An extensive set of benchmark measurement of PDDs and beam profiles was performed in a heterogeneous layer phantom, including a lung equivalent heterogeneity, by means of several detectors and compared against the predicted dose values by different calculation algorithms in two treatment planning systems. PDDs were measured with TLDs, plane parallel and cylindrical ionization chambers and beam profiles with films. Additionally, Monte Carlo simulations by means of the PENELOPE code were performed. Four different field sizes (10 x 10, 5 x 5, 2 x 2, and 1 x 1 cm2) and two lung equivalent materials (CIRS, p(w)e=0.195 and St. Bartholomew Hospital, London, p(w)e=0.244-0.322) were studied. The performance of four correction-based algorithms and one based on convolution-superposition was analyzed. The correction-based algorithms were the Batho, the Modified Batho, and the Equivalent TAR implemented in the Cadplan (Varian) treatment planning system and the TMS Pencil Beam from the Helax-TMS (Nucletron) treatment planning system. The convolution-superposition algorithm was the Collapsed Cone implemented in the Helax-TMS. The only studied calculation methods that correlated successfully with the measured values with a 2% average inside all media were the Collapsed Cone and the Monte Carlo simulation. The biggest difference between the predicted and the delivered dose in the beam axis was found for the EqTAR algorithm inside the CIRS lung equivalent material in a 2 x 2 cm2 18 MV x-ray beam. In these conditions, average and maximum difference against the TLD measurements were 32% and 39%, respectively. In the water equivalent part of the phantom every algorithm correctly predicted the dose (within 2%) everywhere except very close to the interfaces where differences up to 24% were found for 2 x 2 cm2 18 MV photon beams. Consistent values were found between the reference detector (ionization chamber in water and TLD in lung) and Monte Carlo simulations, yielding minimal differences (0.4%+/-1.2%). The penumbra broadening effect in low density media was not predicted by any of the correction-based algorithms, and the only one that matched the experimental values and the Monte Carlo simulations within the estimated uncertainties was the Collapsed Cone Algorithm.

Combined laparoscopic-endoscopic resection is an efficient, safe, and minimally invasive alternative to open resection for selected patients with difficult polyps, but it should be restricted to benign disease.

A common limitation in treatment planning systems for photon dose calculation is to ignore the impact on electron transport and photon scatter from patient heterogeneities. The heterogeneity correlation is often based on scaling operations along beam rays as for the method according to Batho or the more novel approach of 1D convolutions along beam paths applied in pencil-beam-based systems. The effects of the limitation have been studied in a mediastinum geometry for a wide range of beam qualities by comparing the results from a pencil-beam-based treatment planning system with the results from Monte Carlo calculations. As expected, the deviations within unit-density volumes are small while deviations in low-density volumes increase with increasing beam energy from approximately 3% for 4 MV to 14% for 18 MV x-rays as a result of increased electron disequilibrium.

Dose calculations for treatment planning of photon beam radiotherapy require a model of the beam to drive the dose calculation models. The beam shaping process involves scattering and filtering that yield radiation components which vary with collimator settings. The necessity to model these components has motivated the development of multisource beam models. We describe and evaluate clinical photon beam modeling based on multisource models, including lateral beam quality variations. The evaluation is based on user data for a pencil kernel algorithm and a point kernel algorithm (collapsed cone) used in the clinical treatment planning systems Helax-TMS and Nucletron-Oncentra. The pencil kernel implementations treat the beam spectrum as lateral invariant while the collapsed cone involves off axis softening of the spectrum. Both algorithms include modeling of head scatter components. The parameters of the beam model are derived from measured beam data in a semiautomatic process called RDH (radiation data handling) that, in sequential steps, minimizes the deviations in calculated dose versus the measured data. The RDH procedure is reviewed and the results of processing data from a large number of treatment units are analyzed for the two dose calculation algorithms. The results for both algorithms are similar, with slightly better results for the collapsed cone implementations. For open beams, 87% of the machines have maximum errors less than 2.5%. For wedged beams the errors were found to increase with increasing wedge angle. Internal, motorized wedges did yield slightly larger errors than external wedges. These results reflect the increased complexity, both experimentally and computationally, when wedges are used compared to open beams.

To evaluate the dose values predicted by several calculation algorithms in two treatment planning systems, Monte Carlo (MC) simulations and measurements by means of various detectors were performed in heterogeneous layer phantoms with water- and bone-equivalent materials. Percentage depth doses (PDDs) were measured with thermoluminescent dosimeters (TLDs), metal-oxide semiconductor field-effect transistors (MOSFETs), plane parallel and cylindrical ionization chambers, and beam profiles with films. The MC code used for the simulations was the PENELOPE code. Three different field sizes (10 x 10, 5 x 5, and 2 x 2 cm2) were studied in two phantom configurations and a bone equivalent material. These two phantom configurations contained heterogeneities of 5 and 2 cm of bone, respectively. We analyzed the performance of four correction-based algorithms and one based on convolution superposition. The correction-based algorithms were the Batho, the Modified Batho, the Equivalent TAR implemented in the Cadplan (Varian) treatment planning system (TPS), and the Helax-TMS Pencil Beam from the Helax-TMS (Nucletron) TPS. The convolution-superposition algorithm was the Collapsed Cone implemented in the Helax-TMS. All the correction-based calculation algorithms underestimated the dose inside the bone-equivalent material for 18 MV compared to MC simulations. The maximum underestimation, in terms of root-mean-square (RMS), was about 15% for the Helax-TMS Pencil Beam (Helax-TMS PB) for a 2 x 2 cm2 field inside the bone-equivalent material. In contrast, the Collapsed Cone algorithm yielded values around 3%. A more complex behavior was found for 6 MV where the Collapsed Cone performed less well, overestimating the dose inside the heterogeneity in 3%-5%. The rebuildup in the interface bone-water and the penumbra shrinking in high-density media were not predicted by any of the calculation algorithms except the Collapsed Cone, and only the MC simulations matched the experimental values within the estimated uncertainties. The TLD and MOSFET detectors were suitable for dose measurement inside bone-equivalent materials, while parallel ionization chambers, applying the same calibration and correction factors as in water, systematically underestimated dose by 3%-5%.