Medical Physics - 2019 - Ma - Beam Modeling and Beam Model Commissioning For Monte Carlo Dose Calculation Based Radiation

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Beam modeling and beam model commissioning for Monte Carlo dose
calculation-based radiation therapy treatment planning: Report of AAPM Task
Group 157
Chang Ming Charlie Maa)
Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, USA
Indrin J. Chetty
Radiation Oncology Department, Henry Ford Health System, Detroit, MI 48188, USA
Jun Deng
Department of Therapeutic Radiology, Yale University, New Haven, CT 06032, USA
Bruce Faddegon
Department of Radiation Oncology, UCSF, San Francisco, CA 94143, USA
Steve B. Jiang
Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
Jinsheng Li
OUR United RT Group, Xian 710018, China
Jan Seuntjens
Medical Physics Unit, McGill University, Montreal, QC H4A 3J1, Canada
Jeffrey V. Siebers
Department of Radiation Oncology, University of Virginia, Charlottesville, VA 22908, USA
Erik Traneus
RaySearch Laboratories AB, SE-103 65, Stockholm, Sweden
(Received 14 March 2019; revised 1 October 2019; accepted for publication 18 October 2019;
published 19 November 2019)
Dose calculation plays an important role in the accuracy of radiotherapy treatment planning and beam
delivery. The Monte Carlo (MC) method is capable of achieving the highest accuracy in radiotherapy
dose calculation and has been implemented in many commercial systems for radiotherapy treatment
planning. The objective of this task group was to assist clinical physicists with the potentially complex
task of acceptance testing and commissioning MC-based treatment planning systems (TPS) for photon
and electron beam dose calculations. This report provides an overview on the general approach of clini-
cal implementation and testing of MC-based TPS with a specific focus on models of clinical photon and
electron beams. Different types of beam models are described including those that utilize MC simula-
tion of the treatment head and those that rely on analytical methods and measurements. The trade-off
between accuracy and efficiency in the various source-modeling approaches is discussed together with
guidelines for acceptance testing of MC-based TPS from the clinical standpoint. Specific recommenda-
tions are given on methods and practical procedures to commission clinical beam models for MC-based
TPS. © 2019 American Association of Physicists in Medicine [https://doi.org/10.1002/mp.13898]
Key words: acceptance testing, beam model commissioning, beam modeling, Monte Carlo dose cal-
culation, radiation therapy, treatment planning
TABLE OF CONTENTS 3.A. Direct beam simulation

3.B. Phase space-driven models
3.C. Measurement-driven models
1. INTRODUCTION
3.D. Beam models in commercial TPS
1.A. Motivation
3.D.1. Electron beam models
1.B. Objectives
3.D.2. Photon beam models
1.C. Terminology
3.E. Beam modifiers
2. BEAM SIMULATION FOR RADIOTHERAPY
4. GUIDELINES FOR ACCEPTANCE TESTING OF MC-
MACHINES
BASED TPS
2.A. Photon beam simulation
5. RECOMMENDATIONS ON BEAM COMMISSIONING
2.B. Electron beam simulation FOR MC-BASED TPS
3. BEAM MODELING FOR MC DOSE CALCULATION 5.A. Recommendations for TPS uses
e1 Med. Phys. 47 (1), January 2020 0094-2405/2020/47(1)/e1/18 © 2019 American Association of Physicists in Medicine e1
24734209, 2020, 1, Downloaded from https://aapm.onlinelibrary.wiley.com/doi/10.1002/mp.13898 by Morocco Hinari NPL, Wiley Online Library on [12/11/2022]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
e2 Ma et al.: AAPM Task Group 157 Report e2
5.B. Recommendations for TPS vendors the routine clinical setting. Various types of beam models can
5.C. Additional recommendations be used. Challenges arise due to variability in output (dose
Acknowledgments per monitor unit) and dose distributions of different users’
Conflict of interest treatment machines with the same machine specifications and
Appendix: Beam models in commercial TPS source geometry (e.g., nominal energy, dose rate, and field
Table captions size). The beam model must match a given user’s machine
within a clinically reasonable tolerance. Different beam mod-
els will require different adjustments to achieve the end goal
of matching computed doses with measurements. The accu-
1. INTRODUCTION racy of a beam model has a direct impact on the accuracy of
patient dose calculations. This report is therefore motivated
The Monte Carlo (MC) method is a statistical simulation by the need for prescriptive guidelines on beam modeling
method. For ionizing radiation transport problems, it simu- and commissioning procedures as the medical physics com-
lates the tracks of individual particles by sampling appropri- munity integrates MC-based dose calculations in the clinic.
ate quantities, using computer-generated pseudorandom Although electrons, gamma rays, x rays, neutrons, and other
numbers, from the probability distributions that govern the heavy ions have been employed in clinical radiotherapy, this
individual physical processes. Average values of macro- report mainly discusses the beam models for clinical photon
scopic quantities such as particle fluence, energy spectrum, (with or without a flattening filter) and electron beams from
and absorbed dose distribution can be calculated by simulat- linear accelerators (linacs). It is expected that the methodol-
ing a large number of particles. The application of MC sim- ogy of beam modeling and the guidelines on acceptance test-
ulation to radiotherapy physics problems has been discussed ing and commissioning procedures are also useful for MC-
in a number of review publications.1–9 The clinical imple- based dose calculations for radiation therapy with gamma
mentation of MC for radiotherapy treatment planning dose rays, protons, and carbon ions.
calculation and dosimetry verification for advanced radio-
therapy techniques has been reported by several research
1.B. Objectives
groups.4–7,10–14 MC is increasingly used in radiation treat-
ment planning dose calculation for routine clinical prac- This document is a prescriptive report with the following
tice,6,7 thanks to computational efficiency improvements objectives: (a) provide an overview of different beam models
brought about by variance reduction techniques and the use and their implementations; (b) provide recommendations on
of low-cost multicore CPUs or Graphics Processing Units a minimum set of tests needed for acceptance testing and
(GPUs). Commissioning and clinical validation of commer- commissioning of MC-based beam models; (c) provide
cial electron and photon systems have been performed at dif- guidelines for tolerance criteria for acceptance testing and
ferent clinical centers, demonstrating MC to be among the commissioning of beam models to be used for MC-based
most accurate dose calculation methods for radiotherapy clinical dose calculation.
treatment planning.15–22
A radiotherapy treatment planning system (TPS) for exter-
1.C. Terminology
nal beam radiotherapy that uses MC for dose calculation
needs detailed information on the radiation beam incident on Terms specific to beam modeling used in this report are
the patient in order to simulate transport of those particles defined in Table I.
through the patient and score the absorbed dose. The phase
space (PS) information, which includes at minimum the
2. BEAM SIMULATION FOR RADIOTHERAPY
energy, position, direction, and type (e.g., electron, photon,
MACHINES
and positron) of radiation particles directed toward the patient
surface (or beam modifiers) is required in order to initiate the The direct MC modeling of the treatment head of a radio-
transport of particles at or upstream of the patient surface. A therapy machine (termed “beam simulation”) has guided the
direct measurement of this information for a clinical beam is development of beam models for both MC and analytical
difficult, if not impossible, due to many limiting factors such dose calculation algorithms. Beam simulation has been
as the high radiation intensities at the linac exit window and described in the literature since the late 1970s and has been
the availability of suitable detectors to perform the measure- the subject of several reviews.4,5 This section briefly reviews
ment. Thus, MC-based TPS relies on beam models to provide photon beam simulation followed by an overview of electron
the PS information required for patient dose calculations. beam simulation.
1.A. Motivation 2.A. Photon beam simulation

7
The AAPM Task Group report TG-105 identified beam With increased care in the specification of the source and
modeling and the commissioning of the beam model as areas treatment head and improvements in the radiation transport,
central to the implementation and widespread use of MC in the results of the beam simulations have increased in
Medical Physics, 47 (1), January 2020

TABLE I. Beam modeling terminology for Monte Carlo (MC)–based dose Several MC systems have been used by the research com-
calculation in external beam radiotherapy. munity for beam simulation, including BEAM/EGS4,23,24
PENELOPE,25 and GEANT4.26 Various implementations of
Term Definition
patient-specific, beam-modifying devices (e.g., MLC, blocks,
Phase space (PS) data The information on the particles in a radiation cutouts and wedges) have been discussed in the literature and
beam either within or downstream of the treatment have been made part of the BEAM, PENELOPE, and other
head, generally, but not necessarily, in a plane
perpendicular to the collimator rotation axis: the
packages.1–10 Developments in beam simulation also include
particle type, energy, position, direction, charge, the development of powerful variance reduction techniques to
and possibly other optional information such as improve the efficiency of the simulation, that is, to arrive at
the statistical weight of the particle used in the the same statistical uncertainty in a shorter time, without
dose calculation, whether specific regions were modifying the physics of the simulation such as photon inter-
traversed by the particle, and the region of particle
action forcing and bremsstrahlung splitting.1–3
production or scattering
Full PS calculation from a detailed MC simulation of the
Beam simulation MC simulation of radiation particles going
through the treatment head of a radiotherapy treatment head has been used in various ways to study the
machine, which consists of various beam effects of the source characteristics and the treatment head
collimation and monitoring components. Also components (e.g., the shape or density of the flattening filter)
known as treatment head simulation on the computed dose (e.g., build-up,27 depth dose, and pro-
Beam model The entity used to fully describe the initial PS data file distributions) within a water phantom.5,23,28–33 Beam
used in the dose calculation. This includes
simulation has proven instrumental in the study of the sensi-
physical attributes, such as treatment head
geometry, source position, energy and angular tivity of calculated particle fluence and dose distributions to
distribution of the particles, and the methods to source and geometry details.34–36 Results of sensitivity analy-
characterize the beam and generate the PS data ses are critical to developing accurate beam models whether
Beam modeling The process of determining the value of each based on beam simulation or purely analytical.
parameter of the beam model to match the known Factors influencing the characteristics of a photon beam
fluence or dose characteristics of the beam, either
are the energy, spatial, and angular distributions of the elec-
measured or simulated
trons incident on the target or exiting the waveguide of a
Beam representation The set of data that describes the physical
attributes of the beam model linac, and the dimensions, materials, and densities of all of
Phase space generation The method used to generate initial PS data from the components interacting with the beam. Sheikh-Bagheri
the beam representation and Rogers34 performed MC-based calculations of “in-air”
Sensitivity analysis The evaluation of the dependence of the result off-axis factors and depth dose curves (and compared these
(whether it is phase space or dose distribution) on with measurements) to derive and evaluate estimates for the
small adjustments of beam model parameters and parameters of the electron beam incident on the target, and to
geometry details
study the effects of some mechanical parameters such as tar-
Acceptance testing The process or a set of procedures to confirm that
get thickness, primary collimator opening, flattening filter
the treatment planning system (TPS) performs
according to its specifications material, and density. Their study included several different
Commissioning Commissioning of a TPS includes the processes of photon beam energies and linacs produced by various manu-
beam data entry and testing the accuracy of the facturers (Varian, Siemens, and Elekta). Specifically they
dose distributions, output factors, and other found that: (a) a 0.2 MeV change in beam energy induced an
quantities calculated for the full range of observable effect on both the off-axis factors and depth dose;
geometries intended for patient treatment
(b) the width of the Gaussian electron energy distribution
(with 0–20% variation) shows no effect on the off-axis fac-
accuracy. The components in a clinical linac that define the tors for a 6-MV beam although an asymmetrical energy dis-
beam before it enters the patient, as met in order by the accel- tribution has a small effect on the off-axis factors and affects
erated electron beam exiting the waveguide, are typically the dose in the buildup region by up to 1.5 % for an 18-MV pho-
exit window, target, primary collimator, flattening filter, mon- ton beam; (c) the radial intensity distribution influences the
itor chamber, mirror, jaws, multileaf collimator (MLC), retic- off-axis factors to a great extent; a quadratic decrease with
ule, and additional attachable beam modifiers such as radial spread was observed although it had no effect on the
wedges, blocks, and bolus. The electron source parameters depth dose, and the effect of divergence of the electron source
for the beam simulation are those of the electron beam at or on the off-axis factors and depth doses is small for diver-
near the exit window. These include the particle energy, spa- gences up to 1.0°; (d) the primary collimator strongly affects
tial (focal spot size and shape), and angular distributions. In the off-axis factors by its upstream opening, as this may
the absence of direct measurements, the source parameters restrict the fluence of bremsstrahlung photons originating
are usually tuned as guided by the output factor and dose dis- from the target that could contribute to the fluence of scat-
tributions measured in water. In addition, in-air off-axis ratios tered photons reaching off-axis points further downstream,
may be used as they are sensitive to the source characteristics, and based on calculations, they concluded that the exact
as well as the dimensions and densities of components such opening of the primary collimator must be known to better
as the primary collimator and flattening filter.4–7 than 0.01 cm when matching the off-axis factors; and (e) the

off axis ratios are highly sensitive to the composition and these energy and angular differences had a negligible effect
density of the flattening filter; a change in tungsten density of on the calculated dose distributions. This observation indi-
1 g/cm3 causes a 6 % change in the off-axis ratio for a 15- cated that the electron beam modeling might be an
MV beam. These results were augmented by the sensitivity underdetermined problem, and there might be multiple
study by Schreiber et al.36 that among other things quantified solutions when commissioning a beam model based on
the effects of asymmetry showing that (a) the electron beam dose distributions in a water phantom.
energy and angle of incidence had the greatest effect on the The main components to simulate for electron beam dose
resulting dose distributions, as high as 5 % for a 0.25° deflec- calculation include the exit window, primary scattering foil,
tion; (b) spot size, lateral offset of the electron beam, and primary collimator, secondary scattering foil, monitor cham-
photon target thickness had a small effect; (c) small lateral ber, mirror (for some machines), jaws, electron applicator,
offsets of the flattening filter caused significant variation in and cutout. Some machines have dual-monitor chambers, one
beam symmetry; and (d) in general, the greatest sensitivity to for photon beams and one for electron beams, with the elec-
source and geometry parameters could be observed for higher tron beam monitor chamber designed to give low scatter. For
energies and off-axis ratios closer to the central axis. some machines, the mirror can be retracted in the electron
beam mode. For a given applicator/beam energy, the jaw
position is generally fixed.
2.B. Electron beam simulation
Electron beams are more sensitive to the materials and
It is critical to simulate accurately all of the components in geometry of the treatment head components. Bieda et al con-
the linac treatment head traversed by an electron beam in ducted a sensitivity study of electron beams on scattering foil
order to determine its detailed characteristics. This is because geometry.43 They found that MC simulations for high-energy
electron beams easily scatter and also generate x rays by inter- beams and large field sizes are most sensitive to scattering
acting with the various components in the treatment head. foil geometry and should be performed first to help verify the
Many linac components, including the air column within the accuracy of the geometric information. Specifically, they
applicator, can significantly affect the electron beam PS and found that the characteristics of the 20-MeV electron beam
thus should be carefully considered when modeling electron were sensitive to (a) the distance between the scattering foils,
beams. (b) the width of the shaped secondary scattering foil, and (c)
The importance of accurate linac simulation is obvious if the primary or secondary foil thickness. They detected an
the simulated beam PS is used directly in Monte Carlo dose error in the distance between the two scattering foils provided
calculations or to derive parameters for multiple-source mod- by the manufacturer. In a later study conducted by this group,
els. For other source models that require measured data to they again showed the difficulty in accurately modeling large
derive model parameters, a good understanding of electron electron fields.39
beam characteristics based on accurate linac simulation is Schreiber and Faddegon44 conducted another study,
crucial for model design. which suggested that large electron fields, with the jaws
Early work on electron beam simulation was reviewed fully open and the applicator removed, were sensitive to
by Ma and Jiang.4 Since then, the BEAM code has been source and geometry parameters and thus may provide
extensively used for beam simulation and is widely consid- information for accurate beam modeling. They found that
ered the gold standard among MC simulation systems.23 bremsstrahlung profiles and beam asymmetry were good
The accuracy of the BEAM code for simulating linac elec- indicators of misalignments of beam axis and treatment
tron beams has been demonstrated by a variety of publica- head components. More recently, Faddegon et al used both
tions in terms of the calculated dose distributions and EGSnrc and GEANT4 to simulate large electron fields.45
output factors.37–40 Large discrepancies still existed in the buildup region when
The PENELOPE code was also used to simulate electron compared to parallel-plate chamber measurements, which
beams.41 This code has a geometry package that allows the could also reflect possible problems with precise surface
definition of complex quadric geometries for linac compo- dose determination. However, the accuracy in bremsstrah-
nent simulation. Rodrıguez42 developed a code package lung tail calculation was improved by using EGSnrc
called PENLINAC, based on the PENELOPE code, which is instead of EGS4.46,47
dedicated to linac simulation. Similar to BEAM, PENLINAC In summary, electron beams, especially for large fields,
allows the modeling of linac treatment head components are more difficult to simulate to high accuracy than photon
from elementary geometric bodies and their further conver- beams, mainly because electron beams are very sensitive to
sion to the quadric functions-based structure handled by the materials and geometries of linac head components and
PENELOPE. Thus, the code can greatly simplify the creation possible problems with measurement techniques. Therefore,
of the treatment head geometry for linac simulation. for accurate simulation of electron beams, detailed and accu-
A comparison between the BEAM code and the PENE- rate geometric descriptions of all components in the beam
LOPE code showed that the angular and energy distribu- path and accurate dose measurements are necessary. Unfortu-
tions of the electrons and photons exiting the linac nately, such information is not always available to the com-
simulated by these two codes were generally similar41 but, munity. This issue will be further discussed in Section 3.A.
in some cases, substantial differences did appear although below.

accelerator when performing patient-specific dose calcula-

3. BEAM MODELING FOR MC DOSE
tion. The acceptance testing and commissioning process for
CALCULATION
direct beam simulation is similar to that for a traditional TPS.
The goal of beam modeling is to provide accurate PS of For a number of reasons, direct beam simulation has been
radiation particles in clinical treatment beams for MC dose limited only to homegrown MC software. First, the genera-
calculation. A beam model in a MC-based TPS is the entity tion of PS data for MC dose calculation requires the precise
used to provide the PS data in order to initiate the MC radia- knowledge of the treatment head geometry and the source
tion transport in a phantom or patient-specific geometry. This parameters (e.g., electron characteristics at the exit window).
includes physical attributes (such as the geometry of the treat- Although specific details of the geometry and material of the
ment head, source position, energy and angular distribution) linac components may be available from the vendor as propri-
and the methods to characterize the beam and to generate the etary information and subject to inaccuracies, this informa-
PS. Three possible methods for specifying a beam model are tion may not be available for some older machines or when
set forth in the AAPM TG-105 report7 as follows: (a) direct components were replaced without proper record keeping.
use of PS information obtained from the MC simulation of Furthermore, it is well known that the calculated PS is sensi-
the treatment head (direct beam simulation), (b) development tive to input source parameters such as the energy spectrum,
of virtual, multiple-source models reconstructed from the angular spread, and spatial distribution for the electron beam
beam simulation with or without enhancement from measure- at the linac exit window, which are unknown to the linac user
ments (PS-driven models), and (c) development of virtual, and can be variable even among individual linacs of the same
multiple-source models derived exclusively from measure- model. Therefore, a trial-and-error process has to be per-
ments (measurement-driven models). A specific vendor- formed by an experienced MC user to tweak the input source
based implementation of a beam model may be a variant of parameters to match MC calculated dose distributions with
the above three methods. The fundamental aspects of the measurements. A sensitivity analysis34–36 greatly facilitates
three beam modeling approaches are summarized and com- selection of the source and geometry details. It helps to start
pared in Table II. with a validated beam simulation to model a similar
machine.48 Tight constraints on the parameter adjustment can
lead to a more accurate simulation.10 In recognition of dupli-
3.A. Direct beam simulation
cation of work on beam modeling for a limited number of
Direct beam simulation is the most straightforward way to linac types throughout the world, the International Atomic
provide PS data for patient-specific MC dose calculation. Energy Agency (IAEA) has launched a PS database that con-
The PS data can be generated for a particular accelerator, tains data (or event generators) for an increasing number of
accepted and commissioned for the clinical MC dose calcula- clinical linacs.49
tion software, and stored for future patient-specific dose cal- Storage requirements of pregenerated PS data are large
culation. It can also be regenerated on the fly for the same even in the context of ever increasing storage capabilities of
TABLE II. The fundamental aspects of the three beam modeling approaches.
Beam model type Direct simulation Multiple source — simulation driven Multiple source — measurement driven
General description Generates PS by explicit MC simulation of Reconstructs PS using a multiple-source Reconstructs PS using a multiple-source
the treatment head with accurately known model with parameters exclusively model with parameters derived from
component geometry and material derived from the PS data generated by measurements and analytical methods
composition direct beam simulation
Examples for photons See Refs. [5–7,34,35,80] See Refs. [5–7,37,52–58] See Refs. [6,7,52,61–64]
Examples for electrons See Refs. [4,6,7,38,39,44,45] See Refs. [4,6,7,51,59,60] See Refs. [6,7,48,65,66]
Possible advantages Performs highly accurate and detailed Generates a concise representation of a Generates PS in a similar way as a non-MC
modeling of the complete radiation delivery beam and reconstructs its PS potentially TPS, which is more practical for
system without loss of accuracy widespread clinical
Provides PS for patient-specific MC implementationProvides PS for patient-
calculation more efficiently than direct specific MC calculation more efficiently
simulation methods than direct simulation methods
Possible disadvantages Requires accurate treatment head Requires accurate treatment head Has a greater reliance on accurate
information, which may render it impractical information, which may render it measurements than the other methods due
for widespread clinical implementation due impractical for widespread clinical to the possibility of systematic
primarily to vendor proprietary implementation due primarily to vendor uncertainties present in measurements
informationRequires a tuning process that proprietary information Has less accurate model parameter values
may need many calculations or extensive Requires a tuning process that may need than those derived from direct beam
expertise in MC simulation many calculations or extensive expertise simulation
Requires longer computation time to generate in MC simulation
the PS data than beam models do

modern computer storage devices or cloud computing. Addi- The PS-driven multiple-source model was first introduced
tionally, reading tens of gigabytes of stored PS data may by Ma et al.51 which considered each component inside the
cause a bottleneck when performing real-time patient-specific treatment head to be a different subsource, each having its
dose calculation. Thus, it can be more efficient to regenerate own characteristic energy spectrum and planar fluence
the PS data on-the-fly using faster computers than retrieving derived from the simulated PS data. This approach is sup-
it from a storage device. As a result, event generators and ported by the fact that (a) particles from different components
shared library approaches have been developed that deliver of a linac have different energy, angular, and spatial distribu-
particles on demand utilizing the full simulation of the treat- tions; and (b) particles from the same component, however,
ment head. An example of full MC simulation of the treat- have very similar characteristics, in terms of a range of ener-
ment head components and patient-specific geometry has gies and incident directions, which are almost independent of
been tested with the VMC++ code system,47 which was their positions on the phantom surface. A variety of sub-
benchmarked against BEAMnrc to simulate a Siemens Pri- sources including point, plane, annular, and parallel bar
mus linac; the compute photon and electron fluence, energy sources were designed to represent the treatment head com-
fluence, mean energy, and spectral distributions were within ponents in commonly used linacs.
~1% of the BEAMnrc results47 with a 15 time faster compu- PS information is represented in the form of fluence distri-
tation efficiency. butions, describing the spatial, energy, and angular distribu-
The use of variance reduction techniques must be exer- tions of fluence as a function of location within the scoring
cised with caution in both treatment head simulation and plane, which is typically located above the bottom scraper
patient dose calculation.6,50 Ma et al. provide a few differ- (diaphragm) of the electron applicator for an electron beam,
ent examples of situations where systematic errors can be or above the top surface of the upper jaws for a photon beam.
introduced with improper use of such techniques. In one Source particles are first grouped by the location of their last
case,50 it was noted that, for large splitting numbers, photon interaction prior to being scored at the PS plane, resulting in
forcing, while reducing statistical fluctuations as estimated subsources that represent the major components of the treat-
using a history-based method,41 may introduce systematic ment head. Fluence distributions for each subsource may then
errors if too few particles are used in the original PS simu- be derived from the PS data in the form of correlated his-
lation (i.e., the statistical uncertainty becomes limited by togram distributions, thereby approximately retaining correla-
the available PS data, which was also referred to as the “lation of the particle’s position, energy, and direction. As
tent” uncertainty41). The same situation may apply to parti- described by Ma et al.51, for a given fixed location z in the
cle splitting or electron track repeating.50 Reyneart et al.6 scoring plane, a multiple-source model representation for a
provide an example of the use of Russian Roulette to steer clinical electron beam may take the form:
photons preferentially toward the patient. They point out X
n
that, in such situations, other parts of the treatment head Uðx; y; u; v; EÞ ¼ uj fj ðx; y; xs ; ys Þgj ðEÞ; (1)
geometry, outside the primary beam, may not be adequately j¼1
sampled, thereby introducing systematic bias into the com-
where Uðx; y; u; v; EÞ is the multiple-source model represen-
putation of dose within the profile tail regions.6 Such issues
tation on the specified plane. (xs, ys) denotes the source plane
may have relevance in clinical treatment planning when
coordinates. /j is the relative weight of subsource j, and fj(x,
computing dose to organs at risk.
y, xs, ys) and gj(E) represent the particle fluence and energy
distributions, respectively, corresponding to subsource j.
3.B. Phase space-driven models Generally, the spatial, energy and angular distributions are
correlated, that is, for each particle sampled from the particle
The goal of beam modeling is to provide a concise
fluence distribution at a given location in the sampling plane,
description of the PS information and a more efficient way to
corresponding energy, and angular distributions are sampled
produce PS data for MC dose calculation than direct beam
at the same location in the plane, and the relationship of the
simulation. PS-driven beam models are typically developed
particle position on the source plane (xs, ys) and on the sam-
in two steps. The first step requires detailed simulation of the
ple plane (x, y) is correlated with the particle incident angle,
treatment head structures, and acquisition of the PS informa-
that is, direction cosines (u, v). They used the EGS4/BEAM
tion in a plane between fixed linac components (e.g., target,
code to obtain electron beam PS data for a Varian accelerator
primary collimator and flattening filter) and patient-specific
and developed practical methods and software BEAMDP to
components (e.g., wedge, secondary collimator, and bolus).
represent and reconstruct PS particles efficiently and accu-
This step is the same as that in direct beam simulation, in
rately.51 Ma further extended these methodologies and the
which an experienced MC user performs large quantities of
software to beam modeling for clinical photon beams.52 It
beam simulation and dose calculation to validate the PS data
was also shown that beam model parameters (e.g., energy
accuracy against measured dose distributions. The second
spectrum) derived for a particular accelerator could be
step involves the development of methodologies to represent
slightly modified/scaled to generate PS data for other acceler-
the PS data concisely and reconstruct the PS data efficiently
ators of the same model.
and accurately.

The same methodologies have been employed by other This approach has been extended to determine multiple
investigators to develop PS-driven multiple-source models parameters of the beam model, including position of the vir-
for homegrown MC tools to perform clinical dosimetry stud- tual source.88
ies such as treatment plan and delivery verification.48,52–66 The use of measurement-driven beam models obviates the
Their results showed that data storage requirements and need for beam simulation, and therefore circumvents the
computation time were substantially improved using a vir- potential issues associated with the acquisition of detailed
tual beam model vs the direct beam simulation approach; fac- knowledge of the treatment head. Moreover, since these mod-
tors in the range of 400–10 000 for data storage, and els are analogous to those developed for conventional algo-
improvements in calculation time of 10–30-fold were rithms, one does not need to be an expert in MC simulations
estimated.48,51–74 Similar to direct beam simulation, however, to develop them. However, since these models are developed
PS-driven beam models are subject to limitations of users’ from measurements, it is imperative that the measurements
MC experience and sufficient knowledge of treatment head be performed accurately. Possible inaccuracies in measure-
geometries and compositions. ments may be propagated to the representation of the beam
model, resulting in systematic differences. This issue is con-
founded by the fact that highly accurate measurements (at the
3.C. Measurement-driven models
1–2% level) are difficult, especially under small field and
Measurement-driven models refer to a specific class of nonequilibrium conditions.7,89
models in which beam model parameters are derived from a
reasonably limited and standard set of measurements. Flu- 3.D. Beam models in commercial TPS
ence distributions in measurement-driven models are typi-
cally developed starting with analytical models whose A summary of the information on the MC code system,
parameters are optimized based on minimization of the differ- the beam model and the implementation details for dose cal-
ences between calculations and measurements.7,48,62–66,75 culation with the MC method for all commercial TPS can be
Information for the model can be deconvolved from mea- found in the Appendix A. The beam model design details and
sured data.7,48,62,65 Similar methods have been employed with validation results for those commercially available TPS with
conventional dose algorithms.76,77 MC dose calculation are summarized below.
Early work on measurement-driven beam models for MC
dose calculation was an extension of PS-driven models with 3.D.1. Electron beam models
a focus on the subsources of clinical significance, based on a
detailed beam characterization of the treatment head.59,78 The The first implementation of a MC algorithm in a commer-
rationale for a simplified multiple-source model is to simplify cial TPS was in the Oncentra MasterPlan system (Nucletron
the commissioning procedure while maintaining dose calcu- B.V., Veenendaal, the Netherlands) for electron dose calcula-
lation accuracy. Jiang et al.78 demonstrated that for a Varian tion.17,90 The beam model employs multiple-coupled sources,
Clinac 2100C, a beam model located above the last scraper using the VMC++ code,91 for the patient dose calculation.
and consisting of four subsources would be sufficient and The model utilizes a source PS defined at the secondary scat-
versatile for clinical electron beam dose calculation. Based tering foil and an exit PS defined at the level of the cutout.
on this four-source model, Deng et al.59 further developed an The source PS is represented by simple analytical spatial and
automated beam commissioning procedure to derive the spectrum functions. The exit PS is obtained by an MC pre-
beam model parameters from a small set of measurement transport of the source PS down to the cutout while scoring
data, rather than from the simulated PS data. Jiang et al.61 fur- information defining various subsources of indirect electrons.
ther developed a practical method to derive beam model For the patient-specific dose calculation, applicator-scattered
parameters for photon beams to account specifically for the electrons are sampled from collimator scatter kernels precal-
effects of extrafocal scattering radiation and monitor chamber culated using EGSnrc. The source PS parameters are deter-
backscattering. mined by fitting calculated air fluence profiles to the
Experimental methods, in addition to those typically used measured ones for fields of different sizes measured without
in linac commissioning,79 have been employed in beam mod- an applicator in place. The spectrum parameters are deter-
eling. Measurement of fluence in air is becoming increas- mined from an open field depth dose in water. To fully char-
ingly more common. Methods used to measure spot size for acterize an applicator, a depth dose and a lateral profile
x-ray beams80–82 are useful to measure spot-size for electron measured at large depth (for bremsstrahlung) are used. A
beams.83 Head scatter has been measured and incorporated photon dose component is added analytically to account for
into the beam model.84 Spot position, beam angle, exit win- bremsstrahlung generated in scattering foils. In an analysis by
dow thickness, foil thickness, and lateral offset of compo- Cygler et al.17 it was found that this model reproduced a set
nents have been measured directly or inferred from of about 300 measured output factors in water to within 1.3%
measurement.85 The energy distribution has been determined standard deviation.
using spectral reconstruction algorithms, which find the spec- In the RayStation system (RaySearch Laboratories AB,
trum that, when folded with monoenergetic depth dose Stockholm, Sweden), a similar model is applied for electron
curves, matches the measured depth dose curve.48,65,86,87 dose calculation. However, during patient dose calculation the

electron PS is sampled at the secondary scattering foil and The RayStation system (RaySearch Laboratories AB,
transported through air and foils in run-time through a column Stockholm, Sweden) employs the same analytical beam
of geometrical objects. Furthermore, the contamination photon model as is used in the system for the Collapsed Cone dose
fluence is transported through the patient by a pencil beam calculation. This model applies two photon subsources for
style dose algorithm for improved accuracy. Outscatter from primary and secondary (flattening filter) energy fluence,
high-Z elements like applicator scrapers is simulated by a dedi- respectively, and one electron subsource. At a Monte Carlo
cated MC code. As can be expected, the achieved accuracy, as dose calculation the photon and electron phase spaces are
validated and reported by the vendor, is similar to what has reconstructed by sampling from distributions derived from
been reported for MasterPlan. No validation of the model has the analytical models.
been published in peer reviewed journals. The beam model employed in the MultiPlan system
The macro MC92 method (MMC) was implemented for (Accuray Inc., Sunnyvale, CA) consists of a single photon
electron dose calculation in the Eclipse system (Varian Medi- source with a spatial and energy distribution, which is located
cal Systems, Inc, Palo Alto, CA). The MMC method simu- at the target level of the CyberKnife treatment head.15 The
lates transport of electrons in media by using data photon source is assumed to be cylindrically symmetrical
precalculated with EGSnrc for the transport of monoenergetic with a planar fluence distribution as a function of the off-axis
electrons through spheres of different radii and media. The distance that can be determined based on the measured in-air
patient geometry is preprocessed to determine for each voxel cone output factors. The energy spectrum is determined from
the maximum sphere radius without extending into a different the measured central axis PDD in water using a 60-mm cone
material. The implementation uses a model for the incident defined at 80 cm SSD. The planar fluence distribution at the
PS with a mixed source of electrons and photons located at patient plane is also cylindrically symmetrical, derived from
the scattering foil, a source at the ion chamber and a source at the measured profile at the depth of the maximum dose with-
the edges of the cutout.66 To configure the system for a speci- out the cone collimator. The dose contribution of the contam-
fic linac, probability density functions for each source are inant electrons is found to be on the order of 103 of the
determined at the exit of the cutout. This procedure, which maximum dose based on Monte Carlo simulations and there-
only supports Varian Clinac accelerators, requires depth dose fore is omitted in the phase space representation and recon-
curves measured with and without an applicator and a large struction. The PS data are reconstructed at a plane that can be
field air fluence profile measured without an applicator. Pop- anywhere above the patient surface. A sample plane is
ple et al.21 evaluated the implementation against a compre- selected at the middle of the cone collimator, which is
hensive set of measurements for homogenous and divided into two parts, inside the cone inner surface (the col-
inhomogeneous phantoms. They found that with careful limator opening) and from the cone inner surface to 5 cm in
modeling of the beam, dose calculations agreed with mea- radius (the cone material). A cone transmission factor is used
surements to better than 3%/3 mm for fields wider than about to adjust the weight of the particle that passes through the
3 cm. cone material. The starting point of a particle on the source
plane is sampled from the source planar distribution. The
direction of motion of the particle is determined by the line
3.D.2. Photon beam models
linking the starting point on the source plane to a point ran-
Both the iPlan (Brainlab, Heimstetten, Germany) and domly sampled at the collimator plane. The particle is
Monaco (CMS/Elekta, St. Louis, MO) employ the XVMC weighted by the planar fluence distribution at 80 cm SSD to
system and a virtual energy fluence (VEF) model developed match the measured dose distribution. Finally, the energy of
by Fippel et al.62,73 for photon dose calculation. This VEF the particle is sampled from the source energy distribution.
model consists of three subsources corresponding to contri- The spatial variation of the photon energy spectrum on the
butions from primary and secondary radiation (located at the phase space reconstruction plane is negligible since there is
target and flattening filter, respectively), and electron contam- no flattening filter in the CyberKnife unit. The beam model
ination (located at the flattening filter). The primary and scat- was compared against measurements in water and the agree-
ter subsources are Gaussian shaped and the electron source ment was found to be within 2%/2 mm for depth/profile
has a uniform distribution. The full-width half-maximum val- doses and output factors for all collimator sizes.15
ues (FWHM) and relative weights of the three subsources are
iteratively adjusted to produce the best agreement between
3.E. Beam modifiers
analytical calculations of the energy fluence and profiles
measured in air. The energy spectrum is derived by calculat- All commercial TPSs that employ MC dose calculation
ing monoenergetic depth doses in water and minimizing the reconstruct the PS data at a plane above the patient-specific
differences between measurements and the superposition of beam modifiers. This allows the same beam model to be used
the calculated monoenergetic doses.62 The spectrum includes for MC dose calculation of all patients. For electron beam
an off-axis softening term. The VEF model was benchmarked dose calculation, the PS reconstruction plane is typically
against measurements in a water phantom and calculations above the last scraper of the electron applicator; the last scra-
were found to be in agreement within 2%/2 mm, on average, per, the cutout, the bolus, and the patient are included in the
for depth/profile doses and output factors.62 MC simulation geometry. For photon beam dose calculation,

the PS reconstruction plane is typically above the collimator according to the weight of the delivered segment. Approxi-
jaws; the jaws, the MLC, and the blocks and bolus, if present, mations can be incorporated for “blocked” vs “open” field
are added to the patient simulation geometry. The use of MC regions. In one example, Aaronson et al.103 sampled IMRT
for simulating beam modifiers and the patient, enables one to leaf-sequencing files but incorporated corrections for the
perform detailed calculations of radiation interactions within MLC leaf geometry, including the rounded leaf tips and leaf
the beam modifiers and patient’s heterogeneous anatomy. transmission. The model was benchmarked against measure-
Accurate simulation of the MLC geometry is a precursor ments and found to be within the acceptability criteria
to accurate treatment planning, particularly in the context of reported by AAPM Task Group No. 53.79
IMRT and VMAT, where a fraction of dose to structures of Li et al.70 showed that MLC characteristics, such as the
interest (particularly dose limiting critical structures) is due dimension of the MLC leaf, the effective leaf-end position
to radiation scattered from or transmitted through the that associates with the leaf-end shape, and the MLC tongue-
MLC.93 There has been a variety of different approaches pro- and-groove effect as a result of the inter- and intraleaf trans-
posed for simulating the MLC, including direct simulation mission, could affect the patient dose distribution signifi-
without approximations,23,94–99 direct simulation with cantly. For example, the mean dose of the treatment volume
approximations,93,101,102 and approaches based on matrix- could be up to 8% off the real value and the standard varia-
based representations of the fluence modulation pat- tion of the voxel doses could be up to 6% for small voxels of
terns.10,55,70,71,100 Direct simulation approaches without 0.04 cm3, which are typically used for clinical dose calcula-
approximations were performed using specialized component tions, and up to 4.6% for larger voxels of 0.3 cm3, which are
modules developed within BEAM for simulation of detailed comparable with the size of some ion chambers commonly
MLC geometries.23 For example, Heath and Seuntjens96 used for dose measurement. Proper simulation or modeling
developed a component module, DYNVMLC, to simulate of the MLC with adequate details is necessary for accurate
dynamic delivery of a Varian 120-leaf MLC, which included dose calculation.70
detailed structures such as the leaf-driving screw hole, sup-
port railing groove and leaf tips, as well as a method to enable
4. GUIDELINES FOR ACCEPTANCE TESTING OF
movement of the MLC during IMRT delivery. The compo-
MC-BASED TPS
nent module was verified against measurements and found to
be accurate to within 2% and 4% for MLC-defined static and The purpose of acceptance testing is to confirm that a TPS
dynamic IMRT fields, respectively.96 performs according to its specifications, which must satisfy
Direct MLC simulation with approximations has been constraints (tolerances) that are quantifiable and testable or
found to be more efficient than full transport, without signif- measurable. TPS acceptance testing should be carried out by
icant loss of accuracy.101,102 Siebers et al.101 developed an the user after the TPS has been installed in the clinic, but
MLC model to simulate dynamic IMRT delivery. This before it is clinically used. However, if some specific tests
model incorporated geometric details of the MLC. Approxi- have to be performed by the vendor, the user may want to
mations in the transport included simulation of only first repeat some or all of the tests to verify the results. Results of
order Compton scattered photons and exclusion of pair pro- acceptance testing should be documented, as well as varia-
duction and electron interactions within the MLC. The tions from predefined procedures, and kept as long as the
model was found to predict MLC leakage radiation within TPS is used in the department, as they could be used for refer-
0.1% of the open-field dose. Inter- and intraleaf leakage was ence in future upgrades of the system. Documented testing
also accurately accounted for. MLC leaf-edge tongue-and- should continue as long as the equipment is in use.
groove dose effect was computed within 1%/1 mm for 95% The TPS acceptance tests were first recommended in
of the points compared for 6 MV and 88% of the points AAPM report TG-5379 for CT input, anatomical description,
compared for 18-MV beams. Tyagi et al.102 developed a beam description, dose calculation, dose display, and plan
detailed geometric model of the Varian 120-leaf MLC. output. IAEA adapted the same acceptance tests in report
Approximations included exclusion of pair production and IAEA-TRS-430106 and further recommended detailed test
electron interactions within the MLC. The model was veri- cases with specifications and procedures in report IAEA-
fied against measurements to test a range of parameters, TECDOC-1540107 for basic treatment planning systems that
such as MLC leakage, leaf positioning, as well as simulation has either or both two-dimensional (2D) and three-dimen-
of arbitrary, static MLC field shapes. Calculations were sional (3D) dose calculation and display capabilities.
found to agree with measurements within 2%. Computations Although most testing procedures related to beam modeling
of clinical IMRT fields were performed for sites including and dose calculation in these reports are still useful in accept-
breast, prostate, and head/neck. Average agreement with film ing a modern TPS that supports various advanced treatment
measurements was within 2%/2 mm except for highly mod- techniques, the accuracy of dose calculation algorithms in
ulated head/neck fields, where disagreement up to 5% was early commercial TPS was limited and the tolerances pro-
noted in the high dose region.102 vided in these reports were not suitable for MC algorithms.
Matrix-based approaches have been proposed to simulate The acceptance tests and tolerances described in this section
statically or dynamically delivered IMRT fields.100,103–105 In are specific to MC-based TPS due to the high dosimetric
this approach, one samples “leaf-sequencing” fluence files accuracy of MC algorithms.

TABLE III. Acceptance tests for a Monte Carlo (MC) beam model. The dose tolerances should be used for low dose gradient regions and distance-to-agreement
(DTA) tolerances should be used for high dose gradient regions for MC-calculated dose distributions.
Category Test Tolerance
Dose calculation tests Perform dose calculations for a standard photon beam dataset. Tests <2%/2 mm a
should include various open fields, different SSDs, blocked fields,

MLC-shaped fields, inhomogeneity test cases, multibeam plans,
asymmetric jaw fields, wedged fields, and others.
Perform a set of dose calculations for a standard electron beam dataset. <2%/2 mma
Tests should include various open fields, different SSDs, shaped fields,
inhomogeneity test cases, surface irregularity test cases, and others.
Speed Benchmarks Check the time to compute dose for each beam energy to a preset Within 10% of vendor’s benchmark time for the specified
statistical precision, for a specified field size, voxel size, phantom configuration
volume, and SSD, and compare with vendor’s benchmark time on the
same or comparable computer hardware
Statistical tests Verify whether code allows dose calculation at different preset Consistent with documentation
statistical uncertainties (e.g., 2%, 1%, 0.5%, or smaller)
Verify statistical uncertainty for each preset statistical uncertainty in Agrees within 30% of independently calculated statistical
uniform dose regions both inside and outside typical fields for each uncertainties (if available), or within 30% of observed
beam energy, x ray and electron statistical uncertainties, which can be estimated using the dose
values in a uniform dose region, or at the same location but
calculated with different random number seeds
pffiffiffiffi pffiffiffiffi
Verify that the uncertainty quoted by the system follows a 1= N The 1= N behavior is followed to within 10 %
behavior. Note that the history number N is generally proportional to
the CPU time T for the same calculation
Verify the fidelity of the denoising option, if present, in uniform dose The denoising option does not cause a difference of more than
regions both inside and outside typical fields for different voxel sizes 3r from the unsmoothed distribution
(e.g., 1–2 mm voxels for stereotactic radiosurgery or radiotherapy)
a
Tolerance is tighter than those in TG53 and TG244 for regions of electron disequilibrium.
This report encourages TPS users to work with commer- TPS user, the TPS vendor, the linac vendor, and the
cial vendors to develop TPS specifications and acceptance researcher/developer. In this report, the term “beam commis-
test protocols based on the needs and requirements of a par- sioning” includes beam data acquisition, beam modeling, and
ticular clinic rather than simply selecting a particular TPS. dosimetry validation. The routine QA and validation tests
Table III lists some examples of acceptance tests and toler- required following a software update affecting the MC dose
ances recommended by this task group for TPS users to algorithm are the same as those for other “model-based” dose
develop acceptance test plans for implementing MC-based calculation algorithms and are, therefore, recommended to
dose algorithms clinically. These acceptance tests should be follow the AAPM TG224 report.108 More detailed testing
part of a comprehensive acceptance testing program for the cases designed for routine QA of treatment planning and dose
TPS, as part of a comprehensive QA program for the radio- calculations can also be found in IAEA-TECDOC-1583.109
therapy department.
The acceptance tests described in Table III fall into the
5.A. Recommendations for TPS uses
general categories of dose calculation checks, speed bench-
marks, and statistical tests. The dose calculation tests are con- This task group encourages the user of a MC-based TPS
sistent with those recommended by TG5379 but the to work with the TPS vendor to develop a comprehensive
tolerances are tighter and specific to acceptance testing for commissioning protocol based on the available functionalities
beam modeling and dose calculation in a MC-based TPS due of the TPS and the treatment techniques used in the clinic.
to the high dose calculation accuracy achievable with MC This report provides a minimum set of dosimetric tests to
algorithms. The speed benchmarks and statistical tests are commission a MC-based dose calculation algorithm for radi-
specially designed for MC-based algorithms due to the statis- ation therapy treatment planning. The dosimetric tests listed
tical nature of the MC method, which should be performed in in Table IV are a subset of commissioning tests from TG53
addition to all the TPS tests described in TG53.79 and TG24479,108 with tolerances specific for MC-based TPS,
which can be used for the clinical implementation of a newly
acquired MC algorithm in a commercial TPS that has been
5. RECOMMENDATIONS ON BEAM
commissioned following the recommendations of TG53 and
COMMISSIONING FOR MC-BASED TPS
TG244, or for a home-grown MC system intended for clinical
This section summarizes the recommendations of this TG investigation and dosimetry validation of advanced radiother-
to different parties involved in the beam model commission- apy treatment techniques. To commission a new TPS that
ing process for MC dose calculation systems including the provides both MC and other dose algorithms, a user should

TABLE IV. Subset of commissioning tests from TG53 and TG244 with tolerances specific for Monte Carlo (MC)–based treatment planning system (TPS). Note
that the dose difference is the difference between the calculated and measured dose. The dose tolerances should be used for low dose gradient regions and dis-
tance-to-agreement (DTA) tolerances should be used for high dose gradient regions for MC calculated dose distributions. TG53 and TG244 tests not listed in this
table should be performed with the tolerances listed in those reports.
Category Test Tolerance

a
Dose distributions Absolute dose for the reference condition (e.g., the central-axis dose at a depth of 10 cm in water for a 0.5%
10 cm 9 10 cm field defined at 100 cm SSD). Note that this should be the normalization point for
MC calculated dose distributions and the dose differences do not include all the uncertainties
associated with determining the absolute dose under standard calibration conditions
Relative dose distribution in water for each energy and all field sizes available (typically 2%/2 mmb
2 cm 9 2 cm–40 cm 9 40 cm for linacs, 1 cm 9 1 cm if needed, for example, for SBRT)
Output factors For photon beams, open fields with different field sizes (2 cm 9 2 cm–40 cm 9 40 cm), off-axis 2%b
open fields (asymmetric jaws), and blocked fields including trays and wedges (physical and dynamic)
for different SSDs (80 cm–120 cm)
For electron beams, all applicator sizes available and arbitrarily-shaped cutouts used clinically 2%b
Beam modifier Dose distribution for a single field in water for each energy and all beam modifiers available clinically 2%/2 mmb
implementation such as MLC, blocks, wedges, compensators, cutouts, bolus
Patient dose Point dose measurements for composite dose distribution in homogeneous or heterogeneous phantoms 2%b
calculation (relative to the prescription dose)
Planar/volumetric dose array for composite dose distribution in treatment plan QA phantoms 2%/2 mmb, no pass rate
tolerance, but areas that do not
pass need to be investigated108
a
Tolerance is the same as that in TG53 and TG244, the normalization point.
b
Tolerance is tighter than those in TG53 and TG244 for regions of electron disequilibrium.
follow the TG53 and TG244 recommendations for the com- distributions that best match a standard set of measured dose
missioning tests and procedures for all dose algorithms but distributions, as designed for the beam modeling and com-
use tighter tolerances for commissioning tests designed for missioning process. Vendor-specific data requirements for
MC algorithms (see Table IV). MC beam modeling and commissioning can be found in
Because of the high accuracy achievable with MC dose Appendix A for commercially available MC-based TPS. As
algorithms, the tolerances given in Table IV for commissioning can be seen, only open-field dose distributions and output
tests related to MC beam modeling and dose calculation are factors are generally required to derive beam model parame-
equal to or tighter than those recommended in TG 53 and TG ters that best describe the energy, spatial and angular distribu-
244.79,108 Due to the limitations of simple “correction-based” tions of the source particles. However, details in source
and analytical “model-based” algorithms in dealing with elec- particle characterization does have an impact on dose distri-
tron disequilibrium conditions, both TG53 and TG244 divided butions in modulated fields, for example, the photon energy
dose distributions due to a beam into regions of different accu- spectrum will determine dose profile variations at different
racies,110, for example, the more accurate dose regions such as depths when a physical wedged is used, and the angular dis-
the inner beam (central high dose region), and less accurate tribution of scattered photons will affect dose distributions of
dose regions such as the penumbral region, the buildup region small MLC-collimated fields, especially at off-axis locations.
and the outer region. This shortcoming can be easily overcome In order to maintain the dosimetric integrity of a MC-based
by MC algorithms and the tolerance values for relative doses TPS, therefore, this task group not only recommended com-
in Table IV have been set the same (2%/2 mm) for all these missioning tests for open-field water-phantom dose distribu-
regions, either for open fields or modulated fields due to vari- tions but also for modulated fields involving beam modifiers
ous beam modifiers. The tolerance for the absolute dose at the and for complex dose distributions in layered phantoms and
reference point (e.g., the central-axis dose at a depth of 10 cm for advanced treatment techniques, as described below.
in water for a 10 cm 9 10 cm field defined at 100 cm SSD) Basic commissioning of the beam model should be per-
is 0.5%, which is consistent with that in TG53 and TG244. formed by comparing MC calculations with measured dose
While higher accuracy is not required for MC beam modeling, distributions in water over the full range of clinically available
such higher accuracy is often achievable.110 To exploit higher field sizes and SSDs, out to the corners of the largest fields,
potential accuracy of MC calculations, tighter tolerances may including both absolute (dose per monitor unit) and relative
be utilized. values under routine clinical conditions. Aligned dose distri-
Table IV summarizes these commissioning tests in four butions should be evaluated by comparing % dose difference
categories: (a) open-field dose distributions, (b) output fac- in low gradient regions and distance to agreement in high
tors, (c) beam modifier implementation, and (d) patient dose dose gradient regions. Gamma analysis111 should be used
calculation. Beam modeling is an iterative process, in which with caution due to the effect of statistical fluctuations on
beam model parameters are varied in order to generate dose passing rates.

Output factors should be verified with respect to measure- Reporting dose-to-water or dose-to-medium has been dis-
ments of user’s beams under a variety of circumstances. For cussed in TG105 report7 and issues related to correlating
photon beams, these include open fields with different field patient dose distributions calculated using “correction-
sizes (available clinically, or follow the vendor recommended based” algorithms and those calculated using MC dose
range of field sizes), off-axis open fields (asymmetric jaws), algorithms for outcome studies have been further investi-
and blocked fields including trays and wedges (physical and gated and remain to be a topic of discussion.119,120
dynamic) for range of clinically used SSDs. For electron • Correction factors should be used for specific detectors
beams, output factors should be verified for various applica- used for dose measurement to account for the effects of
tor sizes and arbitrarily shaped cutouts.17,112,113 detector size, shape, and composition. For example,
Tests of all beam-modifying devices utilized in the clinic inherent chamber build-up may affect entrance dose
including MLC, blocks, wedges, compensators, cutouts, and measurements and the detector geometry may cause
bolus should be performed for each energy and various field large angular dependence. For dose distributions in
shapes used clinically. Detailed test procedures published in challenging dosimetric conditions, such as the build-up
AAPM reports TG 5379 are recommended to commission region, the penumbral/high-dose gradient region or in
these beam modifiers for MC dose calculation. small photon fields, more than one suitable detector
Validation of patient-specific dose calculation for typical should be used and the results should be reconciled and
clinical treatment plans utilizing different beam modifiers rationalized based on the known differences in detector
(e.g., 3DCRT, IMRT, VMAT) should be performed by com- size and characteristics.89,115,121
paring composite dose measurements in slab phantoms • Although flattening filter free (FFF) beams can be prop-
including low- and high-density (bone, lung, and air-equiva- erly managed in the beam modeling process, it is impor-
lent inserts) and standard 2D or 3D QA phantoms. Detailed tant, especially for measurement-driven beam models,
plan validation tests and procedures as recommended by that physicists account for differences between flattened
TG244108 should be used for advanced treatment techniques and FFF beams, as detailed in the AAPM report on FFF
such as IMRT and VMAT. The users are encouraged to per- accelerators.122 In particular, quantities such as kQ, Pion
form additional tests to verify the implementation accuracy for beam calibration, and dosimetric properties, such as
for complex MLC-delivered fields over a range of clinical cir- depth dose, surface dose, beam penumbra are different
cumstances, including highly modulated fields, either deliv- between flattened and FFF beams, and must be properly
ered statically or dynamically for advanced delivery accounted for during the measurements.121,122
techniques such IMRT and VMAT.102,114 • The statistical precision of MC calculations should be
Considering the potential applications and benefits of MC sufficient to discern at tolerance dose differences used
dose calculation for advanced treatment techniques (e.g., in comparison metrics (The 1r statistical uncertainty
IMRT, VMAT, SRS, SBRT) in heterogeneous patient geome- should be at least three times smaller than the dose dif-
try, comprehensive end-to-end tests can be developed for ference tolerances recommended).
MC-based TPS to prevent errors from all steps in the treat- • For MC commissioning, dose calculation voxel sizes
ment planning and dose delivery process.106,108 A major diffi- should approximate the effective active volume of the
culty in validating MC dose calculation is to obtain accurate detector to compare with measured dose distribu-
dose distributions for various clinically relevant circum- tions.10,63
stances, especially with the existence of charged particle dise- • For MC patient dose calculation, typical values in the
quilibrium, for example, in the beam build-up/build-down scoring dimension are voxel sides of 2–5 mm for field
regions, field edges, and tissue boundaries. While a detailed sizes greater than 3 9 3 cm2 and 1–2 mm for field sizes
review of accurate dosimetry measurement is beyond the <3 9 3 cm2.7 For calculations where geometric details
scope of this report, the user should be cognizant of the of the MLC are included in the modeling, scoring voxel
potentially large uncertainties associated with those nonequi- sizes no larger than 1–2 mm will be necessary to dimin-
librium conditions.89,115 Below are guidelines for the mea- ish volume averaging of dose from inter- and intraleaf
surement, calculation, and comparison procedures: leakage.7 As with conventional algorithms, MC-based
IMRT calculations should be performed using voxel sizes
• Dose profiles should be measured with a detector whose of 2–3 mm or less in the high gradient regions.7,123 In
size is much smaller than the dose gradient, or the true addition to affecting the spatial resolution, voxel size also
dose profile deconvolved from the measured signal prior influences the statistical uncertainty; reducing the voxel
to comparison with MC dose distributions.116 size will generally increase the relative uncertainty for a
• Depth-dose measurements should use precise chamber fixed number of source particles because fewer particles
alignment techniques117 and account for the effective deposit dose in a smaller volume.7
point of measurement and its variation with depth.118 • Clinically, a linac is calibrated under reference conditions
• Depending on the TPS specifications for dose-to-water or (e.g., using the measured central-axis dose at a depth of
dose-to-medium, detector responses should be converted 10 cm in water for a 10 cm 9 10 cm field defined at
appropriately using stopping power ratios specifically 100 cm SSD) to produce a standard machine output, for
derived for the clinically relevant circumstances. example, 1 cGy per monitor unit on the central-axis at

dmax in water for a 10 cm 9 10 cm field defined at

100 cm SSD. For consistency, a Monte Carlo source
• Determine if the reported estimated statistical uncer-
tainty is consistent with results per voxel obtained over
model should be calibrated with the same methodology a large number of repeated dose computations (assum-
in order to calculate absolute dose distributions based on ing nondeterministic conditions achieved by using vary-
a given number of monitor units. This means that the ing random seeds).
Monte Carlo dose distribution will be normalized using
the dose value for the same reference condition rather
• Determine if the reported estimated statistical error is
consistent with the deviation from the mean in a uni-
than at other locations, for example, dmax, where absolute form dose distribution.
dose measurement is more uncertain compared to the ref-
erence point. Furthermore, normalization to the dose at Vendors are encouraged to facilitate users to perform ven-
dmax will introduce additional propagation uncertainties dor’s statistical tests, as described in the vendor’s system
for the absolute dose comparison in Tables III and IV. design and implementation verification documents, to verify
and understand the principles and implementation of the MC
methods in the TPS, and any additional tests of the MC algo-
5.B. Recommendations for TPS vendors rithms to verify the accuracy under the range of clinical cir-
cumstances for which the algorithms will be used for dose
The accuracy and efficiency of MC dose calculation in a calculation.
commercial TPS depend on the implementation of particle
transport, dose scoring, and variance reduction techniques.
This task group encourages TPS vendors to provide users 5.C. Additional recommendations
with guidance and assistance with the beam modeling pro- This task group encourages linac vendors to provide TPS
cess. For example, vendors may provide templates for major vendors, developers, and researchers with sufficient informa-
commercially available linacs, which include the full set of tion regarding the treatment head geometry and materials to
required tests and tolerance on the test results, to facilitate permit full MC simulation of the treatment head and/or tools
acceptance testing and commissioning by the user. Vendors to permit full treatment head simulations for ab initio phase
may also provide users standard beam models, which match space generation. This will facilitate validation of the PS
the output of a manufacturer’s reference machine if available. models as employed in clinical TPS system. Predefined parti-
If the beam model does not meet the required accuracy as cle event generators, if used, should permit alteration of the
mutually agreed upon between the user and vendor, then the spatial, energy, and angular distribution of particles exiting
vendor should be responsible for modifying the beam model the evacuated portion of the linac, and the position, density,
parameters to improve the agreement to measurements. and material composition of key components within the treat-
Parameters used in the phantom or patient calculations ment head. Particle generator outputs should be the PS infor-
should be clearly presented to the users. Examples include mation for particles exiting the treatment head in a
the definition of statistical uncertainty (mean variance) and predefined (e.g., IAEA49) format.
dose-to-medium (Dm) to dose-to-water (Dw) conversion This task group encourages development of benchmarks
method. Methods for denoising of dose distributions, if avail- of commonly used clinical beams (e.g., those standardized
able, should be documented clearly. Comprehensive statisti- beam data) by the medical physics community in collabora-
cal tests of a particular MC implementation are necessary, tion with the linac and TPS vendors. Ideally these bench-
which are beyond the expertise of an average clinical physi- marks would include comprehensive output and dose
cist, and should be done thoroughly by the TPS vendor in the distribution measurements for each beam and applicator, to
implementation process. Vendors should provide users permit commissioning the TPS beam models for linacs with
detailed information about the methods and tolerances used specially matched standard beam data. Measurements in stan-
and the typical results of the statistical tests specific to their dard heterogeneous phantoms for TPS beam model validation
MC implementation to should also be included. This task group recommends the use
of clinical benchmarks as they become available to validate
• Discern whether or not the code is deterministic, that is, commercial beam models for the various linac beams cur-
if repeated dose calculations always yield the same rently in clinical use.
numerical result with different random number seeds
and/or history numbers.
• Discern whether or not determinism is present for a par- ACKNOWLEDGMENTS
ticular hardware or independent of hardware (i.e. is the
code susceptible to the number of CPU cores or threads Comments and suggestions from the AAPM reviewers are
used) if alternative computer hardware is utilized. graciously acknowledged. Information on the beam models
• Determine if out-of-tolerance systematic deviations used for Monte Carlo dose calculation in commercial TPS
was provided by the respective vendors. CM thanks his
exist (comparing mean difference)
• Determine if random deviations are normally dis- administrative assistant, Lorraine Medoro, for her editing and
secretarial support.
tributed.

the off axis dose. The Monaco beam model was likewise
CONFLICT OF INTEREST
modified, with the energy fluence made independent of in-air
The authors have no conflict to disclose. measurements and the analytic spectrum and fluence equa-
tions were modified for higher accuracy.
All of the beam models include one or more sources with
APPENDIX A
energy, spatial, and angular fluence distributions in their
beam representation. All types of particles are generated from
the beam representation with the exception of Masterplan and
BEAM MODELS IN COMMERCIAL TPS
RayStation, where contaminant photon dose is handled ana-
This appendix summarizes the information on beam mod- lytically in electron beam calculation for electron beams. For
els used for dose calculation with the MC method, provided photon beam calculation RayStation uses the same analytical
by commercial vendors listed in Table A1. All of the systems beam model as is used for the collapsed cone dose engine.
are capable of calculating dose to medium per monitor unit. The effect of fixed linac components such as primary colli-
Both iPlan and MasterPlan provide the option to also calcu- mators and flattening filters are usually included in the phase
late dose to a Bragg–Gray cavity of water.7 The statistical pre- space generation, with the exception of Monaco, where parti-
cision of the calculation is generally chosen by the user to be cles are tracked through the flattener using an analytic
1–3% in the high dose region of the dose distribution, using method. Several of the systems use an analytical method to
typical voxel size of 2–4 mm. transport particles through the patient-specific components
Beam model details for each commercial system are either (e.g., jaws, MLC, cutouts, and bolus). iPlan uses MC simula-
published in a peer-reviewed journal or the manual provided tion of the MLC. Particles are not transported through
to the customer. The iPlan beam model was modified from patient-specific components in Eclipse. These components
the publication referenced in the table to include three photon are accounted for in the Eclipse beam model at the time of
sources, allowing a different standard deviation of the Gaus- particle generation.
sian spatial distribution inplane and crossplane, and addi- The beam modeling procedure begins with the customer
tional horn correction parameters to more accurately model measuring the data specified by the vendor. Either the
TABLE A1. Photon and electron beam models for MC-based dose calculation in commercial treatment planning system (TPS).
BrainLAB AG, Varian Medical RaySearch

Company Accuray Inc Oncology Solutions Elekta Nucletron B. V. Systems Laboratories AB
Treatment planning system and mc code system

TPS Multiplan iPlan Monaco Oncentra Eclipse RayStation
MasterPlan
Modality Photon beams Photon beams only Photon beams/ Electron beams only Electron beams Photons and electron
(treatment beam) only electron beams only beams
MC code system EGS4/ XVMC73,74 VMC73,74 VMC++91 MMC92 VMC++91 for
MCSIM24,72 electrons; in-house
MC for photons
Bragg–Gray cavity Not available Water Not available Water Not available Water
material
Beam model
Reference for [15] 62,64
, modified 62,64
, modified Customer manual [92] Customer manual
beam model
Types of particles Photons Photons, electrons Photons, electrons Electrons Electrons, photons Electron beams:
generated by beam onlyContaminant onlyPhoton dose in electrons; photon
model electrons patient calculated contamination dose
negligible in 6- analytically calculated
MV beams analytically
Photon beams:
photons and electrons
How to transport Not applicable Not applicable Analytical method Not applicable Not applicable Electron beams: MC
through fixed linac simulation; photon
components beams: analytical
method
How to transport Analytical method MC simulation for Analytical method Analytical method Analytical method Electron beams: MC
through patient- MLC simulation; photon
specific linac beams: analytical
components method

TABLE A1. Continued.
BrainLAB AG, Varian Medical RaySearch

Company Accuray Inc Oncology Solutions Elekta Nucletron B. V. Systems Laboratories AB
Supports blocks Not applicable Yes No Not applicable Not applicable Yes
and wedges
Beam modeling and requirements
Beam PDD largest PDD, profiles, For photons: PDD, Largest field PDD, Largest field PDD, Electrons: Largest
characterization collimator, profile output, covering full profiles, output, output, in-air output, in-air field PDD, output, in-
measurements uncollimated, in- range of field size covering full range profiles without profile without air profiles without
recommended by air output for each of field size; For applicator; PDD, applicator; PDD, applicator; PDD,
vendor for beam collimator electrons: Largest output, profiles near output each output, profiles near
modeling Extra field PDD, output, surface and beyond applicator surface and beyond
measurements for in-air profiles practical range each practical range each
beam model without applicator; applicator applicator
validation: TPR, PDD, output, Photons: PDD,
profiles, ROF each profiles near surface profiles, output for
collimator, dose in and beyond practical range of field sizes
heterogeneous range each
phantom applicator
Parameter Customer Vendor Vendor Vendor Customer Customer
adjustment
Vendor acceptance Typical results in No specific TG-53 Inside 3%/3 mm Criteria as Inside 3%/3 mm
15,72,105
criteria recommendation gamma criteria specified in Ref. gamma criteria
[21,22]
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Medical Physics - 2019 - Ma - Beam Modeling and Beam Model Commissioning For Monte Carlo Dose Calculation Based Radiation

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24734209, 2020, 1, Downloaded from https://aapm.onlinelibrary.wiley.com/doi/10.1002/mp.13898 by Morocco Hinari NPL, Wiley Online Library on [12/11/2022].

TABLE OF CONTENTS 3.A. Direct beam simulation

1.A. Motivation 2.A. Photon beam simulation

Medical Physics, 47 (1), January 2020

Medical Physics, 47 (1), January 2020

Medical Physics, 47 (1), January 2020

accelerator when performing patient-specific dose calcula-

Medical Physics, 47 (1), January 2020

Medical Physics, 47 (1), January 2020

Medical Physics, 47 (1), January 2020

Medical Physics, 47 (1), January 2020

Medical Physics, 47 (1), January 2020

Category Test Tolerance

should include various open fields, different SSDs, blocked fields,

Medical Physics, 47 (1), January 2020

Category Test Tolerance

Medical Physics, 47 (1), January 2020

Medical Physics, 47 (1), January 2020

dmax in water for a 10 cm 9 10 cm field defined at

Medical Physics, 47 (1), January 2020

BrainLAB AG, Varian Medical RaySearch

Treatment planning system and mc code system

Medical Physics, 47 (1), January 2020

TABLE A1. Continued.

BrainLAB AG, Varian Medical RaySearch

Medical Physics, 47 (1), January 2020

Medical Physics, 47 (1), January 2020

Medical Physics, 47 (1), January 2020

Medical Physics, 47 (1), January 2020

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