Dosimetric comparison of analytical anisotropic algorithm and the two dose reporting modes of Acuros XB dose calculation algorithm in volumetric modulated arc therapy of carcinoma lung and carcinoma prostate.

Volumetric Modulated Arc Therapy (VMAT) is an important modality for radical radiotherapy of all major treatment sites. This study aims to compare Analytical Anisotropic Algorithm (AAA) and the two dose-reporting modes of Acuros XB (AXB) algorithm -the dose to medium option (D) and the dose to water option (D) in Volumetric Modulated Arc Therapy (VMAT) of carcinoma lung and carcinoma prostate. We also compared the measured dose with Treatment Planning System calculated dose for AAA and the two dose reporting options of Acuros XB using Electronic Portal Imaging Device (EPID) and ArcCHECK phantom. Treatment plans of twenty patients each who have already undergone radiotherapy for cancer of lung and cancer of prostate were selected for the study. Three sets of VMAT plans were generated in Eclipse Treatment Planning System (TPS), one with AAA and two plans with Acuros-D and Acuros-D options. The Dose Volume Histograms (DVHs) were compared and analyzed for Planning Target Volume (PTV) and critical structures for all the plans. Verification plans were created for each plan and measured doses were compared with TPS calculated doses using EPID and ArcCHECK phantom for all the three algorithms. For lung plans, the mean dose to PTV in the AXB-D plans was higher by 1.7% and in the AXB-D plans by 0.66% when compared to AAA plans. For prostate plans, the mean dose to PTV in the AXB-D plans was higher by 3.0% and in the AXB-D plans by 1.6% when compared to AAA plans. There was no difference in the Conformity Index (CI) between AAA and AXB-D and between AAA and AXB-D plans for both sites. But the homogeneity worsened in AXB-D and AXB-D plans when compared to AAA plans for both sites. AXB-D calculated higher dose values for PTV and all the critical structures with significant differences with one or two exceptions. Point dose measurements in ArcCHECK phantom showed that AXB-D and AXB-D options showed very small deviations with measured dose distributions than AAA for both sites. Results of EPID QA also showed better pass rates for AXB-D and AXB-D than AAA for both sites when gamma analysis was done for 3%/3 mm and 2%/2 mm criteria. With reference to the results, it is always better to choose Acuros algorithm for dose calculations if it is available in the TPS. AXB-D plans showed very high dose values in the PTV when compared to AAA and AXB-D in both sites studied. Also, the volume of PTV receiving 107% dose was significantly high in AXB-D plans compared to AXB-D plans in sites involving high density bones. Considering the results of dosimetric comparison and QA measurements, it is always better to choose AXB-D algorithm for dose calculations for all treatment sites especially when high density bony structures and complex treatment techniques are involved. For patient specific QA purposes, choosing AXB-D or AXB-D does not make any significant difference between calculated and measured dose distributions.