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BACKGROUND: Many authors stated that cavities or air-gaps were the main challenge of dose calculation for head and neck with flattening filter medical linear accelerator (Linac) irradiation. OBJECTIVE: The study aimed to evaluate the effect of air-gap dose calculation on flattening-filter-free (FFF) small field irradiation. MATERIAL AND METHODS: In this comparative study, we did the experimental and Monte Carlo (MC) simulation to evaluate the presence of heterogeneities in radiotherapy. We simulated the dose distribution on virtual phantom and the patient's CT image to determine the air-gap effect of open small field and modulated photon beam, respectively. The dose ratio of air-gaps to tissue-equivalent was calculated both in Analytical Anisotropic Algorithm (AAA) and MC. RESULTS: We found that the dose ratio of air to tissue-equivalent tends to decrease with a larger field size. This correlation was linear with a slope of -0.198±0.001 and -0.161±0.014 for both AAA and MC, respectively. On the other hand, the dose ratio below the air-gap was field size-dependent. The AAA to MC dose calculation as the impact of air-gap thickness and field size varied from 1.57% to 5.35% after the gap. Besides, patient's skin and oral cavity on head and neck case received a large dose discrepancy according to this study. CONCLUSION: The dose air to tissue-equivalent ratio decreased with smaller air gaps and larger field sizes. Dose correction for AAA calculation of open small field size should be considered after small air-gaps. However, delivered beam from others gantry angle reduced this effect on clinical case.
RESUMO
PURPOSE: This technical note presents an in-house phantom with a specially designed contrast-object module constructed to address the need for three-dimensional rotational angiography (3DRA) testing. METHODS: The initial part of the study was a brief evaluation on the commercially available phantom used for 3DRA and computed tomography angiography (CTA) to confirm the need for a special phantom for 3D angiography. Once confirmed, an in-house phantom was constructed. The novel phantom was tested to evaluate the basic image performance metrics, i.e., unsharpness (MTF) and noise characterization (NPS), as well as to show its capability for vessel contrast visibility study. RESULTS: The low contrast objects in the commercially available tools dedicated for CT is found to yield significantly lower signal difference to noise ratio (SDNR) when used for 3DRA, therefore deemed inadequate for 3DRA contrast evaluation. The constructed in-house phantom demonstrates a capability to serve for basic imaging performance check (MTF, NPS, and low contrast evaluation) for 3DRA and CTA. With higher and potentially adjustable visibility of contrast objects as artificial vessels, the in-house phantom also makes more clinically relevant tests, e.g., human- or model observer study and task-based optimization, possible. CONCLUSION: The novel phantom with special contrast object module shows higher visibility in 3DRA compared to the currently available commercial phantom and, therefore, is recommended for use in 3D angiography.