A finite size pencil beam algorithm for IMRT dose optimization: density corrections

For beamlet-based IMRT optimization, fast and less accurate dose computation algorithms are frequently used, while more accurate algorithms are needed to recompute the final dose for verification. In order to speed up the optimization process and ensure close proximity between dose in optimization and verification, proper consideration of dose gradients and tissue inhomogeneity effects should be ensured at every stage of the optimization. Due to their speed, pencil beam algorithms are often used for precalculation of beamlet dose distributions in IMRT treatment planning systems. However, accounting for tissue heterogeneities with these models requires the use of approximate rescaling methods. Recently, a finite size pencil beam (fsPB) algorithm, based on a simple and small set of data, was proposed which was specifically designed for the purpose of dose pre-computation in beamlet-based IMRT. The present work describes the incorporation of 3D density corrections, based on Monte Carlo simulations in heterogeneous phantoms, into this method improving the algorithm accuracy in inhomogeneous geometries while keeping its original speed and simplicity of commissioning. The algorithm affords the full accuracy of 3D density corrections at every stage of the optimization, hence providing the means for density related fluence modulation like penumbra shaping at field edges.