The accuracy of treatment planning system dose modelling in the presence of brass mesh bolus.

AIM: This work assesses the dosimetric accuracy of three commercial treatment planning system (TPS) photon dose calculation algorithms in the presence of brass mesh used as a bolus.

BACKGROUND: Bolus material is used in radiotherapy to provide dose build-up where superficial tissues require irradiation. They are generally water equivalent but high density materials can also be used.

MATERIALS AND METHODS: Dose calculations were performed on Monaco and Masterplan TPS (Elekta AB, Sweden) using phantoms defined by the three DICOM CT image sets of water equivalent blocks (no bolus, 1 layer and 2 layers of brass mesh) exported from the CT scanner. The effect of the mesh on monitor units, build-up dose, phantom exit dose and beam penumbra were compared to measured data.

RESULTS: Dose calculations for 6 and 15 MV photon beams on plain water equivalent phantoms were seen to agree well with measurement validating the basic planning system algorithms and models. Dose in the build-up region, phantom exit dose and beam penumbra were poorly modelled in the presence of the brass mesh. The beam attenuation created by the bolus material was overestimated by all three calculation algorithms, at both photon energies, e.g. 1.6% for one layer and up to 3.1% for two layers at 6 MV. The poor modelling of the physical situation in the build-up region is in part a consequence of the high HU artefact caused by the mesh in the CT image.

CONCLUSIONS: CT imaging is not recommended with the brass mesh bolus in situ due to the poor accuracy of the subsequent TPS modelling.