PSE calculated depth dose curves of monoenergetic beams to measured depth dose curves in square elds. The positional and directional distributions of the beam components were derived from measurements of the virtual source position and the angular variance (see table 1). For the conguration, depth dose curves measured at two SSDs were used. This method was developed for conventional treatment machines to model the variation in dose contribution from collimator scattered electrons with source to surface distance. For the MM50 the use of two SSDs in the conguration process is less important. For the water and lung phantom synthetic CT images were created with aid of the CADPLAN treatment planning system, and for the air and bone phantom CT information was acquired by using a CT scanner (Picker PQ5000V). Field sizes, beam angles and SSDs were set in the CADPLAN planning system. The CT data les and the planning les with beam positions were used as input for the PSE calculations. The CT information was transferred to the PSE coordinate system (with the z-coordinate along the beam axis) and down-sampled to a coarser grid of volume elements (voxels). Based on the average Hounseld numbers in the voxels, the materials in the voxels for the phantoms considered were dened to be either air, water, polystyrene, bone substitute or lung substitute material. A combination of two materials could be chosen for voxels intersecting an interface. A correction to the default conversion of Hounseld number to density was necessary for polystyrene, since the default formula resulted in the density being underestimated by about 5%. For the lung substitute, interaction data for water were used with an adjusted density. The default resolution of the dose and calculation grid was 5 5 5 mm3 . For situations where it was expected that a higher resolution could especially improve the accuracy, a resolution of 2.5 2.5 5 mm3 (x , y , z) was used as well. The resolution was increased in the directions perpendicular to the beam axis, because in those directions the steepest dose gradients occur for the cases considered. 2.3. Pencil beam model The input for the pencil beam model in CADPLAN consisted of depth dose curves of a large eld and a completely blocked eld, the virtual source position and the angular

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variance (table 1). Additionally, the mean electron energy at the surface has been specied and was derived from the R50 of a measured depth dose curve (ICRU 1984). The depth dose curve of the eld blocked by the multileaf collimator was used to determine the photon contamination in the electron beam, since the photon contribution is handled separately in the dose calculation algorithm. The CADPLAN system was used for the specication of phantoms and the selection of beam parameters, as described in section 2.2. The present implementation of the pencil beam model in CADPLAN contains radiation interaction data for ve materials, i.e. air, lung, adipose tissue, muscle and bone. Heterogeneity corrections were based upon the interaction data for these materials. The resolution of the calculation grid was 5 5 5 mm3 .

2.4. Monte Carlo simulations In the Monte Carlo simulations with EGS4 the positional and directional distributions of electrons in the incident beams were the same as in the initial phase spaces used in the PSE calculations. An energy distribution was determined that resulted in the best agreement between the measured dose distribution for the reference eld and MC calculations. The energy distributions determined for the MC and PSE calculations were in close agreement but not identical, due to the method of tuning the energy distribution until a good agreement between calculated and measured depth dose curves was found. Due to small differences between MC and PSE calculated depth dose curves for the same beam, slightly different energy spectra are needed for the MC and PSE calculations to obtain a good agreement between calculated and measured depth dose curves. The fraction of dose deposited in the phantom by incident photons in the electron beam considered is small (<0.5% of the reference dose), so incident photons have been neglected in the Monte Carlo simulations. Of course, photons generated in the phantom have not been neglected. For each Monte Carlo calculation of an electron track, an element was chosen from the initial phase space and the transport was started for an electron with position, direction and energy corresponding to the phase space element. To take into account the variation in fractions of electrons in phase space elements, the probability that an element was selected was linear with the fraction. The energy thresholds were chosen as ECUT = 0.7 MeV, AE = 0.521 MeV, PCUT = 0.01 MeV, AP = 0.01 MeV and the PRESTA algorithm was used. The number of electron histories was chosen so that the number of incident electrons per voxel near the beam centre at the phantom surface was about 30 000. The statistical uncertainty in the dose distribution was within 1%. The phantoms in the Monte Carlo simulations were dened by specifying the material in each voxel. The resolution was 5 5 5 mm3 . Simulations were performed for the following tests: air cavity, bone cavity and lung.

2.5. Specication of deviations In general, the PSE and PB calculated dose distributions have been compared with measured distributions. In the specication of deviations the methodology has been followed that in regions with small dose gradients, i.e. less than 1% mm1 , the difference is given as a difference in dose values at a certain position, and in regions with large dose gradients the difference is the smallest distance between positions with a certain dose value. A deviation of dose was expressed as a percentage of the reference dose and a deviation in distance was expressed in millimetres.

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Figure 2. Central axis depth dose curves in water for the reference beam; the 25 MeV electron beam with 100 100 mm2 eld size and an SSD of 1000 mm. Dose values have been normalized to the central axis maximum dose.

3. Results 3.1. Conguration After the conguration process was nished, the dose distribution in water of the reference eld, i.e. the 25 MeV electron beam with a 100 100 mm2 eld size and an SSD of 1000 mm, was calculated using the PSE model, the PB model and the Monte Carlo model. The agreement between the calculated depth dose curves and the measurement is well within 2% and 2 mm (gure 2). In the rst 3 cm of the depth dose curve, the PB model underestimates the dose by about 1.5% and for the remaining depth range the results of the three models are similar. For off-axis positions the agreement between measurements, PSE calculations and MC calculations are comparable with the results found for the central axis. The PSE calculated penumbras are somewhat broader than the measured ones, resulting in differences up to 2% and 2 mm. The accuracy of the PSE calculated dose distribution in the penumbra region depends on the resolution of the dose grid. A higher resolution of 2.5 2.5 5 mm3 resulted in a better agreement between calculation and measurement in the penumbra region. The PB calculated penumbras at depth are also too broad, resulting in maximum differences of 3% and 4 mm. 3.2. Inuence of the source to surface distance Measurements of depth dose curves at various SSDs show that the variation of central axis maximum dose with SSD for the racetrack microtron is well described by an inverse square law. The PSE calculated dose distributions exhibit the same inverse square law and for SSDs between 850 mm and 1000 mm the central axis maximum dose agrees within 1% with measurements. The PB model showed an overestimation of the dose at shortened SSDs. At an SSD of 850 mm, the maximum deviation found between PB calculation and measurement is 6% of the reference dose (see gure 3). Figure 3 shows that the R50 range calculated with the PSE model is 2.5 mm less than the measurement. A deviation that is 1 mm larger than that found for an SSD of 1000 mm. This larger deviation may be partly due to both measurement error and set-up variation. (Depth dose curves measured for the reference eld on various days show variations in R50 of about 1 mm. It is uncertain whether this variation is due to measurement accuracy limitations, or

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Figure 3. Central axis depth dose curves in water for the 25 MeV electron beam with a eld size of 85 85 mm2 at an SSD of 850 mm. Dose values have been normalized to the central axis maximum dose of the reference beam.

Figure 4. Depth dose curves (a) and dose proles (b) in the plane 50 mm off-axis in the y direction (plane (2) in gure 1(a)), for the L-shaped eld of 25 MeV. The dose proles are at depths of 30 mm, 75 mm and 100 mm. The dashed line in (b) indicates the x position of the depth dose curves shown in (a). Dose values have been normalized to the central axis maximum dose of the reference beam.

daily variation in accelerator behaviour, or a combination of both.) The depth dose curve for an SSD of 850 mm calculated with the MC model is closer to the PSE calculated curve than to the measured curve. 3.3. L-shaped eld For the L-shaped eld, measured depth dose curves and dose proles have been compared with calculated results in two planes, as indicated in gure 1(a). The agreement between the measured depth dose curves and PSE calculations is within 1% and 1 mm, except for the tail

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Figure 5. Depth dose curves along the beam axis (a) and dose proles in the central axis plane at depths of 30 mm, 75 mm and 100 mm (b), for 30 oblique incidence. The eld size and SSD of the 25 MeV electron beam were 150 150 mm2 and 1000 mm, respectively. Dose values have been normalized to the central axis maximum dose of the reference beam.

of the depth dose curve, where the difference is about 2% (see gure 4(a)). The resolution of the PSE calculation grid was 2.5 2.5 5 mm3 . For the standard resolution of 5 5 5 mm3 the range is underestimated, resulting in a maximum deviation in the R50 of 3 mm. This is due to the fact that the line along which the depth dose curve is considered is close to the eld edge, so the dose distribution is inuenced by the shape of the penumbra and calculations for the standard resolution show a small overestimation of the penumbra width. The depth dose curves calculated with the pencil beam model show an overestimation of the dose in the fall-off region, resulting in a maximum difference between measurement and calculation of 6% in the region around R90 . The measured dose prole in the off-axis plane at 30 mm depth shows an obliqueness that was not found in the calculations, resulting in a difference between measurement and PSE calculations of 3% (see gure 4(b)). This might be due to an accelerator beam asymmetry that is neglected in the initial phase space used in the PSE calculation. The dose proles calculated with the PB model show differences that are equal to or smaller than the maximum difference of 6% found in the depth dose curves. 3.4. Oblique incidence As shown in gure 5(a), the calculated PSE range is too small compared with the measurement and a maximum difference of about 3 mm is found in the region around R80 . The results of the pencil beam model agree with the measurements within 2 mm in the dose fall-off region, but the dose maximum is underestimated by 3% and in the build-up region a maximum difference of 6% was found. Figure 5(b) shows that the obliqueness of the dose proles is well predicted by the PSE model and the PB model. The differences in absolute dose between calculated and measured dose proles is a result of the described differences in depth dose curves. 3.5. Homogeneous polystyrene phantom and phantom with air cavity For the homogeneous polystyrene phantom, the measured central axis depth dose curve and results of the PSE model, PB model and MC model all agree within 2 mm and 2%. This indicates that for the measurement the correct stopping power ratios have been applied and that in the calculations the correct interaction data have been used. The material data set of the pencil beam model in CADPLAN does not contain data for polystyrene, but apparently

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Figure 6. Central axis depth dose curves (a), dose proles at 60 mm depth (b) and dose proles at 80 mm and 100 mm depth (c), for the polystyrene phantom with an air cavity. The eld size of the 25 MeV electron beam was 126 126 mm2 at an SSD of 900 mm. Dose values have been normalized to the central axis maximum dose in water of the reference beam, except for the pencil beam results, for which a renormalization was necessary (see section 3.5).

the use of data for muscle and/or adipose tissue does not result in large errors for calculation of doses in polystyrene. Figure 6(a) shows the depth dose curves for the polystyrene phantom with an air cavity. The effect of the air cavity on the depth dose curve is a reduction of the dose beyond the cavity, followed by a second build up. Another effect is an increase in the electron range of about 20 mm. These effects are well predicted by the three dose calculation models. The agreement between measurements and results of the PSE model and the MC model is within 2% and 2 mm. However, the PB results were about 4% too high at all points along the central axis. This result can be explained in part by the PB models overestimation of dose at an SSD of 900 mm. To separate out the contribution of the SSD to the difference, the dose distributions calculated with the PB model for the phantoms with air, bone and lung were renormalized to 96%. This is similar to considering electron beams at an SSD of 900 mm to be separate beams in the PB model, which require a conguration independent of beams at an SSD of 1000 mm. After renormalization, the PB calculated depth dose curve for the phantom with an air cavity agrees within 2% and 2 mm with the measurement (gure 6(a)). For off-axis positions the variation in dose due to the air cavity is well described by the PSE model, as shown by comparison with the measurement and the Monte Carlo calculations (gures 6(b) and 6(c)). The dose proles calculated with the PB model demonstrate the well known fact that PB models underestimate the effect of air cavities at depth. By using the PB model the dose lateral to the air cavity is overestimated by about 8%, and without the renormalization this would be an error of 12%. 3.6. Phantom with bone heterogeneity The effect of the bone heterogeneity on the depth dose curve is a reduced electron range and the results of the MC model show a reduction of dose in bone, followed by a second build up in bone (gure 7(a)). The two effects are also present in the PSE results, and the differences with

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Figure 7. Central axis depth dose curves (a), dose proles at 60 mm depth (b) and dose proles at 80 mm and 100 mm depth (c), for the polystyrene phantom with a bone heterogeneity. The eld size of the 25 MeV electron beam was 126 126 mm2 at an SSD of 900 mm. Dose values have been normalized to the central axis maximum dose in water of the reference beam, except for the PB results, for which a renormalization was necessary (see section 3.5).

the measured depth dose curve and the MC calculation are within 2% and 2 mm. The depth dose curve calculated with the PB model shows that with this model the build up in bone is neglected, which leads to an underestimation of the dose in and beyond the bone heterogeneity of about 6%. Furthermore the results of the PB model show an underestimation of dose of about 8% that could not be explained from the PB theory, about 6 mm supercially from the front side of the bone heterogeneity. For off-axis positions, maximum differences between dose values calculated with the PSE model and measurements were found of about 4% and 4 mm (gure 7(b)). A comparison of the results of the MC model and the measurements shows differences of the same order, and for most positions the PSE calculations are in better agreement with the MC calculations than with the measurement. This might indicate that deviations between the PSE model and the measurement are partly due to errors in the input data used in the calculations. The magnitude of the lateral dose variations due to the bone heterogeneity is not underestimated when the PB model is used, but the steepness of the dose gradients is too small. Differences between PB calculations and the measurement for off-axis positions have a maximum of 6% and 4 mm. 3.7. Lung phantom As shown in gure 8, the low-density region has a large inuence on the shape of the depth dose curves. In the low-density material the high-dose plateau is absent, instead the dose decreases continuously with depth. The electron range is doubled compared with the depth dose curves in water (gure 2). Both effects are present in the measurement and the results of the dose calculation models. However, differences between measured and calculated results were larger than found in previous tests. The differences between measurement and MC calculations are within 3%. Considering the uncertainties in interaction data and stopping power ratios, as discussed in section 2.1, these differences are acceptable. Compared with

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Figure 8. Central axis depth dose curves (a) and dose proles at 45 mm, 90 mm and 155 mm depth (b) for the polystyrene/lung phantom. The eld size of the 25 MeV electron beam was 90 90 mm2 at an SSD of 900 mm. Dose values have been normalized to the central axis maximum dose in water of the reference beam, except for the PB results, for which a renormalization was necessary (see section 3.5).

both the measurement and the MC calculation, the PSE calculated depth dose curve shows dose values that are too low in the distal part of the lung region. The maximum difference is about 6% of the reference dose. The dose proles show that the penumbra broadening in lung is well predicted when the PSE model is used. The PB model shows an overestimation of the dose in lung that increases with depth. Compared with both the measurement and the MC calculation, the difference has a maximum of about 9%. The dose proles show that at depth the PB calculated penumbras are sharper than the measured ones. 3.8. Calculation times For the PSE model, the time to calculate a 3D dose distribution for the reference eld with a resolution of the dose grid of 5 5 5 mm3 was about 30 min on an HP workstation (HewlettPackard 9000/B1000 with 1 Gb of internal memory). For the PB model in CADPLAN, the time needed to calculate the complete 3D dose distribution, i.e. 30 slices with a slice distance of 5 mm, was about 15 min. So with the PB model the calculation time was only a factor of 2 shorter but the advantage of the PB model is the possibility of calculating the dose distribution in a single slice in a relatively short time of 30 s. The calculation times for the MC model depend on the magnitude of statistical noise that is allowed. Maximum errors were chosen to be within 1% of the reference dose and the calculation time for the reference eld was 12.5 h on the workstation mentioned above. Compared with the MC model, the calculation time for the PSE model was about a factor of 25 shorter but for a still acceptable maximum error of 2% in the MC calculations, the advantage in calculation times drops to about a factor of 6. 4. Discussion and conclusions The majority of results show a good to excellent agreement between PSE calculations and measurements. A simplied summary of the results given above is given in table 3. Differences in absolute dose larger than 3% of the reference dose (the central axis maximum dose of the reference eld), or a shift in dose larger than 3 mm, were only found for limited volumes in the

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Table 3. Maximum differences found between measurements and calculations, in per cent of the reference dose (if the difference occurred in a region with a low dose gradient, see section 2.5) and in mm (if the difference occurred in a region with a high dose gradient). Values are for the central axis and maximum differences for off-axis positions are given in brackets if they exceed the central axis values. PSE Non-standard SSD L-shaped eld Oblique incidence Air cavity Bone Lung phantom 2 mm 2% (3%) 3 mm 2 mm 1% (4 mm) 6% PB 6% 6% 6% 2 mm (8%) 8% 9%

phantom with the bone and in the phantom with the lung density material. For the phantom with bone the agreement between the PSE results and the Monte Carlo calculations was better than the agreement with the measurement, which indicates the presence of measurement errors and/or inaccuracies in the input data used for the PSE and MC calculations. The interaction data used for the bone substitute material could be inaccurate, since it was found that the differences were smaller for the phantom with an air cavity where the interaction data for air are well known. The test in the lung phantom has shown that the PSE calculations are less accurate for large regions of low-density material. When the PSE results are compared with the PB model, it is clear that the PSE model yields more accurate results for the cases considered. However, for some of the results inaccuracies may be caused by the way the PB method is implemented, rather than due to the PB method itself. For instance, in the test of oblique incidence and for the phantom with bone, the largest differences between calculation and measurement were found in the build up region, a region where a poor accuracy of the PB method is not expected on theoretical grounds. Furthermore it should be noted that the PB model tested here was a single Gaussian PB model and a generalized Gaussian PB model might have given better results. Although tests of the latter model show results comparable with what has been presented here (Samuelsson et al 1998, Ding et al 1999). In lung material, PSE calculated results are less accurate than MC calculations. Since the underlying physics in the two models is largely the same, the difference in accuracy is probably due to artefacts introduced by the discretization of phase space (space, energy and direction) in the PSE model. For instance, for an accurate description of energy loss and directional spread of electrons due to interactions in a voxel, the widths of energy and directional bins have to be adopted to the number of interactions in a voxel. In the current version of the PSE model a xed discretization is used throughout the whole volume. An improvement to the PSE model could be a discretization adapted to local interaction properties, which could further increase agreement between PSE and MC results. These investigations have shown that it is difcult to measure dose distributions reliably within 12%, due to both the measurement technique and the day-to-day variation in accelerator behaviour. Since measurements were used for both conguration of the dose calculation models and for the determination of the accuracy, these errors should be taken into account in the judgement of the accuracies of the models. Furthermore, the importance of inaccuracies in calculated dose distributions depend not only on the magnitudes of the errors but also on the magnitudes of the volumes in which the errors occur. To consider the effects of under and overdosage, errors in the dose calculation should be judged against a typical steepness of the dose-effect relation of a 13% increase in tumour control probability (TCP) per 1% increase

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in equivalent uniform dose (EUD) in the tumor (gren Cronqvist 1995, Niemierko 1997). So, errors are clinically more relevant if they extend over larger parts of the target volume. Especially errors in the maximum dose of the central axis (the dose specication point) are important, since they relate linearly to the EUD. At present the time for calculation of a 3D dose distribution using the PSE model is too large for interactive treatment planning. It was found that the PB model can be used to calculate a relative dose distribution in a single slice with a reasonable accuracy and with a calculation time that is acceptable for interactive treatment planning. The accuracy of the PSE model is (just) within clinically acceptable limits, except for large regions with low-density material, as in lung. In that case Monte Carlo calculations are more accurate, assuming that a model is available to describe the incident electron beam. Furthermore, the present study shows that if an adequate description of the initial phase space of the clinical electron beam is available, Monte Carlo calculations provide a reliable reference for the determination of the accuracy of dose calculation models. Acknowledgments The authors wish to thank Jack Janssen for discussions and help with the phase space evolution model, Leo van Battum for contributing his experience in lm measurements, Erik Loeff and Ben G obel for their help with measurements and Evert Woudstra and Joep Stroom for valuable comments. This work was supported by a grant from the Dutch Cancer Society (NKB 961230). References
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