The accuracy of Eclipse AXB and AAA dose algorithms with dental amalgam.

High-density materials used for dental restorations are poorly defined in CT imaging due to scanner limitations. Studies have established that Eclipse offers poor agreement with delivered dose in situations involving high-density material. Defining the accuracy of dose algorithms in situations involving high-density overrides would improve clinical outcomes both for target coverage and OAR sparing. Dental amalgam was placed within a solid water phantom and measurements were taken at 1 cm increments beneath the amalgam down to a depth of 6 cm. Exposed film was compared with Eclipse Treatment Planning system (TPS) calculations on a CT of the experimental setup. The amalgam was overridden with a range of HU values and material selections for dose calculation. AXB performs poorly at describing depth dose downstream of Amalgam, regardless of the override material selected. Applying the known mass density with the Anisotropic Analytical Algorithm (AAA) predicts an average of 1.8% and 2.8% for 6 MV and 10 MV beams. The closest agreement achieved using the Acuros XB (AXB) was overriding with stainless steel, which predicted approximately 1.1% and 1.8% above measured dose for 6 MV and 10 MV respectively. Without overriding the density of amalgam, AAA and AXB return depth dose predictions of 7.3% and 5.8% above film measurement for a 6 MV and 7.6% and 6.5% for 10 MV static beams. Applying override options to a clinical case using an anthropomorphic phantom showed using AXB with Stainless Steel as amalgam override returns the same results as AAA with mass density applied for amalgam. Both of these were in close agreement to the TPS.