Dosimetric impact of Acuros XB deterministic radiation transport algorithm for heterogeneous dose calculation in lung cancer

Purpose: The novel deterministic radiation transport algorithm, Acuros XB (AXB), has shown great potential for accurate heterogeneous dose calculation. However, the clinical impact between AXB and other currently used algorithms still needs to be elucidated for translation between these algorithms. The purpose of this study was to investigate the impact of AXB for heterogeneous dose calculation in lung cancer for intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT). Methods: The thorax phantom from the Radiological Physics Center (RPC) was used for this study. IMRT and VMAT plans were created for the phantom in the Eclipse 11.0 treatment planning system. Each plan was delivered to the phantom three times using a Varian Clinac iX linear accelerator to ensure reproducibility. Thermoluminescent dosimeters (TLDs) and Gafchromic EBT2 film were placed inside the phantom to measure delivered doses. The measurements were compared with dose calculations from AXB 11.0.21 and the anisotropic analytical algorithm (AAA) 11.0.21. Two dose reporting modes of AXB, dose-to-medium in medium (D_m,m) and dose-to-water in medium (D_w,m), were studied. Point doses, dose profiles, and gamma analysis were used to quantify the agreement between measurements and calculations from both AXB and AAA. The computation times for AAA and AXB were also evaluated. Results: For the RPC lung phantom, AAA and AXB dose predictions were found in good agreement to TLD and film measurements for both IMRT and VMAT plans. TLD dose predictions were within 0.4-4.4 to AXB doses (both D_m,m and D_w,m); and within 2.5-6.4 to AAA doses, respectively. For the film comparisons, the gamma indexes (±33 mm criteria) were 94, 97, and 98 for AAA, AXB-D_m,m, and AXB-D _w,m, respectively. The differences between AXB and AAA in dose-volume histogram mean doses were within 2 in the planning target volume, lung, heart, and within 5 in the spinal cord. However, differences up to 8 between AXB and AAA were found at lungsoft tissue interface regions for individual IMRT fields. AAA was found to be 5-6 times faster than AXB for IMRT, while AXB was 4-5 times faster than AAA for VMAT plan. Conclusions: AXB is satisfactorily accurate for the dose calculation in lung cancer for both IMRT and VMAT plans. The differences between AXB and AAA are generally small except in heterogeneous interface regions. AXB D_w,m and D_m,m calculations are similar inside the soft tissue and lung regions. AXB can benefit lung VMAT plans by both improving accuracy and reducing computation time.