Implementation of carbon fibre treatment couches in the XiO^® and Monaco^® Treatment Planning Systems

Abstract

Purpose: Carbon fibre treatment couches on linear accelerators provide a strong, rigid framework for patient support. Patient safety is a priority, therefore the dosimetric properties of treatment couches need to be accurately incorporated in treatment plans, to minimize differences between planned and delivered dose. This study aims to determine the attenuation effect of treatment couches for 3-D Conformal Radiotherapy (3-D CRT) and to validate the implementation thereof in the XiO and Monaco treatment planning systems (TPS).Material and methods: Attenuation measurements were performed on the ELEKTA Connexion couches of the ELEKTA Precise and Synergy-Agility linear accelerators. Measurements were made at 10° intervals in RMI-457 Solid water (30 cm x 30 cm x 30 cm) using a PTW Farmer-type ionization chamber (TW30013) positioned at the accelerator’s isocentre. The percentage attenuation was calculated as the ratio of the electrometer readings for parallel-opposed fields. The Computed Tomography (CT) data sets of the set-ups were obtained on a Philips Big Bore 16-slice CT scanner and exported to the TPS. The individual couch structures were delineated and electron density (ED) values were assigned using the commissioned CT-to-ED curve. Test treatment plans were generated with 100MU per field at 10° gantry intervals.Results: The percentage attenuation was determined to be within 2% and 3% for beams perpendicular to the couch surface for XiO and Monaco, respectively. The maximum attenuation was observed for oblique fields which was significantly higher than the manufacturer specified values. TPS validation showed an agreement to 1% for XiO and Monaco. At extreme oblique angles, both planning systems overestimated this effect up to a maximum of 4%.Conclusions: Couch attenuation differs significantly with gantry angle and beam energy. As a result, the treatment couch models should be included in all treatment planning calculations.