Accuracy of pencil-beam redefinition algorithm dose calculations in patient-like cylindrical phantoms for bolus electron conformal therapy.

Purpose: The purpose of this study was to document the improved accuracy of the pencil beam redefinition algorithm (PBRA) compared to the pencil beam algorithm (PBA) for bolus electron conformal therapy using cylindrical patient phantoms based on patient computed tomography (CT) scans of retromolar trigone and nose cancer. Methods: PBRA and PBA electron dose calculations were compared with measured dose in retromolar trigone and nose phantoms both with and without bolus. For the bolus treatment plans, a radiation oncologist outlined a planning target volume (PTV) on the central axis slice of the CT scan for each phantom. A bolus was designed using the planning.decimal® (p.d) software (.decimal, Inc., Sanford, FL) to conform the 90% dose line to the distal surface of the PTV. Dose measurements were taken with thermoluminescent dosimeters placed into predrilled holes. The Pinnacle3 (Philips Healthcare, Andover, MD) treatment planning system was used to calculate PBA dose distributions. The PBRA dose distributions were calculated with an in-house C++ program. In order to accurately account for the phantom materials a table correlating CT number to relative electron stopping and scattering powers was compiled and used for both PBA and PBRA dose calculations. Accuracy was determined by comparing differences in measured and calculated dose, as well as distance to agreement for each measurement point. Results: The measured doses had an average precision of 0.9%. For the retromolar trigone phantom, the PBRA dose calculations had an average ±1σ dose difference (calculated − measured) of −0.65% ± 1.62% without the bolus and −0.20% ± 1.54% with the bolus. The PBA dose calculation had an average dose difference of 0.19% ± 3.27% without the bolus and −0.05% ± 3.14% with the bolus. For the nose phantom, the PBRA dose calculations had an average dose difference of 0.50% ± 3.06% without bolus and −0.18% ± 1.22% with the bolus. The PBA dose calculations had an average dose difference of 0.65% ± 6.21% without bolus and 1.75% ± 5.94% with the bolus. From a clinical perspective an agreement of 5% or better between planned (calculated) and delivered (measured) dose is desired. Statistically, this was true for 99% (±2σ) of the dose points for three of the four cases for the PBRA dose calculations, the exception being the nose without bolus for which this was true for 89% (±1.6σ) of the dose points. For the retromolar trigone, with and without bolus, the PBA showed agreement of 5% or better for approximately 86% (±1.5σ) of the dose points. For the nose, with and without bolus, the PBA showed agreement of 5% or better for only approximately 58% (±0.8σ) of the dose points. Conclusions: The measured data, whose high precision makes them useful for evaluation of the accuracy of electron dose algorithms, will be made publicly available. Based on the spread in dose differences, the PBRA has at least twice the accuracy of the PBA. From a clinical perspective the PBRA accuracy is acceptable in the retromolar trigone and nose for electron therapy with and without bolus.